Knowledge and attitudinal survey of drug promotional literature among second year undergraduate students: a questionnaire based study

Background: Promotion of drugs has been increased enormously with the advancement of technology and use of internet and media etc. Pharmaceutical manufacturers spend vast amount of money on promotion usually through medical representatives by providing printed advertisements. But, it has been seen that these printed advertisements are not up to the mark usually, they either overemphasize the efficacy or hide the safety profile for the sake of company抯 profit. All these promotional activities influence the prescribing pattern of doctors. So, the present study has been conducted to assess the knowledge and attitude of second year undergraduate students about promotional literature and to train them accordingly for improving the prescribing behaviour.Methods: A questionnaire based study containing 9 questions was conducted in 110 second year undergraduate students after taking informed consent. Statistical analysis was done by using descriptive statistics by graph pad prism version 6.01.Results: Among respondents 60 (61.2%) were males and rest 38 (38.8%) were females. 50 (51%) of the respondents have chosen Indian pharmacopoeia as a trusted source of information followed by others. Most common factor affecting the prescribing attitude was reported as updates from clinical trials 49 (50%) followed by prescriber抯 knowledge. Most important intervention taken to stop misleading drug promotional activities has been reported as formulation of strict regulation by the health care authorities against any misleading promotion.Conclusions: Promotional activities by manufacturers influence the attitude and prescribing pattern of doctors. So, it is important to teach the students about their rational use by critically analysing it.

Antibiotics sensitivity and resistant pattern in tribal region of Chhattisgarh, India: a retrospective observational study

Background: Antimicrobial resistance (AMR) is the biggest health care problem globally, it is responsible for the high rate of mortality worldwide which was commonly observed in developing countries. We tried to find the incidence of antimicrobial resistance in the tribal region of Chhattisgarh, India.Methods: It was an institutional based retrospective observational study. Out of 3389 samples from inpatient and outpatient department, a total number of 1676 cultured proven micro-organism were isolated from Jan 2017 to Dec 2018. SPSS v23 was used for descriptive analysis.Results: More than 75% of the samples collected from the inpatient department in which surgical IPD were significantly higher. The commonest isolated were Staphylococcus aureus followed by Escherichia coli, then Klebsiella species. Amoxycillin-clavulanic acid was resistant to the majority of microorganism followed by 3rd generation cephalosporins then Co-trimoxazole.Conclusions: Antimicrobial resistance was higher even in the tribal region. The incidence of AMR is increasing at an alarming rate. Microorganism targeted antimicrobial therapy with the use of narrow-spectrum antibiotics and avoidance of broad-spectrum antibiotics will possibly overcome the antimicrobial resistance. There is also a need to strengthen laboratory or microbiology department to produce an accurate report to combat antimicrobial resistance.

A world health organization core drug use indicator based prescription study in the dermatology outpatient department of a tertiary care teaching hospital of central South India

Background: Irrational prescribing is a universal problem that may lead to inadequate response to medication therapy, poor patient compliance and increased adverse drug reactions ultimately leading to frequent hospital admissions. Hence this study was done to assess the drug utilization pattern using WHO core drug use indicators so that the recommendation can be made towards the rational prescribing.Methods: A sample of 3650 prescriptions was analysed prospectively to assess the drug utilization patterns in the dermatology OPD of a tertiary care teaching hospital of central south India.Results: The average number of drugs per prescription was 2.74 whereas 79.26% drugs were prescribed by generic names. Percentage of encounters with an antibiotic prescribed was 18.68%. Regarding use of injections, 3.26% prescriptions contains one or more injections. Percentage of drugs prescribed from essential drugs list was 78.37%. Average consultation time was lower (2.9 minutes) than recommended.Conclusions: The data from the present study indicates that prevalence of polypharmacy, inadequate consultation and dispensing time along with poor patient’s knowledge are the areas of medication therapy to be improved. Availability of essential drugs and key drugs in stock should be improved to achieve rational therapeutic goal. Further, continued medical education regarding the rational prescribing will definitely improve the standards of health care delivery.

Drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar Region, Chhattisgarh, India

Background: With the changing lifestyle, the incidence of psychiatric illness is increasing day by day. And the mental illnesses not only affect the social and personal life but also adds additional economic burden affecting quality of life of the person. So, proper diagnosis and management of psychiatric illnesses is utmost important. So, keeping this in mind, the present study has been conducted to evaluate drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar region.Methods: After obtaining approval from Institutional Ethics Committee, present study was conducted in 237 patients for a period of 3 months from February 2019 to April 2019. The data of patients attending psychiatry OPD was collected in a structured case record form. The data were analysed using graph pad prism version 6.0.Results: Out of total 237 patients, males 136(57.38%) outnumbered females 101 (42.62%). The major psychiatric illness reported was schizophrenia (45.99%) followed by bipolar affective disorder (16%) and generalized anxiety disorder (14.35%). Average number of psychotropic drugs per prescription was 1.74±1.02. The percentage of drugs prescribed from state Essential drug List (EDL) was 93.05%.Conclusions: Overall, the principles of rational prescribing was tried to be maintained, as polypharmacy has been avoided and most of the drugs were prescribed from the state EDL. The use of generic drugs should be increased to make prescriptions more rational and to cut down the cost of the therapy which may be helpful in increasing the quality of life of the patients.

Trends of human influenza infection in Chhattisgarh: a retrospective observational study

Background: Human influenza virus was recognized as a pandemic in 2009 by the World Health Organization (WHO). Since then many newer incidences was recognized in India, but there was no sufficient data from all state of India. This study will provide data from the Chhattisgarh state of India.Methods: It was a retrospective observational study from December 2015 to November 2017. All patient samples with suspected influenza infection were collected and analysed by Real-time reverse polymerase chain reaction (RT-PCR).Results: 341 patients’ sample was collected and analysed; among these samples, 07.9% of patients have all three serotype of influenza positive. Raipur district has the highest incidence of influenza A followed by Durg and Raigarh district of Chhattisgarh. There was no significant difference between male and female who was affected by the influenza virus.Conclusions: The incidence of Human influenza virus is lesser in Chhattisgarh as compare to the average states of India and the state capital has a higher rate of sample collection as well as positive influenza infection.

Evaluation of knowledge, attitude and practice of self medication among second year undergraduate students in Bastar Region: a questionnaire based study

Background: Self medication is becoming very popular among medical students as they get exposed to knowledge about diseases and drugs, but which is very superficial in second year undergraduates, so the present study was conducted to evaluate the knowledge, attitude and practice (KAP) of self medication among second year undergraduate students.Methods: A questionnaire based study containing 12 questions was conducted in 175 second year undergraduate students after taking informed consent. Statistical analysis was done by using descriptive statistics by Graph Pad Prism version 6.01.Results: Out of the 175 students, 155 (88.57%) students have taken self medication. The common reason for taking it was no need to visit the doctor for minor illness (64%), quick relief (48.57%) and time saving (34.29%). The common indications for taking self medication were fever (69.14%) and cough and cold (69.14%) followed by headache (64%). Although students rarely practised it due to risk associated like adverse effects 131 (74.86%) and lack of proper knowledge about drugs 118 (67.3%).Conclusions: Self medication is highly prevalent among students, as most of the students get it from pharmacies, it is necessary to make strict guidelines for availability of such medicines over the counter and also there is need to educate the students about harmful consequences of self medication to make them responsible future doctors.

Comparison of Low Pressure and High Pressure Pneumoperitoneum in Patients Undergoing Laparoscopic Cholecystectomy-A Randomized Prospective Study

Pneumoperitoneum of 12-16mmHg is created by instillation of carbon dioxide during laparoscopic cholecystectomy .Nowadays low pressure pneumoperitoneum of 8-10 mmHg is used to decrease the side effects. In our study we have compared the two methods. Methods: Eighty patients with gallstones admitted in Government Hospital Gandhinagar (district hospital Jammu) for laparoscopic cholecystectomy were divided into two groups of forty each. Forty patients were subjected to standard pressure pneumoperitoneum during the procedure and forty patients to low pressure pneumoperitoneum. Results: Very slight difference in operating time of two groups was seen. No significant change in postoperative blood pressure and heart rate seen. Only two patients had shoulder tip pain and required more analgesics. Conclusion: High pressure pneumoperitoneum has no effect on intra operative and post operative hemodynamics but can lead to increase in post operative pain.

Epithelioid Hemangioendothelioma of Penis.

