Levofloxacin-induced tactile hallucination and acute anxiety reaction.

Fluoroquinolones are the commonly used antimicrobials in the treatment of urinary tract infection, bacterial diarrhea, and infections of soft tissue, bone, and joints. They may cause adverse effects ranging from gastrointestinal disturbances, headache, insomnia, and cutaneous reactions. Their rare adverse effects include phototoxicity, cardiotoxicity, arthropathy, and tendinitis. Among the fluoroquinolones, levofloxacin has more propensity to cause the central nervous system adverse effects such as headache, tremor, insomnia, dizziness, convulsions, psychosis, auditory, and visual hallucinations. A case of acute sinusitis in a young male treated with levofloxacin presented with tactile hallucination and acute anxiety reaction is reported for its rarity of occurrence. According to the Naranjo causality scale, the association of tactile hallucination and acute anxiety is a probable adverse drug reaction due to levofloxacin.

Mesotherapy - The french connection.

Mesotherapy involves the use of multiple intradermal or subcutaneous injections of a mixture of compounds in minute doses, by means of very fine needles, directly over/near the affected sites. Originally invented in France to manage painful medical conditions, it is presently the buzz word in the field of cosmetic dermatology, chiefly to get rid of disfiguring fat. Depending upon the condition treated, the drugs injected, the techniques followed and the number of sessions involved vary. The wider reception of mesotherapy by its stakeholders are probably due to factors like inexpensive equipments, relatively minimal training for providers, much reduced dosage need of the drugs with resultant minimal untoward effects, quicker realization of benefits, minimal invasiveness/pain involved and not the least it is an outpatient procedure. Despite so many plus points, it has to be noted that currently there is a dearth of rigorous scientific studies to prove its efficacy and safety. Further, the average cost per session alone ranges from 200 USD to 600 USD.

Bullying among trainee doctors in Southern India: a questionnaire study.

BACKGROUND: Workplace bullying is an important and serious issue in a healthcare setting because of its potential impact on the welfare of care-providers as well as the consumers. AIMS: To gauge the extent of bullying among the medical community in India; as a subsidiary objective, to assess the personality trait of the bullying victims. SETTINGS AND DESIGN: A cross-sectional, anonymous, self-reported questionnaire survey was undertaken among a convenient sample of all the trainee doctors at a Government Medical College in Tamil Nadu, India. MATERIALS AND METHODS: A questionnaire, in English with standard written explanation of bullying was used. Basic information like age, sex, job grade and the specialty in case of Postgraduates (PGs) were also collected. STATISTICAL ANALYSIS: The results were subjected to descriptive statistical analysis and Chi-square test for comparison of frequencies. RESULTS: A total of 174 doctors (115 PGs and 59 junior doctors), took part in the study with a cent percent response. Nearly half of the surveyed population reported being subjected to bullying. Nearly 54 (53%) of the men and 35 (48%) of women were subjected to bullying. Significant proportions (P < 0.0001) of medical personnel and paramedical staff bullied the PGs and junior doctors, respectively. More than 85 (90%) of bullying incidents went unreported. A significant (P < 0.0001) percentage of PGs and junior doctors revealed a personality trait towards bully. CONCLUSIONS: Workplace bullying is common among trainee doctors and usually goes unreported.

Attitude towards rape: a comparative study among prospective physicians of Malaysia.

The global statistics reveal that at least one in every five women experiences rape or attempted rape during her lifetime. Rape myths encompass a set of (false) beliefs. Adolescents have high rates of rape victimization than other age groups. Rape myths among health care providers may have a negative influence on proper care of the victims. A total of 422 medical undergraduates of both sexes, studying at two Malaysian Institutes took part in the study. A validated questionnaire used in an earlier study was used for the present study, with a slight modification of scoring system. The age range of medical students was 17 to 34 years: mean +/- SD of men and women, were 20.6 +/- 2.1 and 20.3 +/- 2 respectively. Only about 19% of women and 11% of men had a very good positive attitude. Nearly 1/3 of women and 1/2 of men had a more negative attitude. On the whole the average total score of women was significantly higher (p=0.0004) than men. Nearly 50% of candidates with a village background carried more negative attitude. Violence against women is a significant public health problem. The major revelation of the present study is that only less than 20% of the medical undergraduates had a more positive attitude towards rape. Introduction of courses on 'sexual violence' in medical curriculum is likely to increase a) awareness, b) skills in management, c) in providing support and care for the victims and d) in implementing preventive actions.

