Prescription pattern analysis of antibiotic use in a paediatric intensive care unit of a tertiary care teaching hospital in South India

Background: Antibiotic resistance is rising to alarming levels that necessitates the evaluation of prescription patterns for the rational use of antibiotics. Hence this study was conducted to evaluate antibiotic use in a government run general hospital.Methods: A prospective observational study was conducted to evaluate the rationality of antimicrobial prescription in a paediatric intensive care unit (PICU) of a government run tertiary care teaching hospital using the USAID indicators for rational use of antibiotics. Case records of 104 patients were documented and analysed.Results: The most common antimicrobials prescribed were 3rd generation Cephalosporins namely Ceftriaxone, followed by Aminoglycosides (Amikacin), Imipenams (Meropenam), Anti-Influenza Antiviral (Oseltamivir) and Oxazolidinones (Linezolid). A common trend of antibiotic overuse emerged due to paucity of resources to support decision making and choice of antibiotic. This led to patients being exposed to a high number of antibiotics with an associated increase in morbidity.Conclusions: Antibiotic resistance would remain a challenge until systems for rapid, precise and low cost detection of the causative micro-organisms and antibiotic sensitivity are developed, surveillance systems are increased and antibiotic stewardship programs are enforced.

Sociodemographic Characteristics as Predictors of Satisfaction in Public and Private Dental Clinics

Objective: This study aimed to investigate influence of multiple sociodemographic characteristics on the patient satisfaction levels in outpatient public and private dental practices of Riyadh, Saudi Arabia

Methods: Questionnaire-based survey data were collected from 500 patients, 250 each from the public and private dental clinics of Riyadh, Saudi Arabia from September to December, 2017. Questions related to demographic factors and service attributes were included. A Likert scale of 5-points was used to measure satisfaction levels. Data was analyzed to calculate the descriptive and inferential statistics [analysis of variance and multiple regression analysis] to find the statistical difference [p < 0.01]

Results: Satisfaction level differed significantly by education level [P< 0.001] and the type of clinic [P<0.001]. The multiple regression analysis suggest that all variables influenced satisfaction, except age and marital status. The satisfaction score was higher by 27 percent for private clinics compared to public clinics

Conclusion: This study was exploratory and revealed an effect of individual variables on overall satisfaction score of the services attributes. Future plans for patient care could be developed with the help of this research

Impact of network aided platforms as educational tools on academic performance and attitude of pharmacology students

Objective: This cross-sectional study aimed to examine the impact of learning management system and WhatsApp application as educational tools on students' academic achievement and attitude

Methods: The sample population was the students of six medical colleges of Riyadh, Saudi Arabia attending Medical Pharmacology's semester course in Bachelor of Medicine, Bachelor of Surgery [MBBS] program from September 2016 to January 2017. An exploratory approach was adopted based on a comparison between students exposed to only in-class lectures [Group-N], inclass lectures together with WhatsApp platform to disseminate the lecture slides [Group-W] and students group with in-class lectures facility blended with Learning Management System [LMS] and WhatsApp platform [Group-WL]. The students' grades were assessed using unified multiple choice questions at the end of the semester. Data were analyzed using descriptive statistics and Pearson correlation [p<0.01]

Results: Using learning management system [LMS] and/or WhatsApp messenger tool showed a significant positive correlation in improving students' grades. Additionally, use of WhatsApp enhances students' in-class attendance though statistically insignificant

Conclusion: The results are pivotal for a paradigm shift of in-class lectures and discussion to mobile learning [M-learning]. M-learning through WhatsApp may be as an alternative, innovative, and collaborative tool in achieving the required goals in medical education

Insulin resistance and glucose levels in subjects with subclinical hypothyroidism

Objective: To compare insulin resistance and glycemic indicators among subjects with euthyroidism and subclinical hypothyroidism

Study Design: Comparative cross-sectional study

Place and Duration of Study: Department of Pathology and Medicine, PNS Hafeez, Islamabad, in collaboration with the Department of Chemical Pathology and Endocrinology at the Armed Forces Institute of Pathology [AFIP], Rawalpindi, from December 2015 to September 2016

Methodology: Subjects referred for executive screening of apparently healthy population [without any known history of diabetes, hypertension, heart disease or other chronic ailments], were included. Subjects were grouped as euthyroidism and subclinical hypothyroidism

