A cross-sectional evaluation of behavior and attitude of pharmacists toward dispensing non-OTC drugs without prescription in a city of Southern Rajasthan

Background: Over the counter (OTC), drugs are found to be safe and appropriate for use without supervision of a healthcare professional such as physician and they can be purchased by consumers without prescription. The study gains its importance because of the spreading of misuse of antibiotics and various drugs adverse drug reactions in the society. Aims and Objectives: The main aim of the study is to observe as to how many pharmacists/chemists/drug store sellers follow or violate the drug cosmetic act. Materials and Methods: It is an observational and cross-sectional study conducted among pharmacies of Udaipur city, urban areas of Southern Rajasthan. The study includes a sample size of 200 pharmacies selected through convenient random sampling. A detailed semi-structured questionnaire is administered to the pharmacists. The set of questions include types of drugs, reason for dispensing, knowledge, and attitude of pharmacist toward dispensing non-OTC drugs. All the private pharmacies willing to participate were included in the study. Data are entered in Microsoft Excel and statistically analyzed. Results: The results throw light on the behavior and pattern of dispensing habits of the drug store sellers of the city of Udaipur, Southern Rajasthan. It was observed that many pharmacists are in fact in the habit of dispensing non-OTC drugs in almost all the areas. Conclusions: Results give insights about the groups of drugs, logic, behavior, and knowledge level of pharmacists involved in dispensing practices in the city of Udaipur. There should be structured educational campaigns (or use of media, internet, newspaper, radio, television, advertisements, mobiles, etc.) for both pharmacists and public.

Use of complementary and alternative medicines in ENT outpatient department of tertiary care hospital in Southern Rajasthan

Background: Complementary and alternative medicine (CAM) use is highly gaining popularity along with main treatment streams these days. Physicians cannot ignore this fact and should question and counsel patients about pros and cons of CAM for cure of different ailments. Aim and Objectives: The objective of the study was to know about use of CAM among patients visiting Ear, Nose, and Throat (ENT) outpatient department (OPD) in tertiary care hospital of Southern Rajasthan. Materials and Methods: An observational cross-sectional study was conducted in ENT OPD for 2 months. Two hundred and fifty patients were considered for the study. Semi-structured questionnaire was prepared and made to be filled by the patients during their visit to ENT OPD after taking informed consent. Various questions were asked like extent of use of alternative therapies, type of CAM used by the patients, patient’s knowledge about ADRs and drug interactions, reasons for which alternative medicine might have been used. Results: Among 250 patients, CAMs were used by 36 patients. The most common CAMs were either Ayurveda or Homoeopathy medicines or both. The majority of patients obtained their information from family and friends. Maximum patients used these alternative medicines for relief of cough and hoarseness of voice. Conclusion: The study throws light on use of alternative drug therapy and streams of medicine along with routine hospital treatment among patients visiting ENT OPD. This knowledge helps to understand about patients’ alternative approach to diseases, about self-medication, patient’s belief about different types of therapies and also ignorance of possible health hazards, side effects, and complications due to use of concomitant main and alternative medicines for treatment purposes.

Drug utilization pattern in ENT outpatient department in tertiary care teaching hospital in Southern Rajasthan

Background: Drug utilization study is one of the most potent tool to promote rational drug use in medical, social, and economic scenario. Very less or no study has been done in Southern Rajasthan, hence this study shows valuable insights in Drug Utilization pattern. Aim and Objectives: To evaluate the drug utilization pattern in ear, nose and throat (ENT) outpatient department (OPD) in M.B. government hospital, Udaipur, Rajasthan. Materials and Methods: A prospective observational study was done in ENT OPD for a period of 9 months. Total 445 prescriptions were taken into consideration. All patients of the age group 18 years and above were included in the study. Results: Of total 445 cases, maximum number of patients (7.19%) suffered from bilateral chronic suppurative otitis media and minimum (2.02%) from eustachian tube block. A total number of drugs prescribed were 60. Maximum utilized drug was ibuprofen and minimum was Acyclovir. Mean number of drugs prescribed were 2.615. Maximum drugs were given by oral route and minimum as gargles. Total prescribed drugs were 1164. Most common prescribed drug group was NSAIDS (23.19%). Total cost of therapy was 58,584, cost per patient was122.6. Prescribed daily dose/defined daily dose ratio was calculated for antibiotics. Conclusion: Study shows rational drug prescribing. Account of Alternative medicine was taken in consideration, isolation of microorganisms prior drug prescribing was not done.

