Electronic Journal: A new way to get Information

Today information available is communicated by various means. While publication is a public announcement, which helps to communicate and transmit information, with evolution of new technology, the way of publishing has also changed. Data centers have changed their role and now act more as hubs for distributed specialized repositories of different types of data and material rather than, as in past, holding as much as possible themselves and carrying out the integration work a their own locations. This is due the fact that evolution of information technology has brought major modifications to hardware and connectivity as well as new tools for e.g. client/server, WWW browser, etc. and concepts like hypertext/hypermedia concepts, virtual libraries, etc. With the emergence of new technology, one way to communicate scholarly information is ‘Electronic Journals’

Pattern of adverse drug reactions due to antibiotics in a tertiary care hospital

Background: Adverse reactions are known to occur with all classes of drugs and the incidence of adverse drug reactions (ADRs) due to antibiotics has increased with rise in infectious diseases contributing significantly to the increased health care costs.Methods: This retrospective observational study analysed the ADRs due to antibiotics that were reported by spontaneous reporting to ADR monitoring centre (AMC), functioning from Department of Pharmacology, ESIC-MC and PGIMSR. The total study period was 48 months from January 2013 to December 2016. During this period, all the ADRs due to antibiotics reported to the AMC were included in the study. This study analysed the retrospective data to find out the pattern of adverse drug reactions due to antibiotic drug class. Causality, severity and preventability were assessed using standard scales.Results: During the study period, a total of 228 ADRs due to antibiotic use were reported among 179 patients. Gender-wise distribution showed that males were slightly more affected than females by the ADRs due to antibiotics [93(52%) Vs. 86 (48%)]. Out of the total 179 antibiotics administered to the patients, beta-lactam antibiotics dominated followed by nitroimidazoles, quinolones and glycopeptide antibiotics in causing ADRs. Rashes and itching were most common ADRs followed by breathlessness and hypotensive episodes. Causality was assessed by Naranjo algorithm scale and causality was definite in 16 (7%), probable in 87 (38%) and possible in 125 (55%). Severity of the ADRs was assessed by Hartwig and Siegel scale and it was found that most of the ADRs 198 (87%) were of mild severity and 30 (13%) were of moderate severity and none of them were severe or lethal. Preventability was assessed by Schumock and Thornton scale and it was found that only 24 (11%) were preventable, 74 (32%) were probably preventable and 130 (57%) were not preventable.Conclusions: The study concluded that ADRs due to antibiotics are common and few of them resulted in increased healthcare cost due to the need for some interventions and increased length of hospital stay. The health system should promote the spontaneous reporting of ADRs due to antibiotics, proper documentation and periodic reporting to regional pharmacovigilance centers to ensure drug safety

Pattern of adverse drug reaction to antiepileptic drugs in a tertiary care hospital

Background: Adverse drug reactions (ADRs) are a major cause of morbidity and mortality, and are the leading cause of hospital admission. The overall rate of ADRs is estimated to be 6.5% and 28% of these ADRs are preventable. Antiepileptic drugs (AEDs) are authorized for several therapeutic indications and are highly prescribed. ADRs due to AEDs range from minor maculopapular exanthem (MPE) to severe life-threatening reactions like Drug reaction eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome (SJS). Objective of the study was to evaluate the pattern of ADRs reported with AEDs in an adverse drug reaction monitoring centre (AMC) of a tertiary care hospital.Methods: Retrospective analysis of the records was done for a period 48 months from January 2013 to December 2016. During this period, all the ADRs caused by AEDs reported to the AMC were included in the study. The study evaluated the pattern of ADRs due to AEDs. The study also assessed the gender-wise distribution, predilection for various systems, causality, severity, and preventability of ADRs. Data was analysed using descriptive statistics.Results: A total of 319 ADRs were reported by spontaneous reporting during the entire study period. Out of the total 319 ADR reports received, antiepileptic drugs related ADRs were 35 (11%). Antiepileptic drugs which caused the ADRs included phenytoin, carbamazepine, clobazam and lorazepam. The most common system affected was dermatological (60%), followed by gastrointestinal system (17.14%), vascular system (11.42%), blood (5.8%), respiratory system (5.8%) and central nervous system (2.9%). Among the dermatological ADRs, SJS accounted for 11 cases of which 10 cases were due to phenytoin and one case was due to carbamazepine. DRESS syndrome due to phenytoin was documented in one case.Conclusions: AEDs are the most commonly prescribed drugs for various indications. Uses of AEDs are accompanied by ADRs which vary from mild rashes and itching to SJS and DRESS/TEN. Post-marketing surveillance of the AEDs is important for compliance, therapeutic efficacy and ultimately safety of the patient

