Survey-based study evaluating current interventions to improve medication adherence

Background: Non-adherence to prescribed medication regimens is an increasingly growing problem, with rates ranging from 40% to 94%. Medication non-adherence leads to increase in morbidity and mortality as well as an increase in healthcare costs. There is a need to improve medication adherence through various interventions that are both implementable and feasible for clinicians. For this purpose, it is essential to understand the perceptions of clinicians regarding the frequency and effectiveness of current practices. Hence, this study is conducted with the core aim of identifying current interventions in use to improve medication adherence as well as perceived effectiveness. In addition, we aim to identify the potential barriers to improving medication adherence. Aims and Objectives: (1) To identify commonly used intervention strategies to improve medication adherence and (2) to assess potential effectiveness of these strategies. Materials and Methods: A questionnaire was administered to 100 clinicians at a tertiary care teaching hospital. Twenty questions about interventions to improve medication adherence and twenty-three questions about barriers to improving medication adherence were included in the questionnaire. Likert scales were used to measure the frequency and effectiveness of interventions. Results: Clinicians (64%) were most commonly identified as currently responsible to conduct interventions. Intervention practices were rated at about 4.71 on a scale of 1 to 10. Strategy most commonly in use all the time included direct education to the patient (69%), whereas electronic reminders (57%) and electronic monitoring (63%) were most commonly identified as not at all in use. Strategies most commonly considered as largely effective included giving written treatment plans to the patient. Most common identified barriers included socioeconomic status of patients (57%) and cost of therapy (57%). Conclusion: The identification of commonly used interventions to improve medication adherence and their perceived effectiveness helps health-care practitioners design better strategies to address non adherence.

Evaluation of obstetric and perinatal outcome of pregnancy with bad obstetric history

Background: Adverse perinatal outcome has always been a devastating experience for the mother. Advanced maternal age and other risk factors are independent risk factor for perinatal outcome. Therefore, aim of study is to compare the effect of these factor in different study group. Aims and Objectives: Case–control study has been conducted to evaluate obstetrics outcome, maternal morbidity, and perinatal outcome in patients with bad obstetric history. Materials and Methods: A prospective observational case–control study has been conducted in two groups; GROUP A: BOH group (n = 44) and GROUP B: Controls (n = 88) who fulfilled inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical college, Sola during the period of August 2018 to August 2020. Statistical analysis was done by descriptive statistics and qualitative and quantitative method. Results: Incidence of hypertension in Group A was 25%, while in Group B incidence was 6.8%. Incidence of hypertension was 4.5 times higher in Group A than B which was statistically significant (P < 0.05). Incidence of PROM, gestational diabetes mellitus, thyroid dysfunction was higher in Group A than Group B. Higher incidence of preterm delivery found in Group A than in Group B which was statistically significant (P < 0.05). Conclusion: Among all BOH group, cases with previous history of preterm delivery, still birth, recognition of prior learning, and HTD were the major risk factors which could be responsible for adverse obstetric and perinatal outcome.

Randomized and controlled trial to determine safety and efficacy of Foley’s catheter and PGE2 gel for induction of labor

Background: The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy mother. During medical or obstetrics complications of pregnancy, cervical ripening and induction of labor are often required. Different methods are available for that. Aims and Objectives: Randomized and control trial has been conducted to determine safety and efficacy of Foley’s catheter and prostaglandin E2 (PGE2) gel for induction of labor. Materials and Methods: Randomized and controlled trial has been conducted on 200 study participant who fullfield inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical College, Sola during the period of July 2017–July 2019. Statistical analysis was done by descriptive statistics and qualitative method. Results: Both groups cerviprim and Foley’s catheter are comparable for cervical ripening for induction of labor in terms of safety and efficacy as there was no statistically significant observation for obstetric and perinatal outcome. Conclusion: Foley’s catheter is equally dependable method for cervical ripening for induction of labor as cerviprim gel as it is cost effective and easily available.

