Comparative evaluation of two prophylactic intravenous bolus doses of phenylephrine for prevention of spinal-induced hypotension in elective cesarean sections: a prospective and randomized study

Background: Hypotension is a common and clinically significant complication associated with spinal anesthesia during cesarean section, often persisting despite standard preventive strategies such as fluid preloading and left uterine displacement. Vasopressors like phenylephrine are routinely employed to counteract the hemodynamic instability, yet limited data exist comparing different fixed bolus doses of phenylephrine for prophylaxis against spinal-induced hypotension in obstetric anesthesia. This study aimed to evaluate and compare the efficacy and safety of two intravenous bolus doses of phenylephrine-150 micrograms and 200 micrograms-administered immediately following spinal anesthesia, in preventing maternal hypotension during cesarean delivery. Methods: A prospective, randomized, double-blind study was conducted at Adichunchanagiri Institute of Medical Sciences, Karnataka, India involving 60 parturients scheduled for elective cesarean section. Group A received 150 µg and group B received 200 µg phenylephrine IV bolus immediately after spinal anesthesia. Hemodynamic parameters, incidence of hypotension and bradycardia, requirement of rescue boluses, and Apgar scores were recorded.Results: The incidence of hypotension was 16.6% in both groups. Group B showed a significantly higher incidence of bradycardia (43.3%) compared to group A (20%, p<0.05). Group A demonstrated better hemodynamic stability with fewer rescue interventions. Neonatal outcomes were similar in both groups. Conclusions: A 150 µg bolus of phenylephrine is as effective as 200 µg in preventing hypotension following spinal anesthesia in cesarean delivery, with fewer adverse effects. It is recommended as the preferred dose for prophylaxis

Clinical studies and safety evidence for human consumption of Shilajit: a herbo-mineral compound with multifaceted health benefits

Shilajit is one of the ancient and traditional herbo-mineral compounds that has been used for multiple health benefits for centuries. It is associated with potent antioxidant and anti-inflammatory effects via modulation of signaling pathways such as NF-kB and Nrf2/HO-1. One of the main components of Shilajit, fulvic acid, is primarily responsible for its diverse health benefits. However, apart from fulvic acid, it also contains humic acid, trace elements, minerals and vitamins, making it a potent health supplement. Recently, there has been a notable increase in Shilajit consumption, resulting in a growing body of scientific evidence from in vitro, in vivo and clinical trials. However, most of the published literature on Shilajit has been limited, mainly emphasizing its history, origin, chemistry or summaries of preclinical research, without thoroughly exploring the mechanisms of action or discussing existing clinical evidence. Hence, this manuscript aims to specifically address this gap by focusing on the mechanisms of action of Shilajit identified in preclinical research and offering a comprehensive overview of various clinical studies and trials.  

A cross-sectional study on attitude and understanding of artificial intelligence and its use in medical education among medical students in a tertiary care teaching hospital

Background: Artificial intelligence (AI) has the potential to revolutionize medical education by enhancing diagnostic accuracy, improving decision-making and streamlining healthcare delivery. Aims and objectives of the study were to assess the attitude towards the use of AI in medical education and to evaluate the level of understanding of AI concepts among medical students along with identification of factors influencing their attitudes and understanding of AI. Methods: A cross-sectional study was undertaken at a tertiary care teaching hospital after taking institutional ethics committee (IEC) approval. A total of 250 medical students from various academic years were included in the study. A self-made structured questionnaire was administered to collect data on student’s demographic characteristics, attitudes towards AI, understanding of AI concepts and their readiness to integrate AI into their future practice. Data were later analyzed using appropriate statistical tests. Results: Majority of students were aware of AI. Most students acknowledged AI’s potential to enhance medical learning, particularly in diagnostics (76%) and nearly half (45%) of students expressed concerns about AI replacing human judgment in clinical decision-making. Moreover, the study found a significant gap in formal education on AI with majority of students stating that AI was not adequately addressed in their curriculum. Conclusions: While medical students recognize the transformative potential of AI in healthcare, there is a clear need for enhanced AI education within medical curricula. So, this study highlights the importance of integrating AI-related content into medical education to prepare students for the evolving landscape of healthcare

A study of awareness of generic drugs amongst residents and intern doctors in a tertiary care hospital in Surat city

Background: As defined by WHO generic drug is “a pharmaceutical product which is intended to be interchangeable with an innovator product that is manufactured without a license from the innovator company and marketed after the expiry date of the patent or other exclusive rights”. They are made with the same active substance as the non-generic drugs which are already authorized and approved for their safety, efficacy and quality before getting licensed. Methods: A cross-sectional, prospective, questionnaire-based study was conducted on 115 residents and intern doctors. Awareness and knowledge about generic drugs were checked using pre-validated questionnaire which was followed by an educational intervention and post-questionnaire. The collected data was analysed using MS-excel. Results: The 94 participants voluntarily responded. As per the result of pre-test many participants were not aware of the difference between generic and branded drug, but after conducting educational intervention, increase in knowledge about generic drugs, branded drugs, safety, efficacy, availability and regulation regarding prescription of generic drug was seen. In post-test, 98.94% believed that generic drugs are cheaper than branded drugs and 95.74% agreed that generic drugs are as safe as branded drugs, while 97.87% believed increasing awareness regarding generic drugs will increase acceptability of generic drugs. Conclusions: The reasons for opting branded drugs were lack of awareness regarding efficacy, safety, acceptability and availability of generic drugs. Periodic training program would help in clearing doubts, enhance the prescribing of generic drugs and reduce the health expenditure and economic burden

