Perceptions and factors contributing to medication errors amongst the health-care providers in a tertiary care hospital

Background: The use of drugs in the medical field (health care) to reduce the illness process and suffering in the patients is very common. The drugs used should not harm or introduce a new ailment in the patients, which will indirectly increase the burden to the patient, relatives, and also to the society in many ways. Aims and Objectives: The primary objective of the study is to assess the awareness about medication errors among various healthcare professionals – doctors, nurses, and pharmacist, also to spread the awareness on avoiding these medication error and suggest remedies to minimize these errors after analyzing the data. Materials and Methods: This is a descriptive study undertaken after ethical committee approval and conducted by self-reported questionnaires in health-care providers. The participants are grouped into three groups as: Group A: Postgraduates of clinical departments; Group B: Nurses in intensive care unit, casualty and OT; and Group C: Pharmacists. The responses are analyzed using SPSS 17 software. Results: The study shows all the three groups that are equally involved in the mediation errors in different levels of health administration starting from selection of drugs, prescription writing, dispensing of medicine, and also administration of drugs to the patients. Conclusion: Many issues are involved in medication errors done by the health-care providers in different levels of care giving which should be corrected and minimized using latest technologies, reducing the overworking, conducting the lectures, seminars regularly will reduce the occurrence of the incidence, and suffering in such patients.

Hoffman抯 syndrome-a rare neurological presentation of hypothyroid myopathy

Hoffman's syndrome is a rare form of hypothyroid myopathy, which causes proximal muscle weakness and pseudohypertrophy of muscles.Itis a complication of untreated or uncontrolled Hypothyroidism.The neurological manifestations of hypothyroidism usually occur late in the course of disease. It is quite rare to present with neurological manifestations in the earlier stage of disease. Very few cases of Hoffman抯 syndrome were reported from India. Here we report a case of 27-year-old male who presented to the medicine OPD with initial symptoms of proximal muscle weakness, fatigue and calf muscle hypertrophy. On further evaluation patient was found to have hypothyroid myopathy in the form of Hoffman抯 syndrome.

A case of superior vena cava syndrome

Superior Vena Cava Syndrome is the clinical manifestation of the Superior Vena Cava obstruction, with severe reduction in venous return from the head, neck and upper extremities. More than 80% cases of SVCS is nearly attributable to advanced malignancy, most commonly lung cancer. SVC syndrome is characterized by congestion and swelling of the face and upper thorax, with distended superficial chest veins. The most severe complications of SVC syndrome include Glottic edema and venous thrombosis in the central nervous system. We represent a case SVC syndrome due to Small Cell Cancer of the lung.

Alterations in heart rate variability before and after percutaneous coronary intervention in patients with ischaemic heart disease

Objectives: Heart rate variability (HRV) is the beat-to-beat variation of heart rate and an important non-invasive tool to study the cardiac autonomic nervous system activity. Ischaemic heart disease (IHD) patients are often considered to have a state of sympathetic predominance. Elimination of myocardial ischaemia with percutaneous coronary intervention (PCI) could restore autonomic balance. Hence, this study aimed to evaluate HRV measures, after successful revascularisation among IHD patients. Materials and Methods: A total of 145 male IHD patients planned for coronary angiography were recruited. Fifteen minutes of electrocardiogram recording was done. Short-term HRV analyses of all the patients were acquired and time-domain indices (standard deviation of normal-to-normal intervals [SDNN], root-meansquared differences of successive R-R intervals [rMSSD]) and frequency-domain indices (low-frequency [LF] power, high-frequency [HF] power and total power [TP]) were analysed. Before and after PCI, all measurements were made. Results: This study included 145 male IHD patients with the mean age of 54.57 ± 10.81 years. There was a significant decrease in SDNN, rMSSD, LF, HF and TP whereas increase in LF/HF ratio following revascularisation. These changes in measures of neurocardiac regulation correlated with risk factors and medication on regression analysis. Conclusion: Increase in LF/HF ratio with the decrease in SDNN, rMSSD, LF, HF and TP in patients with IHD who underwent coronary intervention infers changed cardiac autonomic balance with this surgical procedure. These measures could be potentially used as prognostic measures in the future studies.

