Approach to Optimal Oxygen Therapy in the Management of COVID-19 Patients during Pandemic: An Indian Perspective

Background: A sudden spike in positive cases in the second wave of COVID-19 pandemic took Government, Public, and Healthcare system by surprise in India. It was bigger and deadlier than the first wave. Unsupervised oxygen delivery practiced in oxygen buses and pandals by untrained individuals was a matter of concern and should have been discouraged. This resulted in wastage of oxygen which could have led to catastrophic consequences. Awareness about the optimal use of oxygen by identifying errors in prescribing/practicing oxygen therapy will go a long way in saving lives. This article provides a quick review of oxygen therapy with a focus on the rationale use of oxygen and plausible solutions to mitigate wastage in a resource-constrained scenario, such as the COVID-19 pandemic.

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Abstract INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.

Prescription auditing: an important tool for sensitization of resident doctors for rationale prescription and utilization of drug

Background: The main objective of the Maharashtra Health Systems Development Project (MHSDP) is to enhance the quality of care by improving health care; in the hospitals, in the state. Improvement in the prescribing practice of resident doctors working in the hospitals is one of the initiatives taken up, to improve the rationalizing service delivery. A prescription audit may become an important tool for sensitizing resident doctors for rational prescription and utilization of drug.Methods: An observational study was carried out during the period of March 2017 to May 2017 in tertiary care teaching hospital, Kolhapur. Total 247 first prescriptions written by resident for in-door-patient department were collected, scrutinized and analysed. Prescriptions were evaluated for completeness of prescription format while legibility was graded. Prescriptions were also analysed as per World Health Organization prescribing indicators.Results: In study 247 prescriptions with 1091 drugs with average 4.42% drugs per prescription, 49.8 % prescriptions wrote the drugs by generic name. We found that 44.1 % prescriptions written with drugs included in essential medicines list while antibiotics prescribed were 27.1%. In prescription format 34% had incorrect dosage, 67% of prescriptions omitted the duration of treatment. Direction for drug use was not mentioned in 25% of prescriptions. Weight was not mentioned on any prescriptions even for paediatric group.Conclusions: Through prescription auditing, sensitizing resident doctors for rational prescription and utilization of drug can be done to achieve the goal of the MHSDP of enhancing the quality of care by improving health care; in the hospitals, in the state.

The use of ATC/DDD WHO 2016 and Prescription audit study in the Dermatology OPD of a tertiary care hospital in Jharkhand

Background: To study the prescribing patterns, rationale of drug usage and use of anatomical, therapeutic, chemical (ATC) and defined daily dosage (DDD) classification for the monitoring of drug utilization in the dermatology department of a tertiary care hospital.Methods: A retrospective, observational study was conducted in out-patients department of dermatology at RIMS, Ranchi over a period of two months. Rationale of drug usage was assessed by analysing the prescriptions. Defined daily dosage/1000 patients/day of the commonly used medications was compared to the defined daily dosage by World Health Organization in 2016. Data was analysed by statistical tools. Most of the results were expressed in percentages.Results: The prescriptions were rational in most of the cases. Emphasis was more towards the branded drugs. Polypharmacy was evident in many of the prescriptions. The number of DDD/1000 patients/day in cases of antifungals was more than the WHO DDD and less than the WHO DDD in case of antihistaminics.Conclusions: The number of drugs per prescription must be rationalized so as to avoid polypharmacy. The drugs should be prescribed by their generic names also along with the brand names. Generic medicines should be available in the hospital pharmacy so that a more cost-effective treatment can be assured. CMEs and stewardship programs for health care professionals regarding rational drug usage should be organized.

