Study of knowledge, attitude, and practices towards current updates of pharmacovigilance and adverse drug reaction reporting among doctors in a tertiary care teaching hospital of Western India

Background: In general, adverse drug reactions (ADRs) are global problems causing both morbidity and mortality. Spontaneous ADR reporting is important to monitor adverse effects of medicines but under reporting is still very prevalent so, there is a need of constant monitoring and rectification of system of Pharmacovigilance. The objective of this study was to evaluate the knowledge, attitude, and practices (KAP) of the healthcare professionals about Pharmacovigilance and to identify the reason for under reporting of ADRs.Methods: A cross-sectional study was carried out using a pretested questionnaire among doctors with minimum qualification MBBS or B.D.S. including faculties, senior and junior residents. Subsequently, analysis of association between education and experience was done by chi square test at P-value <0.05.Results: A pretested questionnaire was distributed among 403 doctors and 240 (59.16%) responded voluntarily. In general, 131 (54.58%) participants noted lack of time to report ADR while 90 (37.50%) participants noted no benefit of reporting already known ADR. On the other hand, total 104 (43.33%) participants were aware about need to report a serious adverse event during “Clinical Trial” within 24 hours to the Ethics Committee. Only 87 (36.25%) participants noted a need of reporting of already known ADR.Conclusions: Participants had good knowledge and attitude towards pharmacovigilance, but the actual practice of ADR reporting is still deficient among them that can be improved by sensitization training and involvement of grass root level health care workers.

Drug utilization study in the inpatients of pediatric department of a tertiary care hospital.

Background: Infants and children constitute a large proportion of the population in developing countries. In Gujarat, studies on drug use patterns in the pediatric age group are lacking in the Saurashtra region hospitals. The objective was to study demographical information and the utilization pattern in the in patients of the pediatric ward. Methods: A cross-sectional, observational drug utilization study was carried out over a period of 6 months in 630 pediatric inpatients of the pediatric department of Guru Gobind Singh Hospital, Jamnagar, a tertiary care teaching hospital. Analyzed data included demographic details and drugs prescribed in respective patients. Results: Most commonly affected age group was 1-5 years, boys in 62.06% and girls in 37.94% and 40.16% were admitted in the pediatric ward. Acute gastroenteritis and pneumonia had the highest admission rate with 31.90% and 22.38%, respectively. The majority of children were prescribed 5-6 drugs. Ceftriaxone (64.92%) was the top most frequently prescribed antibiotic, followed by amoxicillin (49.21%). Prescribing drugs were mainly from essential drug list (64.44%) and by generic names (61.89%). Drugs prescribed orally in 66.10% and by injections in 33.90%. Conclusion: It is quite evident that significantly large number of children were from 1 to 5 year age group. The majority of the children were admitted in inpatients of the pediatric ward for acute gastroenteritis, followed by pneumonia and meningitis. Most frequently prescribed antibiotic group was cephalosporin, followed by penicillin group.

Evaluation of Small Group Discussion as a Teaching- Learning Method in Biochemistry for First Year MBBS Students: A Pilot Study.

Background: Significance of Small Group Discussion as a teaching learning method is yet to be explored in teaching Biochemistry for medical students in India. Hence, this experimental pilot study was undertaken to assess the effectiveness of small group discussion for first year MBBS students in learning Biochemistry. Materials and Methods: A voluntary group of 40 first year MBBS students were chosen randomly for the study comprising of both high achievers and low achievers. Study was conducted on a particular day for five consecutive weeks. In each session, small group discussion study pattern included a pretest followed by group discussion then by a post-test. Participants‘ feedback was obtained after completion of the study. Statistical comparisons were done on each PAIR (pre-test and post-test) of Mean scores obtained and Pearson‘s correlation co-efficient were calculated for each pair. Statistical significance was obtained at p<0.05. Results: Mean post-test scores were increased compared to mean pre-test scores in each PAIR and the increase was statistically significant. Significant positive correlations were observed between pretest scores and post-test scores in all PAIRS. Majority of the study group felt that small group discussion method will enhance their learning and memory. Conclusion: This pilot study emphasizes that small group teaching is an effective teaching learning method to develop the student‘s critical thinking and problem-solving skills. However, larger studies at several medical colleges for a longer duration have to be undertaken before arriving at a conclusion.

Prevalence of Overweight and Obesity Among Students of a Medical College in South India: A Pilot Study.

