Prescription pattern & adverse drug reactions of prokinetics

Background & objectives: Prokinetics are extensively prescribed leading to several adverse events (AEs). The aim of this study was to assess the prescription pattern in patients receiving prokinetics, and characteristics of adverse drug reactions (ADRs) in an outpatient department set up in a tertiary care hospital in western India. Methods: Patients attending outpatient departments of a tertiary care hospital and who had received prokinetic agent for at least seven days over the last one month were enrolled. Causality assessment of AEs was done and assessed for severity, preventability, seriousness and predictability. Results: A total of 304 patients [161 males (52.96%); 143 females (47.04%)] were enrolled. Most prescriptions (299/304, 98%) included domperidone, most commonly prescribed as fixed-dose combination (FDC) with pantoprazole (274/304, 90%). Prokinetic dose was not mentioned in 251/304 (83%) prescriptions, and 18/304 (6%) did not mention frequency. Of the 378 AEs reported from 179 patients (47.35%), 306 (81%) were mild, all non-serious; 272 (72%) not preventable and 291 (77%) predictable in nature. Decreased appetite (n=31, 8.2%) and fatigue (n=27,7.14%) were most commonly reported. Causality assessment by the World Health Organization-Uppsala Monitoring Centre scale showed that 180 AEs were related to suspected drug (17 probable and 163 possible ADRs). Significant correlation was observed for AEs with increasing number of drugs per prescription (Spearman's R=+0.8, P =0.05) and with increasing therapy duration (Spearman's R=+1.00, P <0.001). Interpretation & conclusions: Our findings showed that prokinetics were often prescribed as FDCs, with incomplete prescriptions. Domperidone was found to be associated with multiple AEs. It is suggested that regular prescription monitoring should be done in hospitals to encourage rational use of drugs.

A Review on Traditional and Pharmacological Uses of Croton bonplandianum with Special Reference to Phytochemical Aspect

Plant-based traditional medicine system continues to play a vital role in the healthcare system with about 80% of the world’s inhabitants relying mainly on traditional medicines for their primary health care. Modern knowledge on medicinal plant research till contains at least 25% drugs and many others, which are synthetic analogues, built on prototype compounds isolated from medicinal plants. The ongoing growing recognition of medicinal plants is due to escalating faith in herbal medicine. There are many contradictory theories on the subject of herbal Medicines and their relationship regarding with human physiology and mental function. There is a need to develop evaluative data by using sophisticated modern techniques of standardization of Ayurvedic formulations to tackle the issues of negative criticism of Ayurvedic formulations and increased toxicity reports. These kinds of phytochemical investigation both qualitatively and quantitatively will help in understanding the phytochemical composition and safety of herbal formulation. Croton bonplandianum Baill is often called Ban Tulsi (Jungle tulsi). The parts of plant are widely used in traditional system of medicine such as hepatoprotective, swelling of the body, cure against ring worms and skin disease, antihypertensive, antioxidant, wound healing, antifungal, antimicrobial, antidiabetic, antitumor, anticancer, acute constipation, abdominal dropsy, internal abscesses, antifertility, antispasmodic, antiseptic, antidote, analgesic, repellent property against insects, nematicide, anticoronary, anti-inflammatory, larvicidal activity, antihelmentic, this is also used for treatment of cholera, boils, bowel complaints, chicken pox, diarrhoea, dysentry, eye diseases, cold and coughs, epilepsy, gastric disorders, insanity, jaundice, liver complaints, scurvy, sprains, malaria, rheumatism, and so on. Due to its slow rate of conventional multiplication, the plant is very high in demand. In this review report we collected information related to taxonomy, monographs, distribution, morphology, phytochemistry, traditional uses and pharmacological studies of Croton bonplandianum Baill plant in details.