Results: Median [IQR] insulin resistance indices including fasting insulin and Homeostasis Model Assessment for Insulin Resistance in subjects with group-1 [n=176, 87%, Thyroid Stimulating Hormone: 0.5 - 3.5 mlU/L] and group-2 [n=26, 13%, Thyroid Stimulating Hormone: 3.51 -15 mlU/L] were 7.6 [6.70] vs. 11.4 [13.72, p=0.040] and 1.77 [1.79] vs. 2.8 [3.07, p=0.071]

The median differences for fasting plasma glucose were 5.0 [1.0] in group-1 vs. 5.0 [1.47] for Group-2 [p=0.618], and glycated hemoglobin was 5.60 [1.1] vs. 5.60 [1.7, p=0.824]. Homeostasis Model Assessment for beta sensitivity index in paradox showed slightly higher values for group-2 [median [IQR] 86.67 [92.94]] than group-1 [111.6 [189.64, p= 0.040]]

Conclusion: Measures of insulin resistance including Homeostasis Model Assessment for Insulin Resistance and fasting insulin levels were significantly different between subjects with euthyroidism and having subclinical hypothyroidism

Anticonvulsant activity of nitrendipine in albino mice.

Background: The objective is to evaluate the anticonvulsant activity of nitrendipine in seizure-induced mice. Methods: Albino mice (25-30 g) of either sex were randomly selected and divided into four groups of six mice each. After overnight fasting, Group I received 0.25 ml of propylene glycol and served as the control, Group II received valproic acid (110 mg/kg orally) as standard, Groups III received 5 mg/kg of nitrendipine and 100 mg/kg of valproic acid, Group IV received 5 mg/kg of nitrendipine and 75 mg/kg of valproic acid, and Group V received 5 mg/kg of nitrendipine and 50 mg/kg of valproic acid all of which were administered orally 60 mins prior to the test in this acute study. The anticonvulsant activity was screened using maximal electroshock (MES) model and pentylenetetrazole (PTZ) model. Results: The nitrendipine showed a considerable reduction in the duration of hindlimb extensor phase in MES model and also delayed the latency of seizures induced by PTZ when compared with control group. The probable mechanism of anticonvulsant action of nitrendipine could be due to its interference with the gamma amino butyric acid type aminergic mechanism, modulation of nicotinic, and N-methyl-D-aspartate receptors. Conclusion: Nitrendipine possesses the anticonvulsant activity and has a beneficial role in epilepsy.

Preference regarding technique selection for posterior composite restorations among the dentists in lahore

Bonding composites in deep posterior proximal cavities may be a challenge. The aim of the present study was to evaluate the preferences of dentists in selection of technique to prevent microleakage in posterior deep proximal composite restorations. One hundred questionnaires were randomly distributed to the dental surgeons working in hospitals and clinics in Lahore. The questionnaires were designed to elicit information regarding selection of technique for posterior composite restoration. Ninety two completed questionnaires were returned. Fifty eight general dental practitioners and thirty four specialists responded to the questionnaire. 62% dentists adopted sandwich technique using RMGIC, 60% used GIC in sandwich restoration with immediate composite placement, 39% usedflowable composite as a gingival increment, 4.4% used GIC with delay of 48 hours for composite placement and 4.4% reported to do restoration without using any liner. Difference was found among three groups of dentists in the selection of restorative technique but it was not significant. Sandwich restoration with RMGIC or GIC was the main preference among dentists in deep posterior proximal restorations followed by the use offlowable composite

New perspectives in the management of hypertension: role of herbal medicines

To compare the efficacy of coded herbal medicine [Hyprol] and losartan in hypertensive type II diabetic patients. Case control study. This study was carried out at the Out-patient Department of JPMC, Karachi and Herbal Clinics of Karachi from January 2014 to June 2014. This study is a case control prospective study to compare the effects of Losartan with herbal medicine [Hyprol] in type 2 diabetic hypertensive patients. 200 patients were enrolled and divided in two groups [A] [Control group] and [B] [Test group] treated with Losartan and Hyprol respectively. With ARB [Losartan] baseline to final change for SBP as well as DBP was significantly reduced i.e. 22.45% [p<0.001] and 16.84% [p<0.001] respectively and FBS was reduced by 21.85% [p<0.001] while Hyprol shows comparable results i.e. difference in SBP, DBP and FBS was 14% [p<0.001], 15.31% [p<0.001], 34.57% [p<0.001] respectively. ARBs are the first line drug of choice for hypertension since long time. Use of herbal medicine is an alternative mean of therapy to treat these patients and limit its cardiovascular and renal complications

