Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections.

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infections (UTIs) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (doubledisk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates.

Effect of glimepiride compared with glibenclamide on post prandial blood sugar in type II diabetes mellitus patients.

Background: Diabetes mellitus is a major public health problem with many complications. The Global Burden of Diabetes Study has projected that there will be a 122% increase in the number of people with diabetes mellitus worldwide in 2025 compared to 1995. Despite the availability of new agents for the treatment of type 2 diabetes mellitus oral sulfonylureas remain a cornerstone of therapy. Glibenclamide and glimepiride are widely used sulfonylurea antidiabetic drugs. Methods: A randomized, open, parallel group study was conducted by the Department of Pharmacology in association with Department of Medicine at Maharishi Markandeshwar Institute of Medical Sciences & Research (MMIMSR), Mullana, Ambala. Total 50 patients were divided into two groups I & II. In Group I (n=25) glibenclamide (5-15 mg/day) & in Group II (n=25) glimepiride (1-6mg/day) was administered for a period of 24 weeks and data analyzed by Student’s “t”- test. Results: There was a significant improvement in the post prandial blood sugar score (p<0.05) in both the study groups (I&II) after 24 weeks but post prandial blood level did not differ significantly (p>0.05) between the two groups. Conclusions: Both the drugs glibenclamide and glimepiride were effectively reduced post prandial blood sugar in both the groups. But these sulfonylurea drugs lowered post prandial blood sugar to a similar degree without significant difference between the two groups.

A study comparing the effect of Glimepiride and Glibenclamide on Glycosylated Hemoglobin (HbA1c) in Type II Diabetes Mellitus patients.

Background: Diabetes mellitus is a major public health problem. It is worldwide & a major risk factor for cardiovascular diseases. Glibenclamide and Glimepiride are widely used second generation sulfonylurea antidiabetic drugs. Both Glibenclamide and Glimepiride stimulate release of insulin from pancreatic acinar cells, by blocking an ATP-sensitive potassium channel. Therefore we evaluated the effect of Glimepiride and Glibenclamide on glycosylated haemoglobin in patients of type II diabetes mellitus. Aims & Objective: (1) To find out the demographic profile of type II diabetes mellitus. (2) To find out the effect of Glimepiride and Glibenclamide on glycosylated haemoglobin (HbA1c) in type II diabetes mellitus Patients. (3) To compare the effect of Glimepiride and Glibenclamide on glycosylated haemoglobin (HbA1c) among the two study groups. Material and Methods: A prospective, randomized, open, parallel group study was carried out in patients attending OPD of Medicine department MM Institute of Medical Sciences and Research (MMIMSR), Mullana, Ambala. 50 patients were randomly assigned into groups A & group B. In Group A (n=25) Glibenclamide (5-15 mg/day) & in Group B (n=25) Glimepiride (1-6 mg/day) was administered for a period of 24 weeks. Data analyzed by Student’s “t”- test. Results: It was found that prevalence of type II diabetes mellitus is more common among the male patients There was a significant reduction in glycosylated haemoglobin score (p<0.05) in both the study groups after 24 weeks but glycosylated haemoglobin level did not differ significantly (p>0.05) between the two groups. Conclusion: Glibenclamide and Glimepiride lowered glycosylated haemoglobin to a similar degree without significant difference between the two groups.

To Assess the Attitude, Knowledge and Practices of Medical Professionals About Adverse Drug Reactions and Their Reporting in a Teaching Hospital.

Adverse drug reactions (ADRs) are one of the leading causes of morbidity and represent a substantial burden on healthcare resources. It has been reported that 2.4-6.5% of the total admissions in the hospitals are due to the adverse reactions, many of which are preventable. Voluntary ADR reporting is fundamental to medical drug safety surveillance; however, substantial underreporting is the main limitation of the system. It is estimated that only 6-10% of all ADRs are reported. Therefore, the present study has been designed to assess the knowledge, attitude and practices of the medical professionals towards the ADRs and their reporting in our Institute. Aim and objectives: This study is aimed at investigating the knowledge and attitude and practices of medical professionals in a teaching hospital. Material and methods: The present study was a questionnaire based study. A structured validated questionnaire was used consisting of open ended and closed ended questions to collect the information after approval from the Institutional Ethics Committee (IEC). The study population consisted of all the medical teachers of the institute. Results: The response rate was 85%. Eighty percent of the respondents identified ADR as one of the major causes for mortality and morbidity in patients. ADR reporting was considered important by 87.5% respondents. More than 85% wrote that they did not have enough knowledge about how to report an ADR. One hundred percent of the participants believed that there should be a system of ADRs reporting and monitoring in the institute. Interestingly, all the respondents believed that if the teachers from allied streams (dental, nursing, physiotherapy, pharmacy) are sensitized, it can be useful. Conclusion: There are gaps between knowledge and ADRs reporting among doctors working in a teaching hospital. These gaps need to be filled by improved training and awareness in pharmacovigilance at various levels of healthcare system.

Benign Prostatic Hyperplasia: Current and Future Therapeutics.

