Competencies of Indian Medical Graduates in Delivering Effective Tuberculosis care: A Mixed Method Study among Doctors at Chennai, India

Introduction: In spite of the various advances in the Tuberculosis (TB) management system in our country, we are still struggling to achieve the End TB strategy. Addressing the health provider difficulties in TB care will definitely be potential tool to control TB. Objective: To assess the competency, challenges and solutions of Indian medical graduates to provide effective Tuberculosis care. Method: It is a mixed methodological study conducted among the Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates practising in various parts of Chennai, Tamil Nadu, India. The competency of the Indian medical graduates in delivering TB care was assessed using a content validated e-survey questionnaire disseminated through social media affinity groups and free listing;pile sorting and in-depth interview was done in the qualitative part. Results:The proportion of participants having good, fair and poor competency in providing effective TB care was 35%,19% and 46%, respectively. Various challenges in attaining good competency were enlisted by the participants through free listing, a smaller number of TB patients in private medical college has attained the highest Smith S value followed by other eleven challenges. Based on the pile sorting and in- depth interview various solutions have been suggested, with most of them emphasizing on compulsory TB chest clinic posting followed by others measures. Conclusion: The major reason identified in difficulties in delivering TB care was inadequate exposure in managing TB patients, incomplete knowledge on notification,referral and followup system. These lacunae can be overturned by compulsory posting in TB clinics during internship period, provision of required personal protective equipment (PPE) for doctors and patients in TB wards and outpatient department, mandatory teaching on updates of TB management

Morphometric evaluation of great vein of Galen and its clinical implications / 대한해부학회지

The Galenic venous system plays a vital role in the drainage of blood from deeper parts of the brain. This venous system is contributed by many major veins. These veins are located closer to the pineal gland making the surgical approach in this region difficult. Any accidental injury or occlusion of the vein of Galen could lead to devasting results. Thus, studying the dimensions of the vein of Galen is more important. Hence, we aimed to evaluate the morphometry and trajectory to the vein of Galen. About 100 computed tomographic venography records were evaluated and the length, diameter of vein of Galen, angle between straight sinus and vein of Galen and distance from internal occipital protuberance and roof of fourth ventricle to vein of Galen were studied. The mean length and diameter of vein of Galen were 9.8±2.7 and 4.08±1.04 respectively. The mean angle between straight sinus and vein of Galen was 64.2°. The mean distance between external occipital protuberance and roof of fourth ventricle to vein of Galen were 52±6.9 and 33.3±4.5 respectively. No significant morphometric differences were observed between the age groups as well as between the sexs. The results obtained from this study may be helpful for the neurosurgeons in better understanding of the anatomy of the Galenic venous system and to adopt a safe surgical approach to improve the efficacy of the surgeries of the pineal gland and also in the region of vein of Galen.

Manual vs. mechanical ventilation in patients with advanced airway during CPR

Early chest compressions and rapid defibrillation are important components of cardiopulmonary resuscitation (CPR). American heart association (AHA) recommends two breaths to be delivered for every 30 compressions for an adult cardiac arrest victim. Patient with an advanced airway like endotracheal tube (ETT) should be given one breath every 6 s without interruptions in chest compression (10 breaths per minute). All of the modern mechanical ventilators have option to generate spontaneous breaths by the patient if the patient has spontaneous respiratory efforts. During CPR, the mechanical ventilator is fallaciously sensing the chest compressions as patient's spontaneous trigger and thereby it delivers higher respiratory rates. Avoiding excessive ventilation is one of the components of high quality CPR as excessive ventilation decreases venous return thereby decreasing the cardiac output and also it affects intra-thoracic pressure thereby adversely affects intra-arterial pressure. As modern ventilators have trigger for spontaneous breaths and they will be erroneously triggered by chest compressions, it would be prudent to use volume marked resuscitation bags or manual breathing devices (manual self-inflating resuscitation bag, Bain's circuit) for delivering breaths which can be synchronised with compression phase of CPR at RR of 10 breaths per min with advanced airway in place. If any patient who is on mechanical ventilation develops cardiac arrest, patient should be disconnected from the mechanical ventilator and should be ventilated manually. Manual ventilation with aforementioned breathing devices should be used in a patient without and with advanced airway devices during CPR.