Epithelioid Hemangioendothelioma is a rare vascular tumor of low malignant potential most commonly found in the lung, liver and soft tissues. Penis is a very rare site for it. We report a case of penile epithelioid hemangioendothelioma. Surgery is the standard treatment and close clinical follow up is necessary due to its unpredictable natural history.

Anti-diabetic effects of Caulerpa lentillifera：stimulation of insulin secretion in pancreatic β-cells and enhancement of glucose uptake in adipocytes

Objective: To evaluate anti-diabetic effect of Caulerpa lentillifera (C. lentillifera).Methods:The inhibitory effect of C. lentillifera extract on dipeptidyl peptidase-IV andα-glucosidase enzyme was measured in a cell free system. Then, interleukin-1β and interferon-γinduced cell death and insulin secretion were measured in rat insulinoma (RIN) cells by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and ELISA kit, respectively. Glucose uptake and glucose transporter expression were measured by fluorometry and western blotting, using 3T3-L1 adipocytes.Results: C. lentillifera extract significantly decreased dipeptidyl peptidase-IV and α-glucosidase enzyme activities, and effectively inhibited cell death and iNOS expression in interleukin-1βand interferon-γ induced RIN cells. Furthermore, C. lentillifera extract significantly enhanced insulin secretion in RIN cells and glucose transporter expression and glucose uptake in 3T3-L1 adipocytes.Conclusions:Thus, our results suggest that C. lentillifera could be used as a potential anti-diabetic agent.

Design and evaluation of chronomodulated doxofylline tablets.

The objective of this research work was to prepare a chrono- modulated drug delivery system to meet chronopharmacological needs of asthma. In this study doxofylline was selected as a model drug. To meet this objective an initial lag phase of release for 3-5 hrs and later a rapid (surge) release phase was considered. To achieve surge release a rapidly releasing core tablet of doxofylline was developed by admixing doxofylline with effervescent granules and super disintegrants. The lag phase in release (2hr) was achieved by coating EV core tablets with release retarding polymers Eudragit RS-100 6% containing HPMC (Hydroxy Propyl Methyl Cellulose) 5%, further over coated with enteric polymer CAP (Cellulose Acetate Phthalate) 12%. The formulated chronomodulated tablets of doxofylline were able to release more than 90% drug within 4 hrs after the lag phase of 2 hrs.

Polyomavirus nephropathy and Cytomegalovirus nephritis in renal allograft recipients.

Background: Polyomavirus nephropathy (PVN) and Cytomegalovirus (CMV) disease are the most common viral pathogens causing allograft dysfunction in renal allograft recipients. They have been observed in transplant recipients with increasing frequency in the recent years with various reports describing wide differences in the incidence of these infections in renal allografts. We present our experience with Polyomavirus (PV) infection and CMV infection in allograft of renal transplant recipients from a transplant centre in North India performing more than 100 transplants per year. Materials and Methods: 390 renal allograft specimens from 327 patients over a 4 year period, presenting with renal dysfunction were re-evaluated for presence of PVN and CMV disease utilizing histo-morphological features and immunohistochemistry. Results: Thirteen patients with PVN and four with CMV disease were identified. All patients were on triple drug immunosuppression receiving cyclosporine, prednisolone and tacrolimus or MMF. The mean period of diagnosis of viral infection after transplant was 12.4 months (seven days to 3.5 yrs) for PVN and 4.8 months (two to seven months) for CMV nephritis. Biopsies showed varying degrees of tubulointerstitial inflammation, viral inclusions and evidence of tubular damage. Associated features of acute rejection were present in 69.2% of patients with PVN. Conclusion: Histological features of PVN involving the kidneys have considerable morphological overlap with acute rejection while CMV disease presents primarily as tubulointerstitial inflammation. We observed a prevalence of 4% for PVN and 1.2% for CMV nephritis in renal allografts.

Does cytokine gene polymorphism affect steroid responses in idiopathic nephrotic syndrome?