A study of Proximal Humerus Fractures treated by Locking Compression plating

Background: The treatment of proximal humerus fractures is always a challenge for the Orthopedic surgeon. Proximal humeral fractures are a regular presence in clinics. In the past, the standard treatment method was conserva?ve. The results and func?onal outcomes, on the other hand, were not favorable. The func?onal outcomes have been known to improve a?er the development of locking compression plates. The purpose of this study was to see how func?onal proximal humerus fractures were treated with locking compression plates fared. Methods: This cross-sec?onal interven?onal prospec?ve study was carried out in the Department of Orthopedics, Prathima Ins?tute of Medical Sciences. The study included all adult pa?ents with closed two-part and three-part proximal humerus fractures who were reported within a week a?er the incident. Based on the sample size calcula?ons and inclusion and exclusion criteria a total of n=35 pa?ents were included in the study. Pa?ents were followed up for 12months a?er surgery using a typical surgical method with a locking compression plate. Results: n=35 pa?ents out of which n=19(54.2%) were males and n=16 (45.7%) were females. The distribu?on based on age involved in pa?ents with fractures showed equal preponderance among 31-35 years and 20-25 years with n=9(25.71%).Neer’s classifica?on of fractures of proximal humerus was followed in this study. Most of the pa?ents in n=25 (71.42%) cases were having Neer’s Two-part fractures and three-part fractures were found in n=8(22.8%) and four-part in n=2(5.7%). The overall results in the study were 65.71% of pa?ents had excellent results,20% had good results,8.5% had sa?sfactory results and 5.7% had poor results. Conclusion: Locking plates are a preferable therapeu?c choice for proximal humerus fractures, par?cularly when the bone quality is poor and the fracture is comminuted. Complica?on rates can be reduced by using good surgical techniques and selec?ng the right situa?ons. Proximal humeral internal locking plates con?nue to provide strong overall func?onality.

Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (the AP-AF study)

The burden of atrial fibrillation (AF) is increasing worldwide. It is often asymptomatic, with stroke being the first manifestation in some. AF burden in the community and the practice of stroke prophylaxis has not been studied in India. The problem might be higher in rural regions due to poor health awareness and challenges to healthcare access. This study aimed to estimate the prevalence of AF, clinical profile and stroke risk in rural India. Methods: This is a community-based cross-sectional study done in rural Andhra Pradesh (AP). Adults from 40 villages formed the study population. We did a door-to door survey to collect information on demographics, and medical history. Electrocardiogram was recorded using a smart phone based Alivecor device. Participants diagnosed with AF underwent echocardiogram. Study cardiologists assessed the cardiovascular risk profile and collected detailed medical history. Results: Fourteen of the 4281 individuals screened had AF (0.3%). The mean age of the sampled population was 44 ± 16.5 years with 56% women. The mean age of participants with AF was 71 ±7.8 years; males were 71%. Except for one, all were non-valvular AF. Majority had a CHA2D2S2Vasc score of 2. Three had history of stroke. Two were on anticoagulant therapy but without INR monitoring. Conclusion: The prevalence of AF is lower in this study compared to studies from the developed countries. Non-rheumatic cardiovascular risk factors were primary causes for AF. Non-adherence to stroke prophylaxis is a major threat that needs to be addressed

Regeneration and evaluation of somaclones of sugarcane variety Co86032 for yellow leaf disease resistance and yield traits