Patterns of drug use and drug dispensing in dermatology outpatient prescriptions in a tertiary care teaching hospital

Background: Periodic assessment of drug prescribing and dispensing pattern in a hospital facility shall play a major role in avoiding the inappropriate use of drugs which leads to potential hazards and expenses for the patients.Methods: The objective of the study was to analyse the patterns of drug use and dispensing in dermatology outpatient prescriptions from a tertiary care teaching hospital in south India. Data were collected over a period of one month from patients attending dermatology outpatient department by scrutinizing 100 prescriptions and analyzed using WHO formulated 揷ore drug use indicators� like the format, prescribing pattern and rationality of prescriptions.Results: The total number of drugs prescribed in 100 prescriptions was 233 i.e. on average 2.33 drugs were prescribed per patient. The patient's name and age were mentioned in all the prescriptions while diagnosis, dose, route of administration, dosage form, duration of therapy and prescriber's identity was written in 43.29%, 68.04%, 69.07%, 100%, 49.48% and 63.91% prescriptions respectively. Out of all drugs, 42.91% were generic drugs and 57.08% were from National Essential Drug List of India. Steroids (18.02%) were the most common group of drugs used, followed by keratolytics and emollients (15.87%). Most of the drugs were given by topical route (47.63%).Conclusions: A prescription by a doctor is a reflection of physicians� attitude towards the disease and the role of drug in its treatment. It also provides an insight into the nature of health care at that facility. Interventions to rectify over proper prescription format and prescription of generic drugs are necessary to further improve rational drug use in this facility.

A racionalidade nutricional e sua influência na medicalização da comida no Brasil / The nutritional rationale and its influence on the medicalization of food in Brazil

Resumo Ensaio baseado em reflexão teórico conceitual acerca do conceito racionalidade nutricional e sua relação com a medicalização da comida, onde se buscou apontar a influência que práticas alimentares sofrem do suposto estado de supremacia que a ciência detém, a qual sugere em seu discurso a necessidade de saúde. A partir do pressuposto da racionalidade nutricional como dever comer, supõe-se que este participa do processo de medicalização da comida ao descredenciar o sujeito do autocuidado alimentar, engendrar a ideia de risco de suposta alimentação inadequada e fomentar a ideia de que comer bem é comer de acordo com princípios científicos. A disseminação para o grande público de estudos científicos e os resultados de pesquisas relevam o papel da racionalidade nutricional na promoção de "melhor" saúde em detrimento da existencialidade da comida e de seu papel agregador nas relações intersubjetivas.

Abstract This is an article based on a theoretical and conceptual reflection on the concept of nutritional rationale and its relation to the medicalization of food. The objective is to highlight the influence that eating habits suffer from the alleged condition of supremacy that science holds, which proclaims the need for health in its discourse. Based on the assumption of nutritional rationale as an eating obligation, it is assumed that it is responsible for the process of the medicalization of food. This is achieved by disqualifying the individual from self-care in terms of food, instilling the idea of the risk that comes from supposedly inadequate eating habits and fomenting the idea that to eat well is to eat accordingly to scientific principles. The dissemination of scientific studies and the results of research to the general public reveals the part played by eating in promoting a state of "better" health at the expense of the existentiality of food and its role as the aggregator in intersubjective relations.

Fixed‑dose combinations of antimicrobials: A need for special attention.

Objective: To highlight the issue of freely available fixed‑dose combinations (FDCs) of antimicrobials. Methods: A critique of two such antimicrobial FDCs was undertaken wherein the following aspects were assessed ‑ rational and regulatory issues and justification for clinical use. Available in vitro, in vivo (animals and humans) evidence from published literature was analysed. Conclusions: There are several inadequately addressed aspects of the considered FDCs which are available in Indian market. In view of the growing problem of antimicrobial resistance, this issue must get the required attention.

Food-Based Dietary Guidelines of Southeast Asian Countries: Part 1 - A Compilation and Analysis of Key Messages

A project to compile and analyse the key messages and scientific rationale of the officially published food-based dietry guidelines(FBDGs)in six Southeast Asian countries was undertaken to understand their similarities and differences.

Perceptions Of Interns And Faculty Regarding Undergraduate Clinical Pharmacology Teaching On Rationale Prescription Of Drugs.

