Diagnostic Accuracy of Bayley III Screening Tool to Detect Developmental Delay in Moderate to High-Risk Indian Preterm Children.

The present study aimed to evaluate the ability of the Bayley III screening tool to detect developmental delay in moderate to high-risk preterm children in India. In this cross-sectional study, 94 preterm babies were enrolled. The Bayley III screener (index test) and the gold-standard, Developmental assessment scale for Indian Infants (DASII) test were administered to all the enrolled children. Researchers were blinded while performing the tests. Diagnostic accuracy parameters were compared. The Bayley III screener's sensitivity and specificity for predicting the delay (with a DASII cut-off of <70) were 84.62% and 85.18% in the mental domain and 61.11% and 96.05% in the motor domain, respectively. When the DASII cut-off was raised to 85, the sensitivity and specificity in the mental domain were 60.61% and 95.08%, respectively, whereas they were 36.11% and 98.27%, respectively, in the motor domain. The Bayley III screener is found to have good specificity rather than sensitivity with good predictive values.

Usefulness and effectiveness of community pharmacists-led mobile phone communication in identification and referral of presumptive tuberculosis cases in a selected district of Tamil Nadu.

BACKGROUND: Community pharmacists' usually are not able to be actively involved in the identification and referral of presumptive TB cases approaching their pharmacy for over-the-counter (OTC) drugs. The main barriers from their perspective were increased patient volume and work burden. Therefore, a new methodology was adopted by appointing an auxiliary pharmacist who will be actively involved in the identification and referral of presumptive TB cases. The present study aimed to assess the usefulness and effectiveness of community pharmacists-led mobile phone communication in identification and referral of presumptive tuberculosis cases in a selected district of Tamil Nadu. METHODS: A community intervention trial with pre and post-test comparison study was conducted among the community pharmacists in Tiruvallur district of Tamil Nadu. Knowledge about TB and referral practice of community pharmacists were captured and the same were taught to them. Details of the cases with the complaints of TB who came to the enrolled pharmacists for OTC drugs during the intervention period were collected by the community pharmacists and given to auxiliary pharmacist through WhatsApp. Auxiliary pharmacist called each patient and educated about TB and followed the patients. RESULTS: A total of 191 pharmacists were included in the study. 389 patients who approached pharmacy for OTC medications were suspected as TB by the community pharmacists based on their symptoms. 32 patients were not willing to give their details, while the details of others were collected by the community pharmacists and forwarded to auxiliary pharmacist through WhatsApp. 217 patients responded to phone calls made by the auxiliary pharmacist. Of them, 189 patients' health conditions were improved, while 28 patients suffered with symptoms and they had visited PHC and 2 patients were diagnosed as TB by clinician. CONCLUSION: Use of auxiliary pharmacist in collaboration with community pharmacists through phone communication is a useful and comfortable mode of collection of presumptive TB cases from the community pharmacies. Similarly, health education and follow-up of the presumptive cases via phone call is an effective way in the identification and referral of presumptive tuberculosis cases.

Barriers of healthcare professionals in utilizing the service of drugs and poison information Centre: A cross-sectional study.

Background: Health care professionals (HCPs) have been using drugs and poison information centre (DIC) less frequently in recent years. The purpose of this study was to identify the barriers that inhibit HCPs from using the DIC service in a tertiary care hospital, as well as the factors that assist HCPs in using DIC more effectively. Methods: A cross-sectional study was conducted among HCPs in Sri Ramachandra Institute of Higher Education and Research, Chennai. HCPs were given a semi-structured questionnaire that was developed and validated by a subject expert, a public health expert, and a clinical psychologist, and their barriers and facilitators in accessing drug information services were recorded. Findings: A total of 405 HCPs responded to the survey. Among the identified barriers, the top 3 were: HCPs found it easier to use mobile internet (31%) and the department's reference library (25%) instead of contacting DIC for any drug/poison information. In addition, 17% of HCPs stated that they were too busy. The factors that may assist HCPs utilize DIC more effectively were more awareness is required to demonstrate the functionalities of DIC (24%), and a mobile application is required (23%). Conclusion: Today's HCPs have easy access to a variety of drug information resources, and many prefer to do their own drug/poison research. As current generation HCPs find it more convenient to use mobile internet than contacting DIC, the creation of a mobile application for drug information service may enhance the number of questions from HCPs.

Barriers of community pharmacists in identification and referral of presumptive tuberculosis cases in Tiruvallur district of Tamil Nadu.