Background: Obesity is emerging as a serious problem throughout the world, not only among adults but also children, teenagers and young adults. Of the factors contributing to obesity, stress seems to be particularly important as stressful condition leads to irregularity in diet, lack of exercise and addiction, each being considered an independent factor leading to obesity. Medical education is stressful throughout the whole course of training. The amount of material to be absorbed, social isolation, pressure of examination, discrepancies between expectation and reality all can be anticipated to bring psychological stress. Hence, this study was undertaken to find out the prevalence of overweight and obesity among undergraduate medical students. Aims and objectives: To assess the prevalence of overweight and obesity among medical students in Azeezia Medical College and also to find the relationship of the following risk factors with obesity; a) Physical inactivity, b) sleeping habits, c) diet, d) stress and e) association with other diseases (thyroid disorders, menstrual disorders). Study design: A cross-sectional study was conducted in selected sample of 89 subjects. Settings: The study setting was in a rural area in Kollam district of Kerala. Material and methods: Anthropometric measurements including height and weight were taken as per WHO criteria. Body mass index were calculated and classified accordingly as normal, overweight and obese. Details of factors influencing were obtained using a pretested questionnaire in a pilot study. Results and conclusion: The study revealed overall a high prevalence of overweight (44%) and obesity (10%). In males 35% were overweight and 11% were obese, while in females 49% were overweight and 9% were obese. Relation with increased frequency of meals (p = 0.007), increased sleep duration (p = 0.003) and regular exercise (p = 0.047) were found to be significant. Increased prevalence of overweight among females and obesity among males in rural area were observed. The importance of regular physical activity and certain aspects of healthy aging need to be emphasized in the elderly population. Growing old is not an end to everything but an opening for challenges and approach.

Antidepressant activity of spirulina platensis in experimentally induced dipression in mice.

The spray dried powder of Spirulina platensis was used to treatment of depression in different doses (100mg/kg, 200 mg/kg and 400 mg/kg) and Impramine (15mg/kg) as standard drug in experimental animal models like Forced swim test in mice, Tail suspension test in mice, Clonidine induced aggression behaviour in mice test, L-dopa induced hyper activity and aggressive behavior in mice, 5-HT induced head twitches in mice, From all the experimental model results were observed that the Spirulina platensis was possess the dose dependent anti depressant activity.

Lipid peroxidation and total antioxidant capacity in health and disease - Pathophysiology and markers: An overview.

Free radicals play a significant role in the pathogenesis of many chronic diseases such as diabetes mellitus, cancer, chronic renal failure etc. Oxidative stress is defined as “a disturbance in the balance between the antioxidants and pro-oxidants (OFR in particular) with increased levels of pro-oxidants leading to potential damage. The knowledge about pathophysiology of lipid peroxidation and the oxidative stress biomarkers will definitely help the researchers to plan for focused study for better management of oxidative stress induced diseases.

Academic counselling: Impact of an intervention program on medical students of pharmacology.

Background: Students are anxious and stressed during exams; so are not able to perform well in them. Counselling has been found to improve performance of students. Hence, we wanted to conduct academic counselling for medical students and evaluate it. Objective: To improve performance of medical students in exams through academic counselling (AC). Method: Faculty was trained on conducting AC through role play. A pre-test was taken to assess the baseline knowledge of students. AC of students was conducted. A post-test was then taken for the students. Marks of pre-test and post test were compared to see for improvement of students following our intervention. Feedback was taken from students on the effectiveness of counselling using a questionnaire based on 5-point Likert scale. Feedback was also taken from faculty. Results and interpretation: There was a marked improvement in post-test marks of students who underwent counselling. Feedback from students and faculties was positive. Conclusion: Faculty can guide students on study skills through AC. It can be conducted as formative feedback at mid-term or following internal exams of students.

Hyaluronic acid: A promising mediator for periodontal regeneration .

Hyaluronic acid (HA) is a natural-non sulphated high molecular weight glycosaminoglycan that forms a critical component of the extracellular matrix and contributes significantly to tissue hydrodynamics, cell migration and proliferation. The use of HA in the treatment of inflammatory process is established in medical areas such as orthopedics, dermatology and ophthalmology. In the field of dentistry, hyaluronate has shown anti-inflammatory, antiedematous and anti-bacterial effects for the treatment of gingivitis and periodontitis. Due to its potential role in modulation of wound healing, its administration to periodontal wound sites could achieve comparable beneficial effects in periodontal tissue regeneration and periodontal disease treatment.

Tissue distribution & elimination of capsaicin, piperine & curcumin following oral intake in rats.