Use of Plant Extracts for Substrate Sterilization and Its Effect on Competitor Moulds and Biological Efficiency of Oyster Mushroom

Mushrooms are recognized as nutritionally functional food and a source of physiologically beneficial and nontoxic medicines. Oyster mushroom (Pleurotus spp.) is an efficient lignin degrading mushroom and can grow well on different types of lignocellulosic materials including agricultural and forest waste. Cultivation technique for oyster mushroom is very simple and the production cost is low, which gives consistent growth with high biological efficiency. Plant derivatives have shown considerable promise as an effective alternative of chemicals used in surface sterilization. To develop a suitable method for substrates treatment, six different plants extract were evaluated along with most popular chemical treatment (bavistin 75 ppm + formalin 500 ppm) for cultivation of oyster mushroom (Pleurotus florida). Chemical treatment (bavistin 75 ppm + formalin 500 ppm) was found to be most effective among all the treatments and exhibited 120.50% Biological Efficiency (B.E.). Among the phyto-extracts, Zingiber officinale was found to be excellent in controlling the growth of competitor mould fungi (114% B.E.) followed by Azadirachta indica (109.25%) and Allium cepa (98.75%). Chemically treated substrate was taken minimum (20 days) for spawn run and gave 7.10 gm average weight of sporophore followed by Zingiber officinale (22 days and 6.740 gm). In vitro study revealed the superiority of chemicals and reduced 61.80 to 70.67% mycelium growth of four contaminants. Extract of Zingiber officinale was found excellent in inhibiting the mycelium growth of Penicillium sp., Aspergillus niger and Coprinus sp. but, reported to be less effective against Sclerotium rolfsii. While, Azadirachta indica seed oil was found very effective against the mycelium growth of Sclerotium rolfsii, Penicillium sp, and Coprinus sp. Extract of Allium cepa, Lantana camera, Eucalyptus hybrida and Allium sativum showed moderate effects on the mycelium growth of competitor moulds.

Evaluation of Phyto-extracts, Biological Agents and Chemicals against the Development of Alternaria brassicae in vitro and in vivo

Alternaria leaf blight caused by Alternaria brassicae and Alternaria brassicola, is one of the most destructive diseases of mustard (Brassica campestris, B. juncea and B.napus) in West Bengal, causing considerable damages to the crop. The experiment was conducted under in vitro and in vivo conditions to see the effect of bio-agents, plant extracts and chemicals (fungicide and SAR compound) against Alternaria brassicae. Maximum inhibition in mycelial growth (95.56%) was observed with Mancozeb 75% Wp followed by Lantana camera (80%), Salicylic acid (73.33%), Allium sativum (54.44%) and Zingiber officinale (17.78%) in comparison to control. Foliar spray with fungicide (Mancozeb 75% WP @ 0.2%) was found to be most effective in reducing disease severity (81,23%) and infection rate which increased the yield (77.23%) of mustard over untreated control. Among the plant extracts, Lantana camera was found to be excellent in controlling the Alternaria blight infection in the field (71.92% reduction in disease severity and 68.18% increase in yield) in comparison to salicylic acid (SAR compound) and bio-agent (Trichoderma viride) 48.33% and 36.27% reduction in disease severity respectively.

Radiation therapy outcomes in muscle invasive urinary bladder cancer: A single institution experience.

INTRODUCTION: To audit the survival outcomes and loco‑regional control in muscle invasive urinary bladder cancer patients treated with external beam radiation therapy (RT). MATERIALS AND METHODS: From November 2008 through December 2011, 50 consecutively diagnosed muscle invasive urinary bladder carcinoma (T2‑4a N0‑2, M0) patients were included in this retrospective study. All these patients received external beam RT to a median dose of 60 Gy (range 30‑66 Gy), and were not suitable for radical surgery due to patients’ preference or medical comorbidities. A stepwise procedure using proportional hazard regression was used to identify prognostic factors with respect to survival. RESULTS: Completion trans‑urethral resection of bladder tumor was done in 38 (76%) patients of the cohort and 47 (94%) had transitional cell carcinoma on histopathology. Clinical stage T2 was diagnosed in 40 (80%) patients. The median follow‑up for the entire cohort was 14 ± 8.9 months (range 1‑36 months). In conclusion, 24 patients (48%) were free of disease, 5 patients (10%) had residual disease, and 13 patients (26%) had died of disease. Two‑year and 3 year overall survival of intact bladder for the entire cohort was 58% and 43.6%, respectively. Cox regression modeling strongly suggested clinical stage (P = 0.01) and RT dose (P = 0.001) as being predictors for overall survival. CONCLUSION: RT shows reliable outcomes and excellent compliance in this advanced disease. Prescribing a higher RT dose could potentially correlate to better intact bladder control rates while maintaining good quality of life in selected patients.

