Synthetic Hydroxyapatite Bone Graft Substitute In Sinus Augmentation - A Histological Analysis

Aim: Material And Method:To see the effect of synthetic Hydroxyapatite bone graft substitute in sinus augmentation. A lateral window was cut on the buccal aspect of the maxilla on the posterior region in the area of molar I/II and after carefully lifting the sinus membrane, bone graft was packed and a collagen membrane was placed on top of it. After a period of 8 months the site was re-entered to take bone sample for histological analysis using a trephine, at the same time, implant (Bioner Top DM, 4/10) was placed at the surgical site. The surgical site healed well. G-Bone hasResults: shown good bone growth histologically. The surgical site healed well. G-Bone has shown good bone growthConclusion: histologically.

Direct To Consumer Advertising: A Mixed Blessing.

Abstracts: Direct-to-consumer advertising (DTCA) is a tool used by pharmaceutical companies to market and promote medicines directly to potential consumers by means of different media but the debate for and against this is ongoing and fairly balanced. Direct to consumer promotion of pharmaceutical product is considered illegal in many parts of the world. United States and New Zealand are the only two countries which have legalized DTCA, but the advent of internet has broken all barriers. Advertisement of prescription medicines through internet and social media has made it difficult for government and regulatory authorities to effectively implement the laws which govern DTCA. In India Despite the existing legislations banning the advertisement of drugs in certain diseased conditions, lucrative advertisements of drugs and medical remedies are freely flowing in the Indian mass media nowadays. These advertisements allure the vulnerable consumers thus increasing the threat of self-medication in the society. A multi prong strategy involving government, pharmaceutical industry, doctors, medical associations and consumers is urgently required to curb the inappropriate use of DTCA. Through this article it is tried to critically appraise the advantages, disadvantages and remedies regarding direct to consumer drugs advertisement in India.

Extended-spectrum β-lactamase and AmpC β-lactamase Production among Gram-negative Bacilli Isolates Obtained from Urinary Tract Infections and Wound Infections.

Extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases continue to be a major problem in healthcare settings. Due to the scarcity of information regarding the antibiotic susceptibility patterns particularly from urinary tract infections (UTIs) and wound infections, the current study was carried out to assist the clinicians to prescribe appropriate antibiotics against gram-negative clinical isolates. In the current study, urine (n = 620) and pus (n = 228) samples were collected from different sites (at various clinical departments) and subjected to direct microscopic examination, culture and antibiotic susceptibility testing (AST). In the AST testings, the isolates that exhibited reduced zone of inhibition to one or more of the antibiotics such as cefotaxime (≤27 mm), ceftriaxone (≤25 mm), ceftazidime (≤22 mm), cefpodoxime (≤17 mm) and aztreonam (≤27 mm) were considered as potential ESBL producers and the ESBL production was confirmed using phenotypic screening test (doubledisk synergy test) and phenotypic confirmatory test (combined-disk test). However, isolates showing resistance or decreased sensitivity to cefoxitin, cefotaxime, ceftriaxone, ceftazidime, cefpodoxime or aztreonam and sensitive to cefepime were considered as a screen positive AmpC producer and subjected to AmpC disk tests. The current study concluded that 72.41% and 21.76% of ESBL and AmpC producers were detected, respectively in our hospital. It was also observed that the double-disk synergy and combined-disk tests were equally effective for ESBL detection. Further, AmpC disk test is simple, easy to perform and interpret, requiring less expertise for the rapid detection of AmpC isolates.

To Assess the Attitude, Knowledge and Practices of Medical Professionals About Adverse Drug Reactions and Their Reporting in a Teaching Hospital.

Adverse drug reactions (ADRs) are one of the leading causes of morbidity and represent a substantial burden on healthcare resources. It has been reported that 2.4-6.5% of the total admissions in the hospitals are due to the adverse reactions, many of which are preventable. Voluntary ADR reporting is fundamental to medical drug safety surveillance; however, substantial underreporting is the main limitation of the system. It is estimated that only 6-10% of all ADRs are reported. Therefore, the present study has been designed to assess the knowledge, attitude and practices of the medical professionals towards the ADRs and their reporting in our Institute. Aim and objectives: This study is aimed at investigating the knowledge and attitude and practices of medical professionals in a teaching hospital. Material and methods: The present study was a questionnaire based study. A structured validated questionnaire was used consisting of open ended and closed ended questions to collect the information after approval from the Institutional Ethics Committee (IEC). The study population consisted of all the medical teachers of the institute. Results: The response rate was 85%. Eighty percent of the respondents identified ADR as one of the major causes for mortality and morbidity in patients. ADR reporting was considered important by 87.5% respondents. More than 85% wrote that they did not have enough knowledge about how to report an ADR. One hundred percent of the participants believed that there should be a system of ADRs reporting and monitoring in the institute. Interestingly, all the respondents believed that if the teachers from allied streams (dental, nursing, physiotherapy, pharmacy) are sensitized, it can be useful. Conclusion: There are gaps between knowledge and ADRs reporting among doctors working in a teaching hospital. These gaps need to be filled by improved training and awareness in pharmacovigilance at various levels of healthcare system.