Burden of Oral Precancer and Cancer among an Indigenous Tribal Population of South India – An Evaluative Study

Context: Oral cancer is of major concern in the Indian subcontinent and is found to be high among low socioeconomic groups. One such high?risk group is considered to be the tribal people, who are economically and socially marginalised. Aims: The aim of the present study is to assess the prevalence of oral cancer and precancer lesions among the Narikurava population in Puducherry state, India. Methods and Material: A total of 329 Narikurava tribal people were included in this study. Data was collected by clinical examination of the oral cavity by door?to?door screening. The oral cavity was examined for white/red lesions, ulcerative changes, leathery changes and tissue growths. Statistical Analysis Used: Prevalence was calculated in terms of percentages. Descriptive statistics included the calculation of percentages, mean, and standard deviation. Results: The prevalence of precancer in the population is 48.3%. The majority of the lesions were observed in the buccal mucosa: 41.6% had white lesions, 9.1% had red lesions, 0.3% had ulcerations or growth, and 28.3% had leathery changes followed by the labial mucosa: 0.6% had white lesions, 0.6% had red lesions, 0.3% had ulcerations or growth and 16.4% had leathery changes. Conclusions: The present study observed a high prevalence of precancerous lesions among the Narikurava tribe. The main reason for the high prevalence is attributed to tobacco and tobacco?related habits. Hence, cancer control activities should be prioritised. Designing a model to detect precancer and cancer early and to constantly monitor the detected cases in such populations is of utmost importance

Genetic testing in four Indian families with suspected Stickler syndrome

Purpose: Stickler syndrome is associated with the development of rhegmatogenous retinal detachment (RRD), and often presents with ocular, auditory, skeletal, and orofacial abnormalities. Molecular analysis has proven effective in diagnosis, confirmation and classification of the disease. We aimed to describe the utility of next?generation sequencing (NGS) in genetic analysis of four Indian families with suspected Stickler syndrome. Methods: The index cases presented with retinal detachment with family history. Genetic analysis in the index case was performed by next?generation sequencing of inherited retinal degeneration genes, and validated by Sanger sequencing followed by co?segregation analysis in the other family members. Results: Twenty patients were included for the genetic analysis (15 males and 5 females from four families). Clinical details were available for 15 patients (30 eyes). Fourteen eyes (11 patients) developed RRD. In the 16 eyes without RRD, 8 underwent barrage laser to lattice degeneration and 8 were under observation. Disease segregating heterozygous mutations with pathogenic/likely pathogenic effect was identified in COL2A1 (c.4318?1G>A, c.141G>A, c.1221+1G>A for 3 families) and COL11A1 (c.1737+1 G>A for 1 family) gene. In addition to the mutation in the COL2A1 gene, a pathogenic heterozygous variant associated with risk for arrhythmogenic right ventricular cardiomyopathy (ARVC) was identified in one member. Conclusion: NGS testing confirmed the presence of the causative gene for Stickler syndrome in the index case followed by evaluation of family members and confirmation of genetic and ocular findings. We believe that this may be the first such report of families with RRD from India

Morphometric Analysis of Vertebral Artery Groove in Human Atlas Vertebra in South Indian Population

Introduction: Recent trends like pedicle screws and other instrumentation of cervical vertebra are on the rise. However, proximity of vertebral artery coursing in vertebral artery groove (VAG) on the superior surface of the posterior arch of atlas poses a unique challenge to surgeons performing these procedures. Such vascular injuries though rare, are not uncommon and may pose immediate to delayed complications. Radiological studies of atlas vertebra & VAG are being extensively done with CT and MR Angiography, but morphometric studies of VAG in atlas vertebra in South Indian population is lacking. Aims: To understand the morphology and dimensions of the vertebral artery groove and its variations if any, in dry atlas vertebra of South Indian population. Settings and Design: Descriptive observational study Methods and Material: 50 dried adult human atlas vertebra of unknown age & sex from the Anatomy Department, PSGIMS & R, Coimbatorewere studied. Intact cervical vertebrae without any degenerative or traumatic disorders were included. The morphometry of VAG and its distance from midline were evaluated through six linear measurements.The parameters were inner and outer lengths of the groove, width & thickness of the groove and the distance of its medial most and lateral most edges from the midline on both sides. Statistical analysis used: SPSS software Results: There is no statistically significant difference between mean values on right and left side for inner length, outer length, width and thickness of vertebral artery groove. The mean inner and outer distance of the vertebral artery groove from the midline on the right is higher than the left. Conclusions: The present study provides morphometric data of VAG & recommends a safe zone of 11.82 mm from midline for instrumentation in posterior spinal surgeries to minimize vertebral artery injuries.