Access to postpartum tubal ligation services in Cape Town, South Africa - an observational study

Background: Many women receiving antenatal care in public health services in Cape Town choose bilateral tubal ligation as their preferred method of postpartum contraception during their antenatal course. If the sterilisation does not occur immediately, these women are discharged on an alternative form of contraception and, ideally, an interval date for bilateral tubal ligation is arranged. Objectives: To assess the access to tubal ligation services in the Metro West area of Cape Town, South Africa, in women who request permanent contraception following delivery, looking specifically at the number of women requesting bilateral tubal ligation who receive the procedure intrapartum, immediately postpartum or as an interval procedure. Other objectives included determining the reproductive outcomes if bilateral tubal ligation was not performed, investigating the alternative forms of contraception provided and to study the demographics of the population requesting bilateral tubal ligation as a form of contraception. Methods: The study was conducted as a cross-sectional observational study collecting data over a period of 3 months, from June 2019 to August 2019. Maternity case records for deliveries between June 2019 and August 2019 from four facilities were reviewed. The facilities, representing all levels of care, were Vanguard Midwife Obstetric Unit, Wesfleur Hospital (district hospital), New Somerset Hospital (regional hospital), Groote Schuur Hospital (tertiary hospital). Results: There were 260 women who requested tubal ligation as their choice of contraception. Only 50% of these received a tubal ligation. Of the 131 tubal ligations performed, 2 were interval sterilisations. Ninety-one percent (120/131) of the tubal ligations were done at the time of caesarean section. Of the 129 women who received alternative forms of contraception, 13 women had a recurrent pregnancy. Conclusion: The study suggests that only 50% of women requesting tubal ligation as form of contraception actually end up receiving the procedure. Alternative forms of contraception are widely used and relied upon, but not without risks of recurrent pregnancy. Interval tubal ligation was not easily accessed by those women who were referred for the procedure.

Prevalence of Asymptomatic Bacteriuria Among Pregnant Women Attending a Tertiary Care Hospital in Western India

Introduction: Asymptomatic bacteriuria refers to the presence of bacteria in urine having overall inci-dence during pregnancy ranges between 2%-10%. The study was conducted to assess prevalence of asymptomatic bacteriuria in pregnant women. The study also aimed to find out the most common Path-ogenic organism isolates from urine sample. Methodology: Pregnant women with varying gestational periods attending the tertiary care hospital without any symptoms of UTI were included in the study. Their urine was tested for routine microscopy, culture, and certain biochemical testing. Results: Prevalence rate of asymptomatic bacteriuria was seen 13.8% in pregnant women. Proportion of asymptomatic bacteriuria is highest 14.70% in age group 26-30 year, 23.33% in first trimester. Both gram negative and gram-positive bacteria were isolated, but gram-positive cocci isolates were higher comparatively gram-negative bacilli. Organisms recovered in order of frequency were E. coli, Coagulase Negative Staphylococci (CONS), S. aureus, Klebsiella spp, Acinetobacter spp, Citrobacter spp and Entero-bacter spp. Conclusion: High prevalence of asymptomatic bacteriuria demands routine bacteriological screening of pregnant women. This will help in early treatment of asymptomatic bacteriuria which will help in pre-vention of acute and chronic pyelonephritis.

Analysing The Correlation Of Lipid Profile Pattern In Chronic Rheumatic Heart Disease (RHD) Patients