Respiratory Health Problems Among the Ceramic Workers in Dhaka,.

Ceramic factory workers are potentially at risk to develop occupational respiratory diseases due to chronic inhalation of dust particles generated in the ceramic factory. A cross-sectional descriptive study was carried out to assess the respiratory and other health problems among the workers of Mirpur Ceramic Works Limited, Dhaka, Bangladesh during the period of April to June, 2011. Among 200 participants, 132 (66%) were males and 68 (34%) were females. Less than one-third of the workers were habituated to use personal protective equipments (PPE), while more than two-third were not habituated. Nearly half (45.5%) of the workers were suffering from at least one respiratory problem and of them 86.8% (P = 0.001) had problems after joining the factory. Of the respiratory sufferers 27% had chronic bronchitis, 20% bronchial asthma, 1% pulmonary tuberculosis, and 0.5% had silicosis. A significant numbers (60.5%) of workers were suffering from other health problems along with or without respiratory problems, in terms of musculoskeletal pain, back pain, headache, dermatitis, anaemia and fever. The prevalence of respiratory problems was significantly higher among non-users of PPE than PPE users (P = 0.006), and it was found to be higher with the increased of job duration. The study showed the notable higher prevalence of respiratory problems among the workers exposed to ceramic dust, although the other potential environmental confounding factors could not be ruled out in the analysis. Obligatory use of PPE by all workers and health education to increase awareness among the workers might have role to reduce the prevalence.

Anthropometric Status between Tribal and Non Tribal School Children.

A descriptive cross sectional study named "Anthropometric status between tribal and non tribal school children" was conducted on Guimara primary school, Matiranga, Kharagrachari and Thana primary school, Sitakund, Chittagong to assess the difference in nutritional status between tribal and non tribal school children aged 6 to 10 years in terms of selected indicators. The indicators were height for age Z score, weight for height Z score, and weight for age Z score. Data were collected by interview from mother of the child through semi-structured questionnaire and measuring height and weight of 128 children. Among them 63 were selected from tribal community and 65 from non tribal area. The study revealed that 9.2% non tribal and 7.9% tribal children were severely stunted, 12.3% non tribal and 1.6% tribal were moderately wasted and 9.2% non tribal and 1.6% tribal children were moderately underweight. In relation to sex among tribal children 12.9% tribal boys and 3.1% tribal girls were severely stunted, only 3.2% tribal boys were both moderately wasted and underweight. In case of non tribal children 17.9% boys and 2.7% girls were severely stunted, 17.9% boys and 8.1% girls were moderately wasted and 17.9% boys and 2.7% girls were moderately underweight. According to the age group of 6 to 7 years it was found that, only 4.2% non tribal children were severely stunted and 29.2% were moderately stunted where as 12% tribal children were moderately stunted. In both case of moderately wasting and underweight non tribal were 8.5% more than tribal children and among 8 to 10 years age group it was 12.2% and 7.3% more respectively and in case of severely stunted tribal children were 1% more than non tribal. Improper dietary practice was also found among the two group of study population. Information and health education should be provided to the parents of the children by community participation regarding proper use of sanitary latrine, provision of safe drinking water and proper dietary practice.

Quality of Care: View of Patient Satisfaction with Physiotherapy in Government and Private Settings in Dhaka, Bangladesh.