Clinical profile of patients infected with suspected SARS-CoV-2 Omicron variant of concern, Tamil Nadu, India, December 2021-January 2022

Background & objectives: COVID-19 cases have been rising rapidly in countries where the SARS-CoV-2 variant of concern (VOC), Omicron (B.1.1.529) has been reported. We conducted a study to describe the epidemiological and clinical characteristics and outcomes of COVID-19 patients with ‘S’ gene target failure (SGTF, suspected Omicron). Furthermore, their clinical outcomes with COVID-19 patients with non-SGTF (non-Omicron) were also compared. Methods: This study was conducted in Tamil Nadu, India, between December 14, 2021 and January 7, 2022 among patients who underwent reverse transcription-PCR testing for SARS-CoV-2 in four laboratories with facilities for S gene screening. Consecutively selected COVID-19 patients with SGTF were telephonically contacted, seven and 14 days respectively after their date of positive result to collect information on the socio-demographic characteristics, previous history of COVID-19, vaccination status and clinical course of illness along with treatment details. To compare their outcomes with non-SGTF patients, one randomly suspected non-Omicron case for every two suspected Omicron cases from the line-list were selected, matching for the date of sample collection and the testing laboratory. Results: A total of 1175 SGTF COVID-19 patients were enrolled for this study. Almost 6 per cent (n=72) reported a history of previous infection. 141 (13.5%) suspected Omicron cases were non-vaccinated, while 148 (14.2%) and 703 (67.4%) had received valid one and two doses of COVID-19 vaccines, respectively. Predominant symptoms reported included fever (n=508, 43.2%), body pain (n=275, 23.4%), running nose (n=261, 22.2%) and cough (n=249, 21.2%). Five (0.4%) of the 1175 suspected Omicron cases required oxygen supplementation as compared to ten (1.6%) of the 634 suspected non-Omicron cases. No deaths were reported among omicron suspects, whereas there were four deaths among suspected non-Omicron cases. Interpretation & conclusions: Majority of the suspected Omicron cases had a mild course of illness. The overall severity of these cases was less compared to the suspected non-Omicron cases.

Liposome Encapsulated Astaxanthin Altered Biochemical Profile In Diethylnitrosamine (DEN) Induced Hepato Carcinoma On Swiss Albino Mice

Cancer is a disease in which a group of abnormal cells grow uncontrollably by disregarding the normal rules of cell division. Across several cancers, Hepatocellular carcinoma (HCC) is one of the most aggressive cancers in worldwide. It is held responsible for up to 1 million deaths globally per annum. HCC is an inflammation-related cancer, as a chronic inflammatory state is necessary for cancer appearance. In this study, the drug astaxanthin and encapsulated astaxanthin was tested against HCC. Mice were divided into 7 groups; Group I: control, Group II: DEN induced, Group III: DEN + 50 mg/kg astaxanthin, Group IV: DEN + 100 mg/kg astaxanthin, Group V: DEN + 50 mg/kg encapsulated astaxanthin, Group VI: DEN + 100 mg/kg encapsulated astaxanthin, Group VII: DEN + 10 mg/kg sorafenib. Regular diet was given. Body weight, Food intake, water intake was noted. Other biochemical parameters such as ALP, AST, Albumin, proteins and TNF-α was determined. Finally, the liver was removed from each mice of different group by sacrificing them and histopathology was done. In vivo evaluation in mice models showed significant antitumor activities by both encapsulated and non-encapsulated astaxanthin at 100 mg/kg as compared with the control, DEN induced group and positive drug sorafenib. This research suggested that encapsulated astaxanthin can also be used as chemotherapeutic agent for the treatment of Hepatocellular carcinoma (HCC).

