Tobacco use and clinical leukoplakia lesions among south Indian tribes.

OBJECTIVES: Leukoplakia is a white mucosal thickening and perhaps undermining change in the oral mucosa transcendently found in tobacco users. Since the tobacco utilization is extensively higher with the indigenous groups in the Asia Pacific locale, the current examination implicated the prevalence of tobacco consumption and leukoplakial lesions and the relationship between the two. METHODS: This cross-sectional study was conducted through six tribal hamlets of Chithalayath Forest range at Wayanad district of Kerala, South India. Leukoplakia screening was led by a senior consultant on the basis of a visual investigation and pathological evaluation was not done. An organized questionnaire was utilized to gather data on demographic details and tobacco usage status and frequency. The prevalence of clinical oral lesions among tobacco users and non users was determined using statistical analysis. RESULTS: Clinical oral leukoplakia was diagnosed in 27 (8.5%) subjects among the 317 individuals screened. The prevalence of lesions was considerably higher among tobacco consumers in comparison with non users (11 vs. 3.7%). Also, the tobacco chewers group had a higher percentage of leukoplakia. Another significant finding of this study is that the incidence of provisional leukoplakia was observed to be comparatively high among the most frequent tobacco consumers 15 (65.2%) in comparison with 8 (34.8%) in the frequent and nonfrequent users. CONCLUSIONS: Prevalence of abusive habits and clinical oral leukoplakial was substantial among the tribes. The cause and effect relationship and dose-response were also shown to have a significant association.

Implementation of virtual clinical pharmacy services by incorporating medical professionals and pharmacy students: A novel patient-oriented system to advance healthcare in India.

The healthcare sector is continuously evolving in pace to meet the medical needs of the society. Even though therapeutic reforms are happening, medication discrepancies are the prime cause of hospitalization. This has generated an invincible demand for clinical pharmacy services. Accordingly, a program that collaborates the clinical preceptor and students of department of pharmacy practice with the hospital's medical team, has been established. Any individual who has doubts on medicines can inquire through Dr MED, a virtual clinical pharmacy platform. The operating procedure of the program is presented in the article, where the program's coordinator and the pharmacy students play a significant role in sorting out the queries and finding out the evidences. On the other hand, the medical team composed of physicians and clinical pharmacists acts as a supporting component. Finally, the decision on how and what to respond to the inquirer is upon the opinions put forward by the medical team. Moreover, the system also addresses all the clinical concerns confined to medicines that ultimately enhances the patient's treatment outcome.

Tenofovir-induced Stevens-Johnson syndrome in a patient with acute hepatitis B: A rare case report.

OBJECTIVE: To report a rare case of a hepatitis B patient who developed the Stevens-Johnson syndrome (SJS) secondary to tenofovir use. CASE SUMMARY: A 61-year-old woman presented with complaints of jaundice, difficulty in swallowing, and burning sensation all over the body along with erythematous polymorphic rash on the face, upper limbs, and trunk. She was diagnosed with SJS secondary to tenofovir. The causality of adverse drug reaction was assessed using the World Health Organization-Uppsala Monitoring Centre causality scale, and adverse drug reaction was found to be probable. Tenofovir was withdrawn and the patient was conservatively managed. PRACTICE IMPLICATIONS: Through the observation of this event, we could figure out the association between tenofovir and SJS. Prompt withdrawal of the offending agent and the initiation of therapy with systemic corticosteroids and supportive medication were found to be effective.

Clopidogrel-induced hemarthrosis following knee replacement.

Background Clopidogrel is an adenosine diphosphate receptor antagonist used in patients with atherosclerotic vascular disease to reduce the incidence of ischemic events. Case Presentation A 62-year-old woman developed a spontaneous hemarthrosis of her left knee following clopidogrel treatment. To date, no case of spontaneous hemarthrosis following clopidogrel monotherapy was reported. Prompt aspiration after discontinuing clopidogrel by conservative management can assist early diagnosis and prevent further damage to the joint. The assessment of the causality of the event was carried out via Naranjo Causality Assessment Scale. A score of 5 was reported for this patient, indicating clopidogrel as a probable cause of this reaction. Conclusion We conclude that spontaneous hemarthrosis is a possible complication following clopidogrel therapy and it needs assessment when appropriate clinical symptoms (e.g. intra-articular effusion, pain) are present.

Knowledge, Attitudes and Behavior Regarding Topical Corticosteroids in a Sample of Pharmacy Students: A Cross Sectional Survey.

INTRODUCTION AND BACKGROUND: The abuse and misuse of topical corticosteroids, especially over the face, is an increasing problem encountered by dermatologists in India. Lack of patient awareness and the ease of obtaining topical corticosteroids without a prescription are important underlying factors. As the first point of contact, the pharmacist has an important role in controlling topical corticosteroid abuse. AIMS: This study aimed to evaluate the knowledge, attitudes, and behavior regarding topical corticosteroids in a sample of pharmacy students. METHODS: A cross-sectional survey was carried out among pharmacy students using convenience sampling method. A total of 110 questionnaires were distributed, and 103 valid responses were obtained. RESULTS: Majority of the students were conversant of the fact that different classes of topical corticosteroids effectuate different effects. Majority of the students concurred on points such as topical corticosteroids can have significant cutaneous adverse effects, the important role pharmacist plays in preventing topical steroid abuse, and the need to hold fast dispensing of topical corticosteroids on a prescription-only basis. However, a significant gap in knowledge related to specific side effects and awareness of different classes of topical corticosteroids was noted. Moreover, there was no statistical significant difference in terms of knowledge and awareness regarding topical corticosteroid use between postgraduate and undergraduate students. CONCLUSION: In our study, although several students were aware of the potential adverse effects of topical corticosteroids, there were gaps in the awareness about specific classes and adverse effects. Knowledge regarding the ethical and rational use of topical corticosteroids should be disseminated among pharmacy students, and the dermatologists should play a key role in this.