BACKGROUND: Tuberculosis (TB) still continues to be a major public health threat. Early diagnosis is the cornerstone in combating TB. Community pharmacists are the front line health care providers among the health care system. The present study aimed to identify the barriers of community pharmacists in the identification and referral of presumptive pulmonary tuberculosis cases. METHODS: Prospective, cross-sectional study was conducted among the community pharmacists in Tiruvallur district of Tamil Nadu. One pharmacist from each pharmacy was interviewed using semi-structured questionnaire. Knowledge component, practice and barriers of identification and referral in presumptive TB cases were captured. RESULTS: A total of 143 pharmacists were included in the study. Barriers in identification and referral by pharmacists' perception were patient volume (32%), pharmacy workload (22%), difficulty in identifying the cases (16%), etc. Research team also identified few barriers such as pharmacists do not have adequate knowledge about TB (34%), pharmacists are not trained enough to identify and refer presumptive TB cases (26%), etc. All the pharmacists (100%) refer the presumptive TB cases, if they come across for OTC medications. Pharmacists also provided health education to their community (45.7%). CONCLUSION: Adequate training of community pharmacists and a follow-up system for the presumptive TB cases identified by the community pharmacist are essential in reducing the barriers of pharmacists in TB case detection.

Pyridoxine and Magnesium Administration-Induced Hyperactivity in Two Children With Autism Spectrum Disorder: Case Reports From a Clinical Trial.

PURPOSE: Pyridoxine hydrochloride and magnesium sulfate (pyridoxine-Mg) have been used for the management of autism spectrum disorder (ASD). We present a case report of 2 children with ASD who were administered pyridoxine-Mg for 2 months. METHODS: The Childhood Autism Rating Scale, Second Edition, was used to confirm the adverse reaction. The Naranjo Adverse Drug Reaction Probability Scale was used to assess causality. RESULTS: Children were reported by their parents as being hyperactive. Evaluation by the psychologist using the Childhood Autism Rating Scale, Second Edition, also confirmed the reaction. According to the Naranjo scale, hyperactivity had a possible and probable association with pyridoxine-Mg for child 1 and 2, respectively. IMPLICATIONS: A probable to possible association exists between hyperactivity and pyridoxine-Mg. Clinical Trial Registry-India identifier: CTRI/2019/07/020102.

Challenges of non-COVID-19 patients with chronic illness during the pandemic.

Challenges faced by non-COVID-19 patients with chronic illness are limitless during the lockdown period. These patients are mostly immunocompromised and vulnerable to infection. The worst affected would be chronic disease patients with lower household income. Patients' fear of approaching medical facilities and also travel restrictions limit the patients to reach the healthcare team, and either of this leads to poor health outcome. Frequent communication with chronic disease patients by healthcare professionals is a key to encourage the patients to be adherent to the medications and manage their disease conditions.

Prevalence and pattern of usage of complementary and alternative medicine among south Indian asthma patients in a tertiary care hospital.

OBJECTIVES: The study aimed to investigate the prevalence of CAM users among asthmatic patients in a tertiary care South Indian hospital. METHODS: Prospective, cross sectional study was conducted in 394 asthmatic patients. RESULTS: 30.4% of the patients used CAM therapies. The most commonly used CAM treatment was herbal medicine followed by pranayama (controlled breathing exercises). Most of the CAM users were found to be in lower middle class. The baseline characteristics of the CAM users and the non CAM users were found to be similar except for education and socioeconomic status (p < .008). Among the CAM users, none of the patients disclosed about their CAM treatment to their pulmonologists. CONCLUSION: Patients must be educated about CAM therapies and they must be advised to discuss all their treatment related issues with treating clinicians. Healthcare professionals should be familiar with the merits and demerits of using CAM therapy so that they could provide proper guidance to their patients.

Effectiveness of vitamin D3 in severe persistent asthmatic patients: A double blind, randomized, clinical study.

OBJECTIVE: To assess the pulmonary function and quality of life in asthma patients receiving vitamin D3 supplementation with inhaled budesonide and formoterol. MATERIALS AND METHODS: This was a double blinded, randomized, comparative study. Patients were recruited as per the study criteria and randomized into two groups: usual care group (n = 69) patients received budesonide (800 µg) with formoterol (24 µg) and intervention care group (n = 72) patients received vitamin D3 (1000 IU) supplementation along with budesonide (800 µg) plus formoterol (24 µg) for a period of 6 months. RESULTS: A total of 140 patients completed the study. Significant within-group improvement and non-significant between-group improvement is observed with respect to FEV1. In terms of health-related quality of life, within-group comparison revealed a significant (P < 0.05) improvement in all the domains of SGRQ. However, between-group comparisons showed statistically significant (P < 0.05) improvement in symptom, impact and total scores. CONCLUSION: On the basis of our findings, we conclude that supplementation of vitamin D3 is effective in improving the quality of life rather than pulmonary function in severe asthmatics. However, further studies are warranted to substantiate the present findings.

