Medical certification of cause of death during COVID-19 pandemic - a challenging scenario.

Death certificate data is used to monitor local, regional and national mortality trend and is helpful in improving public health as well as public safety. Accurate and reliable information about the cause of death in a population is useful for understanding disease burden estimation and trends in the health of populations; moreover, the information provided by such data is vital in terms of public health planning as well. With the continuous upsurge in mortality due to coronavirus disease 19 (COVID-19), mortality analysis could be valuable in addressing the current pandemic and implementing the epidemic control strategies effectively and efficiently. Given that COVID-19 death certification substantially affects the local and national responses towards disease prevention and transmission, the importance of the accuracy and quality of information in these certificates cannot be understated. Hence, accurate death certification related to COVID-19 is vital to understand the extent and progression of the current pandemic.

Impact factor: Mutation, manipulation, and distortion.

Currently, there is an increased dependency on the impact factor in scientific research publications. Sometimes the overzealousness in implementing the impact factor value to a publication is detrimental to the growth of the scientific authors, especially the junior lot, for no fault of theirs. The inept and myopic application of the impact factor defeats the purpose of making the value judgment and hence has been criticized by many learned authors. The scientist Eugene Garfield, who formulated the impact factor, feels wrong that it is being not judiciously used. A corollary is the invention dynamite by Alfred Nobel which instead of helping, aiding, and reducing human effort and endeavor it was more misused for human annihilation and pained the scientist who gave it to the world. The authors reexamine the application of impact factor to scientific manuscripts for rightful application of the value judgment.

Why the Jan Aushadhi Scheme Has Lost Its Steam in India?

The Jan Aushadhi Scheme (JAS) initiated by the Government of India is a powerful intervention against the unjustifiable pricing of medicines by private pharmaceutical industry, to make the generic medicines available at affordable prices. The marginalized populations of India are not able to afford many branded medicines; hence, there is an urgent need for making the cheaper generics available to Indians in the best interest of populations. It has been observed that lack of awareness in the public, distribution of free medicines by state governments, lack of support for JAS, poor supply chain, and doctors not prescribing generic medicines are the major constraints faced by the JAS leading to its poor success.

Efficacy of Atorvastatin in Prevention of Contrast-induced Nephropathy in High-risk Patients Undergoing Angiography: A Double-blind Randomized Controlled Trial.

OBJECTIVE: To evaluate the efficacy and safety of atorvastatin (ATN) 80 mg in the prevention of contrast medium- induced nephropathy (CIN) in high risk patients undergoing angiograph. MATERIALS AND METHODS: This was a prospective, double-blind, two-arm, parallel group RCT. A total of 216 patients undergoing coronary angiography were screened, and 188 eligible patients were randomized to two treatment arms. Patients in Group A received tablet N-acetylcysteine (NAC) 1200 mg once daily, and patients in Group B received tablet atorvastatin 80 mg + NAC 1200 mg once daily, for 3 days before, and 2 days after angiography. RESULTS: A total of 160 patients completed the trial. Postprocedure, nine and two CIN cases were found in Group A and B, respectively. The mean change in serum creatinine was 0.086 ± 0.168 in Group A and 0.021 ± 0.083 in Group B, which was statistically significant (P = 0.0289). Postprocedure, the estimated glomerular filteration rate was reduced by 19.52 in Group A and 13.55 in Group B (P = 0.003). CONCLUSION: This trial indicates the positive role of statins in preventive strategy against CIN along with NAC.

Disposal practices of unused and expired pharmaceuticals among general public in Kabul.

BACKGROUND: Most of the medicine users remain unaware about the disposal of unused or expired medicines. The aim of this study was to know the disposal practices of unused and expired medicines among the general public in Kabul. METHODS: This was a descriptive, cross-sectional survey, conducted through face-to-face interviews using prevalidated structured questionnaire. Returned questionnaires were double-checked for accuracy. Statistical Package for Social Science (SPSS) version 23 was used for statistical analysis. RESULTS: Total of 301 valid questionnaires were returned with a response rate of 100% in which 73.4% men and 26.6% women participated. More than half of the respondents were university graduates. Interestingly, 83.4% of the interviewees purchased medicines on the prescription of which 47.2% were university graduates, while 14.6% purchased medicine over the counter. Among the respondents, 46.5/100 purchased antibiotics and the remaining purchased NSAIDs, anti-hypertensive and anti-diabetic medicines. Significantly, 97/100 checked the expiry date of medicine before buying. Majority (95.3%) of the respondents' stored medicines at home. 77.7% of the respondents discarded the expired medicines in household trash. Majority of respondents held government responsible for creation of awareness for proper medicine disposal. Almost entire sample (98%) felt that improper disposal of unused and expired medicines can affect the environment and health. CONCLUSION: Gaps exist in practices, therefore robust, safe and cost-effective pharmaceutical waste management program supported with media campaign is needed. Healthcare practitioners and community pharmacists should offer training to educate customers on standard medicine disposal practices.

