Antimicrobial prescribing pattern in a tertiary care teaching hospital: a pilot study

Background: The emergence of antimicrobial resistance is a worldwide challenge threatening to negate the gains made by discovery of antimicrobial agents (AMAs). Antimicrobial Stewardship Program (ASP) is an important strategy for ensuring appropriate use of AMAs and controlling emergence of antibiotic resistance. Implementation of ASP must start with assessment of the current state of antimicrobial use. This study was therefore conducted to assess the prevalent prescribing patterns in a tertiary care hospital and identify gaps which warrant corrective intervention.Methods: This prospective pilot study presents analysis of the first 30 Patients from the medicine ward prescribed at least one antimicrobial agent during the two months of study period. Relevant data was collected in AMA record form. Appropriateness of AMAs was analyzed regarding selection as well as administration protocol as per the hospital antibiotic policy.Results: Out of the 60 AMAs prescribed to these patients, most commonly prescribed were cephalosporins (63.3%), anti-amoebics (26.6%) and macrolides (23.3%). Common diseases involved were urinary tract infection, acute gastroenteritis, sepsis and lower respiratory tract infections. Use of AMAs was found to be appropriate for the indication in 42 %, dose in 97%, duration 60 %, route 93% and frequency 90 %.Conclusions: This gap between the appropriate and the actual practice use of AMAs indicates an urgent need of rigorous implementation of ASP in order to avoid emergence of resistance and to conserve the sensitivity to the available AMAs.

Tobacco use patterns among women in reproductive age group: a cross sectional study in the rural area of Belgaum district, Karnataka, South India

Background: Tobacco imposes a colossal burden of disease and death leading to catastrophic health, social, economic, and environmental effects. “Tobacco” kills both men and women but sex-specific differences exist. Traditional forms of tobacco like dentifrice or tobacco tooth powder and betel quid, tobacco and lime mixture are commonly used and also, the new products use is increasing not only among men but even among children, teenagers, women of reproductive age. This study was done to know the patterns and other correlates of tobacco use among the rural women in the reproductive age group.Methods: A community based cross sectional study, conducted from January 2011 to December 2011 among 1200 rural women aged between 15 years to 49 years residing in primary health centre, Vantmuri area, Belgaum, Karnataka, India. Statistical analysis was done using rates, ratios and chi-square tests.Results: Tobacco consumption was seen in 9.7% of the study participants. A very high percentage of 79 (67.5%) had more than 10 years of exposure to tobacco amongst the users. Dentifrice was the most common form of tobacco used (85.5%) followed by 32 (27.4%) plain tobacco consumption. However, 49 (4.1%) consumed multiple forms of tobacco, most common being dentifrice along with plain tobacco or paan with beetelquid or used snuff.Conclusions: The distribution of tobacco consumption is likely to maintain, and perhaps increase, the current considerable socioeconomic differentials in health in India. Dual users are at much higher health risks than those who consume the individual tobacco product. It also emphasizes the variations in patterns of using tobacco among rural women. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Safety evaluation of directly observed treatment short course (DOTS) regimen in a tertiary care hospital, Pune.

Background: Directly observed treatment short course (DOTS) is a cornerstone of Revised National Tuberculosis Control Program of India. Adverse drug reactions (ADRs) induced by this therapy is common and it causes signifi cant morbidity and mortality. Hence, the present study was undertaken to determine the incidence and pattern of ADRs and to assess causality and severity. Methods: We conducted prospective, observational study at DOTS center of tertiary care hospital, Pune. 150 pulmonary tuberculosis patients undergoing DOTS therapy were enrolled. They were monitored weekly in an intensive phase and monthly in the continuation phase. The suspected ADRs were recorded and assessed for causality and severity by standard algorithms. Results: Incidence of ADRs due to DOTS was 19.33% & total 35 ADRs had occurred in our study. Gastrointestinal intolerance, arthralgia & itching with or without rashes were most common ADRs (incidence rates: 12.67%, 2.67% and 2.67%, respectively). On evaluation of causality by Naranjo algorithm, majority of ADRs 91.43% were “possible.” As per WHO- Uppsala Monitoring Center scale, majority of ADRs 91.43% were “possible.” As per Modifi ed Hartwig and Siegel scale, majority of ADRs were “moderate” (48.57%) but 8.57% were “severe.” Female gender was found to be a signifi cant risk factor for developing ADRs (odds ratio: 3.08, 95% confi dence interval: 1.33-7.12. 3.33%). ADRs & hepatotoxicity was major reason for defaulting from DOTS (60%). Conclusion: ADRs induced by DOTS are common and there is need of incorporating pharmacovigilance system for this vital public health program. Counseling of patients for timely prevention, detection, and management of ADRs will help in minimizing the further occurrence of ADRs.

Role of trimetazidine in carbon tetrachloride induced liver damage in rats.

