An analysis of prescription patterns in cases of uncomplicated hypertension in a tertiary care hospital.

Background & objectives- Prescribing pattern in hypertension patients were found to be different from the recommended guidelines in the past. The objectives of the present study were to analyze prescribing trends in uncomplicated hypertension and to compare with those of current international guidelines with the objective to note any deviation. Methods- A prescription based analysis in 1400 hundred uncomplicated hypertensives in the age group 30 to 60 years was carried out. Results- Monotherapy was prescribed to 893 cases (M 407; F 486) and combination therapy to 507 cases (M 342; F 165). Overall, Calcium Channel Blockers (CCBs) were the most common agents used 787 (56.21%) cases, 350 monotherapy and 437 as combination therapy. Angiotensin Converting Enzyme Inhibitors (ACE I) 452 (32.28%) and Angiotensin II Receptor Blockers (ARBs) 231 (16.5%) cases were the next preferred groups. In double drug combination CCB+ Beta Blockers (BB) and for triple drug combination CCB+ARB+ Diuretics (D) were more preferred. A significant effect of age (p<0.01) on prescription of CCBs was noted. Prescription of ARBs and D were significantly (p<0.05 and <0.01 respectively) influenced by gender. Gender had no significant effect on the prescribing trend of antihypertensive agents in combination therapy, while a significant effect (p<0.05) of age and combined drug classes CCB+ACE I and CCB+BB+D was noted. The overall prescription rate for diuretics was 40.24% and that for monotherapy was meagre 5.15% (M 1.23%±; F 3.92%). Diuretics were always prescribed in triple drug combinations. Interpretation & Conclusions- CCBs were the most commonly prescribed agents. A deviation existed between antihypertensives prescribed and current international guidelines thus calling upon greater awareness.

Analytical study of water safety parameters in ground water samples of Uttarakhand in India.

The main problem of the locality is the drinking water. Certain health problems are associated with people living in hills that are because of the presence of excess of heavy metals and other impurities. The present study was conducted to analyze the various parameters of ground water in uttarakhand, India and to check its fitness for drinking. It will also clarify the health hazards imposed on the population of this state. The present study was conducted in five regions of Uttarakhand, India (Haridwar, Vikasnagar, Mussoorie, Dehradun & Dakpathar). Ten samples of ground water were collected from each of the five regions during the pre-mansoon (Jan-Feb ) and post-mansoon (Sept-Oct )seasons.The pH was estimated by pH meter, acidity,alkalinity, sulphates,chorides,Total hardness(Ca & Mg) were determined by titration methods. The total suspended solid was calculated by the formula. The heavy metals like Mn, Al, Ba, Cd, Cr, Co, Cu, Fe and Pb were determined in the ground water samples by ICP mass spectroscopy. The concentrations of heavy metals, pH, alkalinity, sulphate, chloride, TDS & Total Hardness (TH) were compared with the standards by BIS for Drinking water (IS 10500:1991). The results shows that water pH of all the five regions showed no remarkable variation from the BIS recommended value of pH (6.5-8.5). The alkalinity was above the BIS desirable level of 200mg/l in all the samples, but was less than the maximum permissible limit. The Drinking water of all the regions contains higher amounts of TDS than the desirable limits. maximum TDS was detected in Haridwar & dehradun state. The ground water of mussoorie region shows total hardness to be above the BIS desirable level of 300mg/l. The chloride content was above the BIS desirable level of 250mg/l in dehradun only. The sulphate content was highest in haridwar (197.5mg/l) and dehradun (170mg/l) but it was below the desirable limit of 200mg/l. The Cd,Cr,&Pb content of all the five regions of Uttarakhand showed higher the BIS permissible limits of 0.01, 0.05 and 0.05 mg/l respectively. The content of Mn,Ba,Cu, Co&Fe are within the permissible limit of BIS standards for drinking water.

Study of antibiotic sensitivity pattern in urinary tract infection at a tertiary hospital.