Benign Prostatic Hyperplasia: Current and Future Therapeutics.

Benign prostatic hyperplasia (BPH) is one of the most common diseases of old-aged men affecting >90% of men in their 70s and 80s. Although the exact cause is not known, most people agree that dihydrotestosterone plays a strong role in pathogenesis. BPH can be a progressive disease. Severe BPH can cause serious problems including renal insufficiency. Surprisingly the risk factors for BPH are found to be the same as for cardiovascular diseases. Management of BPH has changed significantly in the last decade. α-blockers and 5α-reductase inhibitors are the most commonly used drugs. A number of other drugs belonging to newer groups like phosphodiesterase inhibitors, hexokinase inhibitors like lonidamine, antagonists of endothelin, vanilloid and purine receptors and modulators of JM-27 expression are also showing promise. These are in different stages of clinical trials. The surgical counterpart of treatment has also witnessed recent advancements. Newer techniques like potassium-titanylphosphate (KTP) laser and photo selective vaporization of prostate have been shown to have nearly equal efficacy as that of transurethral resection of prostate (TURP) with less side effects.

Osteoporosis: Current Management Guidelines.

Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass and deterioration of bone microarchitecture. Fragility fractures, the consequence of osteoporosis, are responsible for excess mortality, morbidity, chronic pain, admission to hospitals and economic costs. Approximately 1.6 million hip fractures occur each year worldwide and the incidence is set to increase to 6.3 million by 2050. Preventive measures should be started at an early age and should include smoking cessation and weight-bearing exercises. Pharmacologic prevention methods include calcium supplementation and administration of raloxifene or bisphosphonates. No treatment can completely reverse established osteoporosis. Early intervention can prevent osteoporosis in most people. For patients with established osteoporosis, medical intervention can halt its progression. Currently available therapies include bisphosphonates, selective estrogen receptor modulators (SERMs), hormone replacement therapy (HRT), denosumab, teriparatide, calcitonin and strontium ranelate. Cathepsin K inhibitors (balicatib and odanacatib) are among recent drugs under development. Saracatinib, a novel orally available competitive inhibitor of Src kinase has been shown to inhibit bone resorption in vitro. Lasofoxifene, bazedoxifene and arzoxifene are new SERMs in late-stage treatment trials. Nonpharmacological measures are required when patients experience adverse effects because of drug therapy, when symptoms are not controlled by drug therapy alone or when patient is not willing to take drugs for a prolonged duration.

Probiotics: The Friendly Microbes.

We tend to think of bacteria as harmful ‘germs’, but, many bacteria actually help the body functions work properly. These bacteria are known as probiotics. The scientific evidence of beneficial effects of probiotics in health and disease is growing. This article highlights various such beneficial and potentially beneficial effects of probiotics.

Medication Errors: A Preventable Problem.

Advancements in human healthcare are on an all time high. The treatment system is becoming hi-tech and sophisticated and vulnerable to errors at the same time. Various disasters have occurred due to medication errors at different levels of healthcare delivery. However, if a little bit of extra caution is observed by the various stakeholders these can be prevented largely.

Nanomedicine: Current Status and Future Implications.

Adverse effects form a major part of the drawbacks of the current therapeutics. The two main reasons are: Distribution of drugs to an area, which is not the desired site of action and another is attaining higher than desired concentration at the site of action. Nanomedicine raises hopes to overcome these problems. Nanomedicine is the medical use of nanobiotechnology. It is a relatively newer technology based on the uses of engineered nanomaterials (ENMs). ENMs are medical materials available in nanometer (one-millionth of a millimeter) scale. Because of nanoscale, the molecules acquire changes in their physicochemical properties which are utilized for easier and more thorough penetration in cells. Nanomedicine has shown promising results both in diagnostics as well as therapeutics e.g. in oncology and diseases of central nervous system. Nanoparticle targeting and neuroelectronic interface raises hopes for a number of clinical disorders for which the satisfactory treatment is currently not available. The most striking use can be repairs at a molecular level. Like other modalities of treatment, nanomedicine also has disadvantages; however, currently the benefits outweigh the risks. It will be interesting to see how the rising ethical concerns will be dealt with.

Carbapenemases: The New Face of Antimicrobial Resistance.

With the advent of antibiotics, a new era ushered in bringing within its folds, a strong defense against the invading deadly microorganisms. This phenomenon is referred to as antimicrobial resistance. Carbapenemases are b-lactamases which hydrolyse carbapenems. The enzyme, New Delhi metallo-beta-lactamase (NDM-1) breaks this ring, rendering the drug ineffective. NDM-1 producing bacteria are resistant to many existing antibiotics including carbapenems - a class of drug often reserved for emergency use and last resort treatment.

Nanomedicine: Current Status and Future Implications.