Background:The global burden of ARF and RHD is significant, and is predominantly found in populations living in low-resource settings. This study was conducted with a view for analysing the lipid profile variation in patients with chronic Rheumatic Heart Disease (RHD) and correlating the same. The early management of RHD has to be started to prevent further cardiac complications. To date no hypothesis is established on the relation between the Lipid Profile and RHD. This study would be beneficial to Indian cardiologists in defining the optimal treatment by the choice of antibiotic therapy and Lipid lowering agents like Statins.Material And Methods:It was a cross-sectional study carried out on the patients visiting Cardiology Out Patient Department (OPD) at a tertiary care hospital in Ahmedabad and who were diagnosed with Rheumatic Heart Disease (RHD).The blood lipids levels of thepatients were evaluated with current classification schemes and treatment levels for hyperlipidemia based on the National Cholesterol Education Panel’s (NCEP) Adult Treatment Program-3 (ATP-III) guidelines.Result:Total 89 patients were included in the study. 76 patients were associated with dyslipidaemia and 13 patients had normal lipid values. As far as total cholesterol levels were concerned, 23 out of 76 patients (30.26%) had above target levels for total cholesterol. Also 46 patients out of 76(60.52%) had raised triglycerides levels and 47 patients (61.84%) had raised LDL levels. As far as HDL levels were concerned, 38 out of 76 patients (50.00%) had below desirable levels. The frequency of deranged LDL is higher as compared to HDL, triglycerides and total cholesterol levels. If these values are to be co-related to the disease, then LDL as a lipid parameter stands most significant.Conclusion:Morbidity and mortality in RHD is very high in Indian patients and one of the determinants of the cardiovascular morbidity is the increased lipid levels. The frequency of deranged LDL is higher as compared to HDL and total cholesterol levels in these patients. This study was planned to evaluate an entirely novel hypothesis that RHD is an independent risk factor for Atherosclerosis and CAD. The exact reason behind the occurrence is unknown but it can be environmental or genetic. RHD and Dyslipidaemia might engulf younger patients. The study is also aimed at evaluating all lipid parameters with RHD.

Perception Of Undergraduate Students to Online Teaching During COVID-19 Pandemic At Tertiary Teaching Care Hospital

Background:The corona virus disease pandemic has created remarkable disruption in health system and medical education worldwide. On March 25,2020, the Indian government proclaimed state wise lockdown. During this pandemic, online classes became an educational change from conventional classroom teaching method. Our institute have conducted online classes during this pandemic. Objective of our study was to analyse undergraduate students' perspectives of online classes and compare this to traditional classroom teaching.Material And Methods:The pharmacology department at AMC MET medical college carried out a cross-sectional observational study. A total of 294 students (2nd MBBS and 2nd BDS) took part in the research. Students were given a pre-tested self-designed que stionnaires to analyse the online teaching method.Result:In the present study shows that majority 107(36.3%) of the students believed that the course content provided in online classe s was not helpful. We observed that majority 215(73.1%) of the students were dissatisfied with the practical knowledge provided in online classes. More than half 166(56.4%) of the students believed that online teaching is not helpful in various skill development. A total of 168(57.2%) students agreed to the statement that physical absence of teacher affects both teaching and learning. Only 85(28.9%) students believed that online classes are interactive.Conclusion:From above study we conclude d that majority of students are not ready to adopt online teaching method.

Beyond Creatinine - A Focus on Mineral Bone Disease

Background:Chronic kidney disease (CKD) is a term that encompasses all degrees of decreased renal function, from damaged–at risk through mild, moderate, and severe chronic kidney failure. CKD is now a public health problem affecting an estimated 10-13% of the world population. The Kidney disease: Improving global outcomes (KDIGO) define CKD as either structural or functional kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. CKD-mineral and bone disorder (CKD-MBD) is a broader, newly defined term to define the mineral, bone, hormonal, and calcific cardiovascular abnormalities occurring in CKD. Ours study aims to evaluate the prevalence CKD-MBD in CKD stages 3, 4 and 5. Material And Methods:Ours is a retrospective observational study involving Patients >18 years known cases of CKD as per KDIGO guidelines with a minimum follow up duration of 3 or more months. Result:Our study population had a mean age of 52.8 years with male preponderance (72%). All of the patients had some form of MBD present. Conclusion:Our study was able to demonstrate a very high prevalence of CKD-MBD in patients of CKD indicating a need for better understanding the factors behind MBD in Indian patients and the need to emphasize on preventing and treating MBD in patients.