Describing the perceptions of bioethics training requirements among young medical professionals: an observational studies

Background: Medical Council of India emphasises the training on bioethics for medical graduates and included the same in medical curriculum reforms. However, the universal implementation of structured training in bioethics remains elusive due to many challenges. Hence the study was planned to describe the perception about the bioethics training needs among trainee interns and junior residents training at tertiary medical teaching hospitals across Tamil Nadu.Methods: A web-based cross-sectional survey was conducted during September-December 2019.Google forms survey was designed, and link was disseminated using affinity groups and snowballing techniques through social media among current medical interns and junior resident doctors working at tertiary care teaching hospital settings across Tamil Nadu. Data was analyzed using MS Excel auto generated through google forms and descriptive statistics were performed.Results: Among 136 respondents of online survey from across 25 medical colleges in Tamil Nadu, 73 (57.5%) were females, 57 (42.2%) had training on bioethics and 31 (54.4%) during internship period. During these trainings, experts in bioethics scholarship conducted training for only 34% of participants. Self-reported inadequate levels of awareness on bioethics was seen in 20.6% subjects and 17.8% subjects professed awareness on Indian Council of Medical Research clinical research ethics guidelines. Combination of curriculum and self-directed learning was the favoured teaching-learning method.Conclusions: This study reveals major gaps in knowledge and attitudes of young medical professionals towards bioethics training and can be addressed through testing novel methods of training.

Complications and pregnancy outcome in women with preeclampsia and eclampsia

Background: One of the complications of pregnancy which till today challenges the obstetrician is preeclampsia and its severe form of eclampsia. Objective of this study was to find out the complications and outcome of pregnant women with preeclampsia and eclampsia admitted in a tertiary referral center.Methods: Case records, in labor room, were scrutinized to find out the number and the outcome of pregnancy, in women admitted with preeclampsia or eclampsia in the year 2018.Results: Pregnant women admitted with preeclampsia or eclampsia numbered 2511 and, 109 women developed complications. Maternal complications, were more often seen in mothers, (62.4%) of female babies. Only 37.6% of mothers of male babies developed complications. Complications seen were Renal complications in 34.8%, Hematological complications in 33%, Neurological complications in 25.6%, Pulmonary complications in 16.5%, ophthalmological complications in 11% and Sepsis in 6.4% and MODS in 10%. Of total maternal deaths, 34% was caused by complications of preeclampsia or eclampsia. Major cause of maternal death was MODS and Pulmonary complications. Nearly, 62.3% of babies born had birth weight of 1.8 kg and nearly one-third of babies (26.6%) were dead born.Conclusions: The incidence of preeclampsia and eclampsia in our referral center for the year 2018 was 15%, and 4.3% of women developed complications, and 6% died, making preeclampsia and eclampsia the causative factor for 34% of total maternal deaths. Major maternal complications were Renal, Hematological, Neurological, Pulmonary and MODS. Complications of preeclampsia were more often present in 62.4% mothers of female babies in contrast to 37.6% of mothers of male babies. Nearly one-third of babies (26.6%) were dead born.

Gymnema montanum improves endothelial function via inhibition of endoplasmic reticulum stress by activating Nrf2 signaling

Objective: To investigate the effects of Gymnema montanum leaf extract against endoplasmic reticulum (ER) stress-induced toxicity in endothelial cells.Methods: The immortalized endothelial hybrid cell, EA.hy926 was treated with different concentrations of Gymnema montanum leaf extract (0-100 μg/mL) and the ER stress inducer, tunicamycin. The cytotoxicity was assessed by MTT as well as lactate dehydrogenase and malondialdehyde levels were determined. The levels of ER stress markers, GRP78 and CHOP were analysed by Western blot assay. The Gymnema montanum leaf extract-mediated activation of nuclear factor erythroid 2-related factor 2 (Nrf2) was assessed by cell-based luciferase enzyme fragment complementation assay and antioxidant responsive element driven luciferase reporter assay. The levels of phosphoproteins of the MAPK pathway were analyzed using the Bioplex system. Results: A dose-dependent cytoprotective effect of Gymnema montanum leaf extract was observed in tunicamycin-induced toxicity. Gymnema montanum leaf extract significantly reduced lactate dehydrogenase activity and malondialdehyde levels in ER stress-induced endothelial cells. It also suppressed ER stress markers dose dependently and inhibited the phosphorylation of JNK, ERK, MEK and p38 MAPK in tunicamycin-induced endothelial cells. Moreover, Gymnema montanum leaf extract increased the expression of Nrf2 and its downstream targets in endothelial cells. Conclusions: Gymnema montanum leaf extract attenuates ER stress by increasing the expression of Nrf2 and its downstream genes.

