PSYCHOSOCIAL FACTORS AS RISK FACTOR IN SUICIDAL POISONING: A CROSS-SECTIONAL STUDY

  Objective: Suicide is known to be a phenomenon in low-, middle-, and high-income countries and occurs in all sociodemographic groups. It ranges from acute to fatal lethal attempts which occur in the context of a social crisis. Deliberate self-poisoning for suicide is a growing public health concern with frequent emergency department admissions. An epidemiological surveillance is essential for every region to understand the pattern, underlying psychological factors, and the scope of preventive measures.Methods: The 2-year retrospective study describes the epidemiology and influencing factors of suicides by self-poisoning in patients admitted to a Government Hospital and a Teaching Hospital in Pune, Maharashtra, from January 1, 2014 to December 31, 2015.Result: Out of 1010 poisoning cases reported, 539 were suicidal self-poisoning. Significantly males more than females were brought to the hospitals due to deliberate self-poisoning (1:0.86, χ2=38.05; p<0.001). The age group most recorded was 20-35 years (67.7%). Psychosocial factors were associated with increased risk of suicidal self-poisoning attempts (risk ratio 4.76, 95% confidence interval 4.07-5.57; p<0.001). Psychosocial factors were interpersonal conflict (52.4%), stress (30.4), dissatisfaction in life (6%), and alcoholism or mental disorders (11.1%). Household and agricultural products (71.8%) were the popular choices of the toxic agent in self-poisoning with phenols (20%) being the most common. 19 cases (3.5%) were severe, out of which 15 cases lead to death (2.8% mortality).Conclusion: There is an urgent need to develop and implement preventative and treatment strategies for high-risk groups attempting suicide by self-poisoning

ANTIBIOTIC UTILIZATION PATTERN AT THE SURGERY DEPARTMENT OF A TERTIARY CARE HOSPITAL

Objective: The present study aims to determine the pattern of antibiotic utilization at the surgery department of a tertiary care hospital.Method: A prospective observational study was conducted over a period of 6 months period in surgical ward at Bharti Hospital and Research Centre, Pune, a 1000 bedded teaching hospital. Patients above 18 years and receiving antibiotic therapy pre and post-surgery were included in the study.Results:160 patients with surgical operations were included in the study.The disease spectrum was classified into respective system-wise surgical procedures of which 49.37% cases are skin & soft tissue infections, 25.62% cases of general surgical procedure, 12.5% cases of gastrointestinal surgical procedure, 11.25% cases of urinary system and 1.25% case of head neck system. 20.62% of the study patients had hernia, 18.12% patients had cellulitis, 16.87% patients had diabetic foot ulcer, 16.25% patients had abscess, and 10.62% patients had appendicitis and cholelithiasis. In this study, it was found that 471 antibiotics were used in total of 160 patients, among which highest group of antibiotics prescribed were third generation Cephalosporin (28.23%) followed by Penicillins (23.56%). The most frequently prescribed antibiotics were Metronidazole − 19.74% among the Nitroimidazoles followed by Ceftriaxone − 19.53% of the class Cephalosporins.Conclusion: The rate of prescribing of broad-spectrum antibiotics has increased demonstrably which may result in development of bacterial resistance; however development of guidelines for antibiotic prescription and use of appropriate drugs for the diseases can minimize the unfavourable use of antibiotics and cost of healthcare.Â

Evaluation of prescribing pattern and rationality of fixed dose combinations in patients of general medicine department

Background: Fixed dose combinations are widely used in India, they are either irrational or prescribed irrationally. Moreover, the government has recently banned over 300 fixed dose combinations (FDCs) because of a lack of therapeutic justification. This study was conducted to study the prescribing pattern of FDCs in a tertiary care teaching hospital and to highlight the rationality of FDCs, and adverse drug reactions (ADRs) associated with them.Methods: In the present prospective observational study, a total of 500 inpatients were evaluated for prescribing pattern, cost analysis, and adverse drug reactions (ADRs) of FDCs. The FDCs were assessed for their rationality. The ADRs and severity were assessed using the WHO causality scale, Hartwig severity scale respectively.Results: Out of total 103 FDCs, 58 were approved, 86 were rational and 17 were irrational. 5 FDCs were banned and irrational. 48.54% of rational FDCs had rationality score from 7 to 9. The most commonly prescribed FDCs belonged to the anatomic therapeutic and chemical class of respiratory system, followed by anti-infectives in younger age group and cardiovascular FDCs in the elderly. The 886 ADRs occurred in 500 patients with a mean of 1.81±1.9. Banned FDCs contributed to 76 ADRs. According to causality and severity assessment, most of the ADRs were possible (62.53%) and mild (70.77%) respectively.Conclusions: Although FDCs were rational in most cases but banned FDCs were also prescribed. As these FDCs were associated with ADRs, monitoring of patients is necessary. Knowledge and attitude of healthcare professionals can be assessed through awareness programs