Background & objectives: Curcumin, capsaicin and piperine - the bioactive compounds present in spices-turmeric (Curcuma longa), red pepper (Capsicum annuum) and black pepper (Piper nigrum) respectively, have a considerable portion of structural homology. Tissue distribution and elimination of these three structurally similar bioactive compounds was examined following their oral intake in rats. Methods: Separate sets of animals (150 - 160 g) were orally administered the three spice principles at dosages of 30 mg (capsaicin), 170 mg (piperine) and 500 mg (curcumin) / kg body weight. The tissue concentrations of administered spice compounds were determined by HPLC. Results: Maximum distribution of 24.4 per cent of administered capsaicin was seen at 1 h, while no intact capsaicin was detectable after 4 days. Absorption of capsaicin was about 94 per cent and very rapid relative to other two compounds. A maximum of 10.8 per cent of administered piperine was seen in tissues at 6 h. Absorption of the administered piperine was about 96 per cent. Curcumin concentration was maximum in the intestine at 1 h; maximum in blood at 6 h and remained at significantly higher level even at 24 h. About 63.5 per cent of the curcumin dose was absorbed. Only a small portion of the administered dose of capsaicin (< 0.1%) and curcumin (0.173 %) was excreted in urine, whereas piperine was not detectable in urine. Enhanced bioavailability of curcumin was evidenced when the same was orally administered concomitant with piperine. Intestinal absorption of curcumin was relatively higher when administered concomitantly with piperine, and it stayed significantly longer in the body tissues. Intact curcumin was detected in brain at 24, 48 and 96 h with a maximum at 48 h. Conclusions: Considerable difference exists in the bioavailability of the three test compounds. Curcumin could be traced in the brain following its administration. Bioavailability of curcumin can be improved by co-administration with piperine.

Photodynamic therapy - A strategic review.

Mechanical removal of the biofilm and adjunctive use of antibacterial disinfectants or various antibiotics have been conventional methods of the periodontitis therapy. There has been an upsurge of bacterial strains becoming resistant due to the injudicious use of antibiotics, recently. As a result there is pronounced interest and keenness in the development of alternate antimicrobial concepts. As the scientific community seeks alternatives to antibiotic treatment, periodontal researchers have found that photodynamic therapy (PDT) is advantageous to suppress anaerobic bacteria. Hence, PDT could be an alternative to conventional periodontal therapeutic methods. This review elucidates the evolution and use of photo dynamic therapy. The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Even though PDT is still in the experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. PDT application has an adjunctive benefit besides mechanical treatment at sites with difficult access. Necessity for flap operations may be reduced, patient comfort may increase and treatment time decrease. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

Hepatitis C virus: Molecular biology & current therapeutic options.

Hepatitis C virus (HCV) is a small (~55 to 65 nm), spherical, enveloped, hepatotropic RNA virus that causes acute and chronic hepatitis in humans. Persistent virus infection with HCV often leads to cirrhosis and hepatocellular carcinoma (HCC). At present there is neither a selective antiviral therapy nor a preventive vaccine. The only available treatment option is a long-acting pegylated-interferon-alpha, given in combination with nucleoside analog ribavirin, which is not very effective. Molecular studies of HCV began with the successful cloning of its genome in 1989. For many years, research to develop therapeutics was stalled by the inability to grow virus in tissue culture. A major milestone was achieved with the recent development of a robust cell culture system for HCV propagation. HCV proteins assemble and form replication complexes on modified host membranes, called as membranous webs. Even though HCV is detected and targeted by host immune mechanisms, it establishes and maintains a life-long persistent infection. HCV has evolved multiple strategies to survive and persist in hostile cellular environments; and the viral population is known to rapidly change during the course of a natural infection thereby escaping immune surveillance. Rapid mutations also help virus to survive by selecting for the variants which are resistant to antiviral drugs. Although precise mechanisms regulating HCV entry into hepatic cells via receptors remain unknown, HCV also has the capability of direct cell-to-cell transmission. The extremely complex and incompletely understood nature of the HCV lifecycle has complicated the discovery of new therapies. A complete understanding of the functional roles played by the HCV proteins during HCV lifecycle is vital for developing a successful cure. This review deals with current status of efforts in addressing these daunting tasks and challenges in developing therapeutics against chronic and rapidly changing hepatitis C virus.

Intracrevicular application of 0.3% Flurbiprofen gel and 0.3% Triclosan gel as anti inflammatory agent. A comparative clinical study.

This study compared the anti-inflammatory efficacy of Triclosan and Flurbiprofen in a gel form on clinical parameters of moderate gingivitis cases. The study comprised of 100 sites from 16 volunteers and used split mouth technique. 0.3% Triclosan/0.3% Flurbiprofen gels applied intracrevicularly once daily for one week. Clinical parameters like Plaque index, Gingival index and Bleeding index scores were recorded at 0 day, 4th day and 8th day. The obtained results showed significant reductions in clinical parameters from baseline to 8th day. This indicates local delivery of 0.3% Triclosan/0.3% Flurbiprofen gel can be used as an anti-inflammatory agents either alone or as an adjunct to scaling in periodontal therapy.