This study was conducted in a tertiary hospital at Bareilly, Uttar Pradesh between Aug 2009 and July 2010 to check the changing pattern of antibiotic sensitivity among uropathogens causing urinary tract infections (UTI). A total of 170 urine culture sensitivity reports were analyzed. The predominant growth of single bacteria was seen in 143 (84.12%) samples. The most common organisms isolated were Escherichia coli, klebsiella, pseudomonas, and Staphylococcus aureus. (These represented 64.33%, 92; 20.3%, 29; 9.1%, 13 and 6.30%, 9 of isolates respectively). More than 80% of the isolates were sensitive to amikacin and nitrofurantoin, while more than 70% were sensitive to norfloxacin, ciprofloxacin and levofloxacin. Very high rate of resistance was seen against cotrimoxazole (81.82%), amoxicillin (77.42%) and amoxi-clav (64.34%). E. coli showed high sensitivity to Amikacin 98.91% (91), Nitrofurantoin 93.48% (86). 75% of E. coli isolates were sensitive to minocycline, showing a good utility of this drug for the treatment of outdoor patients with urinary tract infections.

Determinants of nutritional status of school children - A cross sectional study in the western region of Nepal.

Under-nutrition continues to be a primary cause of ill health and mortality among children in developing countries. Besides poverty, there are other factors that directly or indirectly affect the nutritional status of children. In the present study, an attempt was made to find the prevalence of under-nutrition among school children in 4 – 14 year age group and the role of socio-demographic characteristics of mother on child nutrition. Methods: Descriptive, cross-sectional study was conducted in schools of Kaski district of Western Nepal from January 2007 to June 2007. A total of 786 students were randomly selected from six schools in the study area and nutritional status of the children was assessed by anthropometric measurements. Results: Among 786 students, 26% of the students were found to be undernourished and 13% stunted, 12% wasted and only 1% both stunted and wasted. The present study shows highly significant association (p<0.005) of maternal factors like literacy, occupation, diet knowledge and monthly per-capita income respectively with child nutrition. Conclusion: Maternal education status, socio-economic status, occupation and dietary knowledge are important determinants of nutritional status of school children.

Risk factors for low birth weight (LBW) babies and its medico-legal significance.

Birth weight is the most important factor that affects infant and child mortality. This one year study was conducted in a cohort of pregnant women to study the proportion of low birth weight babies and to find out the socio-economic and maternal risk factors affecting the birth weight of newborns and its medico-legal significance. Information regarding socio-economic status, obstetric history and present pregnancy was collected. These women were followed up till their delivery and birth weight was recorded with 24 hours of delivery. Birth weight was available for 256 births. The overall prevalence of low birth weight was 34.37%. Overall mean birth weight was found to be 2.64±0.444 with 95% confidence interval of 2.59-2.69. Primigravida mothers showed the highest prevalence of low birth weight (30.86%, p< 0.001). The main factors which were significantly associated with LBW were maternal education, stature, age at delivery; short inter pregnancy interval, inadequate antenatal care, and per capita income of family.

Cytotoxic drug: towards safer chemotherapy practices.

Health care is nearly 10 years behind other industries in its efforts to reduce the errors. Medication error may be nobody's baby, but when it happens, it could well turn out to be everyone's worry and the reasons given for medication error range from silly to the downright serious. The anticancer drugs are known to be mutagenic, teratogenic and carcinogenic, so extra precaution should be taken while storing, diluting, administering the drugs and disposing the waste. The objectives of this article are to define the standards for using cancer chemotherapy in hospitals; to tackle any spillage of drug and how to dispose of the waste of anticancer drugs. This could be beneficial to any hospital where chemotherapy is given without any defined standard operating procedure. The information furnished in this article is collected from the mentioned references and also from websites- The American Cancer Society: Cancer Facts and Figures 2002, www.cancer.org and www.cancersourceRN.com.

Effect of aqueous extract of neem (Azadirachta indica) leaves on offensive and diffensive gastric mucosal factors in rats.

Standardized aqueous extract of Neem (Azadirachta indica) leaves (AIE) has been reported to show both ulcer protective and ulcer healing effects in normal as well as in diabetic rats. To study the mechanism of its ulcer protective/healing actions, effects of AIE (500 mg/ kg) was studied on various parameters of offensive acid-pepsin secretion in 4 hr pylorus ligation, pentagastrin (PENTA, 5 microg/kg/hr)-stimulated acid secretion and gastric mucosal proton pump activity and defensive mucin secretion including life span of gastric mucosal cells in rats. AIE was found to inhibit acid-pepsin secretion in 4 hr pylorus ligated rats. Continuous infusion of PENTA significantly increased the acid secretion after 30 to 180 min or in the total 3 hr acid secretion in rat stomach perfusate while, AIE pretreatment significantly decreased them. AIE inhibited the rat gastric mucosal proton pump activity and the effect was comparable with that of omeprazole (OMZ). Further, AIE did not show any effect on mucin secretion though it enhanced life span of mucosal cells as evidenced by a decrease in cell shedding in the gastric juice. Thus, our present data suggest that the ulcer protective activity of AIE may be due to its anti-secretary and proton pump inhibitory activity rather than on defensive mucin secretion. Further, acute as well as sub acute toxicity studies have indicated no mortality with 2.5 g/kg dose of AIE in mice and no significant alterations in body or tissues weight, food and water intake, haematological profile and various liver and kidney function tests in rats when treated for 28 days with 1 g/kg dose of AIE.