Patients' satisfaction plays an important role to attract patients for health services. It has not been closely monitored in physiotherapy; limited studies exist in this area of allied health services. The objective of the study was to determine the level of satisfaction of patients at the government and private hospitals in Dhaka and to compare between two facilities. This descriptive type of cross-sectional study was carried out with patients who sought physiotherapy care at the outdoor of Physical Medicine Department of the Dhaka Medical College Hospital (DMCH) and the Centre for Rehabilitation of Paralyzed (CRP), Mirpur, Dhaka. In total, 150 patients - 75 from each setting were interviewed. Appropriate research instruments comprising a structured and semi-structured questionnaire developed by the American Physical Therapy Association (APTA) were administered by interviewers to collect data. To find out any association among the socio-demographic characteristics, chi-squire test was applied, and the level of satisfaction was measured in percentages to compare between the two settings (government and private). Patients attendance differ because different socio-demographic characteristics and location of physical health problem in two hospital. Location of the hospital, privacy of patients, behaviour of staff members, physical qualities of hospitals (cleanliness, light, ventilation, etc.) had more than 10% variation in the level of satisfaction between the two settings. So, patient satisfaction with physiotherapy is higher in private setting than that in government setting in Dhaka.

Pattern of Tobacco Consumption among the Diabetic Patients.

Diabetes Mellitus (DM) is a public health challenge all over the world. Recent evidence suggests that there is a positive association between smoking and the risk of diabetes. This descriptive cross-sectional study was conducted from March to June 2008 at BIRDEM Hospital, Shahbagh, Dhaka to find out pattern of tobacco consumption among diabetic patients. Age of the respondents was >15 years. With purposive sampling total 255 respondents were selected. Data was collected through face-to-face interview with structured questionnaire. Out of 255 respondents, 51.4% consumed deferent type of tobacco. Smoker was 63.36% and smokeless tobacco user was 52.67%. The highest (45.80%) had habit of smoking, 36.64% had habit of smokeless tobacco and 17.56% had habit both types of tobacco consumption. The highest smoking and smokeless tobacco consumption found within 50-60 years age group. Total 60.80% male had smoking habit and 32.82% female were smokeless tobacco consumer but no female was smoker. Twenty nine percent tobacco consumers were primarily educated, 16.08% service holders were tobacco consumer and 13.75% service holders were smoker. Among respondents lung diseases and heart diseases were common (78.54.0% and 49.36%). Respondents who consumed tobacco were suffered (74.36%) more complication than non-tobacco consumer (25.64%). So an effective awareness program is required to discourage the consumption of tobacco to protect diabetic patients.

A prospective study of suicidal behaviour in Sundarban delta, West Bengal, India.

Background. Deliberate self-harm is a challenging public health issue but there is a paucity of data on non-fatal deliberate self-harm in the literature. We aimed to understand the behaviour of deliberate self-harm, both fatal and nonfatal, in a primary care setting. Methods. A year-long prospective study of all admitted patients of deliberate self-harm at 13 block primary health centres of the Sundarban region was done to examine the sociodemographic profile and clinical outcome of suicidal behaviour. Data were collected by using an especially devised deliberate self-harm register. Each subject was administered a 20-item case history sheet by trained medical officers and nursing staff. Results. A total of 1614 deliberate self-harm subjects (619 men, 995 women) were admitted during the year, of whom 143 (62 men, 81 women) died. Although women, especially in the younger age groups, constituted the majority of subjects (61.6%), the fatality trend was higher among men than among women (10% v. 8.1%). Poisoning was the commonest (98.4%) method of self-harm, particularly using pesticide. Easy availability of pesticides was a risk factor. Psychosocial stressors, such as conflict with spouse, guardian or in-laws, failed love affairs and economic distress, were the common underlying reasons. The majority of acts of deliberate self-harm (92.6%) were committed inside the home, especially by women. Only a small proportion of subjects had a past or family history of attempt at deliberate self-harm. The overall incidence of fatal and non-fatal deliberate self-harm was 5.98 and 61.51 per 100 000 population, respectively. Conclusion. Both fatal and non-fatal pesticide-related deliberate self-harm is a major public health issue in the Sundarban region. An intersectoral approach involving primary health, administration and agriculture may help in developing an effective preventive programme to reduce the morbidity and mortality from deliberate self-harm.