Background: Hepatotoxicity by chemicals and drugs is a common clinical problem. Presently very few drugs are showing effectiveness in prevention and treatment of hepatic damage. So in this study, we evaluated the role of trimetazidine in carbon tetrachloride (CCl4) induced liver damage in rats. Objective of current study is to evaluate effects of prophylactic trimetazidine against carbon tetrachloride induced liver damage in rats. Methods: Liver damage was induced in 30 albino rats by CCl4 (0.5 ml/kg, i.p.) once daily for 7 days. Extent of damage was studied by assessing biochemical parameters (SGOT, SGPT, ALP, proteins and bilirubin). These biochemical observations were supplemented by pentobarbitone Sleeping Time and Histological Examination of liver. The effect of co-administration of trimetazidine (doses 5 and 10 mg/kg p. o.) on the above parameters was investigated. Liv.52® was used as Positive Control. Data was analyzed by one way ANOVA, followed by Dunnett's test. Results: Trimetazidine significantly prevented CCl4 induced elevation of serum SGOT, SGPT, ALP and bilirubin (total and direct), and reduction in protein level. Pentobarbitone sleeping time and histological examination of the liver showed consistent results. The results were comparable to that of Liv.52®. Conclusions: Trimetazidine, when administered prophylactically, shows hepatoprotective effect against CCl4 induced liver damage.

Assessment of antimicrobial prescribing and rationality of drug usage in general practitioners in Pune city, India.

Background: Most of the common ailments are managed by general practitioners (GPs). GPs prescribe major bulk of the drugs sold in the market. Naturally, irrational use of drugs at this level could lead to disastrous consequences. So this study was undertaken to determine prescribing pattern of Antimicrobials (AMA) and the rationality of drug usage by GPs in Pune city. Methods: It was a cross-sectional study. Pune city was divided into 5 zones. MBBS, BAMS and BHMS GPs doing Allopathic practice were selected randomly. 2 GPs of each specialty per zone were selected; this gave us 10 GPs of each degree – so total 30 GPs.30 Prescriptions at each GP were collected – total 900 prescriptions. The following parameters were studied- Diagnosis of patient, Average no. of drugs/prescription Percentage of AMAs prescribed, Rationality of AMA, Selection of AMAs diagnosis wise, Rationality of Prescription. Results: More than 75% patients coming to GPs were suffering from communicable diseases. Average no. of drugs / prescription and percentage of prescription with AMAs was high in all GPs. Macrolides was the most common group of AMA used by MBBS whereas Cephalosporins was used by BAMS and BHMS. Irrational use of AMAs was high in BHMS GPs. Use of irrational FDCs, banned drugs, steroids was high in BAMS GPs. Conclusions: There are deficiencies in prescription practices among all GPs. Not only are GPs prescribing the highest number of AMAs per prescription anywhere, their prescription practices for common health problems are highly inappropriate. High level of irrational use of drugs by BAMS and BHMS GPs are cause of concern.

Objective structured clinical examination; a tool for formative assessment.

Background & Objective: Conventional examination system mostly assesses student’s theoretical knowledge and fails to assess clinical competencies required for future practice. OSCE is objective and reliable method of assessment; if included as formative assessment, can identify student deficiencies and help them to prepare better for summative assessments. Methods: The present study was conducted to know the role of OSCE in formative assessment, in comparison with long case discussions in Community Medicine. 126 undergraduate medical students of 2008 admission batch, who had appeared for practical and OSCE exams in pre-final year were included in the study. Mean, S.D. and correlation co-efficient were used for analysis. Results: The students performed better in long case discussions (68.60 ± 9.7) compared to OSCE (48.67 ± 10.3) in the present study. 80% of students perceived that OSCE is one of the good methods of assessment. The students felt that it creates an insight on self performance of students and helps them to prepare better in summative assessment. Conclusion: OSCE can be included in formative assessments, as there is uniformity in assessment and objectivity in scoring. Majority of students perceived OSCE as one of the good methods of assessment.

Role of piracetam on cognitive function in epilepsy and with antiepileptics in rats.

Background: To study extent of cognitive impairment by epilepsy & antiepileptic treatment and evaluate the role of piracetam on it. Methods: 48 animals were divided into 6 groups: I-Control, II- Topiramate, III-Topiramate+Piracetam, IV-Valproate, V-Valproate+Piracetam, VI-Piracetam. Baseline cognitive functions were measured using Cook’s pole climbing apparatus (CPCA) and Elevated plus maze (EPM). In CPCA, on completion of training, number of avoidances (NOA) out of 10 trials were noted while in EPM, transfer latency (TL) was measured. Kindling was induced by 30mg/kg Pentylenetetrazol (PTZ), i.p. to all groups (except Group I) on alternate days till seizures developed. Groups were treated with respective drugs orally for 21 days and cognitive functions measured again. Results: Significant decrease in NOA & increase in TL was observed after PTZ kindling. Topiramate further significantly impaired NOA and TL whereas Valproate significantly reduced NOA in CPCA but increase in TL was not significant. Treatment with Piracetam significantly increased Topiramate, Valproate and PTZ kindling induced decrease in NOA as also significantly reduced Topiramate and PTZ kindling induced increase in TL. Conclusion: Seizures are associated with cognitive impairment. Cognitive impairment caused by Sodium valproate differs from Topiramate. Piracetam, a known nootropic can be used in alleviating cognitive impairment associated with epilepsy & chronic antiepileptic therapy.