Adverse effects form a major part of the drawbacks of the current therapeutics. The two main reasons are: Distribution of drugs to an area, which is not the desired site of action and another is attaining higher than desired concentration at the site of action. Nanomedicine raises hopes to overcome these problems. Nanomedicine is the medical use of nanobiotechnology. It is a relatively newer technology based on the uses of engineered nanomaterials (ENMs). ENMs are medical materials available in nanometer (one-millionth of a millimeter) scale. Because of nanoscale, the molecules acquire changes in their physicochemical properties which are utilized for easier and more thorough penetration in cells. Nanomedicine has shown promising results both in diagnostics as well as therapeutics e.g. in oncology and diseases of central nervous system. Nanoparticle targeting and neuroelectronic interface raises hopes for a number of clinical disorders for which the satisfactory treatment is currently not available. The most striking use can be repairs at a molecular level. Like other modalities of treatment, nanomedicine also has disadvantages; however, currently the benefits outweigh the risks. It will be interesting to see how the rising ethical concerns will be dealt with.

Premenstrual Syndrome - A Monthly Menace.

Most women feel some discomfort before or during their periods, but if the discomfort is of such a severity that starts interfering with some aspects of life: The diagnosis of premenstrual syndrome or tension (PMS or PMT) should be considered. About 80- 95% of females of childbearing age have some premenstrual symptoms. PMS affects upto 30% of women with regular menstrual cycles. Some women (about 3-8% of menstruating women) have a more severe and disabling form of PMS having a psychiatric designation called premenstrual dysphoric disorder (PMDD). The etiology of PMS remains unknown and may be complex and multifactorial, but hormones, neurotransmitters and genetic factors have a role to play. Behavioral symptoms along with physical symptoms should be present to establish a diagnosis. Certain lifestyle changes and dietary modifications along with a number of drug options can improve the quality-of-life of a patient of PMS upto a considerable extent.

Longitudinal study of peak expiratory flow rate in pregnant women.

Background: Several changes have been reported in the maternal pulmonary function tests during pregnancy. A longitudinal study was undertaken to document these changes throughout pregnancy using Peak Expiratory Flow Rate (PEFR). Effect of age and height on PEFR was also documented. Method :The study included 100 pregnant females and 100 non-pregnant female controls. PEFR was measured in each trimester of pregnancy at postpartum with Mini Wright peak flow meter and the highest value of PEFR from three correctly performed blows was considered. Results: There was a decrease in mean PEFR as the pregnancy advanced from 1st to 3rd trimester and increase in PEFR in post-partum, both being statistically significant. PEFR had significant negative correlation with age. Mean PEFR increased with an increase in age of the study subjects in all the 3 trimesters of pregnancy, with maximum value at 24 -29 years of age and there after started declining. PEFR had highly significant positive correlation with height in all the 3 trimesters of pregnancy. Conclusion : The study documented the changes in PEFR during pregnancy, the effect of age and height on PEFR along with their prediction equations.

Assessment of hepatoprotective effect of Tecomella undulata (Sm.) Seem., Bignoniaceae, on paracetamol-induced hepatotoxicity in rats

The aim of the present study was to validate the hepatoprotective activity of bark of Tecomella undulata (Sm.) Seem., Biognoniaceae, against paracetamol (PCM) induced hepatic damage. Chloroform soluble fraction (Fraction-I), acetone soluble fraction (Fraction-II), methanol soluble fraction (Fraction-III) and methanol insoluble fraction (Fraction-IV) of ethanolic extract of bark of T. undulata were evaluated for hepatoprotective activity against paracetamol induced hepatic damage using biochemical, morphological, functional and histopathological studies. The methanol soluble fraction (Fraction-III) was most potent among the four fractions studied in detail. Fraction-III showed significant hepatoprotective activity against paracetamol induced hepatic damage as evident by normalization of substantially elevated levels of aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TBil), decreased level of total protein (TP), increased wet liver weight and volume, increased thiopentone sodium induced sleeping time and abnormal histopathology. Present study showed that the Fraction-III of ethanolic extract of bark of T. undulata significantly restores physiological integrity of hepatocytes. Fraction-III did not show any sign of toxicity up to oral dose of 1500 mg/kg in mice.

Perceptions and suggestions of 2nd professional MBBS students about their teaching and learning process: An analytical study.

Objectives : A questionnaire based analytical study was done to know the perceptions and suggestions of 2nd professional medical students about various aspects of their teaching and use them for improvement. Material & Methods : Study was conducted on 2nd professional students (n=150) using a structured validated questionnaire after approval from the Institutional Ethical Committee. Results : Students found pharmacology and pathology most relevant but difficult subjects. They found it difficult to synchronize and integrate the different subjects. They found tutorials and group discussions more useful than lectures and seminars and suggested to cut short the duration of the lecture. They advocated the judicious use of power point along with the conventional method of teaching. They wanted some multiple choice questions to be included in the tests and in the final exams. They wanted some sessions on career counseling and wished the effective implementation of the mentoring system. Conclusion: The suggestions obtained from the students, if addressed effectively, can improve their learning and produce better health care professionals.