Abstracts: Background: Interns being the most junior doctors involved in prescription of drugs in hospitals, there is a unmet need to obtain perceptions regarding undergraduate clinical pharmacology teaching on rationale prescription of drugs and level of retention of knowledge on clinical pharmacology .Hence this study was planned to assess the perceptions of Interns and faculty regarding undergraduate clinical pharmacology teaching on rationale prescription of drugs. Methodology: 58 internees and 52 faculties of JN medical college were administered with a structured questionnaire. The questionnaire sought information about demographics, undergraduate clinical pharmacology teaching, confidence in rationale drug prescription and experiences of adverse drug reactions. Results: Among 58 internees recruited, 26(44.8%) disagreed that training in clinical pharmacology has equipped them to prescribe rationally and 30(51.7%) Internees expressed lack of confidence while prescribing rationally. Out of 52 faculties recruited, it was observed that 20(38.5%) faculty disagreed that undergraduate training in clinical pharmacology has equipped interns to prescribe rationally and 29(55.8%) of faculty agrees that interns are not confident enough to prescribe rationally. Conclusion: The present study showed that interns are not adequately equipped to prescribe rationally and confidently based on undergraduate clinical pharmacology teaching. Hence there is a need of vigorous training in clinical pharmacology during their graduation. [

The Korea National Suicide Survey (KNSS): Rationale and Design

Suicide, the fourth leading cause of death in Korea, is a serious national problem. The Korea National Suicide Survey (KNSS) is the result of the first legislation to address this issue, "Article 11 of THE ACT FOR THE PREVENTION OF SUICIDE AND THE CREATION OF A CULTURE OF RESPECT FOR LIFE" (the "Act for the Prevention of Suicide"). To overcome the limitations of previous studies, the KNSS was designed by collaborators from a variety of fields : psychology, epidemiology, social welfare, and psychiatry. The KNSS was composed of four substudies that addressed the multifaceted process involved in suicide-related behavior over time, exploring general attitudes toward suicide and suicidal ideation, suicide planning, suicide attempts, and completed suicides. Study 1 examined the risk factors for suicide based on data regarding completed suicides ; Study 2 adopted the approach of a psychological autopsy ; Study 3 focused on suicide attempters ; and Study 4 explored attitudes toward suicide in the general population. The KNSS was designed to provide a comprehensive understanding of suicide from a longitudinal, multifaceted perspective to serve as a basis for policies aimed at suicide prevention.

Prescription Pattern of Antibiotics among Physicians in a Secondary Health Facility in Abuja, Nigeria.

Aim: This study was aimed at assessing the prescription pattern of antibiotics by physicians in Federal Staff Clinic, Abuja: A secondary health care facility in Nigeria. Study Design: It was a descriptive cross sectional study Place and Duration of Study: Federal Staff Clinic, Abuja, Nigeria between August 2012 and February 2013. Methodology: A total number of 1022 prescription sheets containing 1648 prescribed antibiotics were obtained retrospectively and examined. Results were analysed using SPSS version 15 and presented in form of descriptive statistics. Results: Results showed that Amoxicillin was the most prescribed antibiotic followed by Metronidazole (31.79% and 27.37% respectively). The mean number of antibiotics prescribed per prescription was 1.61± 0.55. The drug per prescription ranged from 1 to 9 with a mean of 3.04± 1.51. About Ninety five percent of the antibiotics were prescribed correctly in terms of frequency and duration of use. Only 21.2% of the antibiotic was prescribed in generic name. Almost all of the antibiotics were prescribed in oral form (98.3%) and were available for dispensing at the pharmacy as at the time of prescription (97.59%). All antibiotics prescribed were found in the Essential Drug List. Conclusion: Antibiotic usage in this health facility was largely in accordance with National Drug policy which promotes rationale use of drugs. However, majority of antibiotics were not prescribed in generic form, an area where the physicians need to be educated on and monitored further.

