Knowledge, Attitude And Practice (KAP) Of Pharmacovigilance Among Undergraduate Medical Students In A Tertiary Care Teaching Hospital Of Kumaon Region, Uttarakhand

Introduction: Pharmacovigilance program is responsible for conducting activities related to ADR monitoring.But it is encountering problem of underreporting. The medical students are the budding doctors who can play a major role in strengthening this program. Therefore, our study was carried out to assess and compare the KAPof MBBS students according to the year of study. Materials and Methods: It was a questionnaire-based cross-sectional study. Questionnaire contained 21 questions to evaluate KAP of second, prefinal and final year MBBS students regarding pharmacovigilance. Results: KAPscoring was average for knowledge, good for attitude and poor for practice. The mean score for knowledge was highest for final year students (7.01 ± 1.96) whereas attitude and practice score was highest for second year students (5.65 ± 0.64; 2.18 ± 0.95). There was a significant difference in mean score between three groups for practice. Conclusion: Students lack adequate knowledge and practice but they have positive attitude towards pharmacovigilance

Micro-health insurance in dentistry: the road less travelled

Oral health is indeed a challenge for the urban poor. Majority of the patients spend from their pocket, which aggravates their financial condition. It is paramount for the government and the healthcare industry to adopt a value-based approach to redress the oral health lapses for the underserved population. Micro health insurance (MHI) can have a game changing effect on the oral healthcare space too, if concerned stakeholders build the right partner network. Aim of the study was to discuss the principal features, basic structure, and functioning of a few MHI schemes, and presents a hypothetical model of MHI which can be implemented in dentistry. Literature search was conducted in two main databases, pubmed and cochrane, using key phrases such as “community based health insurance,” “micro health insurance,” micro or community based health insurance,” and “health insurance and financial protection”. Articles published in last ten years with full texts were considered. 23 schemes were eligible for the systematic review. Our analysis shows that MHI, in the majority of cases, contributes to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, household borrowings and poverty. However, the studies did not affirm oral health benefits. The importance of oral healthcare in India is superficial. Focus on oral healthcare can be achieved only if the impending cost due to out of pocket payments can be supplanted with a more affordable and dynamic payment model. With MHI extended to oral healthcare, India can certainly achieve its SDG goal. It’s time to look beyond.

Use of Traditional Indian Plants in the Inhibition of Caries-Causing Bacteria - Streptococcus mutans

The aim of the study was to comparatively evaluate the antibacterial activity of six Indian plant extracts and 0.2% chlorhexidine against clinical strains of Streptococcus mutans, which were isolated from the plaque samples of 45 pediatric patients. Six plant extracts were prepared in three different forms, namely aqueous extracts, organic solvent-based extracts and crude (raw) extracts. The antimicrobial sensitivity testing was done by agar well diffusion method. Antimicrobial activity of the extracts was determined by measuring the mean zones of inhibition (mm) produced against the bacterial isolates. Results showed that crude garlic extract exhibited greater antibacterial activity than chlorhexidine. Aqueous extract of amla and organic solvent-based extract of ginger showed the maximum antibacterial activity against S. mutans, whereas aqueous extract of tulsi and organic solvent based extract of amla showed the minimum antibacterial activity. This study suggests that plant extracts like garlic in crude form, amla as aqueous infusion and ginger as alcoholic tincture have potential for the control of S. mutans. These extracts can be used as an alternative remedy for dental caries prevention or in the form of mouthwash, which is safe and economical.

O objetivo do estudo foi avaliar comparativamente a atividade antibacteriana de seis plantas indianas contra linhagens clínicas de Streptococcus mutans, que foram isoladas das amostras de biofilme dental de 45 pacientes pediátricos, com 0,2% de clorexidina. Seis extratos vegetais foram preparados em três formas diferentes, a saber, extratos aquosos, extratos à base de solventes orgânicos e extratos brutos. Os testes de sensibilidade antimicrobiana foram realizados por método de difusão em agar. A atividade antimicrobiana dos extratos foi determinada através da medição da zona de inibição, em milímetros, produzida contra os isolados bacterianos. Os resultados mostraram que o extrato de alho cru apresentou maior atividade antibacteriana do que a clorexidina. O extrato aquoso de amla e o extrato à base de solventes orgânicos de gengibre mostraram a máxima atividade antibacteriana contra S. mutans, enquanto o extrato aquoso de tulsi (manjericão) e o extrato à base de solventes orgânicos de amla mostraram mínima atividades antibacteriana. Este estudo sugere que extratos de plantas como o alho em forma bruta, amla como infusão aquosa e gengibre como tintura alcoólica tem um potencial para o controle de S. mutans. Estes extratos podem ser utilizados como uma via alternativa para a prevenção de cáries dentárias ou sob a forma de bochechos, que são seguros e econômicos.

Does hypertension play a role in diabetic retinopathy?