Histopathological study of salivary gland tumors: a tertiary care hospital-based study

Introduction: Salivary gland tumors (SGTs) are relatively uncommon and show a wide variety of morphological heterogeneities. The incidence of SGTs is said to be affected by geographical and racial factors. Histopathological diagnosis plays a major role in the diagnosis of these neoplasms. Objectives: This study investigated the incidence of SGTs and histopathological features of various SGTs, aimed at knowing the epidemiological pattern of these tumors and comparing the results of our study with other studies of SGTs in the literature. Materials and Methods: A retrospective study was conducted on SGTs at the Pathology Department of the Government Medical College and Hospital for a period of 5 years. Clinical and demographic data were documented and analyzed concerning histopathologic type. Results: A total of 86 SGTs were identified, 65.12% of which were classified as benign and 34.88% as malignant. Most tumors occurred in the parotid gland (59.14%). Pleomorphic adenoma (PA) was the most common tumor (56.98%), followed by mucoepidermoid carcinoma (MEC) (17.44%). The tumors occurred more often in men (51.16%) than in women (48.84%). Conclusion: SGTs exhibit broad morphological heterogeneity and these tumors are rare. The parotid gland is the most common location, and PA is the most frequent benign tumor. MEC followed by adenoid cystic carcinoma is the most common malignancy of the salivary gland.

Experimental Studies to Define the Role of Calcium (Ca2+) and Voltage-Gated Calcium Channel Blockers (vCa-CCB) against Neurosteroid Induced Obesity

Introduction:Obesity is closely associated with various types of illness, primarily caused by more calorie intake than body burn. In adipocytes, Calcium (Ca2+) is an important second messenger involved in theregulation of many physiological functions which are essential for survival. In the present research, we have investigated the role of Ca2+ions in obesity by manipulating cytosolic Ca2+ion concentration by selective blocking/advancing the Ca2+ions through the voltage-gated calcium channels. Voltage-gated calcium channel (vCa) plays a key role in regulating intracellular and extracellular Ca2+concentration.Cytoplasmic level of Ca2+was manipulated by supplying calcium carbonateand by using vCa blockers i.e. nifedipine-(N-type-vCa-CCB) and ethosuximide (T-type, vCa-CCB).Methods:Obesity was induced by progesterone in female mice and test drugs were co-administered with progesterone whereas sibutramine was used as standard. The treatment was carried out for 28 days, during and afterthetreatment periodvarious parameters were studied viz food consumption, change in body weight and temperature, the effect on WAT (white adipose tissue, adiposity index, histology of fat pad) and fecal lipid content.Results:Calcium carbonate treated group has shown promising effects in the decrease in body weight by increasing fecal lipid content and lipolysis which was reflected by an increase in body temperature. Ethosuximide also offered significant protection by decreasing the food intake but has not shown any notable effect on fecal fat content, whereas nifedipine has not offered any protection against the obesity induced by neurosteroid.Conclusion:Calcium carbonate has significant anti-obesity activity by including thermogenesis, and increasing fecal lipid content

Study of Blood Pressure Variability and Nocturnal Dipping in Primary Hypertensive Patients by Ambulatory BP Monitoring

Introduction: Assessment of fluctuation of blood pressure in atime range from minutes to hours is possible through the use ofintermittent, noninvasive 24 h ambulatory blood pressuremonitoring (ABPM).This study was conducted with the Aimsand Objectives of determining BP variability and nocturnaldipping in primary hypertensive patients.Materials and Methods: The present observational study wasconducted at a tertiary care hospital after getting approval fromEthics Committee with 80 patients between August 2016 toOctober 2017. Schiller BR-102 plus 24 hour ambulatory BloodPressure Recorder was the equipment used for our study.Statistical analysis of data derived from patients was done.Results: Out of 80 patients studied, 53 patients had one ormore of Target Organ Damage and there was no evidence ofTarget Organ Damage in 27 patients. In the present study, nosignificant difference has been found in nocturnal dipping andblood pressure variability in patients with and without targetorgan damage.

A comparative study of effects of nebivolol and atenolol on blood pressure and lipid profile in patients of mild to moderate hypertension

