Neuroanatomical Correlates of Post Stroke Depression

Depression after stroke is common entity known to psychiatrist from many decades. multiple theories have been given for post stroke depression ranging from functional disability, social support, emotional reaction to stroke, location of lesion etc. Considering lesion location as causative factor for post stroke depression multiple research have been done in last two decades with inconsistent results. The findings of past two decades of research indicates frontal lobe or lesion in left hemisphere as causative factor for post stroke depression with out reaching any definitive conclusion. Through this paper we have tried to find out the relationship between lesion location and post stroke depression. We have also tried to find out the relationship between size of lesion and severity of depression. Methods: cohort study design, tools used were CT scan, HAM-D, SPSS-22 software. Results: Infarct in left parital lobe resulted in significant depression as compared to infarct in right parital lobe. Over all depression post stroke was significantly more than non depressed in all areas. Conclusion: Lesions in left parietal lobe are significantly associated with occurrence of clinical depression. As the Size of lesion increases the risk of post stroke depression increases. Size of lesion has no positive or negative correlation with severity of depression

Improving continuing medical education by enhancing interactivity: lessons from Iran

Introduction: Continuing Medical Education [CME] has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners

Methods: Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general

Results: The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME

Conclusion: Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME

An overview of drugs approved in India from 1999 through 2015.

Background: The drug approval regulations in India have changed since 2005 with new regulations for the conduct of clinical trials from 2013 onward. The present study was planned to see the number of drugs approved by Drugs Controller General of India (DCGI) and their trend over the last 16 years in view of new regulatory guidelines. Methods: Data obtained from website of the regulatory authority, i.e., Central Drugs Standard Control Organization regarding DGCI approval of drugs in India from 1999 until May 2015 was noted for analysis. Results: We identified 1716 drug approvals by the DCGI from 1999 to 2015, with a mean of 100.94±83.80 (standard deviation) approvals per year (median approvals per year: 57; range: 3-270). There is a rising trend for approval of drugs as a single agent, as well as in combination from 2004 showing a peak in 2008 with a decline from 2010 onward. Thus, very few drugs have been approved in last 3 years. Conclusions: Thus, the present study highlights the changing scenario of drug approval, with few drugs being approved for clinical practice in the last 3 years.

Cost analysis of oral hypolipidemic agents available in India.

Background: Cardiovascular diseases are the most prevalent cause of death and disability in developed and developing countries. There is a wide variation in the prices of hypolipidemic drugs marketed in India. Thus, a study was planned to find out variation in cost in the oral hypolipidemic drugs available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same oral hypolipidemic drug by calculating percentage variation in cost in Indian rupees. Methods: Cost of oral hypolipidemic drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October 2014 and “Indian Drug Review” Vol. XXI, Issue No.4, 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost per 10 tablets was calculated. Results: Percentage variation in cost for hypolipidemic drugs marketed in India was found to be atorvastatin (10 mg): 1108.33%, simvastatin (5 mg): 709.09%, rosuvastatin (10 mg): 431.91%, lovastatin (10 mg): 287%, fenofibrate (200 mg): 163.58%. Among the combination therapy, variation in cost was atorvastatin + fenofibrate (10+160 mg): 233.33%, atorvastatin + ezetimibe (20+20 mg): 132.90%, rosuvastatin + fenofibrate (10+145 mg): 105.56%. Conclusion: There is a wide difference in the cost of different brands of oral hypolipidemic drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.

Comorbid conditions in patients with physician diagnosed COPD: Data from a tertiary centre in South India.

Background: COPD represents an increasing burden worldwide. COPD is a leading cause of hospitalizations in adults, particularly older adults. Comorbidities are a common cause, or a contributing cause, to many of these hospitalizations. Aims & Objective: To study the comorbid conditions in patients with physician diagnosed COPD in a tertiary centre in South India. Material and Methods: A random sample of 500 patients after taking verbal consent were selected from all COPD patients who attended Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinnaavutapalli, Vijayawada, over a period of 1year in 2012. Personal interview was held to collect data including age, gender, literacy, occupation, comorbidities. Results: The mean age of 500 COPD patients was 61.2. Out of which 47.2% are below 60 years and 52.8% are above 60 years. Males constituted majority of the study population (80.8%). 77% of the total study population gave a history of smoking. Majority of the patients had 2 comorbid illnesses (30%). Among the co morbidities, depression was the commonest comorbid illness (50.4%), followed by anaemia (44%). Conclusion: Knowledge regarding associated comorbidities with COPD in a tertiary care center helps the physician to take the comprehensive management plan. We recommend screening of patients with COPD for possible comorbidities so that appropriate treatment can be initiated at the earliest so as to decrease the cost burden.