Gymnema montanum improves endothelial function via inhibition of endoplasmic reticulum stress by activating Nrf2 signaling

Objective: To investigate the effects of Gymnema montanum leaf extract against endoplasmic reticulum (ER) stress-induced toxicity in endothelial cells. Methods: The immortalized endothelial hybrid cell, EA.hy926 was treated with different concentrations of Gymnema montanum leaf extract (0-100 μg/mL) and the ER stress inducer, tunicamycin. The cytotoxicity was assessed by MTT as well as lactate dehydrogenase and malondialdehyde levels were determined. The levels of ER stress markers, GRP78 and CHOP were analysed by Western blot assay. The Gymnema montanum leaf extract-mediated activation of nuclear factor erythroid 2-related factor 2 (Nrf2) was assessed by cell-based luciferase enzyme fragment complementation assay and antioxidant responsive element driven luciferase reporter assay. The levels of phosphoproteins of the MAPK pathway were analyzed using the Bioplex system. Results: A dose-dependent cytoprotective effect of Gymnema montanum leaf extract was observed in tunicamycin-induced toxicity. Gymnema montanum leaf extract significantly reduced lactate dehydrogenase activity and malondialdehyde levels in ER stress-induced endothelial cells. It also suppressed ER stress markers dose dependently and inhibited the phosphorylation of JNK, ERK, MEK and p38 MAPK in tunicamycin-induced endothelial cells. Moreover, Gymnema montanum leaf extract increased the expression of Nrf2 and its downstream targets in endothelial cells. Conclusions: Gymnema montanum leaf extract attenuates ER stress by increasing the expression of Nrf2 and its downstream genes.

A Review of Cosmos caudatus as A Promising Antidiabetic Plant

@#Cosmos caudatus Kunth is an edible plant commonly known for its beneficial medicinal effects on human health and traditionally used to treat various health conditions, including diabetes. This review summarizes the current state of knowledge about this plant, to provide some basic information about this herb that reflects its antidiabetic potential through multiple mechanisms. Currently, available evidence suggests that C. caudatus possess some pharmacological effects, including anti-inflammatory, antimicrobial, the formation of healthy bone and regulation of blood pressure and glucose levels. The review summarized the antidiabetic activity and its significant phytoconstituents in C. caudatus

A cross-sectional study on morbidity status among school going adolescents in Thiruvallur district, Tamil Nadu

Background: Adolescents represent about 21.8 percent of India’s population. Various health risks with potentially life-threatening consequences become prominent in this age group. This study was undertaken with the objective to determine the morbidity profile of school going adolescents in Tamil Nadu.Methods: This descriptive, cross sectional study was planned and conducted from January 2016 to August 2017. The study population included 987 adolescent boys and girls aged between 10 to 19 years studying in high and higher secondary Government schools of Thiruvallur district of Tamil Nadu. Semi-structured questionnaire was used as data collection tool.Results: The mean age groups of this school going adolescent are 14.2 yrs. In the present study 583 (59%) of the study participants were affected by one or more morbidity condition. Among them, 395 (67.7%) were in the age group 10-14 years and 188 (32.2%) in the age group 15-19 years. 122 (21%) and 461 (79.1%) of male and female were affected respectively. In the present study, fever (21%) was the commonest reported morbidity followed by acute respiratory infection (15.7%) and acute gastrointestinal disease (13. 4%).Conclusions: This study shows that adolescents are prone to a wide range of morbidity conditions. Apart from respiratory and gastro intestinal diseases, reproductive tract infections and sexual health problems are important morbidities affecting this age group. There is strong need to sensitize health care practitioners at all levels, in both government and private sectors towards health problems in adolescent age groups.