Background: Immunological responses may be possibly involved in the pathogenesis of idiopathic nephrotic syndrome (INS). Cytokines act as a potent immunomodulator. Pathogenesis of INS is associated with Th1 and Th2 cytokines imbalance. Aims, Settings and Design: We have investigated the association of IL-4, IL-6, and TNF-alpha gene polymorphisms and analyzed the data to evaluate the effect of these polymorphisms on the pathogenesis and clinical course of INS. Materials and Methods: One hundred fifty children with INS were selected. Children were analyzed for IL-4, IL-6, and TNF-alpha gene polymorphisms by using polymerase chain reaction and restriction fragment length polymorphism. Statistical Analysis Used: Chi-square test was used for different comparisons. The synergistic effects of IL-4, IL-6, and TNF-alpha gene polymorphisms were evaluated by using logistic regression analysis. Results and Conclusions: We compared the steroid-resistant (SR) and steroid-responsive (SS) groups. Our results showed strong association of IL-6 -G174C, and IL-4 -C590T at genotypic level (P = 0.0121, OR = 14.71, 95% CI = 1.59-136.46; and P = 0.0386, OR = 7.29, 95% CI = 1.26-41.69). TNF-alpha revealed a strong association at genotypic level (P = 0.0121, OR = 14.71, 95% CI = 1.59-136.46), as well as at allelic level (P = 0.0433, OR = 2.251, 95% CI = 1.09-4.66), demonstrating that it may be considered one of the genetic risk factors affecting the steroid response in INS patients. The GG genotype of IL-6 -G174C, TT genotype of IL-4 -C590T, and AA genotype of TNF-alpha -G308A cytokine gene polymorphisms may be causative factors for nonresponsiveness towards steroid therapy among INS children.

Steroid resistant nephrotic syndrome: role of histopathology.

This study was conducted to (1) see the histopathological distribution of different subtypes in steroid resistant nephrotic syndrome (SRNS) and (2) compare the clinical, biochemical parameters and outcome between Minimal Change Disease (MCD) with non-MCD subtypes in response to immunosuppressive therapy. A retrospective analysis was done of data on all biopsy proven children with idiopathic SRNS (no response to 4 weeks of standard prednisone therapy (60 mg/m(2)/day)) referred to our institute over last 12 years. They were treated with one of the following medications: oral or intravenous cyclophosphamide, cyclosporine or combination of dexamethasone and azathioprine. A comparison was done of the demographic clinical and biochemical features different histopathologies. We studied 136 children with SRNS (100 M, 36 F). They accounted for 15.1%(136/900) of all children with idiopathic nephrotic syndrome. Focal segmental glomerulosclerosis (FSGS) was the commonest 80/136 (59%), followed by MCD (17.6%). Children with non-MCD had a significantly greater prevalence of microhematuria as compared to MCD. The other baseline clinical and biochemical features including the glomerular filtration rate (GFR) were similar. After a mean follow up of 46 (8-148) months, a significantly greater children with non-MCD 65/112) continued to be proteinuric as compared to the MCD (3/24) (p=0.0001). FSGS was the commonest cause of SRNS in our patient population. Children with SRNS secondary to MCD are more likely to achieve remission as compared to non-MCD subtypes and have a better long-term prognosis. Hence kidney biopsy is of significant prognostic value in SRNS.

Review of breast cancer cases in Jaipur region.

Breast cancer forms the commonest cancer in females in Jaipur region. Two hundred cases of breast malignancy were recorded in a single year (1990). This constituted 8.30% of total cancers and 19.40% of all female cancers. The commonest age group was 45-54 years (37.0%) followed by 35-44 years (24.50%). Only 13.50% were below the age of 35 years. Majority of the patients (97.50%) were married and 76.0% got married below the age of 20 years, 26.50% got married below the age of 15 years. Most (75.0%) has menarche between the age of 13 and 16 years. Menstrual irregularities were present in only 17.50% of the cases. More than 6 pregnancies had in 33.50% patients and 50.50% had 3-5 pregnancies. Only 4.50% had no issue. Most of the women (68.50%) had their first live child between 18 and 25 years and 13.50% had below 18 years. Majority reported having breastfed their children for 1-2 years. Only 12.0% and 5.0% women reported having any problem with breast during lactation and otherwise respectively. A family history of cancer was present in 10.0% of the cases. A personal delay of more than two years in seeking medical help was observed in only 6.0% of the cases while 22.50% sought medical advice within a week time. Risk factors which are implicated in the aetiology of breast cancer in the western setting might not necessarily hold true in our country. More epidemiological studies are required to elicit correlation, if any, in the Indian context.