Clinical evaluation of coded herbal medicine [hypoess] and angiotensin receptor blocker [candesartan] in essential hypertensive patients

The basic aim of this research study was to determine the comparative effect of herbal treatment in comparison with standard allopathic medicine in control and treatment of essential hypertensive patients. Prospective and comparative study. This study was carried out in Department of Pharmacology, HCM and D, FH and MS, Hamdard University, Karachi, from January 2014 to July 2014. A total of 200 patients were enrolled in study and were given Hypoess in one hundred patients while remaining one hundred patients received allopathic medicine Candesartan. In test group one hundred patients were treated with herbal drug [Hypoess] and it decreased mean systolic blood pressure of study patients with a decrease of 15.17% whereas, a reduction of 20.56% was found with allopathic medicine Candesartan Cilexetil. Similarly a decrease of 18.07% was found in mean diastolic blood pressure with herbal medicine in test group patients and a decrease of 21.65% was observed in case of allopathic drug in mean diastolic blood pressure of control group patients. The effects of herbal medicine were found statistically significant in controlling blood pressure and it has been found as an alternative option to treat essential hypertensive patients with its cost-effectiveness

Health care service quality: a comparison of public and private hospitals in karachi

The objective of the study was to compare the levels of patient satisfaction with the health service quality between the public and private hospitals in Karachi, so that their gaps, if any, may be identified and incorporated in future programs and policies. Cross sectional comparative study. This study was conducted in one public and one private hospitals in Karachi from May 2013 to July 2013. A random sample of 400 patients, 200 each from both public and private hospitals was drawn. Data was collected, on a pre-tested and pre coded questionnaire, and analyzed using SPSS version 16.0 level of satisfaction between patients in both the public and private health care settings were compared. The results of the study revealed that 75% of the patients availing health care services at the public hospital were not satisfied with the overall hygiene and cleanliness. 58.5% of the patients at public hospital were not involved in decision making regarding their own treatment. As for the patients availing services at the private hospital, 83.5% mentioned that they were provided with adequate privacy by their physician and hospital staff;however, 51% of the respondents replied that they had to pay huge medical bills which were beyond their affordability. Significant difference was found in the patients' satisfaction level with the quality of health care services provided in the private and public hospitals, with private hospitals performing better in most of the aspects of health care service delivery

Cardiovascular and renal protection in type 2 diabetic hypertensive patients. the role of calcium channel blockers

To study the effects of Calcium Channel Blocker [Amlodipine] as monotherapy in diagnosed hypertensive, non-insulin dependent diabetes mellitus [NIDDM] patients. Prospective study. This study was conducted at Jinnah post graduate medical centre [JPMC] Karachi, in collaboration with the department of medicine JPMC, Karachi from July 2010 to January 2011. This study is to examine the effects of Amlodipine in type 2 diabetic hypertensive patients with base line proteinuria. 20 normal subjects were also selected as a control group with CCB [Amlodipine] baseline to final change for SBP as well as DBP was significantly reduced i.e.24.70 % [p<0.001] and 16.20% [p<0.001] respectively. CCB showed 44% [p<0.001] reduction in FBS, creatinine clearance reduced by 8.10% [p<0.5], serum potassium reduced by 4.50%, non significant increase in serum urea i.e.3.70% and serum creatinine i.e. 3.8% was observed. Aim of treating hypertension is to control or limit its cardiovascular complications; CCB and are the drug of choice in controlling blood pressure and to prevent the progress of cardiovascular events in patients without diabetic nephropathy as well as reserves for add-on therapy in hypertensive patients complicated with diabetic nephropathy

observe the role of angiotension receptor blocker losartan in treating prehypertension