Awareness of antibiotic usage and antimicrobial resistance among interns in a tertiary care hospital

Background: Antibiotic resistance is a global threat and new resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. Reducing the incidence of drug resistant infections is crucial and is a top priority at global and national levels. A study was conducted among interns to assess the awareness related to antibiotic usage and resistance.Methods: The questionnaire was administered to a batch of 75 medical interns whereby their awareness regarding antibiotic use and resistance was assessed by a five point Likert scale, whose responses ranged from “strongly agree” to “strongly disagree”, and always to never. Some questions were of true and false type. The data was analysed by using simple descriptive statistics.Results: Out of the 78 interns, 75 participated in the study and completed the questionnaires. All the 75 (100%) interns believed that indiscriminate antibiotic use leads to antimicrobial resistance and 78.6% (n=59) believed that if antimicrobials are taken too often, they are less likely to work in the future. Majority (90.6%) of the interns knew of the fact that common cold and influenza are due to viral aetiology and not bacterial. Regarding the antibiotic practices of the interns, questionnaire addressed questions related to their practices related to use of antimicrobials, 66.6% (n=50) of the interns disagreed on the question that antibiotics are safe drugs, hence can be commonly used while 62.6% (n=47) do not believe that skipping one or two doses of the drug does not lead to antibiotic resistance.Conclusions: The antibiotic resistance crisis has been attributed to the overuse and misuse of these medications. Judicious use of antibiotics is the only solution for which awareness is required at the level of both health care providers and patients. Our study provides an important insight regarding the regarding awareness of antibiotic usage and antibiotic resistance among interns

Clinicopathological Correlation of Oral Lichen Planus

INTRODUCTION : Oral lichen planus is a chronic inflammatory disease of oral mucosa with associated skin involvement. Oral lichen planus is difficult to treat and typically lasts longer than cutaneous lichen planus. It is a disease of remissions and exacerbations and is commonly a disease of the elderly. The oral mucosa forms an interface between the milieu interior and the external environment. The clinical and morphological changes seen in the oral mucosa are due to the interaction of both extrinsic and intrinsic forces. Careful examination of the oral cavity should be an integral part of a detailed physical examination. Lichen planus has a significant association of the skin lesions with those of mucous membrane. The diagnosis of oral lichen planus may pose a challenge because of the difficult visualization of the oral lesions. Other factors that interfere with diagnosis are alteration in the original appearance due to maceration from moisture, abrasion due to sharp tooth, food and infections. Oral lichen planus is often diagnosed in dental clinics during routine check up, because asymptomatic patients may be unaware of the lesions in the mouth. Patients with severe types like erosive lichen planus present earlier to a dermatologist. The pathological significance of the disorders affecting the oral mucosa may be a reflection of internal disease. Oral lichen planus has a premalignant potential. Hence, knowledge about the various precipitating factors and modes of presentation of oral lichen planus may help in predicting the course of the disease. Further, it helps in early treatment and prevention of further complications. AIMS : 1. To study the age and sex incidence of oral lichen planus. 2. To look for any known provocative factors in the onset of oral lichen planus. 3. To study the various types of clinical presentation of oral lichen planus. 4. To study the various sites of distribution of oral lichen planus. 5. To study the associated disorders in oral lichen planus 6. To study the histopathological features of various clinical types of oral lichen planus MATERIALS AND METHODS : The patients for this study were selected from the Outpatient Department of Dematology, Government Stanley Hospital, Chennai. All cases of Lichen Planus were screened for oral mucosal lesions and other patients who presented with oral lesions were examined specially to rule out Lichen Planus. Patients were enrolled and consent obtained for study, biopsy and clinical photo. The cases were given a thorough clinical examination. Detailed enquiries were made with regards to the symptoms and their duration, nature of occupation and history of taking any drugs prior to the development of lesion. Detailed personal history regarding other skin diseases, personal habits, exposure to sexually transmitted diseases and the possibility of emotional or physical stress prior to the onset of the lesions were recorded. Family H/o similar skin lesions, Diabetes Mellitus and Hypertension were asked for. History of remissions and exacerbation with or without treatment was noted. All the cases were given a routine general check up with special reference to skin and nail changes. Hypertension was ruled out by appropriate measures. Patients were examined under good light, magnifying lens and retractor. The sites affected, the types of changes in the mucous membrane, skin and nail changes along with associated skin disorders if any were made note of. Systemic examination was done in all cases to rule out systemic disorder. All patients were referred to ENT and Dental department to rule out focal sepsis. SUMMARY : 1. The number of male patients affected is more than female patients. 2. The peak age incidence in males is thirty one to forty years. 3. The peak age incidence in females is twenty one to thirty years. 4. The youngest age affected is sixteen years and oldest age is seventy years. 5. Emotional stress is the predisposing factor in 30% of patients. 6. The most common morphological type is reticular pattern. 7. Male patients, who were smokers had plaque type of oral lichen planus. 8. Fifteen patients had cutaneous lichen planus and four patients had genital lesions. 9. Two patients had hypertension, three had diabetes mellitus and two patients had vitiligo. 10. Classical histopathological changes are seen in oral as well as cutaneous lesions. CONCLUSION : In this study of oral lichen planus conducted with a sample of thirty patients, a male predominance has been observed. But previous studies report a female predominance or equal sex incidence in oral lichen planus. Male preponderance observed in our study could be attributed to the smaller sample size or could be due to health seeking behaviour of males in our country. More over, the proximity of our institution to the industrial belt, facilitates easy access for males to the skin OPD. Reticular type of oral lichen planus was the commonest type as per literature. Erosive type was the second most common type showing marked basal cell degeneration. Plaque type showed features of classical lichen planus along with marked acanthosis. Papular type showed significant pigmentary incontinence and atrophic type showed significant epidermal thinning along with features of lichen planus. None of the patients showed features of dysplasia. The patients with ulcerative and erosive type of oral lichen planus have to be followed up at 6 monthly intervals and preferably with histo pathological correlation, because it has been reported that malignant transformation is common in these types of oral lichen planus. In our study risk factors like stress and smoking played a significant role in the pathogenesis of oral lichen planus. In future, studies with larger sample size and longer duration have to be undertaken for better analysis of the risk factors involved and for better clinico pathological correlation which will help in early detection of malignancy and management