Comparative efficacy, safety, and tolerability of diclofenac and aceclofenac in musculoskeletal pain management: A systematic review

Diclofenac and aceclofenac are nonsteroidal antiinflammatory drugs (NSAIDs). Diclofenac is advocated for the treatment of painful and inflammatory rheumatic and certain nonrheumatic conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, and bursitis, and in other inflammatory or painful conditions such as strains and sprains, dysmenorrhea, back pain, sciatica, and postoperative pain. Aceclofenac provides symptomatic relief in a variety of painful conditions such as joint inflammation, and reduces pain intensity and the duration of morning stiffness in the patients with rheumatoid arthritis, improves spinal mobility in the patients with ankylosing spondylitis. Gastrointestinal (GI) problems are the most frequent effects, which are caused by diclofenac and include dyspepsia and abdominal pain. Aceclofenac also has similar adverse effect but they are mild compared to diclofenac. We have reviewed 9 prospective studies that compared efficacy and safety of diclofenac with those of aceclofenac, 5 studies on osteoarthritis patients, 1 study on rheumatoid arthritis patients, 1 study on overall musculoskeletal disorders, 1 study on lower back pain, and 1 study on postextraction dental pain. Western Ontario and McMaster (WOMAC) universities scores, visual analogue scale (VAS), the Ritchie index, Lequesne OA severity index (OSI) were used in assessing the pain intensity and measuring the efficacy of the drug that proved beneficial in assessing the pain intensity and measuring the efficacy of both the drugs. All the studies came to the conclusion that aceclofenac is a better choice of drug in managing pain in case of all the above conditions with better efficacy and tolerability, patients experienced more number of adverse events (AEs) with diclofenac when compared with aceclofenac

Suspected hepatotoxicity and thrombocytopenia: Sodium valproate and carbamazepine

A young male was admitted in a tertiary care hospital with the complaints of excessive nausea, loose stools and fever with chills since few days. He was found to have thrombocytopenia, elevated liver enzymes, and suspected renal impairment. The patient was a known case of epilepsy, mood disorder and mental retardation. Since 6 months he was on sodium valproate, carbamazepine and trihexiphenidyl/risperidone fixed dose combination. Suspecting adverse drug reactions (thrombocytopenia, elevated liver enzymes), carbamazepine and sodium valproate were withdrawn. The patient was treated symptomatically with anti-pyretics and parentral fluids. On follow-up visit, the liver enzymes and platelet count were normal. The patient was maintained on levetiracetam and trihexiphenidyl/risperidone and the caretakers were counseled for the drugs therapy and monitoring parameters

A study of prescribing pattern, comorbidities, and cost analysis in elderly hospitalized patients in Pune

Aim: To study prescribing pattern, comorbidities, and cost analysis in elderly hospitalized patients. Materials and Methods: A prospective, observational study was conducted to assess the prescribing pattern, drug utilization, and cost analysis in elderly patients at a tertiary care hospital in Pune. Data of 120 patients were used to carry out the analysis. Result: A total of 120 elderly inpatients were included in the study. Of these 120 patients, 62 were male and 58 were female; among them, maximum number of patients belong to 60-74 years age group. Common comorbidities found were anemia, lower respiratory tract infections (LRTI), urinary tract infection, hypertension, diabetes mellitus, etc. Mostly hospitalized patients were hypertensive (27.5%), diabetic (18.33%), and anemic (15.83%) followed by respiratory tract infections such as pulmonary Koch′s, pneumonia, and LRTI. Two comorbid conditions were found in 33.33% of patients followed by 25% with one comorbid condition and 24.16% had three comorbid conditions; on an average, three comorbidities were found in a total number of patients. Major classes of drugs prescribed for treatment were cardiovascular drugs (22.60%), antibiotic (20.13%), antiplatelet (7.26%), and antidiabetic drugs (6.43%). The average cost per patient was calculated 5016.48 international normalized ratio, which includes physician, nursing, bed charges, and therapy cost. Conclusion: This study concludes that the prescribing pattern of elderly patients with age group 60-74 years were commonly prescribed for cardiovascular drugs and antibiotic, whereas this proportion was low compared to patients with age >74 years and prescribing pattern also resulted in financial burden on patients healthcare cost

Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic

Background: India is one of the emerging markets for over-the-counter (OTC) drugs and offers significant growth potential for the industry. There has been a huge rise in the use of OTC drugs since the beginning of the pandemic for which some major reasons are lack of time, non-availability of prescribers, and hospital exposure during a pandemic. Aim: To assess knowledge, attitude, and practice (KAP) of ‘over-the-counter’ medications among medical and non-medical professionals during the COVID-19 pandemic. Settings and Design: The study was conducted at Bharati Hospital and Research Center, Pune, Maharashtra, India. Materials and Methods: A descriptive observational study was conducted. Statistical Analysis Used: Descriptive (mean, percentage, and standard deviation) and inferential (chi-square test) statistics were used. Statistical analysis was done using the Statistical Package for the Social Sciences(SPSS) software version 10.0. Results: Out of 310 samples majority showed poor knowledge (50.65%), high practice (56.13%), and negative attitude (70%) towards the use of OTC drugs. There is a significant association found between age (p-value 0) and health care status (p-value 0) with the level of knowledge. Age group (p-value 0.046) and employee status (p-value 0.00033) showed a significant association with the practice of OTC drugs. Healthcare status showed a significant association (p-value 0.0007) towards attitude toward the use of OTC drugs. Conclusion: Participants reported overall poor knowledge with a negative attitude and adopted the high practice use of OTC drugs during the COVID-19 pandemic. Increased awareness about self-medication is important to avoid complications associated with the high practice of OTC medications

Medical officer's perspectives and professional challenges in handling poisoning cases in rural India

Introduction: Poisoning is a significant public health problem in developing countries, more so in rural areas. Very little is known about the treatment available for poisoning cases in the context of rural health care provision in India. This study explores the perceptions of the primary health care medical officers regarding the management of poisoning cases. Material and Methods: A semistructured, self-designed survey form was used to interview the medical officers in Pune district. The interview focused on understanding rural hospital settings in terms of infrastructure, available facilities, and medical officers' perception of professional challenges in the management of poisoning cases. Results: Underreporting of poisoning cases in these primary health centers (PHCs) and transferring to higher hospitals without basic first aid provided was noted through interviews. Conclusion: Medical officers in rural PHCs lack the necessary training and knowledge required for the management of poisonings which is further worsened by lack of resources. There is a need to focus on poison management in continuous medical education. Training programs and education for medical officers are needs of the hour

Research & Reviews: Journal of Hospital and Clinical Pharmacy Monitoring Of Adverse Drug Reactions in Elderly Patients in an Indian Tertiary Care Hospital

ABSTRACT Aim: Present study was carried out to assess the incidence of adverse drug reactions (ADR) and assessment of causality, severity, preventability and additional financial burden associated with reported suspected ADRs. Methodology: A prospective spontaneous reporting study was conducted over a period of six months in inpatients of medicine wards and medical intensive care unit at Bharati Hospital, Pune. WHO Probability scale was used for causality assessment. Reported ADRs were classified according to Wills & Brown classification and assessed for severity using scale was developed. Average cost incurred in treating an ADR was calculated. Results: A total of 319 suspected ADRs were reported and evaluated from 78 patients showing an overall incidence of 9.17%. Most of the ADRs were augmented type, whose pharmacology is known. 66% ADRs were classified as "POSSIBLE" in view of causality, while 87% were found to be "MILD" in case of severity. Preventability was found to be 22.87%. Average cost incurred in treating an ADR in hospitalized inpatients was found to be Rs.1328.71 (US $21.90) in India. Conclusion: Incidence of ADRs was more in hospitalized patients compared to ADR induced hospital admission. Awareness about ADR reporting is still poor amongst healthcare professionals in India. Average cost incurred for treating ADR leading to hospital admission was higher