The present investigation was focussed on regeneration, evaluation and screening of somaclones for yellow leaf disease(YLD) resistance using in vitro mutagenesis from a popular susceptible sugarcane variety Co86032 using four chemicalmutagens at three levels of concentration (sodium azide (SA) at 0.5 mg L-1, 1.0 mg L-1, 1.5 mg L-1; sodium nitrite (SN)at 3 mg L-1, 5 mg L-1, 7 mg L-1; ethyl methane sulphonate (EMS) at 0.6 lM L-1, 0.8 lM L-1, 1.0 lM L-1 and 2,4 D at 4mg L-1, 5 mg L-1, 6 mg L-1). A total of 1138 tissue culture seedlings obtained were evaluated for virus resistance both innatural field conditions and in controlled greenhouse condition after aphid vector transmission and presence or absence ofvirus was observed by visual screening and reverse transcription-polymerase chain reaction method. Four out of 207asymptomatic plants (16T22, 16T23, 16T29 and 16T31) were devoid of virus coat protein band and were considered to beYLD resistant. The obtained resistance somaclones showed inferior yield traits so they have to be exploited as parents inhybridization programmes with commercial varieties to impart YLD resistance ultimately yielding agronomically superiorYLD-resistant varieties in sugarcane.

Hypomagnesemia as a predictor of mortality in critically ill pediatric patients in picu using prism score

Background: Magnesium is the fourth most abundant cation in the human body and the second most abundant intracellular cation after potassium. A potential relationship between low magnesium levels and increased mortality has been suggested in the literature. The objectives were to detect prevalence of hypomagnesemia in critically ill children, its association with sepsis and to correlate this with mortality.Methods: This study was an observational study done on 100 children who met the inclusion criteria, admitted to the PICU of Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India. Patients under the study were managed and treated according to their clinical status and supportive traditional treatment.Results: Prevalence of hypomagnesemia in critically ill pediatric patients was 53%. In this study, majority of the cases admitted to PICU were dengue (19%) and bronchopneumonia (15%) which were significantly associated with hypomagnesemia as p value was less than 0.05. As regard prognosis, Mg had an AUC of 0.576 for prediction of mortality whereas the AUC for PRISM score was 0.811. Logistic regression analysis showed that hypomagnesemia is a significant predictor for mortality among critically ill children (p value=0.028) and OR=3.180 (0.854-7.965).Conclusions: Present study has found high prevalence of hypomagnesemia in critically ill patients. Hypomagnesemia was associated with a higher mortality rate in critically ill patients and commonly associated with infections and respiratory diseases. Hypomagnesemia indicated poor outcome and higher mortality rates in critically ill patients.

Nondestructive Analysis of Litchi Fruit Quality Using FT-NIR Spectroscopy

A non-destructive optical method based on near-infrared spectroscopy has been used for the evaluation of litchi fruit quality. Diffuse reflectance measurements (12500–3600 cm-1), physical, and biochemical measurements were performed individually on 100 litchi fruits of cv.Shahi cultivar harvested at different ripening stages. Relationships between spectral wavelengths and quality attributes were evaluated by application of chemometric techniques based on partial least squares (PLS) regression. The fruit set was divided into two groups: 60 fruits for calibration and 39 for validation. Good prediction performance was obtained for pH, soluble solids, and titratable acidity with correlation coefficients of 0.96, 0.91 and 0.94 respectively and root mean square errors of prediction of 0.009, 0.291ºBrix and 0.011% malic acid respectively. For the other quality traits such as vitamin C and color the prediction models were not satisfactorily accurate due to the higherror of calibration and prediction.