Efficacy of Standardized Extract of Bacopa monnieri (Bacognize®) on Cognitive Functions of Medical Students: A Six-Week, Randomized Placebo-Controlled Trial.

Rationale. Bacopa monnieri, popularly known as Brahmi, has been traditionally used in Ayurveda since ages for its memory enhancing properties. However, data on placebo-controlled trial of Bacopa monnieri on intellectual sample is scarce. Hence this study was planned to evaluate the effect of Bacopa monnieri on memory of medical students for six weeks. Objective. To evaluate the efficacy of Bacopa monnieri on memory of medical students with six weeks' administration. Method and Material. This was a randomized double blind placebo-controlled noncrossover, parallel trial. Sixty medical students of either gender from second year of medical school, third term, regular batch, were enrolled from Government Medical College, Nagpur, India. Baseline biochemical and memory tests were done. The participants were randomly divided in two groups to receive either 150 mg of standardized extract of Bacopa monnieri (Bacognize) or matching placebo twice daily for six weeks. All baseline investigations were repeated at the end of the trial. Students were followed up for 15 days after the intervention. Results. Statistically significant improvement was seen in the tests relating to the cognitive functions with use of Bacopa monnieri. Blood biochemistry also showed a significant increase in serum calcium levels (still within normal range).

The Zest for Patient Empowerment.

Patient Empowerment (PE) can be considered as an active and self-determining role of patient than a passive recipient of health related services. It encourages the provider-patient relationship to blossom and helps in clearing patients' doubts, confusion and fears to bring in clarity, relief and assurance. For the active involvement of the patient's in own health management they need to be awakened, motivated, educated and enlightened to enable them to exercise their rights. Active patient involvement in the decision-making achieves favourable health outcome. In an empowerment based approach, the focus is not on defining a particular type of behaviour, but on how the behaviour is defined as a goal to be achieved by a particular individual. As a result of their empowerment process, the patients can better self-manage their illness and their lives. Thus empowerment of the patients will positively help medical uprising of the community by creating an educated, health aware, informed and health conscious mass.

Total Protein Profile and Drug Resistance in Candida albicans Isolated from Clinical Samples.

This study was done to assess the antifungal susceptibility of clinical isolates of Candida albicans and to evaluate its total protein profile based on morphological difference on drug resistance. Hundred and twenty clinical isolates of C. albicans from various clinical specimens were tested for susceptibility against four antifungal agents, namely, fluconazole, itraconazole, amphotericin B, and ketoconazole. A significant increase of drug resistance in clinical isolates of C. albicans was observed. The study showed 50% fluconazole and itraconazole resistance at 32 µg mL(-1) with a MIC50 and MIC90 values at 34 and 47 and 36 and 49 µg mL(-1), respectively. All isolates were sensitive to amphotericin B and ketoconazole. The SDS-PAGE protein profile showed a prevalent band of ~52.5 kDa, indicating overexpression of gene in 72% strains with fluconazole resistance. Since the opportunistic infections of Candida spp. are increasing along with drug resistance, the total protein profile will help in understanding the evolutionary changes in drug resistance and also to characterize them.

Retrospective Analysis of Pattern of Cutaneous Adverse Drug Reactions in Tertiary Hospital of Pauri Garhwal.

INTRODUCTION: Cutaneous Adverse Drug Reactions (CADR) are the common drug induced adverse reactions which usually have wide range of manifestations and severity. AIM: To describe the prevalence and clinical spectrum of CADR's in a tertiary hospital of the Garhwal region in Uttarakhand, India. MATERIALS AND METHODS: All patients suspected of having CADRs reported in the various out-patient departments, and in-patients of HNB Base & Teaching Hospital, from 1(st) January 2012 to 31(st) December 2014 were retrospectively analysed. Drug history was recorded in a format specified in Indian National Pharmacovigilance Programme. RESULTS: Total 111 cases of CADRs were reported from Jan 2012 to Dec 2014. Mean age of patients was 33.34±18.7 years and maximum ADRs were reported in the age group of 20-39 years (36.9%). Female were affected more than male (W:M :: 66:45). Most of the ADRs were exanthematous eruptions (EE) type (33.3%). Medicine department reported maximum cases of CADRs (47.7%), followed by Dermatology. Most of the CADRs were reported with antimicrobial agents (69.4%). Significant associations of different types of various cutaneous reactions were observed in relation to the duration (in days) of ADRs (p = 0.038), types of outcome (p= 0.006), different departments (p= 0.014) and between different groups of medicines (p = 0.008). CONCLUSION: CADRs have proved a significant problem in healthcare for decades. Major bulk of CADR result from physician prescribed drugs. Hence, awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them.