Prescribing pattern and quality of life in patients of migraine at tertiary care teaching hospital

Background: Migraine, a prevalent and disabling neurological disorder, affects over a billion people globally, with a significant impact in India. Despite effective treatments, poor adherence and limited data on drug use and quality of life persist, especially in developing nations. Understanding these patterns is crucial for enhancing patient care, optimizing healthcare resources, and reducing the socioeconomic burden of migraine. Methods: This one-year prospective observational study was conducted at Shree Krishna Hospital, Gujarat, following ethical clearance. A total of 150 migraine patients diagnosed according to the ICHD-3 (International Classification of Headache Disorders, 3rd Edition) were enrolled. Data on demographics, treatment, and quality of life (via MIDAS [Migraine Disability Assessment] and MIBS-4 [Migraine Interictal Burden Scale]) were collected. Statistical analysis was conducted using STATA 14.2. Informed consent ensured participant confidentiality and adherence to research standards. Results: Among 150 migraine patients (74.7% female), most had low-frequency episodic migraine with moderate throbbing pain. NSAIDs (mainly naproxen) and TCAs (mainly amitriptyline) were widely used. MIDAS showed 11.3% had severe disability; MIBS-4 revealed 24% experienced severe interictal burden. Sleep disturbance, stress, and anxiety were common triggers, highlighting migraine's multifactorial impact on daily routine affecting quality of life. Conclusions: Although triptans have proven efficacy as acute treatment, their utilization remains limited. Quality of life assessments using MIDAS and MIBS-4 revealed significant disability, underscoring the need for enhanced management strategies targeting associated psychological conditions such as anxiety and depression. Optimizing prescription practices, improving patient education, and incorporating lifestyle modifications are crucial for effective long-term migraine management. These interventions promise improved patient outcomes

Perceptions of AETCOM module amongst medical students: a questionnaire-based study

Background: The Attitude, Ethics and Communication (AETCOM) module is a cornerstone of competency-based medical education (CBME), implemented in the medical curriculum. It aims to instill effective patient communication skills in students. The present study evaluates students' perspectives on the implementation of the AETCOM module. Methods: This cross-sectional questionnaire-based study was conducted through Google form filling in 2nd phase MBBS students. Questions about knowledge attitudes and perspectives about the implementation of the AETCOM module in their MBBS curriculum were assessed.  Results: 172 students filled out the Google forms with a response rate of 86%. 169 (98.25%) students felt that it was essential to learn this module. 170 (98.83%) opined that ethics in medical practice is very important and learning it will help them in their future practice of medicine. 34% students reported of getting burdened in exams. Students preferred case-based scenarios and role plays most effective methods of learning. 53.5% of participants felt both summative assessment (SA) and formative assessment (FA) are essential for the complete evaluation of AETCOM competencies. Conclusions: The participants reported inclusion of AETCOM is important because it helped them improve their communication skills and good relationships build with doctors. 34% of participants reported being stressed during exams due to the burden of the already existing heavy curriculum. These findings draw the attention of all stakeholders for a revision in the implementation of the module to ease learning. Students think that even though time-consuming, conducting both FA and SA is justifiable

The rising global burden of osteoporosis: insights into prevalence, fracture rates, and future trends

Osteoporosis is a global health concern, marked by reduced bone density and increased fracture of risk, which unfavorably impacts quality of life and results substantial burdens on healthcare systems. This condition often progresses asymptomatically, with fractures, functional decline, and rise in mortality emerging in advanced stages. However, projections indicate that by 2050, over 50% of global osteoporotic fractures will occur in Asia, highlighting the urgency for targeted interventions. Early detection is very crucial for mitigating osteoporosis-associated morbidity. Screening programs enable timely identification of at-risk individuals, may facilitating interventions such as pharmacological therapy and lifestyle modifications that significantly lower the fracture incidence. Furthermore, community-based awareness campaigns may be playing a critical role in promoting bone health by encouraging sufficient intake of calcium and vitamin D supplement, in-addition regular to do physical activity. A life-course approach to bone health is essential. In postmenopausal women, pharmacological and non-pharmacological treatments, lifestyle strategies are imperative for decline bone loss and preventing bone fractures. To achieve optimal bone mineral density (BMD) and postpone the onset of disease, premenopausal women must receive early preventive measure care and proper education. However, substantial rise in the prevalence of osteoporosis worldwide suggests to improve awareness among the public, expand access to healthcare, and create all-encompassing prevention and management plans. In order to lessen the significant societal and economic effects of this silent epidemic, multidisciplinary collaboration and continuing public health initiatives are essential