Effect of punica granatum peel extract on burn wound healing in albino wistar rats.

Introduction: Punica granatum is known to have long history of medicinal use. Aqueous fractions prepared from pomegranate peel extract has been found to stimulate type 1 procollagen synthesis and inhibit matrix metalloproteinase (which breaks down skin protein) produced by dermal fibroblasts. Objectives: To study the effect of a topical Punica granatum peel extract on healing of burn wound and to compare its effect with that of standard (silver sulfadiazine). Materials and Methods: Partial thickness burn wounds were inflicted upon wistar rats by pouring hot molten wax at 80˚C in to a metal cylinder with 300mm square circular opening, placed on the back of the animal. There were four groups in the study viz. control (topical petroleum jelly), standard (topical Silver Sulphadiazine Cream) and test groups (topical Punica granatum peel extract 10% and 20 %). The parameters measured were wound contraction and epithelization period in this burn wound model. Results & Discussion: The percentage of wound contraction was significantly increased in the topical Punica granatum extract (10% and 20%) and silver sulfadiazine group compared to control group. The mean period of epithelization was significantly reduced in topical Punica granatum extract (10% and 20%) group and silver sulfadiazine group as compared to the control. Conclusion: Punica granatum peel extract is effective in healing burn wound and the effect was comparable to the standard drug silver sulfadiazine.

Epidemiology of group a streptococcal pharyngitis & impetigo: A cross-sectional & follow up study in a rural community of northern India.

Background & objectives: Group A streptococcus (GAS) causes a wide array of human diseases. Epidemiological picture of streptococcal infection in India is not complete. Hence, disease burden due to GAS in 5-15 yr old school children in northern India was studied and emm typing of GAS isolates was carried out to help in designing prevention strategies. Methods: A cross-sectional survey was carried out among 4249 school children (5-15 yr) from Raipur Rani Block of Panchkula district in Haryana during 2000-2002; 334 children were followed up fortnightly for one year. Standard clinical and microbiological procedures were used for collection of swabs from throat and skin and confirmation of GAS and its emm types. Results: Of the 4249 children studied, 658 (15.5%) had pharyngitis; 579 of them could be swabbed, of which 2.8 per cent had GAS. From 3591 children without pharyngitis, 3385 who could be swabbed, GAS was found in 1.3 per cent of them. Impetigo was rare (0.7%), but 7.1 per cent (2/28) children had GAS. In the followup study, 17.4 per cent (776/4447 child-contacts) had pharyngitis, 761 could be swabbed and 2.4 per cent had GAS; among those without pharyngitis, 2016 swabs could be taken and GAS was found in 1.3 per cent; whereas only 2.6 per cent (2/75) of skin sores had GAS. Three children had GAS pharyngitis twice during follow up. Fourteen different GAS emm types were found. emm 71, 77 and 81 constituted 69 per cent of the pharyngeal isolates. GAS pharyngitis and impetigo were more common in winters and summers respectively. Interpretation & conclusions: In north India, pharyngitis was more common than impetigo. Most prevalent emm types of GAS in this region differ from those included in M protein-based vaccines.

Gastric mucosal cellular changes induced by indomethacin (NSAID) in male albino rats.

Indomethacin (2 mg/100 g body weight), induces haemorrhagic gastric ulcers in albino rats. The incidence and severity of ulceration increased with starvation period. Indomethacin caused little or no effect on the cellular and the nuclear diameter of parietal and chief cells while reduction was observed in mucus and endocrine cells. The effect was enhanced with increased duration of starvation. Both mucous and endocrine cells decreased in their number after 72 hr of starvation. Thus prolonged starvation enhanced the gastric mucosal damage induced by indomethacin.