Clinical Significance Of Serum HbeAg Among HbsAg Positive Patients.

Hepatitis B Virus (HBV) infection is a menace worldwide as a major cause of morbidity & mortality through its consequences viz. acute hepatitis, chronic active, or persistent hepatitis, cirrhosis of liver and primary hepatocellular carcinoma. A total of 127 'HBsAg positive' patients were studied for 'HBeAg' by serum ELISA. Patient's aged between 11 to 60 years with a mean age 27.11. Out of 127 'HBsAg positive' cases 19 (14.96%) were 'HBeAg positive', of which maximum (21.43%) were among <20 years age group. Among 106 male patients 15 (14.155) & among 21 female patients 4 (19.055) were 'HBeAg positive'. Often the initiation of therapeutic approach remains a dilemma in absence of laboratory assessment of viraemic load or presence of HBV DNA through PCR or other DNA hybridization techniques. In such situations, alternatively, a significantly serum 'HBeAg' among 'HBsAg positive' patients may be taken as a surrogate marker for acute viral replication, and, thus apply justifying the initiation of antiviral chemotherapy without delay.

Comparison of sputum induction with broncho-alveolar lavage in the diagnosis of smear-negative pulmonary tuberculosis.

Sputum microscopy and AFB-culture being gold standard and a fundamental tool for diagnosis of pulmonary tuberculosis (PTB) has got its limitation of low sensitivity. Fibreoptic bronchoscopy (FOB) has been widely recommended as the diagnostic procedure of choice in smear negative patients. But bronchoscopy is an invasive procedure, costly, not readily available in our country and needs expertise. Several studies abroad have directly compared the yield of sputum induction (SI) with 3% saline (NaCl solution) with Bronchoalveolar lavage (BAL) through FOB in smear-negative suspected PTB patients and showed that SI was a low cost, safe and well tolerated procedure with equal efficacy to BAL through FOB for the diagnosis of PTB in such patients. For the first time a prospective comparison was conducted in Bangladesh to see the yield of sputum induction (SI) and BAL in 52 selected smear- negative patients of suspected PTB. Each of the samples of induced sputum and BAL fluid were examined for AFB by Ziehl-Neelsen's method. Samples of both SI and BAL from 20 patients were cultured for AFB in Lowenstein-Jensen medium for 6 weeks irrespective of their induced sputum smear being positive or negative for AFB. Data were managed and analyzed using computer program SPSS version 10.0. Agreement of SI and BAL was tested using Pearson Chi-square and Kappa test. The results showed that the yield of SI were significantly more than that of BAL (p<0.05).The AFB smear results from specimens obtained by SI and BAL were in agreement in 75% cases (p=0.02).Statistical analysis of the yield of culture results from SI and BAL group with Fishers Exact test showed they were in agreement in 90% cases (p=0.0001) and was measured by Kappa test as significant (p=0.0004). The sensitivity of AFB-smears in samples from SI and BAL were 74% and 58% respectively. The specificity of smear positivity and of culture was assumed to be 100%. SI is a safe procedure with considerable diagnostic yield and a high agreement with the results of BAL through FOB for the diagnosis of PTB. SI offers an alternative or additional approach to the diagnosis of smear-negative suspected PTB patients and would enhance sensitivity for the diagnosis of tuberculosis.

A study on mortality and morbidity pattern of acute childhood poisoning cases admitted in block primary health centres of Sundarban, West Bengal.