Cefepime-Enmetazobactam: a novel β-Lactam/β-Lactamase inhibitor combination for complicated urinary tract infections

Complicated urinary tract infections (cUTIs) represent a significant global health challenge, particularly with the rising prevalence of extended-spectrum β-lactamase (ESBL)-producing pathogens. Cefepime-Enmetazobactam, approved in India in June 2024, represents a novel β-lactam/β-lactamase inhibitor combination specifically developed to address multidrug-resistant Gram-negative infections. This review examines the pharmacological properties, clinical efficacy, and therapeutic potential of Cefepime-Enmetazobactam in managing cUTIs. The Phase 3 ALLIUM trial demonstrated superior clinical cure and microbiological eradication rates compared to Piperacillin-Tazobactam, with particularly pronounced efficacy against ESBL-producing Enterobacterales (73.7% vs 51.5%). The combination exhibits a favourable safety profile with transaminase elevation, increased bilirubin, headache, and infusion site reactions being the most common adverse events. As a carbapenem-sparing option, Cefepime-Enmetazobactam addresses critical antimicrobial stewardship concerns while providing an effective treatment alternative for resistant pathogens. While demonstrating promising results, further research regarding long-term outcomes, resistance development, and cost-effectiveness is warranted to fully establish its role in contemporary antimicrobial therapy

Antimicrobial usage in post operative patients in general surgery wards and intensive care units of a tertiary care hospital in central India: an ATC/DDD-based observational study

Background: The rise of antimicrobial resistance (AMR) is a major global health concern, due to inappropriate use of antibiotics. General surgery wards and intensive care units (intensive care units), are high-risk areas due to frequent use of antimicrobials for postoperative prophylaxis and treatment. This study focuses on assessing antimicrobial consumption patterns in postoperative patients using the world health organization (WHO) anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. Methods: A prospective, observational study was conducted over 12 months in the general surgery unit of tertiary care hospital. Antimicrobial usage data were collected from postoperative patients using WHO’s ATC/DDD methodology and expressed as DDD/100 bed-days. Descriptive statistics were used for analysis, and ethical approval was obtained prior to study initiation. Results: Out of 600 participants enrolled, majority were males (64.5%), 49.66% were in 18-40 age group, and majority (69.33%) were from rural areas. Most patients (47.5%) were prescribed two antibiotics. A total of nine antibiotics were commonly prescribed, with inj. metronidazole being the most frequently used (35.8%), followed by inj. amoxicillin + clavulanic acid (24.3%) and inj. cefotaxime (12.0%). According to WHO ATC/DDD methodology, inj. metronidazole showed the highest antibiotic consumption at 14.96 DDD/100 bed-days, followed by inj. amoxicillin + clavulanic acid at 7.17 DDD/100 bed-days. Conclusions: Study highlights extensive antibiotic use (99.66%) in postoperative patients, with a predominance of injectable drugs (86.07%). Average of 2.12 antibiotics per patient suggests a trend toward broad-spectrum prophylaxis, raising concerns about costs, adverse effects, and resistance. The findings underscore the need for prescription audits and antimicrobial stewardship to improve rational and cost-effective drug use

An observational comparative study on the immediate, deferred, and no use of antiepileptics in the management of seizure

Background: The rationale for starting AEDs in patients with seizure and early epilepsy is still unclear. The decision to start and stop the drugs in patients with single seizures remains controversial. This study aims to compare the efficacy, safety, and short-term outcome of the immediate, deferred, and no use of AEDs in patients presenting with seizure. Methods   This observational study, included 87 patients with either gender or age group with first or multiple seizures to investigate immediate, deferred, or no AED use. Detailed demographics, history, and diagnostic test reports were recorded. Drug use patterns and outcomes of seizure recurrence and safety were evaluated. Results: Out of 87 patients (56 male, 31 female), there were 26 paediatrics, 47 adults, and 15 elderly. Immediate AED treatment was given to 75%, 16% deferred, and 9% received no/SOS AED. Levetiracetam was commonly prescribed (78% in ED, 86% in wards, 63% at discharge). For immediate AEDs: 49% had good seizure control, 25% had recurrence, and 9% had breakthrough seizures. Deferred AEDs showed 36% good control/recurrence and 7% breakthrough. Without AEDs: 63% had good control and 25% had recurrence. AEs were higher in the immediate AED group (42%) vs. deferred (15%). Conclusions: The study indicates that immediate use of antiepileptic drugs (AEDs) reduces short-term seizure recurrence but may increase adverse effects. In cases of reversible causes, it may be best to forgo AEDs. Decisions regarding AED therapy should be tailored to the patient's preferences and risk considerations