A Retrospective Study of Histopathology and Clinical Correlation of Renal Cell Carcinoma in a Tertiary Medical College, India

Background: The study was conducted to understand the clinical solution of renal cell carcinoma. Correlation was done by clinical presentation with radiological features and histopathology of renal cell carcinoma. The stress upon to understand the necessity for a team-approach between Clinician, Radiologist and Pathologist and vice versa is emphasized. Aim: Histopathology and Clinical Correlation of Renal cell carcinoma. Methods: The total number of renal tumours studied during the 8 years period was 45 cases among which 25 cases were diagnosed by histopathology as various types of renal cell carcinoma conclusively. This is a retrospective study of renal tumours, diagnosed by histopathology as various types of renal cell carcinoma. All the relevant clinical data of the patients were searched from the ward records. The various Radiological features were collected. Results: The total number of renal tumours studied during the 8 years period was 45 cases among which 25 cases were diagnosed by histopathology as various types of renal cell carcinoma conclusively. MRI provides molecular information with regard to renal cell carcinoma and potentially aid in biopsy planning. The total cases reported in the department is twenty five vases out of which sixteen cases are attending follow up after 3 years. Conclusion: The Fuhrman grading of renal cell carcinoma correlated grading of renal cell carcinoma. Preoperative radiological classification can be used as a supplement to the histopathological grading. Renal cell carcinoma needs correlation between Radiologist, Pathologist and Clinician.

Maternal and perinatal outcomes in women with first trimester vaginal bleeding

Background: First trimester bleeding is one of the common complications during pregnancy which affects almost 16-25% of all pregnancies. To evaluate and ascertain the adverse maternal and perinatal outcomes in pregnant women presenting with first trimester vaginal bleeding.Methods: Prospective case-control study. A case control study involving 60 pregnant women with vaginal bleeding in the first 13 weeks + 6 days of gestational age with 60 matched controls. The study period was from March 2015 to March 2016 and conducted at PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu.Results: The complications seen in the study group were: first trimester abortion (16.7%), second trimester abortion (6.7%), preterm labour (25%), abruption (6.7%), neonatal intensive care admission (25%), ectopic (6.7%), IUGR (10%), IUD (1.7%) and PROM (8.3%). When compared with the parity matched controls there was statistically significant increase in first and second trimester abortions, preterm labour, abruption, NICU admission and ectopic pregnancy whereas there was no significant difference between the two groups with regard to intrauterine growth restriction (IUGR) and intrauterine death (IUD).Conclusions: Women with first trimester vaginal bleeding had several adverse outcomes in both the mother and the fetus, and it is very important to explain about the possibility of these outcomes and ensure proper follow up with close antenatal surveillance.

Neck circumference as a risk indicator for type 2 diabetes mellitus: a community based cross-sectional study

Background: Diabetes mellitus is a metabolic syndrome due to insulin deficiency, characterized by hyperglycaemia. Indian diabetes risk score (IDRS) is the most commonly used one to determine the risk status. However there is lot of inconvenience and possible errors in measuring the waist circumference to determine the IDRS, hence the study was planned to evaluate if neck circumference could replace waist circumference in determining the diabetes risk.Methods: This cross sectional study was conducted among 300 study participants fulfilling the eligible criteria. Socio-demographic variables, parameters required for determining the IDRS was assessed, in addition, neck circumference (NC) was measured using standard protocol. Another risk score was calculated by replacing waist circumference (WC) with neck circumference and scoring was named as IDRS-NC. Pearson correlation and Wilcoxan sign rank test was done to find out the relationship between WC and NC and also to determine if IDRS-NC could replace IDRS.Results: Out of 300 study population, majority of the participants are in the age group of <35 years 129 (43%) and around 2/3rd of the participants were females. Among the study participants proportion of participants belonging to low risk, medium risk and high risk assessed using IDRS and IDRS-NC was 18.7%, 41%, 40.3% and 31.7%, 38%, 30.3% respectively. There was a strong positive correlation (r=0.837) between the neck circumference and waist circumference. Wilcoxan sign rank test was significant between the 2 scores having a p value of <0.05.Conclusions: In our study there was a positive correlation between neck circumference and waist circumference.