Implementation and outcome evaluation of the medical education partnership initiative biostatistical reasoning workshops for faculty and postgraduate students at the university of kwazulu-natal; durban; south africa

Background. There is a shortage of biostatistics expertise at the University of KwaZulu-Natal (UKZN); Durban; South Africa and in the African region. This constrains the ability to carry out high-quality health research in the region.Objectives. To quantitatively and qualitatively evaluate a programme designed to improve the conceptual and critical understanding of bio statistical concepts of UKZN health researchers.Methods. A 40-hour workshop in biostatistical reasoning was conducted annually between 2012 and 2015. The workshops were structured around interpretation and critical assessment of nine articles from the medical literature; with a mix of in-class sessions and small group discussions. Quantitative evaluation of the knowledge gained from the workshops was carried out using a pre- and post-workshop quiz; and qualitative evaluation of the workshop process was done using a mid-workshop questionnaire and focus group discussions.Results. For each year that the workshop was conducted; post-workshop quiz scores were significantly higher than pre-workshop scores. When quiz assessments from all 4 years of training were combined; the pretest median score was 55% (interquartile range (IQR) 40 - 62%) and the post-test median score was 68% (IQR 62 - 76%); with p0.0001 for the overall comparison of pre- v. post-scores. There was a general consensus among participants that the workshop improved their reasoning skills in biostatistics. Participants also recognised the value of the workshop in building biostatical capacity at UKZN. Conclusion. The workshops were well received and improved the critical and conceptual understanding of the participants. This education mode offers the opportunity for health researchers to advance their knowledge in settings where there are few professional biostatistician collaborators

Predictors of site choice and eventual learning experiences in a decentralised training programme designed to prepare medical students for careers in underserved areas in south Africa

Background. There is a dire need for medical schools in South Africa to train medical doctors who have the capacity and willingness to work in primary healthcare facilities; particularly in rural areas. Objectives. To assess the effect of students' gender; race; place of birth and place of high school completion on their choice of training site location and to assess the extent to which the training programme enhanced students' learning experiences relevant to primary care across training sites. Methods. A survey design involving six cohorts of 4th-year undergraduate medical students (N=187) who were part of the 2013 Family Medicine rotation at the Nelson R Mandela School of Medicine. Self-administered questionnaires were completed by students at the end of each rotation. Data analyses involved descriptive computations and inferential statistical tests; including non-parametric tests for group comparison and generalised polynomial logistic regression. Results. Students believed that their knowledge and skills relevant to primary care increased after the rotation (p0.0001). There were statistically significant differences between rural and urban sites on certain measures of perceived programme effectiveness. Male students were less likely to choose urban sites. Black students were less likely to choose rural sites compared with their white and Indian counterparts; as were students who attended rural high schools (odds ratio (OR) 9.3; p0.001). Students from a rural upbringing were also less likely to choose rural sites (OR 14; p0.001). Conclusion. Based on the findings; an objective approach for student allocation that considers students' background and individual-level characteristics is recommended to maximise learning experiences

Synthesis of Novel Hydrogels based Poly(4-Hydroxyphenylazo-3-N-(4-hydroxyphenyl)maleimide) for Specific Colon Delivery of Chemotherapeutic Agent.

In recent years azo functionalized polymeric hydrogels are very interesting; it is due to their promising applications in various fields especially in the colon drug delivery. 4-Hydroxyphenylazo-3-N-(4-hydroxyphenyl) maleimide (HPM) was synthesized and used for development of hydrogels by free radical polymerization with acrylamide (Am) and N,N-methylene bis acrylamide. Synthesized poly(Am-co-HPM) (PAH) hydrogels were used for encapsulation of 5-fluorouracil (5-FU) an anticancer drug. Structural, thermal, morphological and drug distribution of PAH hydrogels were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy and X-ray diffraction techniques, respectively. Maximum percentage of encapsulation efficiency i.e. 78.25±1.3 was observed for AZ1 PAH hydrogels. 5-FU release studies were performed by in vitro method in simulated gastro intestinal fluids (pH 1.2 & 7.4). To support the 5-FU release mechanism from PAH hydrogels, swelling and deswelling kinetics were studied in doubly distilled water.

Patient Satisfaction With Complete Denture Fabrication Using Two Neutral Zone Impression Materials - An Invivo Study.

The concept of Neutral zone is an important biomechanical consideration in fabrication of complete dentures. There are different methods of recording the Neutral zone. This article compares the levels of patient satisfaction with complete denture fabricated using two neutral zone impression materials.