A hospital - record based study was conducted in Sundarban of West Bengal to explore the profile of mortality and morbidity pattern of acute accidental poisoning among children. Sundarban is an underdeveloped coastal region of West Bengal. Three years retrospective (1999 - 2001) data of childhood accidental poisoning cases were collected from the indoor admission registers and case history sheets of 11 Block Primary Health Centers (BPHC) of the region. A total of 1056 children with accidental poisoning were admitted during those three years of which 58% were males. Mean age of males was slightly higher than females in all the three years. Organophosphorus pesticide poisoning was the commonest.

Media influenced imitative hanging: a report from West Bengal.

Media influences behaviour, especially of the young children and adolescents in various ways. The present study examined the media coverage of a judicial hanging and its immediate social effect. In a qualitative study the media coverage of a case of a judicial hanging was thoroughly discussed and the media influence, for over a period of ten weeks of the incident, in terms of suicide and copying of hanging among children, was collected and analysed. Eighteen cases were reported as an aftermath of this hanging: 1 suicide and 17 imitative hanging in children with 5 deaths. This report calls for attention that media should be cautious and responsible in presenting the news items that have potential social impact.

Leiomyosarcoma of stomach: a case report.

We report a rare case of leiomyosarcoma of stomach infiltrating into the spleen and tail of pancreas, which presented at the age of 28 years of age with haematemesis and was diagnosed after exploratory laparotomy. En block excision of tail of pancreas, spleen and part of the greater curvature of stomach containing the mass was done.

Isolated tuberculosis of testis.

Isolated epididymo-orchitis is an uncommon presentation of tuberculosis. We report a case of left sided epididymo-orchitis and scrotal involvement due to tuberculosis in a young male patient. The diagnosis was suspected on clinical examination of scrotum and confirmed by FNAC of scrotal and testis. Patient improved after taking antitubercular treatment. Key words: infection, scrotum, treatment.

Estimation of tear glucose level and its role as a prompt indicator of blood sugar level.

Tear glucose level was measured by glucose oxidase method to determine the relationship between tear glucose and corresponding blood glucose levels in 200 patients. It was observed that this test had a definite value in finding the hyperglycaemics semiquantitatively.

Application of InterPro for the functional classification of the proteins of fish origin in SWISS-PROT and TrEMBL.

InterPro (http://www.ebi.ac.uk/interpro/) is an integrated documentation resource for protein families, domains and sites, developed initially as a means of rationalizing the complementary efforts of the PROSITE, PRINTS, Pfam and ProDom database projects. It is a useful resource that aids the functional classification of proteins. Almost 90% of the actinopterygii protein sequences from SWISS-PROT and TrEMBL can be classified using InterPro. Over 30% of the actinopterygii protein sequences currently in SWISS-PROT and TrEMBL are of mitochondrial origin, the majority of which belong to the cytochrome b/b6 family. InterPro also gives insights into the domain composition of the classified proteins and has applications in the functional classification of newly determined sequences lacking biochemical characterization, and in comparative genome analysis. A comparison of the actinopterygii protein sequences against the sequences of other eukaryotes confirms the high representation of eukaryotic protein kinase in the organisms studied. The comparisons also show that, based on InterPro families, the trans-species evolution of MHC class I and II molecules in mammals and teleost fish can be recognized.

Revolutions in ophthalmology.

Cataract is the major cause of blindness worldwide. The transition of couching of cataract to most modem phaco-emulsification gained popularity with more scientific capsulorhexis. Ongoing research is taking place with laser technologies for removal of cataract. Surgery has an important role in advanced corneal diseases. Corneal transplantation is the most successful form. The refractive errors can be corrected by laser-assisted in-situ keratomileusis, intrastromal corneal rings and phacic intra-ocular lenses. Current research is going on to identify the gene responsible for glaucoma and once this is identified, medical therapy can be developed to control the disease. Thermocautery or photocoagulation and indenting the globe so as to bring the choroid nearer the break by scleral buckling forms the basis of modern surgery of retinal detachment. Vitreoretinal diseases, macular degeneration, diabetic retinopathy are no longer considered problematic. We are optimistic that more clinical breakthroughs are expected in the 21st century with new advances of ophthalmic researches.