Prevalence and antibiotic utilization pattern of uropathogens causing community-acquired urinary tract infection in Kerala, India.

BACKGROUND: A prospective observational study was carried out over a period of 6 months among the inpatients and outpatients in the departments of general medicine, urology, obstetrics, and gynecology of a tertiary level referral hospital in south Malabar region of Kerala to assess the prevalence of various bacterial isolates and their changing susceptibility to antimicrobial agents and to evaluate the pattern of antibiotic utilization in urinary tract infection (UTI). METHODS: A total of 680 samples were analyzed from December 2015 to May 2016; among them, only 74 patients met the inclusion criteria. Of the 74 patients, 53 were female and 21 were male. Female patients were found to be significantly higher in number in the age group of 61-70years. The maximum number of UTI cases was reported from the general medicine department. RESULTS: The disease was more significantly portrayed in suburbans (47%) and rural (38%) population compared with urbans (15%). Fever (60.81%) and dysuria (48.64%) were the most common symptoms. Diabetes (34%) was found to be the major predisposing factor followed by postmenopausal factors (24%), previous UTI (14%), renal disease (9%), benign prostatic hypertrophy (8%), smoking (7%), and oral contraceptives (4%). Escherichia coli was the major isolate (n=36) followed by Klebsiella (n=13), Citrobacter (n=8), Enterococcus (n=7), Enterobacter (n=4), Pseudomonas (n=3), coagulase-negative Staphylococcus (n=2), and Proteus (n=1). Majority of patients were prescribed with cefoperazone+sulbactum (n=28) followed by levofloxacin (n=25) and nitrofurantoin (n=10). Cumulative antibiogram was prepared as the final step of the study using the WHONET 5.6 software. Gram-negative organisms such as E. coli, Klebsiella, and Citrobacter showed higher susceptibility toward piperacillin-tazobactum, cefoperazone-sulbactam, imipenem, meropenem, amikacin, and netilmicin. Gram-positive organisms such as Enterococcus showed higher susceptibility toward piperacillin-tazobactum, cefoperazone-sulbactam, amoxicillin-clavulanic acid, vancomycin, and linezolid. CONCLUSIONS: In our setting, routine culture may be necessary as treatment failure with empirical therapy is likely to occur.

Prevalence, risk factors and antimicrobial susceptibility pattern of extended spectrum ß-lactamase-producing bacteria in a tertiary care hospital.

BACKGROUND: The widespread misuse of antibiotics over the past several decades has been regarded as the contributing factor in the development of resistance toward them. Extended spectrum ß-lactamases (ESBLs) are enzymes produced by certain bacteria that can make them resistant to certain antibiotics. Early detection of ESBL strains and judicious use of antibiotics and proper implementation of infection control strategies are essential to prevent the spread of this threat in the community. The study aimed at appraising the prevalence, risk factors and antimicrobial susceptibility pattern of ESBL-producing microorganisms. METHODS: A prospective observational study was carried out in a tertiary care referral hospital located in Malappuram district of Kerala among inpatients with infection by ESBL-producing bacteria in order to estimate the prevalence, risk factors and their antibiotic susceptibility pattern. RESULTS: Out of the total 1156 patients studied, 118 had confirmed diagnosis on the presence of ESBL-producing microorganisms. Overall, 9.79% of all samples growing Enterobacteriaceae yielded an ESBL producer. Out of the total isolates identified, 66.1% were urinary tract infections, 15.1% were respiratory tract infections, 14.4% were surgical site infections and the remaining constituted blood stream infections. The highest antimicrobial activity against ESBL-producing isolates was observed for meropenem. CONCLUSIONS: High prevalence of ESBL-producing organisms is evident in the study setting implicating the necessity to report the ESBL production along with the routine sensitivity reports supplemented with control measures which can assist a clinician in prescribing appropriate antibiotics.

A prospective drug use evaluation of antihypertensive drugs in in-patients of a tertiary referral care hospital.

BACKGROUND: Hypertension is a chronic illness associated with high morbidity and mortality. Once hypertension is diagnosed, starting antihypertensive therapy on a long-term basis along with regular follow up is important. Standardizing treatment guidelines and conducting drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to analyze the prescription patterns of antihypertensive drugs in a tertiary care referral hospital in Malabar region, Kerala, India. METHODS: The study was conducted at the General Medicine and Cardiology Department involving the in-patients. Patients suffering from essential hypertension with or without other co-morbidities were included in the study. The frequency and proportion of prescribing different groups of antihypertensive drugs as monotherapy or combination therapy, and prescription of fixed drug combinations (FDCs) were analyzed. A total of 200 hypertensive patients were included in the study. Patient data were collected from in-patient's case sheets and direct interviews with the patients and their observers. RESULTS: The majority of the patients were females with 56%, whereas the males comprised 44%, with most of the patients suffering from stage-II hypertension. The study revealed that a high proportion of the hypertensive patients had co-morbid diabetes mellitus. The most commonly prescribed class of antihypertensive drugs was angiotensin receptor blockers, followed by calcium channel blockers and ß-blockers. With regard to patient therapy, 32.0% received monotherapy, whereas 68.0% received combination therapy, 16% of which received FDCs. CONCLUSIONS: The study shows that clinical pharmacists can play a key role in promoting rational prescription and improving adherence to medication.