Role Of Ultrasound In First Trimester Bleeding Per Vaginum

Background:Bleeding per vaginum in the first trimester is a common obstetric situation ranging from an insignificant episode to life threatening emergency. The major causes are abortion, ectopic, and molar pregnancy. Ultrasonography is playing an increasing role in the management of such patients. The aim of this study was to determine the role of first trimester bleeding on obstetrical ultrasound.Material And Methods:This was a retrospective observational study done at urban health care Hospital Ahemdabad, a tertiary care teaching hospital. All obstetric cases with a history of bleeding per vaginum in the first trimester of pregnancy between July2019 and December2019 were included. A complete general physical and pelvic examination was done to arrive at a clinical diagnosis. Patients were then subjected to ultrasound examination. Clinical diagnosis and ultrasound diagnosis were correlated.Result:150 of all 2000 obstetric cases had the first trimester bleeding (incidence of 7.5%). Commonest causes were abortion (78.66%), ectopic (6%), and molar pregnancy (2%). Of 150 cases, 106 cases were correctly identified by ultrasonography. 44 cases proved by sonography were misdiagnosed by clinical examination with a disparity of 52.38%. In this study, 56% pregnancies were clinically diagnosed as viable, but only 34% pregnancies were viable.Conclusion:When the first trimester of pregnancy is complicated by vaginalbleeding, the history and clinical findings are often misleading and if relied upon can only lead to a delay in diagnosis and management.This study reinforces that USG is important to establish a definitive diagnosis, differential diagnosis and subsequent management.

A Comparative Evaluation Of Enamel Surface Abrasion Of Three Different Herbal Dentifrices Using A Customized Brushing Model: An In Vitro Profilometric Study

Background:Abrasives are the insoluble components added to dentifrices to aid the physical removal of stains, plaque and food debris. However, replete of abrasivity cause enamel abrasion, dentin hypersensitivity, damaging the smile as well as masticatory apparatus.The aim of this study is to evaluate the enamel surface abrasivity using three different herbal dentifrices and a customised brushing machine under profilometer.Materials And Method:A total of 30 enamel blocks are prepared from buccal surface of maxillary central incisor which are randomly divided into three groups. Group-1 Specimensbrushed with Colgate Vedshakti, Group-2 Specimens brushed withPatanjali Dant Kanti, Group-3 Specimens brushed with Dabur Red. All specimens were brushed using a customised brushing model with Oral-B powered brush for 30 minutes. Surface roughness of all three groups specimens were analysed using a surfaceroughness tester-profilometer. Statistical analysis used in this study was one-way analysis of variance (ANOVA) followed by post hoc turkey’s test.Results:Statistically significant difference was observed in value of enamel abrasion amongst Group1, 2 and 3. (p<0.05)Conclusion:Toothpaste with higher relative enamel abrasivity has the potential to abrade the enamel and cause hypersensitivity.The least enamel abrasion was observed in Colgate Vedshakti when compared with Patanjali Dant Kanti and Dabur Red toothpaste.

Role Of Supportive Periodontal Therapy (SPT) In Implant Therapy And Periodontitis: A 4-Year Follow-Up

Periodontal diseases include a group of chronic inflammatory conditions usually connected with dysbiotic plaque biofilms leading to progressive destruction of the tooth-supporting apparatus, ultimately leading to tooth loss. Patients with a history of periodontal diseases are potential candidates for dental implant therapy; therefore it is imperative to address the management of implants survival in such patients. This case report depicts an instance of a case of implant-prosthetic rehabilitation in a patient with history of periodontitis,highlighting the importance of initial periodontal treatment and continuous supportive periodontal therapy (SPT) which is fundamental for effective outcome following implant rehabilitation.