A survey on current attitude of practicing physicians upon usage of antimicrobial agents in southern part of India.

CONTEXT: Antimicrobial resistance is a serious public health concern worldwide. Inappropriate prescribing, including the wrong drug, incorrect dose/duration, and poor compliance, contributes to it. OBJECTIVE: To identify factors determining the attitudes and practices of prescribers regarding antibiotic usage and to suggest measures that contain antibiotic resistance. DESIGN AND SETTING: With a convenient sample, general practitioners and specialists of both sexes from 5 districts of Tamilnadu state, India, were approached for the study. A slightly modified, self-administered, anonymous questionnaire of the Alliance for the Prudent Use of Antibiotics was used. The deciding factors to prescribe an antibiotic and the reasons for the attitude to prescribe a broad-spectrum antibiotic were elicited. RESULTS: Out of the 285 participants 120, 110, and 47 practiced at city, semiurban, and rural areas, respectively. The responses were graded with a total possible score of 150. There was no significant difference between men and women or between specialist and nonspecialists in scores. The majority believed that antibiotics are overprescribed. Purulent discharge (65%), antibiotic-resistance concerns (48%), fever (40%), and patient satisfaction (29%) were the strong influences to prescribe an antibiotic. Similar reasons were cited for the belief of prescribing a broad-spectrum antibiotic. The 3 most commonly prescribed antimicrobials were amoxicillin (21%), ciprofloxacin (18%), and co-trimoxazole (11%). About 42% used an antibiogram only to the extent of less than 10%. CONCLUSION: Patient requests/expectations, patient satisfaction, purulent discharge, and fever strongly pressurized practitioners to prescribe antibiotics. Patient and time pressures, diagnostic and treatment uncertainties, and the poor utilization and/or ill-affordable antibiogram facility all point to an urgent, multidimensional approach to contain antibiotic resistance.

Study of the knowledge, beliefs, and practice of sleep among medical undergraduates of Tamilnadu, India.

CONTEXT: Sleep-related problems are common in young adults who are enrolled in professional colleges due to academic and social pressures, which may subsequently have serious consequences. OBJECTIVES: This study was conducted to find out whether final-year medical undergraduates possess basic, clinically relevant knowledge (K) regarding sleep and sleep-related problems and to discover their beliefs (B) regarding sleep and sleep hygiene. We also wanted to assess their sleep practices (P) and suggest remedial measures, if necessary. DESIGN AND SETTING: Six hundred fifteen final-year medical undergraduates of both sexes belonging to 6 medical colleges of Tamilnadu state, India, were given a self-administered, anonymous questionnaire to test their basic knowledge (11 items), prevailing beliefs regarding sleep (including sleep hygiene [13 items]), and their sleep practices (6 items). RESULTS: In all 3 domains tested (K, B, and P), there was no significant difference between sex. An appreciable percentage scored < or = 70% marks ("good") only in K and P (63.9% and 79.5% of all participants, respectively), whereas only a very small percentage scored "good" in B (9.1%). There was no difference in K, B, or P in terms of sex or domiciliary status except for a significant difference (P < .012) regarding beliefs between urban and rural groups. There was also no correlation between knowledge and beliefs or between knowledge and practice. CONCLUSION: We conclude that future doctors have insufficient knowledge with more misconceptions (indirectly reflecting inadequate knowledge) regarding sleep. Hence, there is a compelling need to develop an educational strategy to overcome misconceptions and improve knowledge regarding sleep-related problems and proper sleep practices among students.