Epidemiology and outcome of burn injuries.

Burn injury is a serious public health problem in developing countries. The causes vary in different communities and so this study was done to know the epidemiology and outcome of burn injuries. A one year cross sectional study was done of all the burn injury patients admitted during April 1st, 2004 to March 31st, 2005. Data was collected using a pre designed and pre tested proforma from the patients themselves or their relatives and analyzed using chi square test and percentages. A total of 76 burn injury patients were admitted. Majority were females (52.63%) and sustained burn injuries at home (p=0.000). Maximum number of females were wearing synthetic clothes (p=0.000) and suffered from flame injuries (0.006).The case fatality rate was 31.58%.Burn injuries can be reduced by bringing about regulations to develop safer cooking appliances, promoting less inflammable fabrics to be worn at home and educating the community especially women.

Morbidity among infants in south India: A longitudinal study.

To study the incidence and types of morbidity in the first year of life in a birth cohort, a longitudinal study. This study was undertaken in northern part of Karnataka state in India. Birth cohort consisted of all the children born during first six months of the study period. They were assessed at the time of enrollment and monthly follow up was done till they attained one yr of age. Out of the 194 newborns, 46.4% were boys and 53.6% were girls. 24.8% of newborns were of low birth weight and 5.1% were preterm. Four (2.1%) had congenital anomalies and 2.5% developed birth asphyxia. Diarrhea (10.8%) and skin diseases (8.2%) were the commonest morbidities in the neonatal period. The incidence of morbidity was 3.28 per infant per yr. It was more among boys and in the second half of infancy. Commonest morbidities during infancy were respiratory tract infection (62.4%), diarrhea 42.8% and skin diseases (21.6%). Incidence of disease in infancy highlights the need to improve and plan health programmes.

Minor injuries among under-fives in a south indian village.

The present study was conducted with the objective to determine the treatment seeking behavior of parents/caretakers for injuries sustained by children under five years of age in rural Southern India. Out of 325 children, 39.7 % were treated by a health personnel, 29% received home remedy while the rest (31.3%) did not receive any treatment. Abrasion (72.6%) was the commonest type of injury observed. 47.3% of injuries were treated within an hour of onset. Commonest home remedies used ranged from antiseptics to folk remedies. Training of parents and caretakers for hygienic and timely treatment of injury is recommended.

Effect of renal ischaemia reperfusion on calcium oxalate retention.

The effect of ischaemia reperfusion induced renal injury for calcium oxalate deposition under normal and simulated conditions was studied. Male Wistar rats of both control (group I) and urolithic (group II) groups underwent (1 h) unilateral renal artery occlusion and were subjected to 1, 3, 6, 12, 24 and 72 h reperfusion. The group I rats subjected to 1 h renal ischaemia followed by 3 and 6 h reperfusion had significant oxalate retention than that of sham operated controls. In group II, under hyperoxaluric condition, in addition to accumulation of oxalate, calcium oxalate deposits were also observed. The increased retention of calcium oxalate was attributed to increased oxalate binding protein activity, oxalate synthesizing enzymes lactate dehydrogenase and xanthine oxidase activities and accumulation of calcium. Our findings suggested that renal cellular injury produced by ischaemia reperfusion could accelerate calcium oxalate precipitation reaction.

Studies on triacylglycerol ester hydrolase from bat adipose tissue.

Triacylglycerol ester hydrolase was isolated from bat adipose tissue and characterized. The partially purified enzyme had pH optimum of 8.6 and a Km value of 0.6 mM. The enzyme was denaturated upon freezing and thawing, which was prevented by 25% glycerol. The enzyme was activated by EDTA and NaCl, while it was inhibited by serum and bovine serum albumin. Heparin, sodium fluoride and diisopropyl fluorophosphate had no effect on triacylglycerol ester hydrolase activity. It hydrolyzed triglycerides partially. Triacylglycerol ester hydrolase lost its activity during delipidation but it was reactivated by endogenous lipids and phospholipids, viz. phosphatidyl ethanolamine, phosphatidyl choline and sphingomyelin. The enzyme shows kinetic properties altogether different from lipoprotein lipase and hormone sensitive lipase.