The primary objective of the present study was to determine whether in patients with prehypertension six months of treatment with an angiotensin II, type I receptor antagonist [at a dose of 8mg once a day] reduces the incidence of hypertension in borderline patients Randomized, open-labeled, prospective study. This study was conducted in the department of pharmacology and therapeutics, Basic Medical Sciences institute [BMSI], Jinnah Post Graduate Medical Centre [JPMC], Karachi, from July 2007 to January 2008. This study involved eighty untreated participants between 30 to 60 years of age of either sex with blood pressure on study entry in high-normal range i.e. systolic blood pressure of 130 to 139 mmHg and diastolic blood pressure of 85 to 89 mmHg, according to the classification developed by Joint National Committee on prevention, Detection, Evaluation, and Treatment of high blood pressure [JNC-VI]. All participants were randomized and enrolled in study after baseline investigations and informed written consent. All values have been expressed in standard error of mean [ +/- SEM]. Forty patients were treated with DRI and DR2 from day 0 to day 90[th] of study period respectively. InDRI group the mean systolic BY was decreased from 138 mmHg to 125.8 mmHg from day 0 to day 90[th] In DR2 group an increase was observed in systolic BY from 128 mmHg to 136 mmHg from day 0 to day 90[th]. An average percentage decrease of 8.21% in case of DR] while, 5.52% was increased in DR2 group. In same way a decrease of 11.82% in DR] group, while, an increase of 11.5% was observed in case of DR2 group in mean diastolic blood pressure respectively from day 0 to day 90[th] of study duration. Treatment of prehhypertension with an angiotension receptor antagonist May decreases incident hypertension. Additional studies will be needed to ascertain whether this or other strategies involving early pharmacological treatment of prehypertension would positively affect clinical outcomes

Prevalence of metabolic syndrome in patients present with unstable angina

The main objective of this study was to determine the frequencyof metabolic syndrome in patients presesnting with unstable angina at DUHS. Cross-sectional observational study. This study was carried out at all medical wards of a DUHS from January 2012 to July 2012. 81 patients with Unstable Angina [UA] presented in medical ward that fulfilled the inclusion and exclusion criteria and gave informed consent were enrolled for the study. Metabolic syndrome was defined according to ATPIII criteria. Patients were evaluated for obesity, diabetes, hypertension, hypertriglyceridemia and low HDL. Total 81 patients with unstable angina were included in this study Out of them 43 [53.1%] were male and 38 [46.9%] were female. Mean age was 60.23 +/- 8.7. Majority of patients [49.4%] were lying in 51 to 60 years age group. The frequency of metabolic syndrome was thirty nine [48.1%]. Among them twenty three [53.5%] were male and sixteen [42.1%] were females, hence it shows insignificant p value of 0.018. Metabolic syndrome is common with high frequency in our population. This study provides a quantitative estimate of the frequency of metabolic syndrome and suggests Diabetes, low HDL, hypertension, hypertriglyceridaemia and obesity strongly correlates with unstable angina

Sensitivity pattern of causative microorganisms in septicemia

The study was conducted to find out the various etiological organisms in septicemia and their sensitivity to different antimicrobial drugs. Observational study. This study was conducted in Medical units of Civil Hospital Karachi from January 2010 to December 2010. A total of 90 patients between the ages of 15 years to 80 years, irrespective of gender with septicemia were included in this study. Total number of patients was 90. There were 47 [52%] male and 43 [48%] were female. Staphylococcus aureus and Salmonella Typhi were the most common organisms isolates in 26% cases. Regarding the sensitivity pattern of bacteria to different antimicrobial drugs, the results showed that Staph. Aureus had good sensitivity to Augmentin, Imipenem and Tazobactum and marked resistance to Ciprofloxacin. No MRSA was isolated in the study. Salmonella Typhi showed good sensitivity to Quinolones and Ceftriaxone and marked resistance to Chloramphenicol, Co-trimaxazole and amoxicillin [Table 4]. Klebsiella showed good sensitivity to Amikacin, Ceftriaxone, Imepenem and marked resistance to Ampicillin and Carbencillin, Pseudomonas aeuroginosa had good sensitivity to Tazobactum, Amikacin and Ceftriaxone. Septicemia is a major cause of death worldwide and the random use of antibiotics has considerably increased the resistance to commonly used antibiotics. Blood culture should be sent immediately to know the spectrum of microorganisms, and their sensitivity pattern, however this may not delay the empirical use of antibiotics to hasten recovery