Injection practices in southern part of India.

The World Health Organization defines 'a safe injection' as one that does not harm the recipient, does not expose the provider to any avoidable risk, and does not result in any waste that is dangerous to the community. Irrational and unsafe injection practices are rife in developing countries. The objective of the present study was to assess the injection practices in the state of Tamilnadu, India, using the Rapid assessment and response guide of the Safe Injection Global Network of the World Health Organization. Thirty-nine prescribers, 62 providers, and 175 members of the general public were interviewed. The areas were chosen out of convenience while at the same time adhering to the guidelines. The study was carried out between April and June 2001. The per capita injection rate was 2.4 per year. The ratio of therapeutic to immunization injections was 6.5:1, and the proportion of injections given with a disposable syringe and needle was 35.4%. Knowledge about diseases transmitted by unsafe injections, for example involving human immunodeficiency virus and hepatitis B virus, was greater among all the study groups. The annual incidence of needlestick injuries among providers was 23.6, which is extremely high. It is concluded that there are deficiencies in practice such as an excessive, unwarranted usage of injections, a sizeable prevalence of unsafe injection practices, the short supply of injection equipment leading to a high incidence of needlestick injuries, a low proportion of hepatitis B virus immunization among providers, and a lack of adequate sharps containers and disposal facilities in this part of India. It is suggested that immediate and long-term remedial measures, such as the education of prescribers to reduce the number of injections to a bare minimum, an adequate supply of injection equipment, provider protection with immunization for hepatitis B virus, the provision of adequate sharps containers with safe disposal facilities and, not least, community education, be undertaken to avoid the future epidemic of transmissible diseases.

A comparative study of the knowledge, beliefs, and practices of diabetic patients cared for at a teaching hospital (free service) and those cared for by private practitioners (paid service).

The aim of this study was to determine and compare the knowledge, beliefs, and practices of diabetics receiving free medical care and those paying for medical care in Tamilnadu, India. A questionnaire was administered to elicit diabetic patients' knowledge regarding diet, exercise, adverse effects, habits, and other matters; their beliefs about diabetes; and their practices regarding diet, medication, and self-monitoring. The results showed a large gap between knowledge and action in both groups and a need for increased efforts toward patient education regarding diabetes.

Ascorbic acid delays the development of tolerance to amphetamine induced anorexia but does not affect the reverse tolerance which develops to the locomotor activity.

Ascorbic acid (1 g/kg) accentuated anorectic and locomotor effects of amphetamine (5 mg/kg) and delayed development of tolerance to anorectic effect. On the contrary, it did not alter the pattern of reverse tolerance to increased locomotor activity. The results suggest that modulation of dopamine receptor sensitivity by ascorbic acid may be the reason for the delay in development of tolerance to amphetamine induced anorexia.

Short term anti-tubercular drug therapy and hepatic microsomal enzyme activity. Antipyrine metabolism as an index.

The effect of short course chemotherapy on the drug metabolising capacity of the liver was studied in 7 newly diagnosed pulmonary tuberculosis patients, using antipyrine as a model drug. Antipyrine elimination half-life and plasma clearance rate were not significantly altered by 3 weeks of therapy. It is concluded that short course chemotherapy does not affect antipyrine metabolising enzyme activity.

Alphamethyldopa analgesia: its possible mechanism of action.

The analgesic activity of alphamethyldopa (MD) was studied in mice using the acetic acid writhing test and the hot plate method. In the writhing test, MD produced a dose-dependent analgesic effect with an ED 50 of 26.5 mg/kg. The results of the hot plate test confirmed the analgesic activity of MD. Yohimbine, but not naloxone, antagonized the analgesic effect of MD in the writhing test. Atropine antagonized MD analgesia while physostigmine potentiated it. The study suggests that MD analgesia is of the nonopioid type involving both adrenergic and cholinergic systems.