Phylogenetic and Functional Diversity of Faecal Microbiome of Pack Animals

The present chapter describes the microbial diversity of faecal microbiomes of pack animals. The sequencing data generated through ion semiconductor sequencing technology were analysed using EBI metagenomics and MG‐RAST server tools. Bacteria were the major domain in all the pack animals. At the phylogenetic level, Firmicutes was the major phylum. Clostridiales was the major order. Ruminococcus flavefaciens was the major species in camel, whereas the top‐most species existing in Equidae family was Streptococcus equinus. Among the 28 major functional categories, protein metabolism functionality was dominant in pack animals. The genes associated with protein processing and modification as well as for protein folding are higher in mules and in camel they are lowest. Central carbohydrate metabolism was the major functional group under carbohydrate metabolism in pack animals. Variation in the amino acids and its derivatives was seen in pack animals. Genes associated with proline and 4‐hydroxy prolines were present in Equidae family only. Clustering using ward with Bray‐Curtis distance matrix for the functional categories showed that donkey and mule are most closely related and clustered with the horse metagenome

Evaluation of the risk of malignancy index in preoperative diagnosis of ovarian masses

Background: Ovarian cancer possesses a challenge to screening tests due to its anatomical location, poor natural history, lack of specific lesion, symptoms and signs and low prevalence. Authors shall be considering RMI 2 and RMI 4 (forms of RMI) and comparing them with histopathology report to derive the sensitivity, specificity and other parameters of these tests.Methods: A prospective   study was conducted from September 2016- September 2017 at Mazumdar Shaw Hospital, Narayana Hrudayalaya, Bangalore.73 patients met the inclusion criteria. RMI 2   and RMI4 were calculated for all the patients and these scores were compared to the final histopathology reports.Results: In present study of 73 patients RMI2 showed a sensitivity of 86.6%, specificity of 86.5 %, Positive predictive value of 81.25% and negative predictive value of 90.24 %. Whereas RMI4 showed a sensitivity of 86.6%, specificity of 86.5 %, Positive predictive value of 83.87 and negative predictive value of 90.48 %. These results are comparable to other studies conducted.  The risk of malignancy index 2 and 4 are also almost comparable with each other and so either can be used for determining the risk of malignancy in patients with adnexal masses. These results were derived in an Indian population across all age groups showing that authors can apply this low-cost method even in resource limited settings.Conclusions: Authors found that Risk of malignancy index is a simple and affordable method to determine the likelihood of a patient having adnexal mass to be malignant. This can thus help save the resources and make the services available at grass root level