Pathogenicity Tests and Evaluation of Efficacy of Fungicides Against Rhizoctonia Bataticola, the Causal Agent of Dry Root Rot of Chickpea.

The pathogen was identified based on its mycelial and sclerotial characters and pathogenicity test was proved by soil inoculation method. Efficacy of two non systemic fungicides (copper oxychloride and captan), two systemic fungicides (hexaconazole and tebuconazole) and one antifungal antibiotic validamycin each at different concentrations were tested against Rhizoctonia bataticola, incitant of dry root rot of chickpea under in vitro conditions. The fungicides copper oxychloride, captan, hexaconazole and tebuconazole were found to be highly effective (100%) in inhibiting the mycelial growth of the highly virulent pathogen at all the concentrations tested.

Mycoparasitism of Trichoderma Spp. on Rhizoctonia Bataticola, the Causal Agent of Dry Root Rot of Chickpea.

Mode of parasitism between Trichoderma and Rhizoctonia bataticola was examined under a microscope. Formation of several loops and coiling around the hyphae of pathogen, forming a thick compact rope like structure followed by rupturing, twisting and leakage of hyphal protoplasm, air bubbling inside the cytoplasm, breaking of cytoplasmic continuity, aggregation of cytoplasm within cell leading to severe vacoulation were observed at later phase of interaction.

Effect of dental treatments on salivary immunoglobulin A of children with and without dental caries: A comparative study.

Aim: To evaluate and compare the effect of dental treatment on the salivary immunoglobulin A (IgA) levels of children with and without dental caries. Materials and Methods: The study involved 30 children, among which 15 had caries and the other 15 were without caries. Salivary sample collection was done for all the children before dental treatment, and for the children with caries, the sampling was repeated 3-4 weeks after the dental treatment. The salivary IgA quantitation was done by enzyme-linked immunosorbent assay (ELISA), using Human IgA ELISA Quantitation kit, and the results were statistically analyzed by independent sample "t" test. Results:The salivary IgA level was significantly more in children with caries (13.07 ± 1.55 mg/100 ml) than in caries-free children (11.90 ± 1.58 mg/100 ml) in the pre-treatment phase. The salivary IgA level in children with caries was 13.52 ± 1.68 mg/100 ml in the post-treatment phase and it was not statistically different from the pre-treatment value. Conclusion: Mere quantitation of salivary IgA levels might have no reflection on the functional antibodies involved in caries process, and successful dental treatment alone does not alter the salivary IgA levels, suggesting a multifaceted approach to combat the cariogenic challenge.

Feeding Obturator - A Presurgical Prosthetic Aid For Infants With Cleft Lip And Palate - Clinical Report.

Cleft lip and palate is a congenital deformity that may be associated with various craniofacial problems and crumbles the overall development of the child. Early surgical treatment is imperative but may need to be postponed until certain age and weight gain of the infant. The present article is a case report of an infant with cleft lip and palate for whom a feeding obturator was the treatment of choice. It describes various problems associated with cleft lip and palate, available treatment modalities; and advantages of the feeding obturator.

Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh.

The sub-centers (SCs) are under constant criticism for their inability to deliver quality services due to the nonavailability of adequate infrastructure, manpower and supply of drugs.A cross-sectional study was conducted in Chittoor District of Andhra Pradesh to assess the availability of physical infrastructure and manpower in the SCs. A total of 34 SCs were selected by multistage and stratified random sampling technique. The data was statistically analyzed by using Microsoft Excel. The deficiency in the availability of health workers male and female were found to be 67.7% and 27.5%, respectively. The residential facility for health workers was available only in 26.4% SCs. Only 20.6% of SCs had stethoscope and B.P apparatus. The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS). Facilities to conduct the normal delivery and 24-hours emergency referral services need to be addressed at the earliest.