Evaluation of trigger tool method for adverse drug reaction reporting by nursing staff at a tertiary care teaching hospital

Background: To sensitize nurses about Trigger Tool Method (TTM) and to evaluate the impact of TTM on adverse drug event (ADE) reporting by nurses at a tertiary care teaching hospital in India.Methods: This was prospective, interventional, single center study conducted among nursing health professionals of Civil Hospital Ahmedabad (CHA) posted in Medicine Department. They were sensitized about ADE reporting, pharmacovigilance, methods of ADRs reporting and details about TTM. Also, a list of 17 triggers was prepared by the investigator and given to nurses. They were educated to report ADEs using TTM. At the initiation and end of study, questionnaires were given to evaluate knowledge, attitude and practice of ADR reporting among participant nurses. All triggers and ADEs reported were analyzed in terms of association between them, effectiveness of trigger in detecting an ADR and in terms of Positive Predictive Value (PPV). Reported ADRs were also assessed for causality, severity and preventability.Results: A total 758 patients were admitted during the study period in the respective medicine department. List of 17 triggers consists of 9 drug triggers (DT), 1 laboratory trigger (LT) and 7 patient triggers (PT). Of these 17 triggers, 14 triggers were identified by nurses. These 14 triggers were noticed 130 times. These included DT (100 times), LT (0 times) and PT (30 times). Of the various triggers observed, 7 DT and 4 PT were related to ADRs. Hence, 11 triggers (64.70%) were positive (related to ADRs), out of 17 total triggers under evaluation. 21 ADRs were observed using TTM by nurses.Conclusions: The TTM helps to detect and report ADRs by nurses. Educational interventions about TTM help in better detection and reporting of ADRs.

Efficacy of piperonyl butoxide (PBO) as a synergist with deltamethrin on five species of mosquitoes.

Development of insecticide resistance has been a challenging problem for a long time and new solutions are yet to emerge. In this regard, the use of synergist with the insecticide is thought to play a key role in reducing the resistance levels. Present study demonstrates the efficacy of PBO with deltamethrin against the field collected mosquito larvae of five species of Aedes, Anopheles and Culexfrom in and around Mysore.

Pyrethroid susceptibility & enzyme activity in two malaria vectors, Anopheles stephensi (Liston) &. A. culicifacies (Giles) from Mysore, India.

BACKGROUND & OBJECTIVES: Anopheles stephensi and A. culicifacies are the two major vectors of malaria in Karnataka. These mosquito populations are continuously being exposed directly or indirectly to different insecticides including the most effective pyrethroids. Therefore, there is a threat of insecticide resistance development. We subjected these vectors to larval bioassay using two popular pyrethroids viz deltamethrin and permethrin. An attempt was also made to correlate the activities of certain detoxifying enzymes such as A- esterase, B-esterase, glutathione-S transferase (GST) and glucose-6-phosphate dehydrogenase (G6PD) with the tolerance levels of the two vectors. METHODS: Larval bioassay was carried out following the standard WHO procedure on field-collected larvae. The LC50 and LC90 values were calculated following Probit analysis. Biochemical estimations were done with a U V spectrophotometer and the isozyme studies employing native polyacrylamide gel electrophoresis (PAGE). RESULTS: The results of the larval bioassay revealed that A. stephensi has more tolerance to deltamethrin than A. culicifacies and vice versa for permethrin. Biochemical estimations revealed significantly (P < 0.05) higher levels of A-esterase and GST activity in A. stephensi whereas A. culicifacies showed significantly higher (P < 0.05) levels of B-esterase and G6PD activity. The total larval protein assayed was found to be more (P < 0.05) in A. stephensi. The isozyme profiles also revealed difference in mobility, intensity and the number of bands. INTERPRETATION & CONCLUSION: As these malaria vectors are exposed to different kinds of insecticides, they develop increased enzyme activities to overcome the insecticide pressure. This has enhanced the tolerance level against the pyrethroids tested. Thus, A. stephensi was found to be tolerant to deltamethrin depicting a higher activity of A-esterase and GST enzymes, whereas the higher activity of B-esterase and G6PD has resulted in the development of tolerance to permethrin in A. culicifacies.

Role of esterases and monooxygenase in the deltamethrin resistance in Anopheles stephensi Giles (1908), at Mysore.

Field collected An. stephensi larvae were colonized in the laboratory for 15 generations and acclimatized. An isofemale line was raised from this colony and the larvae were subjected to continuous deltamethrin selection pressure. LC50 and LC90 values were calculated at every generation. The values indicated that at the end of seventh generation the larvae have developed 87 fold tolerance in terms of LC50 value compared with the first generation. The reason for this kind of resistance was analyzed on the basis of differential activity of A-esterase, B-esterase, glutathione s-transferase (GST) and glucose 6-phosphate dehydrogenase (G6PD). A significant correlation (P < 0.05) was observed with B-esterase and G6PD activity with the rise in the LC50 and LC90 values. However no significant rise were observed in the other enzymes tested such as A-esterase and GST. The isozyme analysis of the A-esterase and B-esterase using polyacrylamide gel electrophoresis (PAGE) have shown differential profiles.

Deltamethrin tolerance & associated cross resistance in Aedes aegypti from Mysore.

BACKGROUND & OBJECTIVES: The indiscriminate use of insecticides in public health and agriculture has led to the development of resistance to these insecticides in the vector mosquitoes. To understand the development of resistance to synthetic pyrethroids, selection studies on Aedes aegypti were done at Mysore. METHODS: Ae. aegypti collected from the field were subjected to selection experiment with deltamethrin for 16 generations in the laboratory. Cross resistance test was conducted against permethrin and fenvalerate. RESULTS: Tolerance level was found to increase by 333.83 folds in terms of its LC50 values. Cross resistance of this deltamethrin selected line was tested against permethrin and fenvalerate. The results show that the selected line has developed cross resistance as much as 5.19 and 5.92 folds respectively against permethrin and fenvalerate. INTERPRETATION & CONCLUSIONS: The findings show a continuous elevation in tolerance in Ae. aegypti with increase in deltamethrin selection pressure, and development of cross resistance to other insecticides of the same class. The natural or developed tolerance has its implications in the control of these mosquitoes.