Benign prostatic hyperplasia (BPH) is one of the most common diseases of old-aged men affecting >90% of men in their 70s and 80s. Although the exact cause is not known, most people agree that dihydrotestosterone plays a strong role in pathogenesis. BPH can be a progressive disease. Severe BPH can cause serious problems including renal insufficiency. Surprisingly the risk factors for BPH are found to be the same as for cardiovascular diseases. Management of BPH has changed significantly in the last decade. α-blockers and 5α-reductase inhibitors are the most commonly used drugs. A number of other drugs belonging to newer groups like phosphodiesterase inhibitors, hexokinase inhibitors like lonidamine, antagonists of endothelin, vanilloid and purine receptors and modulators of JM-27 expression are also showing promise. These are in different stages of clinical trials. The surgical counterpart of treatment has also witnessed recent advancements. Newer techniques like potassium-titanylphosphate (KTP) laser and photo selective vaporization of prostate have been shown to have nearly equal efficacy as that of transurethral resection of prostate (TURP) with less side effects.

Probiotics: The Friendly Microbes.

We tend to think of bacteria as harmful ‘germs’, but, many bacteria actually help the body functions work properly. These bacteria are known as probiotics. The scientific evidence of beneficial effects of probiotics in health and disease is growing. This article highlights various such beneficial and potentially beneficial effects of probiotics.

Nanomedicine: Current Status and Future Implications.

Adverse effects form a major part of the drawbacks of the current therapeutics. The two main reasons are: Distribution of drugs to an area, which is not the desired site of action and another is attaining higher than desired concentration at the site of action. Nanomedicine raises hopes to overcome these problems. Nanomedicine is the medical use of nanobiotechnology. It is a relatively newer technology based on the uses of engineered nanomaterials (ENMs). ENMs are medical materials available in nanometer (one-millionth of a millimeter) scale. Because of nanoscale, the molecules acquire changes in their physicochemical properties which are utilized for easier and more thorough penetration in cells. Nanomedicine has shown promising results both in diagnostics as well as therapeutics e.g. in oncology and diseases of central nervous system. Nanoparticle targeting and neuroelectronic interface raises hopes for a number of clinical disorders for which the satisfactory treatment is currently not available. The most striking use can be repairs at a molecular level. Like other modalities of treatment, nanomedicine also has disadvantages; however, currently the benefits outweigh the risks. It will be interesting to see how the rising ethical concerns will be dealt with.

Nanomedicine: Current Status and Future Implications.

Adverse effects form a major part of the drawbacks of the current therapeutics. The two main reasons are: Distribution of drugs to an area, which is not the desired site of action and another is attaining higher than desired concentration at the site of action. Nanomedicine raises hopes to overcome these problems. Nanomedicine is the medical use of nanobiotechnology. It is a relatively newer technology based on the uses of engineered nanomaterials (ENMs). ENMs are medical materials available in nanometer (one-millionth of a millimeter) scale. Because of nanoscale, the molecules acquire changes in their physicochemical properties which are utilized for easier and more thorough penetration in cells. Nanomedicine has shown promising results both in diagnostics as well as therapeutics e.g. in oncology and diseases of central nervous system. Nanoparticle targeting and neuroelectronic interface raises hopes for a number of clinical disorders for which the satisfactory treatment is currently not available. The most striking use can be repairs at a molecular level. Like other modalities of treatment, nanomedicine also has disadvantages; however, currently the benefits outweigh the risks. It will be interesting to see how the rising ethical concerns will be dealt with.

Premenstrual Syndrome - A Monthly Menace.

Most women feel some discomfort before or during their periods, but if the discomfort is of such a severity that starts interfering with some aspects of life: The diagnosis of premenstrual syndrome or tension (PMS or PMT) should be considered. About 80- 95% of females of childbearing age have some premenstrual symptoms. PMS affects upto 30% of women with regular menstrual cycles. Some women (about 3-8% of menstruating women) have a more severe and disabling form of PMS having a psychiatric designation called premenstrual dysphoric disorder (PMDD). The etiology of PMS remains unknown and may be complex and multifactorial, but hormones, neurotransmitters and genetic factors have a role to play. Behavioral symptoms along with physical symptoms should be present to establish a diagnosis. Certain lifestyle changes and dietary modifications along with a number of drug options can improve the quality-of-life of a patient of PMS upto a considerable extent.

Perceptions and suggestions of 2nd professional MBBS students about their teaching and learning process: An analytical study.

Objectives : A questionnaire based analytical study was done to know the perceptions and suggestions of 2nd professional medical students about various aspects of their teaching and use them for improvement. Material & Methods : Study was conducted on 2nd professional students (n=150) using a structured validated questionnaire after approval from the Institutional Ethical Committee. Results : Students found pharmacology and pathology most relevant but difficult subjects. They found it difficult to synchronize and integrate the different subjects. They found tutorials and group discussions more useful than lectures and seminars and suggested to cut short the duration of the lecture. They advocated the judicious use of power point along with the conventional method of teaching. They wanted some multiple choice questions to be included in the tests and in the final exams. They wanted some sessions on career counseling and wished the effective implementation of the mentoring system. Conclusion: The suggestions obtained from the students, if addressed effectively, can improve their learning and produce better health care professionals.