The perceived usefulness of community based education and service (COBES) regarding students' rural workplace choices.

BACKGROUND: Community Based Education and Service (COBES) are those learning activities that make use of the community as a learning environment. COBES exposes students to the public and primary health care needs of rural communities. The purpose of this study was to investigate students' perceived usefulness of COBES and its potential effect on their choice of career specialty and willingness to work in rural areas. METHOD: A mixed method cross sectional study design using semi-structured interviews, questionnaires, and focus group discussions were used for health facility staff, faculty and students and community members. RESULTS: One hundred and seventy questionnaires were administered to students and 134 were returned (78.8% response rate). The majority (59.7%) of students were male. Almost 45% of the students indicated that COBES will have an influence on their choice of career specialty. An almost equal number (44%) said COBES will not have an influence on their choice of career specialty. However, 60.3% of the students perceived that COBES could influence their practice location. More males (64.7%, n = 44) than females (57.8%, n = 26) were likely to indicate that COBES will influence their practice location but the differences were statistically insignificant (p = 0.553). The majority of students, who stated that COBES could influence their practice location, said that COBES may influence them to choose to practice in the rural area and that exposure to different disease conditions among different population groups may influence them in their career choice. Other stakeholders held similar views. Qualitative data supported the finding that COBES could influence medical students' choice of specialty and their practice location. CONCLUSION: Medical students' 'perceptions of the influence of COBES on their choice of career specialty were varied. However, most of the students felt that COBES could influence them to practice in rural locations.

Topiramate: a new safe and effective antiepileptic.

Twenty patients of either sex, with refractory partial epilepsy with or without secondary generalisation were entered in an open label study to evaluate the efficacy and safety of topiramate in them. Topiramate was used as an adjunctive therapy with an initial starting dose of 50 mg/day. The dose was then titrated upwards with increments of 50 mg per week, till a time the most effective and the best tolerated dose was reached. This most effective/tolerated dose was then continued for 6 months. Of the 17 patients entering the maintenance phase, 4 patients (24%) became seizure free, while a total of 14 patients (83%) out of 17 cases responded with a reduction in monthly seizures rate by 50% or more. Mean reduction of 68.9% was observed in monthly seizure rate during the maintenance phase. The median effective dose of topiramate was 600 mg per day. Five patients dropped out of the study due to adverse events such as anxiety, aggressiveness, rash, lethargy, etc. The central nervous system (CNS) related side effects such as dizziness, headache, and tremor were reported, which are commonly seen with other presently available antiepileptics like carbamazepine, phenytoin sodium, sodium valproate, etc, as well. Most adverse events, however, were mild and transient and did not interfere with the day to day activity of the patients. Topiramate was not associated with any abnormality in laboratory or neurological examination findings. The excellent response with topiramate therapy in Indian patients, uncontrolled with the available antiepileptics, as well as its good safety profile endorse the international efficacious and safe image of topiramate.

Risperidone in schizophrenia.

Efficacy and safety of new antipsychotic agent-risperidone was evaluated in the confirmed schizophrenic patients of either sex, over 15 years of age. Of the 30 patients who entered the study, 27 completed the trial as per the protocol and only 3 dropped out, one was lost to follow up, the other was an uncooperative patient who pulled out of the trial due to moderate side effects while one patients withdrew the consent at his own free will. The significant improvements were seen in the broad range of symptoms of schizophrenia at various time points in the trial. The significant beneficial effect on negative symptoms was particularly obvious. The drug was well tolerated by most patients, and side effects, when reported, were mild. Even the extrapyramidal symptoms reported could be easily controlled with oral trihexyphenidyl hydrochloride. The exhaustive extrapyramidal symptom rating scale also did not show any worsening during risperidone therapy. The efficacy and safety profile of novel antipsychotic drug risperidone makes it a useful therapeutic agent in the broad range of patients with schizophrenia.

Ribavirin in acute viral hepatitis.

A double-blind, placebo-controlled trial using ribavirin (200 mg orally four times a day for two weeks) was conducted in 30 patients with acute uncomplicated viral hepatitis (excluding hepatitis B). Clinical and laboratory parameters were evaluated on days 5, 10 and 14 after starting treatment. Mean levels of ALT and AST were significantly lower in the ribavirin treated group as compared to the placebo group on days 5, 10 and 14; serum bilirubin levels were significantly lower in the ribavirin group on days 10 and 14. Ribavirin therapy was not associated with any significant side effects. We conclude that ribavirin therapy in acute uncomplicated non-B viral hepatitis leads to more rapid normalisation of biochemical parameters.

Ribavirin in acute viral hepatitis.

Sixty-four patients suffering from acute viral hepatitis (excluding those suffering from hepatitis B) were selected for the double blind clinical trial. They were randomly allocated to either ribavirin therapy (200 mg four times a day) or placebo. Four patients were lost to follow up and therefore final analysis was carried out on 60 patients (thirty had received ribavirin and the rest placebo). Patients receiving ribavirin showed significant rapid improvement, with the disappearance of annoying symptoms (e.g., nausea, vomiting, etc) and return of good appetite; moreover, the abnormal blood parameters showed significant rapid changes towards normal values in ribavirin treated patients as compared to those observed in placebo group. Ribavirin was well tolerated and there were no side effects. Since acute viral hepatitis is endemic with outbreaks of epidemics in many areas at various times and as yet there is no effective anti-viral drug available with the physicians in India, ribavirin is indeed a most welcome drug for its therapy.