Effect of plantain banana on gastric ulceration in NIDDM rats: role of gastric mucosal glycoproteins, cell proliferation, antioxidants and free radicals.

Methanolic extract of Musa sapientum var. Paradisiaca (MSE, 100 mg/kg) was studied for its antiulcer and mucosal defensive factors in normal and non-insulin dependent diabetes mellitus (NIDDM) rats. NIDDM was induced by administering streptozotocin (STZ, 70 mg/kg, ip) to 5 days old rat pups. The animals showing blood glucose level >140mg/dL after 12 weeks of STZ administration were considered as NIDDM positive. Effects of MSE were compared with known ulcer protective drug, sucralfate (SFT, 500 mg/kg) and anti-diabetic drug glibenclamide (GLC, 0.6 mg/kg) when administered orally, once daily for 6 days against gastric ulcers (GU) induced by cold-restraint stress (CRS) and ethanol and subsequent changes in gastric mucosal glycoproteins, cell proliferation, free radicals (lipid peroxidation and nitric oxide) and anti-oxidants enzymes (super oxide dismutase and catalase) and glutathione (GSH) levels. MSE showed better ulcer protective effect in NIDDM rats compared with SFT and GLC in CRS-induced GU. NIDDM caused a significant decrease in gastric mucosal glycoprotein level without having any effect on cell proliferation. However, all the test drugs reversed the decrease in glycoprotein level in NIDDM rats, but cell proliferation was enhanced in case of MSE alone. Both CRS or NIDDM as such enhanced gastric mucosal LPO, NO and SOD, but decreased CAT levels while CRS plus NIDDM rats caused further increase in LPO and NO level without causing any further changes in SOD and CAT level. MSE pretreatment showed reversal in the levels of all the above parameters better than GLC. Ethanol caused a decrease in glutathione level which was further reduced in NIDDM-ethanol rats. MSE reversed the above changes significantly in both normal as well as in NIDDM rats, while GLC reversed it only in NIDDM rats. However, SFT was ineffective in reversing the changes induced by CRS or ethanol or when given in NIDDM-CRS or NIDDM-ethanol rats. The results indicated that the ulcer protective effect of MSE could be due to its predominant effect on mucosal glycoprotein, cell proliferation, free radicals and antioxidant systems.

Filaria situation in the Union Territory of Dadra & Nagar Haveli.

A resurvey conducted 8 years later in the Union Territory of Dadra & Nagar Haveli revealed the persistence of filariasis amongst its residents. Though no control measures have been in operation since the detection of filariasis in Dadra and Nagar Haveli in 1982, the parasitological indices, microfilaria (mf) and disease rates as well as mf count have remained static. The entomological studies revealed five times increase in density of Culex quinquefasciatus both in Silvassa and Naroli towns.

Epidemiology of Brugia malayi infection and its co-existence with Wuchereria bancrofti in and around Sillaberia PHC, District Midnapur, West Bengal.

Of 2186 persons investigated in thirteen villages of Sillaberia PHC, 19 were found to be infected with Brugia malayi and only one person harboured microfilaria (mf) of Wuchereria bancrofti. Similarly 41 persons exhibited signs and symptoms of chronic filariasis. The mf and disease rates percent worked out to be 0.914 and 1.87 respectively. The earliest ages showing mf and disease manifestations were 3 and 11 respectively. The mean mf density ranged from 2 to 12.2 per 20 cumm of blood. The male and female ratio in terms of mf carriers and chronic cases worked out to be 1.4:1 and 1:2 respectively. The entomological collections revealed a high ten man hour density (163.20) in case of Culex quinquefasciatus and comparatively much lower in case of Mansonia (Mansonioides) annulifera (47.51) and Mansonia (Mansoni oides) uniformis (23.83) respectively. The infection and infectivity rates in case of Mansonia (Mansonioides) annulifera were 6.1 and 1.2 per cent respectively.