Assessment of montelukast, doxofylline, and tiotropium with budesonide for the treatment of asthma: which is the best among the second-line treatment? A randomized trial.

PURPOSE: Data comparing various second-line treatments for asthma with subjective and objective assessment are lacking. This study aimed to compare the efficacy and safety of montelukast, doxofylline, and tiotropium with a low-dose budesonide in patients with mild to moderate persistent asthma. METHODS: Patients, all of whom were concurrently using inhaled budesonide (400 µg), were treated for 6 months with formoterol (12 µg), montelukast (10 mg), doxofylline (400 mg), or tiotropium (18 µg). Outcomes included forced expiratory volume in 1 second (FEV1), Saint George Respiratory Questionnaire (SGRQ) scores, asthma symptom scores (daytime and nighttime), and assessment of tolerability and rescue medication use. FINDINGS: A total of 297 patients completed the study. In all 4 groups, significant improvements were observed in all the outcome measures, with formoterol treatment having greater and earlier improvements than the other 3 second-line controller medications with budesonide. Among the second-line treatments, monteradlukast improved the FEV1 from day 45 (P < 0.01), SGRQ scores from day 30 (P < 0.0001), daytime scores from day 30 (P < 0.05), nighttime scores from day 30 (P < 0.0001), and rescue medication use from day 15 (P < .0001) at a faster rate than doxofylline or tiotropium with budesonide. No patients discontinued the treatment because of adverse reactions. IMPLICATIONS: Among the tested second-line treatment regimens, the budesonide/montelukast combination was found to be superior to either the budesonide/doxofylline or budesonide/tiotropium combination in all the outcome measures without adversely affecting the tolerability of the patients. Further clinical studies with blinding techniques are likely to be useful.

Assessment of antioxidant supplementation on the neuropathic pain score and quality of life in diabetic neuropathy patients - a randomized controlled study.

BACKGROUND: Diabetes is a chronic disease characterized by elevated blood glucose levels. The appropriate goals in the management of diabetes include maintaining blood glucose levels as close to the normal range as possible, minimizing the adverse effects of free radicals by enhancing antioxidant defenses. Supplementation with appropriate vitamins may therefore be of value in the prevention and treatment of diabetes. METHODS: A total of 92 patients with diabetic neuropathy were enrolled in this randomized controlled study from the general medicine department of a tertiary care hospital. Patients were randomized into two groups viz., usual care (n = 46) and intervention group (n = 46). Usual care group patients received pregabalin with oral hypoglycemic agents. Patients in the intervention group received vitamin-E along with their regular medicines. Pain intensity and quality of life (QoL) of patients were assessed using Neuropathy Pain Score and RAND 36 questionnaire. Blood samples were analyzed for the levels of random blood sugar level and HbA(1c) at the baseline and on the 12th week. RESULTS: Significant (p < 0.05) decrease in the random blood sugar level was observed in intervention group when compared with the usual care group and a significant (p < 0.01) reduction in total pain score, and a significant (p < 0.05) improvement in physical health after 12 week treatment of vitamin-E was observed. CONCLUSION: The study concluded that vitamin-E is a natural antioxidant and it is found to be effective in reducing pain score in diabetic neuropathy patients. The future studies may be directed towards extended duration of action.

Assessment of various second-line medications in addition to inhaled corticosteroid in asthma patients: a randomized controlled trial.

Many patients with persistent asthma cannot achieve the treatment goal for asthma with a single controller medication. The aim of the present study was to assess lung function and rescue medication use in asthma patients receiving four different categories of drugs in combination with an inhaled corticosteroid. Patients recruited to the study were randomized into four groups to receive budesonide with either formoterol, doxofylline, montelukast or tiotropium for a period of 3 months. Lung function (i.e. forced expiratory volume in 1 s (FEV1 )) and rescue medication use were determined at baseline and on Day 15, 30, 45, 60 and 90 of treatment. A total of 297 patients completed the study. At baseline, no significant differences (P > 0.05) were observed in any of the outcome measures. Significant within-group improvement in FEV1 was observed in all groups. On Day 90, between-group differences showed that the improvement in FEV1 was significantly (P < 0.05) higher for patients receiving budesonide + formoterol, followed by budesonide + montelukast and budesonide + doxofylline, and least for those receiving budesonide + tiotropium. Similarly, within- and between-group comparisons showed significant (P < 0.05) reductions in rescue medication use in all groups. However, the magnitude of the decrease was greater in the budesonide + formoterol group, followed by the budesonide + montelukast, budesonide + doxofylline and budesonide + tiotropium groups. Based on our findings, among the second-line treatment regimens, budesonide with either montelukast or doxofylline was found to be better than budesonide + tiotropium in patients with mild-to-moderate persistent asthma. Further studies with a longer duration are likely to be useful.