Compreender as racionalidades leigas sobre saúde e doença / Understanding lay rationalities about health and illness

A ciência é uma forma de conhecimento que foi instituída como a forma de conhecer a verdade única e universalmente válida, assente nas questões epistemológicas e nos critérios de rigor metodológico. O saber leigo, popular, que preenche a vida e orienta a ação quotidiana, busca o significado através do simbólico cultural, no que é o oposto do conhecimento científico. A questão das possibilidades de conhecimento sobre a realidade social situou o debate nos modos de produção de conhecimento e na consequente contingência dessas mesmas produções, o que sustenta a afirmação de que todas as formas de conhecimentos são válidas nos seus contextos de produção. Em matéria de saúde e doença, a produção sociológica tem desvendado os conteúdos do saber leigo e a sua incontestável presença na experiência individual, desde a percepção dos fenômenos no corpo até a relação com a instituição médica. Este texto parte de uma reflexão sociológica sobre a questão do conhecimento. Em seguida, revê o essencial da literatura sociológica sobre o saber leigo de saúde e doença. Finaliza com uma proposta de compreensão dos processos do saber leigo como racionalidades que, na forma de configurações de elementos interdependentes, sustentam as práticas de saúde na vida quotidiana.

Science is the form of knowledge that has been established as a way to know the only and universally valid truth, based on the epistemological questions and criteria of methodological rigor. The lay knowledge that fills life and guides daily actions, seeks meaning through the symbolic cultural, as opposed to scientific knowledge. The issue of knowledge possibilities about the social reality placed the debate on ways of knowledge production and the consequent contingency of those productions, which substantiates the claim that all forms of knowledge are valid in their context of production. In terms of health and illness, the sociological production has unveiled the contents of lay knowledge and its indisputable presence in individual experience, since the perception of bodily phenomena until the relationship with the medical establishment. This text takes a sociological production on the knowledge issue. Then it reviews the key sociological literature on lay knowledge about health and illness. It concludes with a proposal for understanding lay knowledge processes as rationalities that, in the form of configurations of independent elements, keep health practices in everyday life.

Osteochondroma of the mandibular condyle.

Osteochondroma (OC) of the mandibular condyle is a relatively rare condition that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporomandibular joint (TMJ) dysfunction, and malocclusion. Radiographically, there is a unilaterally enlarged condyle usually with an exophytic outgrowth of the tumor from the condylar head. We present a case of a left mandibular condylar OC that created a major facial asymmetry, malocclusion, and TMJ dysfunction. Discussion includes the rationale for treatment and the method used in this case. In actively growing OCs, surgical intervention is indicated to remove the tumor stopping the benign growth process and improve facial symmetry, occlusion, and jaw function.

Shen: categoria estruturante da racionalidade médica chinesa / Shen: structuring category in the rationale of Chinese medical

A medicina chinesa é hoje praticada no Ocidente e na própria China através das vertentes denominadas medicina clássica chinesa, medicina tradicional chinesa e medicina chinesa contemporânea, que divergem parcialmente em relação à valorização dada a algumas de suas categorias, entre elas a categoria Shen, freqüentemente traduzida no Ocidente como mente ou espírito. O presente artigo pretende estudar a medicina chinesa diante do conceito de racionalidade médica, definido pela presença de seis dimensões: cosmologia, dinâmica vital, doutrina médica, diagnose e terapêutica. Pretende, ainda, demonstrar a importância da categoria Shen em cada uma dessas dimensões, o que a faz estruturante da medicina chinesa como racionalidade médica. Sob tal perspectiva, a não valorização desta categoria poderia comprometer a medicina chinesa, transformando essa teoria milenar em mera prática terapêutica.

Today, Chinese medicine is practiced in the West and in China itself by means of classical Chinese medicine, traditional Chinese medicine, and contemporary Chinese medicine, which mainly diverge in the value given to some of their categories, including Shen, which is often translated in the West as 'mind' or 'spirit'. This article seeks to discuss Chinese medicine from the perspective of medical rationale, defined by the presence of six dimensions: cosmology, vital dynamics, medical doctrine, diagnosis and treatment. It also attempts to demonstrate the importance of Shen in each of these dimensions, making it an element that structures Chinese medicine as a medical rationale. Seen from this angle, the diminishment of this category could compromise Chinese medicine, turning this age-old theory into no more than a treatment.