Various clinical presentations of falciparum malaria and outcome: a study of 100 patients

Various clinical presentations of falciparum malaria and outcome. Malaria is an important disease worldwide, result in estimated 300-500 million new cases and 1.5-2.7 million deaths per year. Most deaths occur due to Plasmodium Falciparum infection. Falciparum malaria is a major community problem in our country. Presentation of falciparum malaria with paroxysms of fever chills and rigors are easy to diagnose and treat. Case series study. This study was conducted at DUHS from January 2011 to December 2011. 100 patients above 12 years of age with any gender, presenting with high grade fever and diagnosed as a case of Falciparum malaria on thick and thin film are included in this study. Among 100 patients 69 were male and 31 females. Clinically all patients presents with fever, while 69 with headache, 39 with vomiting and 28 with altered level of consciousness. The most common sign was anemia i.e. in 40 patients, splenomegaly in 37, and jaundice was found in 35 patients. 7 patients were expired during the study. Falciparum malaria is a notorious for various presentations which may mimic like upper and lower respiratory tract infection, acute gastroenteritis and bacterial meningitis. The treating physician should be aware of the various presentations because early detection and treatment may reduce the morbidity and mortality associated with falciparum malaria

Comparison of hemodynamic responses of intrathecally placed hyperbaric 0.75% bupivacaine hydrochloride in different height groups of patients undergoing caesarean section

To compare the Hemodynamic response of intrathecally placed 1.5 ml of 0.75% hyperbaric bupivacaine hydrochloric in different height groups of patients undergoing caesarean section in spinal anesthesia. Quasi experimental study. This study was carried out in the Department of Anesthesia, Sindh Govt, Lyari General Hospital, Dow Medical College, Dow University of Health Sciences from July 2009 to December 2009. In this study patients enrolled for elective caesarean section, were divided into two groups. In Group-A the height of the patients was equal or less than 60 inches [5 feet] and the height of the patients of Group-B was between 60 -66 inches [5 - 5.5 feet]. Hypotension was observed in 67 patients. 46 patients belonged to Group-A and 21 patients from Group-B. The study showed that height of the patients influenced the hemodynamic response of local Anesthetics given during spinal anesthesia

Radiographic patterns in HIV associated pulmonary tuberculosis

To evaluate Radiographic patterns in HIV associated PULMONARY TUBERCULOSIS. Observational, retrospective, descriptive study. This study was conducted in the Department of Infectious Diseases, Civil Hospital, Karachi between July 2008 to April 2009. This study is conducted by reviewing the admission records of 54 HIV diagnosed patients. A total of 30 patients presented with pulmonary symptoms were evaluated by sputum smear for acid fast bacilli [AFB] and chest radiographs. Out of 30 HIV seropositive patients, 29 were male and 1 was female of mean age +/- SD 33.9 +/- 95 years. Sputum staining for acid-fast bacilli was positive in 10 patients [33.3%]. Frequent radiographic patterns were 12 [40%] normal, 5 [16.6%] apical infiltrate, cavitatory lesion was observed in 1 patient. Dominant symptoms were weight loss 29 [93.3%], fever 24 [80%]. Majority of HIV seropositive patients with pulmonary tuberculosis were male, common radiographic patterns were normal radiograph, apical infiltrates atypical radiographic presentation is particularly related in advance stages of immunosuppressant. Cavitatory lesions and pleural effusion were rare findings

To compare the efficacy of rocuronium bromide and succinylcholine in elective surgery for endotracheal tube

To compare the efficacy of rocuronium bromide and Succinylcholine in elective surgery for endotracheal tube. Randomized, double blind study. This study was conducted in the Department of Anesthesia and Surgical ICU, Civil Hospital Karachi over a period of six months i.e. January 2009 to August 2009. This study was conducted on sixty patients. They were aged between 20-60 years. Patients were divided into two groups following inclusion i.e. Group A and Group B. Patients in Group A were given inj. Rocuronium 0.9mg / kg and group B received inj. Succinylcholine 1.5mg / kg. In group A which was received rocuronium bromide 0.9mg / kg, showed excellent intubating conditions in 83.33% of patients as compared to group B which was given Succinylcholine 1.5mg / kg, showed 96.66%. The intubating conditions were significantly better in group B which received inj. Succinylcholine 1.5mg / kg as compare to group A was given inj. Rocuronium 0.9mg / kg