Plagiarism: an egregious form of misconduct.

BACKGROUND: Publishing research papers for academic fraternity has become important for career advancement and promotion. Number of publications in peer reviewed journals and subsequent citations are recognized as measures of scientific success. Non-publishing academicians and researchers are invisible to the scientific community. DISCUSSION: With pressure to publish, misconduct has crept into scientific writing with the result that research misconduct, plagiarism, misappropriation of intellectual property, and substantial unattributed textual copying of another's publication have become common. The Office of Research Integrity, USA, defines research misconduct as "fabrication, falsification or plagiarism in proposing, performing or reviewing research, or in reporting research results." Although plagiarism is difficult to define in few words, it can be viewed as the stealing of another person's ideas, methods, results, or words without giving proper attribution. The Office of Research Integrity defines plagiarism as being "theft or misappropriation of intellectual property and the substantial unattributed textual copying of another's work." Plagiarism is one of the most vehemently derided breaches of research integrity as it undermines the original and honest contribution to an existing body of knowledge. CONCLUSION: Plagiarism has many forms viz. blatant plagiarism, technical plagiarism, patchwork plagiarism, and self-plagiarism. In any form, the plagiarism is a threat to the research integrity and is unacceptable. We do need to detect such acts and effectively prosecute the offenders.

The fruits of authorship.

Scientific paper authorship is an important academic achievement for all research professionals. Being designated as an author of a paper has academic, research, social and financial implications. Signing of a manuscript as an author does confer credit but also transfers responsibility. While authors get credit for the published work, they must accept the public responsibility that goes with it. Over the past few years, there has been a rising trend in authorship abuses. The prevalent culture of "publish or perish" appears to be responsible for this. In an endeavor to ensure honest practice, the International Committee of Medical Journal Editors (ICMJE), the Vancouver Group, developed the criteria for authorship and said that "all persons designated as authors should qualify for authorship and all those who qualify should be listed." However, authorship irregularities continue to exist and are a cause of concern. Budding authors should be enlightened about concurrent problems in authorship, during their formative years and encouraged toward fair practices in publications.

Impact of medicine-related information on medicine purchase and use by literate consumers.

AIMS: To measure impact of information, education, and communication intervention (IEC) on rational medicine use, purchase, and stocking behavior. MATERIALS AND METHODS: This was a pre- and post-design, interventional study. Base data were collected in first visit, using pre tested questionnaire from 500 respondents, who were of either gender, English speaking, at least graduates, permanent residents, and willing to participate. IEC was framed based on problems identified from this data. First intervention was handouts distributed in the second visit, containing information on cost saving in medicine purchase. Second intervention was a lecture session on medicine prices, rational use of medicines, and tips on saving on medicine purchase. Five articles about medicine use and price differences were published in the local newspaper, over 10 days, formed third intervention. After 1 month, post-intervention data was collected using same instrument with some additional questions. Results were analyzed by Chi-square test using Graph Pad prism Version 3.0. RESULTS: Awareness about price variation, self-medication, expiry period, generic and brand quality increased post-intervention. Attitudes toward new, costly, brands, injections, sharing and reusing old prescriptions changed post-intervention. Behavioral changes in stocking habits, adherence to doctors' advice, getting cash memo, comparing prices, reading labels, were seen post-intervention. CONCLUSION: People carry false notions about medicines which influence their use and habits. This intervention successfully changed behavior and could bring awareness on many aspects of medicine use.

Ethnomedical properties of taxus wallichiana zucc. (Himalayan yew).

Taxus wallichiana Zucc., known as Himalayan yew, belongs to the family Taxaceae. It is a medium-sized, temperate, Himalayan forest tree of medicinal importance. In India, this evergreen tree is found at altitudes between 1800 and 3300 m above mean sea level (MSL). It has been used by the native populations for treating common cold, cough, fever, and pain. Its uses are described in Ayurveda and Unani medicine. It received attention recently as its leaves and bark were found to be the prime source of taxol, a potent anticancer drug. It possesses many other biological activities also. We focus on its importance in traditional medicine for its multiple medicinal properties.