Bilateral Narrow Internal Auditory Canal With Duplication: High Resolution CT And MRI Findings

Inner ear malformations account for only 20 % of cases of congenital sensorineural hearing loss.A narrow internal auditory canal (IAC) with duplication is a very rare congenital anomaly that can be associated with other malformative ear abnormalities. Identification and characterization of these abnormalities will be crucial for the proper management of patients.We report two cases of bilateral duplicated internal auditory canal with other associated inner ear anomalies.

Design And Development Of Rilpivirine Nanoparticle Containing Chitosan Using Ionic Gelation Method For Hiv Infections

Objective: The primary objective of the current research was to prepare rilpivirine loaded Nanoparticles containing Chitosan using the ionic gelation method for HIV infections. Methods: The nanoparticles of rilpivirine were prepared using the ionic gelation technique. Further, nanoparticles were characterized by Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), scanning electron microscopy (SEM) and in vitro drug release. Results: The optimized nanoparticles were found with a particle size of 130.30±5.29 nm (mean±SD) and entrapment efficiency (% EE) of 77.10±0.50%. Scanning electron microscopy technique exposed spherical particles with uniform size. It was observed that the nanoparticles created showed the absence of the crystalline nature of the drug and its switch to the amorphous state. Results showed that more than 45% of the pure drug is released in 50 min and after 90 min almost about 95% of the drug is released. Conclusion: The research study concluded that the in vitro release profile of nanoparticles was found to be sustained up to 24 hr. Sustained release of the rilpivirine could improve patient obedience to drug regimens, growing action effectiveness.

Retrospective case-series analysis of haematological malignancies in goldmining areas of South Africa

Background. South Africa (SA)'s high levels of environmental contamination of mine tailings from uranium and its decay products, coupled with remarkably short distances between mine tailings and residential areas, raise concern about whether there is an association between environmental uranium exposure and risk of cancer, including haematological malignancies. Objectives. We reviewed information on cases from the central hospital offering cancer diagnostics and treatment in a major mining area of SA to describe their basic clinical and demographic characteristics, as part of assessing whether a cancer epidemiological study in this area would be feasible.Methods. Basic clinical, demographic and residential information on patients with haematological malignancy diagnosed between 2004 and 2013 was collected retrospectively from the patient files at Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg.Results. In total, 1 880 patients aged 18 - 94 years were identified. Referral from distant provinces was not uncommon, but >80% lived within 50 km of the hospital. Non-Hodgkin's lymphoma accounted for 44% of the haematological malignancies, followed by leukaemia with 26%. HIV status was known for 93% of the patients, of whom 47% were HIV-positive.Conclusions. Caution is required when interpreting spatial distributions of patients, given inaccuracies in residential addresses and referral patterns to the hospital, and with HIV and other infections probable important confounders. Our study therefore shows that active case recruitment is required for accurate assessment of residential information. However, some findings on spatial distributions in the study warrant the continuation of efforts to develop a study protocol to investigate the possible link between uranium exposure in mining areas and haematological malignancies in residents. Disproportionately high incidence rates of haematological malignancies observed in specific districts would be relevant for further investigation

Single dose amoxicillin induced toxic epidermal necrolysis A rare life threatening dermatological condition.

Toxic epidermal necrolysis is a severe cutaneous drug reaction, mainly involving skin and mucous membranes. We have presented here a case report of 16 year old female patient who was diagnosed with toxic epidermal necrolysis clinically as well as histopathologically. The patient presented with history of fever, oral cavity ulcer, skin lesions which were ill defined, erythematous macular with darker hemorrhagic centre. Skin biopsy showed full thickness necrosis of dermis, dermal-epidermal separation and paucity of upper dermal cellular infiltration. The patient was treated with intravenous immunoglobulins, low dose steroids and systemic antibiotics and the patient improved significantly. The main purpose of the case report was to emphasize that even one single dose of amoxycillin can induce a toxic epidermal necrolysis.

Dyslipidemia and electrolyte metabolism in essential hypertensive North Indians.