Assessment of drug attitude, medication adherence and quality of life among psychiatric patients in South Indian population: a cross sectional study

Background: In spite of many progresses in treatment of psychiatric disorders, medication nonadherence plays an important role in worsening of clinical condition and affects quality of life among psychiatric patients. There are numerous factors contributing for medication nonadherence among patients with mental illness. So, this study was conducted to assess psychiatric patients’ adherence of medication and to improve their quality of life with psychiatric disorder. The objectives of the study were to analyze impact of pharmacophilia and pharmacophobia on medication adherence among patients with psychiatric disorders at a tertiary care hospital and to assess quality of life among pharmacophilic and pharmacophobic patients.Methods: A cross-sectional study was conducted in outpatient psychiatric department for a period of two months. After obtaining informed voluntary consent, patient’s socio-demographic details, diagnosis, and treatment were recorded from prescription slip. Patients above 18yr age with psychiatric diagnosis as per International Classification of Diseases 10 (ICD-10) and receiving at least one psychotropic medication for >1 month were enrolled in study and assessed using: Drug attitude inventory classification (DAI-10); Medication Rating Scale (MARS); Quality of life enjoyment and satisfaction Questionnaire-Short Form (Q-LES-Q-SF).Results: Among 130 patients, 116 were pharmacophilic and 14 were pharmacophobic as per DAI-10 scale. 81.9% of pharmacophilic were adherent to prescribed medication assessed using MARS scale only 14.3% were pharmacophobic. The quality of life was better in pharmacophilic compared to pharmacophobic group (p=0.002) using Q-LES-Q-SF.Conclusions: This study concluded that pharmacophilic patients have higher adherence and good quality of life index compared to pharmacophobic. Proper counselling of pharmacophobic patients by psychiatrists could improve adherence and QOL.

Effects of video game on socio- behavioral environment

Background: Nowadays the teens playing outdoor games are difficult to be seen and of course, they play all these games not in reality but in a screen using video games. The biggest revolution in electronic world has put our teens more addicted towards video games which not only affect their academic performance but also have impact on their behaviour and health. The objectives of the study were to assess the pattern of video game usage among the study population; to determine the influence of video game in behaviour of the study population.Methods: The study was conducted as a cross sectional study during January and February 2018, among medical students of tertiary care hospital, Chennai. The data was collected using preformed pretested questionnaire. Data were analyzed using SPSS 21.Results: Out of 211 study participants, majority 168 (80%) were males. Around, 97 (45.9%) participants, liked to play during night hours and most 114 (54.1%) of them preferred adventure and racing games. The change in behavioral patterns like, skipping sleep 20 (25.3%), using bad words 22 (27.8%), betting 40 (50.6%), risky stunts 38 (48.1%) were observed. Around half of the participants 97 (46%) were giving complaints of various health problems like finger pain, 72 (34.1%) wrist pain, 63 (29.8%) neck pain, and 54 (26%) eye pain due to usage of video games.Conclusions: The behavioral patterns explored in this study are alarming which suggest that this age group has to be sensitized on the self control to use the video games.

Identification of α-glucosidase inhibitors from Clinacanthus nutans leaf extract using liquid chromatography-mass spectrometry-based metabolomics and protein-ligand interaction with molecular docking / 药物分析学报

The present study used in vitro and in silico techniques, as well as the metabolomics approach to char-acterise α-glucosidase inhibitors from different fractions of Clinacanthus nutans. C. nutans is a medicinal plant belonging to the Acanthaceae family, and is traditionally used to treat diabetes in Malaysia. n-Hexane, n-hexane: ethyl acetate (1:1, v/v), ethyl acetate, ethyl acetate: methanol (1:1, v/v), and methanol fractions were obtained via partitioning of the 80％ methanolic crude extract. The in vitro α-glucosidase inhibitory activity was analyzed using all the fractions collected, followed by profiling of the metabolites using liquid chromatography combined with mass spectrometry. The partial least square (PLS) statistical model was developed using the SIMCA P +14.0 software and the following four inhibitors were obtained:(1) 4,6,8-Megastigmatrien-3-one; (2) N-Isobutyl-2-nonen-6,8-diynamide; (3) 1′,2′-bis(acetyloxy)-3′,4′-didehydro-2′-hydro-β, ψ-carotene; and (4) 22-acetate-3-hydroxy-21-(6-methyl-2,4-octadienoate)-olean-12-en-28-oic acid. The in silico study performed via molecular docking with the crystal structure of yeast isomaltase (PDB code: 3A4A) involved a hydrogen bond and some hydrophobic interactions be-tween the inhibitors and protein. The residues that interacted include ASN259, HID295, LYS156, ARG335, and GLY209 with a hydrogen bond, while TRP15, TYR158, VAL232, HIE280, ALA292, PRO312, LEU313, VAL313, PHE314, ARG315, TYR316, VAL319, and TRP343 with other forms of bonding.