Diabetic retinopathy is a common complication of diabetes. It represents one of the frequent causes of visual disability among diabetic subjects during the period of active life. The risk factors for diabetic retinopathy are poor glycemic control, hypertension, duration of diabetes, hyperlipidemia and proteinuria. It has been observed that prevalence of hypertension is higher in diabetic subjects than in the general population and as it also plays a major role in the progression of diabetic retinopathy, so tight control of hypertension is mandatory. The possible mechanisms by which hypertension affects diabetic retinopathy are haemodynamic (impaired autoregulation and hyperperfusion) and secondly through VEGF (Vascular Endothelial Growth Factor), as it has been observed that hypertension independent of hyperglycaemia upregulates the VEGF expression in retinal endothelial cells and ocular fluids. The level of control of blood pressure are debatable but nearer the blood pressure to the normal levels, better the chances of preventing the onset and progression of diabetic retinopathy. The lowering of blood pressure to a normal range is more important than the type of antihypertensive medication used. Diabetic retinopathy is one of the important causes of visual disability in diabetic subjects during the period of active life. It is characterized by gradually progressive alterations in the retinal microvasculature, leading to increased vasopermeability, areas of retinal occlusion and retinal neovascularization. The complications associated with increased vasopermeability and uncontrolled neovascularization can result in severe and permanent visual loss.

Protection by live Mycobacterium habana vaccine against Mycobacterium tuberculosis H37Rv challenge in mice.

BACKGROUND & OBJECTIVES: In recent years the efficacy of BCG vaccine against tuberculosis has been questioned and there is no alternative vaccine available. Several strategies are being applied to get a satisfactory vaccine. Two approaches are generally considered: the subunit vaccines and the whole cell vaccines. The objective of this investigation was to evaluate an avirulent mycobacteria, Mycobacterium habana, as a whole cell vaccine to protect mice from infection of M. tuberculosis H37Rv. METHODS: AKR and immunocompromised SJL/J mice were immunized with live M. habana vaccine. These mice were challenged with M. tuberculosis H37Rv eight weeks later along with unimmunized control mice. Protection by M. habana vaccine was measured through several parameters, which included survival of challenged mice, dissemination of challenge strain and histopathology of lung tissues. RESULTS: M. habana vaccinated animals were healthier than the unvaccinated mice after challenge with M. tuberculosis and survived with significant increase in mean survival time. The viable count of challenge strain was at least 100-fold less in vaccinated mice than the control mice. The lung tissues in unvaccinated mice showed marked bronchopneumonia with clusters of acid fast bacilli, whereas vaccinated mice showed small areas of damage and evidence of protection subsequently. INTERPRETATION & CONCLUSION: It may be concluded from the evidence presented here that mice vaccinated with M. habana were protected from challenge with M. tuberculosis in both normal and immunocompromised states.

Diagnosis of tuberculous meningitis by detection of antigen and antibodies in CSF and sera.

OBJECTIVE: To evaluate diagnostic potential of three immunological tests, namely, detection of H37Rv antigen of M. Tuberculosis in CSF, detection of antibodies (IgG) against H37Rv in CSF and detection of antibodies (IgG) against H37Rv in serum for diagnosis of tuberculous meningitis in children. SUBJECTS: 50 children diagnosed as patients of tuberculous meningitis were included as cases and 48 children with CNS diseases of nontubercular etiology [pyogenic meningitis (n = 31), encephalitis (n = 10), seizure disorder of unknown etiology (n = 5), brain tumor (n = 2)] served as controls. METHODS: H37Rv antigen of M. tuberculosis was detected in CSF by Dot ELISA, and antibodies (IgG) against H37Rv in CSF and serum were detected by Plate ELISA. RESULTS: Detection of H37Rv antigen in CSF was the most sensitive (90%) and specific (95.83%) with positive and negative predictive values of 95.74% and 90.19%, respectively, followed by detection of antibodies in CSF (sensitivity-74%, specificity-89.58%, positive predictive value-88.10%, negative predictive value-76.78%). Detection of antibodies in serum had low sensitivity (50%), specificity (91.67%), positive predictive value (86.21%) and negative predictive value (63.76%). CONCLUSIONS: Detection of antigen in CSF is a rapid, sensitive and specific test for diagnosis of tuberculous meningitis in children. Detection of antibody in CSF may be useful in some cases but needs further evaluation. Detection of antibody in serum does not appear to be useful for diagnosis of tuberculous meningitis.

Genetics of cholera toxin.

Cholera is caused by the toxin secreted by Vibrio cholerae 01. Cholera toxin (CT) is a protein consisting of A and B subunits. The former contributes to intracellular toxicity whereas the B subunit is required for binding of CT to eukaryotic cell surface receptor. The structural genes encoding A and B subunits are designated as ctxA and ctxB respectively. These genes are located on the chromosome forming an operon in which ctxA precedes ctxB. The ctxAB have been cloned and sequenced. Classical strains contain two full copies of unlinked ctxAB. Most el tors have single copy. However, in some strains there are two copies which are arranged in tandem. The tandem duplication and amplification of ctxAB is controlled by a transposable element like DNA sequence called RS1. A number of genes have been identified which regulate the expression of ctx operon. V. cholerae seems to elaborate more than one toxin which are different from the one encoded by ctxAB genes.

Mother's attitude towards child's health education and play in ICDS and non-ICDS areas.

To lay the foundation for proper physical and psychological development of children is one of the stated objectives of Integrated Child Development Services Scheme, which is operational in India since 1975-76. This objective can not be achieved unless a positive change in maternal attitude is accomplished. The present investigation was conducted in an oldest project area of India to assess this change using an adjacent Non-ICDS area as control. Majority of the mothers in both the areas were apathetic towards the health, education and play of their children. Nevertheless one encouraging trend was also observed. Significantly higher number of mothers in ICDS area had positive attitude in all the three variables in comparison to mothers in Non-ICDS area. It appears that ICDS Scheme has given the start but to have more acceptable answers, in depth investigations at national level are needed.