Background: Beta blockers have been used in the treatment of hypertension, since last four decades and are widely accepted as the first-line treatment for hypertension. Nebivolol, a third generation ?-blocker has highest ?1 selectivity and is devoid of intrinsic sympathomimetic activity. Along with peripheral vasodilatation and nitric oxide (NO)-induced benefits such as antioxidant activity and reversal of endothelial dysfunction, nebivolol promotes better protection from cardiovascular events. The objective of the study was to compare the effects of atenolol and nebivolol on both blood pressure and lipid profile in patients of mild to moderate hypertension.Methods: This was a prospective, randomized, parallel, open labelled study. Patients were recruited from the medicine out-patient department (OPD) and cardiology OPD. A total of 100 patients were enrolled in the study. 50 patients were allocated to atenolol group and 50 patients to nebivolol group. BP and baseline investigations such as lipid profile were performed. Tests to determine lipid profile were performed on the first visit (Week 0) and at 24 weeks. Continuous variables between the two treatment groups were analyzed by unpaired t-test. Efficacy endpoints within the group were analyzed by using paired t-test.Results: All the lipid levels except HDL-C were increased with atenolol therapy. At 24 weeks, atenolol therapy led to increase in LDL-C, VLDL-C, TC and TG which was highly significant (p<0.0001). HDL levels were decreased at 24 weeks which was also statistically highly significant (p<0.0001). The mean values of lipids in nebivolol group at baseline and at 24 weeks. At 24 weeks, nebivolol therapy led to changes in LDL-C, VLDL-C, HDL-C, TC and TG which was not statistically significant (p>0.05).Conclusions: From study it can be concluded that atenolol and nebivolol are equally effective in reducing BP but atenolol worsens lipid profile as compared to nebivolol.

Distribution of killer immunoglobulin-like receptor genes in HIV infected long-term non-progressors from Mumbai, India

Background: Few reports suggest the association of killer immunoglobulin-like receptors of natural killer cells with human immunodeficiency virus infection. India with world's third largest population of human immunodeficiency virus / acquired immunodeficiency syndrome, offers scope to study such association. Objective: Current study (2010-2015) was designed to evaluate if killer immunoglobulin-like receptors gene polymorphisms are associated with HIV infection outcomes specifically, with long term non progressors. Methods: Killer immunoglobulin-like receptors genotyping was done using polymerase chain reaction - sequence-specific primer method. Viral load was measured by Cobas Taqman HIV-1 test. Estimation of CD4 counts was done using BD FACS CD4 count reagent. Results: The activating gene frequencies identified were 3DS1 (53.8%), 2DS3 (69.2%), 2DS4 (76.9%), 2DS5 (69.2%), 2DS1 (76.9%) and 2DS2 (92.3%). The inhibitory gene frequencies were 2DL2 (92.3%), 2DL5 (76.9%), 2DL3 (69.5%), 3DL1 (84.6%), 3DL2 (92.3%) and 2DL1 (100%). The results highlight high frequency of 3DS1/3DL1 heterozygote and killer immunoglobulin-like receptor 2DS1, among these long term non progressors indicating their possible association with slow progression. Genotype analysis shows total 13 genotypes, of which 8 genotypes were identified for the first time from India. Two genotypes were unique/novel, which were unreported. All genotypes observed in this study were considered to be Bx genotype (100 %). Limitations: A small sample size (n=13, due to a rare cohort) and the absence of control group were the limitations of this study. Conclusions: The present study highlights the distribution of killer immunoglobulin-like receptor genes in a very rare group of human immunodeficiency virus -1 infected individuals - long term non progressors. All the long term non progressors tested show the presence of Bx haplotype and each long term non progressors has a different killer immunoglobulin-like receptor genotype.

A Brief Review on the Potential Medicinal Plants and Screening Models of Urolithiasis.

Kidney stones or urolithiasis is a growing global problem. It is a complex phenomenon which results due to physiochemical changes including super saturation, crystallization and retention within the renal tubules. The problem of the stone formation is considered as a medical challenge due to its high rate of recurrence and also due to multifactorial etiology. Medicinal plants are found to be useful in this metabolic disorder from ancient days due to its no or low-toxic nature, easily available in rural areas, cheap, there are less chances of recurrence. The purpose of this paper is to critically review available literature on herbal medicines and screening models for urolithiasis inorder to develop effective drug to treat the disease.

Clinical utility of multiplex ligation-dependent probe amplification technique in identification of aetiology of unexplained mental retardation: A study in 203 Indian patients.