Background: In the present study we are going to evaluate lipid profile and Electrolytes levels (Sodium, Potassium in Serum & Urine) in Essential Hypertensive and in healthy controls in North Indian Population. Methods: A total of 210 age and sex matched E. hypertensive & healthy controls were included in our study from outpatient department (OPD) of Medicine in King George Medical University, Lucknow, India. First group consist of 110 subjects were known E. hypertensive patients (B.P ≤ 139/89mm of Hg). Another group is control group consist of 100 subjects who were healthy controls (B.P ≤ 120/80mm of Hg) with no history of hypertension. Fasting venous blood sample was collected from all the subjects in plane vacationer and the sample was centrifuged for the estimation of lipid profile & electrolyte i.e. Sodium (N+) & Potassium (K+). Lipid profile was measured with an automated analyzer (Biochem) & Electrolytes was measured using ion-selective electrolyte auto-analyzer in the Clinical lab of biochemistry in KGMU. Results: After analyzing results almost control subjects had normal lipid profile level. In patients of E. hypertension there was a highly significant increase in serum Total Cholesterol (p˂0.0001), LDL-Cholesterol (p˂0.0001) & Triglycerides (p˂0.001). HDL-Cholesterol (p˂0.03) is also significant as compare to controls. Not significant difference was found in serum sodium & potassium level. The Urinary Na+ levels were significantly lower in E. hypertensive patients when compared to controls while Urinary K+ levels were not significant. Conclusion: So we conclude that dyslipidemia is associated with essential hypertension this may due to the genetic predisposition, secondary lifestyles, fatty food consumption, saturated fat, cholesterol in the food increase the blood cholesterol and saturated fat is the main culprit. Essential hypertensive is linked with increased Na+, K+ - ATPase activity and increased renal tubular sodium reabsorption.

Effect of ondansetron on sensory level produced by intrathecal bupivacaine.

Background: For spinal anesthesia there are drugs which can increase the level and quality of analgesia. Any drug which decreases sensory block level in spinal anesthesia is of great concern as it may need analgesic, sedative, supplement or even conversion to general anesthesia. Ondansetron is one such drug which has been reported to decrease the height of sensory block achieved after subarachnoid administration of bupivacaine. In this prospective observational study, we studied the effect of administration of ondansetron on the level of the sensory block achieved after subarachnoid blockade. Methods: In Group II, 4 mg ondansetron was given and 15 mins before giving spinal anesthesia Group II against control group receiving 2 ml saline intravenous (Group I). 15 mins before giving spinal anesthesia. Both groups received 3.5 ml of bupivacaine heavy was given intrathecally. Sensory and motor block was assessed 5, 15, and 30 mins. We analyzed both highest spinal block level achieved and time to regress to L1 level. Results: We found that in Group II both highest level of sensory block (T6 by median method) duration to regress to L1 level (1.43±0.22 hrs) was lesser as compared to group I and Group III T4 by median method and time to regress from T6 to L1 Group I 2.03±0.06 hrs Group III 1.84±0.27 hrs. Motor block did not differ between groups. Conclusions: We concluded that probably ondansetron was responsible for lower spinal block level and early recovery from spinal anesthesia after intrathecal bupivacaine and should not be given empirically for nausea and vomiting.

Cervical tuberculosis masquerading as cancer cervix: A report of three cases.

Summary: Tuberculosis is still frequently observed in third world countries like Africa and Asia. Here we report three cases of genital tuberculosis with variable presentations. First case was a lady of reproductive age group who presented with polymenorrhea and post-coital bleeding with unhealthy cervix. Histopathology of cervical tissue revealed tubercular cervicitis. Second and third cases presented with different complaints like discharge per vaginum, post-coital bleeding and pain in lower abdomen with growth over the cervix. Cervical biopsy was inconclusive of tuberculosis but endometrial tissue sampling for TB PCR was positive. This shows that newer diagnostic marker test can help us to detect secondary genital tuberculosis.