Estimated reference interval of ionized [free] calcium

To determine the reference values of Ca++ in whole blood in our setup. The Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from Jan 2008 to June 2008. Three hundred healthy individuals were included in the study after obtaining written consent. Out of these 76 individuals were excluded from the study after clinical assessment and collection of laboratory data. One hundred and fourteen were males with mean age 35 +/- 12 years and 110 were females, with mean age 28 +/- 9 years of age. Their Ca++ was estimated by ion selective electrode [ISE] method in heparinized whole blood [WB]. The mean and SD of whole blood Ca++ was calculated separately for the females and the males. The results showed that in our setup males have Ca++ levels of 1.12 +/- 0.05 [mean +/- SD] mmol/l and females have Ca++ levels of 1.12 +/- 0.04 [mean +/- SD] mmol/l. The study revealed that estimated reference range of Ca++ of the studied population was lower than the reference range published for the western population that is used by our physicians for the interpretation and comparison of results

Comparison of haemodynamic responses between atropine and glycopyrrolate used with neostigmine during reversal of neuromuscular blockade

The aim of the study was to compare the haemodynamic responses between atropine and glycopyrrolate used with neostigmine during reversal of neuromuscular blockade. The experimental study was conducted in the Department of Anesthesia, Sindh Govt Lyari General Hospital over a period of 6 months from February 2009 to July 2009. In this study we included total sixty patients undergoing elective surgeries. These patients were allocated into two equal groups. The patients in group I received inj Neostigmine 0.04 mg/kg with inj atropine 0.4 mg/1 mg neostigmine and the patients in group II were given inj neostigmine 0.04 mg/kg with inj. Glycopyrrolate 0.2mg/1 mg neostigmine at the end of the surgery. In both the groups heart rate and blood pressures were recorded as a base line value prior to administration of reversal agents and then after 1, 5, and 10 minutes interval after giving the reversal agents. The comparison was made between groups I and group II. Out of 60 patients 37 [61.66%] were males and 23 [3 8.33%] were females with 1.6:1 male to female ratio. The base line mean heart rate, systolic and diastolic blood pressure readings in group I were 75.13 +/- 5.23, 130.18 +/- 7.1 and 75.22 +/- 4.37 respectively while in group II these readings were 71.19 +/- 4.21, 121.12 +/- 11.52 and 75.77 +/- 3.61 respectively. Mean heart rate and systolic blood pressure readings between groups at 1, 5 and 10 minutes were statistically significant while diastolic blood pressure readings between groups were significant only at 5 minutes. Glycopyrrolate, in comparison to atropine, is more effective in providing cardiovascular stability in antagonizing the muscarinic cardiovascular effects of neostigmine

Comparison of propofol and sevoflurane for laryngeal mask airway insertion [LMA] in adults

To compare the effects of Porpofol and Sevoflurane in Laryngeal Mask Airway insertion. This study was quasi experimental was carried out in the Department of Anesthesiology, Surgical Intensive Care and Pain Management, Dow Medical College and Civil Hospital Karachi, Dow University of Health Sciences. The duration of the study was six months. In this study 60 patients schedule for elective surgery were enrolled which were divided into two groups. The average age of the patients was 25.1 +/- 10.6 years [95% CI; 23.7-29.0]. Out of 60 patients, 28 [46.6%] were males and 32 [53.3%] were females with 1:0.8 male to female ratio. Gender difference was not statistically significant between the groups [Chi-Square= 0.601; P=0.44]. The average age, weight and LMA insertion time were not statistically significant between groups. Induction time was significant between groups. Induction time was significantly higher in porpofol group [B] than in the sevoflurane group [A]. Condition of LMA insertion of 24 [80%] patients were excellent [score = 18] and 6 [20%] patients were satisfactory [Score between 16 to 17] in group A while condition of LMA insertion of 28 [93.3%] were excellent and 2 [6.7%] were satisfactory in group B. This study concludes that porpofol is a better anesthetic agent for insertion of LMA as compared to sevoflurane by using loss of eye lash reflex as the end point for induction