Background & objectives: Developmental delay (DD)/mental retardation also described as intellectual disability (ID), is seen in 1-3 per cent of general population. Diagnosis continues to be a challenge at clinical level. With the advancement of new molecular cytogenetic techniques such as cytogenetic microarray (CMA), multiplex ligation-dependent probe amplification (MLPA) techniques, many microdeletion/microduplication syndromes with DD/ID are now delineated. MLPA technique can probe 40-50 genomic regions in a single reaction and is being used for evaluation of cases with DD/ID. In this study we evaluated the clinical utility of MLPA techniques with different probe sets to identify the aetiology of unexplained mental retardation in patients with ID/DD. Methods: A total of 203 randomly selected DD/ID cases with/without malformations were studied. MLPA probe sets for subtelomeric regions (P070/P036) and common microdeletions/microduplications (P245-A2) and X-chromosome (P106) were used. Positive cases with MLPA technique were confirmed using either fl uorescence in situ hybridization (FISH) or follow up confirmatory MLPA probe sets. Results: The overall detection rate was found to be 9.3 per cent (19 out of 203). The detection rates were 6.9 and 7.4 per cent for common microdeletion/microduplication and subtelomeric probe sets, respectively. No abnormality was detected with probe set for X-linked ID. The subtelomeric abnormalities detected included deletions of 1p36.33, 4p, 5p, 9p, 9q, 13q telomeric regions and duplication of 9pter. The deletions/duplications detected in non telomeric regions include regions for Prader Willi/Angelman regions, Williams syndrome, Smith Magenis syndrome and Velocardiofacial syndrome. Interpretation & conclusions: Our results show that the use of P245-A2 and P070/P036-E1 probes gives good diagnostic yield. Though MLPA cannot probe the whole genome like cytogenetic microarray, due to its ease and relative low cost it is an important technique for evaluation of cases with DD/ID.

Validation of DNA Damage Progression with Days after Single Exposure of Sublethal Dosage of Electron Beam Radiation.

The aim of this study was to asses the DNA damage progression with days after single exposure of 6Gy electron beam radiation (EBR). Molecular DNA damage in lymphocytes of mice was assessed using alkaline comet assay and in bone marrow cells by micronucleus assay. In comet assay %DNA in tail, Comet length, Olive Tail Moment (OTM) served as a measure of DNA damage and in micronucleus test, frequency of micronucleus formation in bone marrow cells was measured to evaluate the DNA damage. The experiment was performed by taking 24 healthy Swiss albino mice with body weight 30+5g. The animals were grouped into four. Group1 served as control, Group 2, 3 and 4 were irradiated by 6Gy EBR. Animals of Group 2, 3 and 4 were sacrificed on 5th, 10th and 15th day post irradiation respectively. The comet assay procedure was carried out for all these groups by using lymphocytes separated from EDTA treated blood. The micronucleus test was performed in bone marrow cells (PCE-Poly chromatic erythrocytes, NCE-normochromatic erythrocytes). The slides prepared for this were scored for the measure of DNA damage. The results showed all comet parameter were significantly (P<0.05) affected by prolonging the post irradiation days from zero (control) to 5, 10 and 15. There was an alteration found in the PCE/PCE+NCE ratio in irradiated mice. A linear increase in the micronucleus formation was observed in post irradiated days. These results conclude a progression in DNA damage with days, post irradiation.

A rapid densitometric method for quantification of wedelolactone in herbal formulations using HPTLC.

Wedelolactone possesses a wide range of biological activities and is used for the treatment of hepatitis, cirrhosis. A simple HPTLC method has been developed for the quantification of wedelolactone. The samples were dissolved in methanol and linear ascending development was carried out in twin trough glass chamber saturated with mobile phase consisting of toluene: ethyl acetate: acetone: formic acid (6:2:1:1v/v/v/v). Spectrodensitometric scanning was performed by TLC scanner III (CAMAG) in absorbance mode at the wavelength of 351nm.The system was found to give compact spots for wedelolactone (Rf value of 0.39 ± 0.03). The linear regression analysis data for the calibration plots showed good linear relationship with r2 = 0.9963 in the concentration range 400-800 ng/spot with respect to peak area. According to the ICH guidelines the method was validated for accuracy, precision, recovery, and robustness. The wedelolactone content quantified from herbal formulations was found well within limits. Statistical analysis of the data showed that the method is reproducible and selective for the estimation of wedelolactone.

Use of multiplex ligation-dependent probe amplification (MLPA) in screening of subtelomeric regions in children with idiopathic mental retardation.

Objective. To detect subtelomeric copy number variations (deletions and duplications) using Multiplex Ligation-Dependent Probe Amplification (MLPA) technique in children with idiopathic mental retardation. Methods. All children presenting to the genetics out-patient department for evaluation of mental retardation or developmental delay over a period of two years, for whom no identifiable cause could be found by clinical evaluation, karyotyping, neuroimaging and other relevant investigations. Results. In the present study, two cases deletions and one case of duplication were detected amongst 65 cases with idiopathic mental retardation/ global developmental delay. The overall detection rate is 4.6%. The detection rate is higher (13%) in children with facial dysmorphism. Conclusion. MLPA for subtelomeric regions is recommended for evaluation of children with idiopathic mental retardation/ global developmental delay were included in the study.