Knowledge, attitude and practice of research ethics among medical faculty in a teaching hospital

Background: To assess the knowledge, attitudes and practice of medical faculty regarding research ethics and research ethics committees (RECs).Methods: A cross-sectional, questionnaire-based study was conducted in ESIC medical colleges in Bangalore among faculty using a validated questionnaire. Questions were designed to assess the knowledge, attitudes and practice of medical faculty regarding research ethics and research ethics committees. Statistical analysis was done using descriptive statistics and chi-square tests.Results: Majority (76%) of faculty had not undergone training in research ethics. Less than half of the participants answered correctly to a question on guidelines in research ethics, 60% responded correctly to question on research involving children. Majority responded correctly to question on role of a research ethics committee and confidentiality, informed consent and to question on composition of Institutional Ethics Committee. 68% taught that ethical review of research by an ethics committee would delay research. >90% were favourable towards research ethics training. Faculty held attitudes regarding certain research ethics practices that were not optimal, 96% believed that it is okay to fabricate data, 68% taught that if no surrogate is available to give informed consent for vulnerable groups, they could still be included.Conclusions: We conclude that among the medical faculties participating in our study, there is acceptance of RECs and training in research ethics, while there are knowledge gaps in research ethics guidelines, research involving children. There is need to train researchers and students to make them aware about various aspects of research

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

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

Opinion of Health Care Professionals towards Submitting a Research Article to a Journal.

There are no specific criteria to measure a journals quality, but indexation of a journal in a reputed database such as PubMed/Medline, SCOPUS, EMBASE etc, and whether the journal is having an impact factor produced by Thomson Reuters are looked upon. Many more indexation database have come up recently, and authors are publishing more articles than before. This questionnaire based study was conducted in November 2012 in two medical colleges in south India with the aim to know the opinion of health care professionals towards submitting a research publication to a journal. Prior approval was taken from the Institutional Ethics Committee to conduct the study. The selected participants were from tutors to professors. The information was recorded and analyzed using Microsoft Excel (2007 version). A total of 297 respondents participated in the study, out of which 263 completed the questionnaire. Assistant professors had more number of publications and also had the maximum number of publications as first author. Among the papers published <10% were published in journals which are pubmed indexed. Highest percentage of pubmed indexed journals were published by professors which was around 10%. The knowledge about impact factor was higher among the junior faculty than the professors. The knowledge regarding quality of a journal, with respect to indexation and impact factor of a journal is grossly inadequate among the doctors. Necessary steps should be taken by editorial board of reputed journals and associations such as International Council Of Medical Journal Editors or regulatory authorities such as Medical Council of India to spread the knowledge about quality of a journal

A Low Area, Switched-Resistor Based Fractional-N Synthesizer Applied to a MEMS-Based Programmable Oscillator

Abstract-MEMS-based oscillators have recently become a topic of interest as integrated alternatives are sought for quartz-based frequency references. When seeking a programmable solution, a key component of such systems is a low power, low area fractional-N synthesizer, which also provides a convenient path for compensating changes in the MEMS resonant frequency with temperature and process. We present several techniques enabling efficient implementation of this synthesizer, including a switched-resistor loop filter topology that avoids a charge pump and boosts effective resistance to save area, a high gain phase detector that lowers the impact of loop filter noise, and a switched capacitor frequency detector that provides initial frequency acquisition. The entire synthesizer with LC VCO occupies less than 0.36 sq. mm in 0.18 m CMOS. Chip power consumption is 3.7 mA at 3.3 V supply (20 MHz output, no load). Index Terms-MEMS, fractional-N synthesizer, reference frequency, phase-locked loop (PLL), loop filter, high gain phase detector, switched resistor, switched capacitor, frequency acquisition, frequency detection, phase detection, oscillator, temperature stable

Multi-center feasibility study evaluating recruitment, variability in risk factors and biomarkers for a diet and cancer cohort in India

<p>Abstract</p> <p>Background</p> <p>India's population exhibits diverse dietary habits and chronic disease patterns. Nutritional epidemiologic studies in India are primarily of cross-sectional or case-control design and subject to biases, including differential recall of past diet. The aim of this feasibility study was to evaluate whether a diet-focused cohort study of cancer could be established in India, providing insight into potentially unique diet and lifestyle exposures.</p> <p>Methods</p> <p>Field staff contacted 7,064 households within three regions of India (New Delhi, Mumbai, and Trivandrum) and found 4,671 eligible adults aged 35-69 years. Participants completed interviewer-administered questionnaires (demographic, diet history, physical activity, medical/reproductive history, tobacco/alcohol use, and occupational history), and staff collected biological samples (blood, urine, and toenail clippings), anthropometric measurements (weight, standing and sitting height; waist, hip, and thigh circumference; triceps, sub-scapula and supra-patella skin fold), and blood pressure measurements.</p> <p>Results</p> <p>Eighty-eight percent of eligible subjects completed all questionnaires and 67% provided biological samples. Unique protein sources by region were fish in Trivandrum, dairy in New Delhi, and pulses (legumes) in Mumbai. Consumption of meat, alcohol, fast food, and soft drinks was scarce in all three regions. A large percentage of the participants were centrally obese and had elevated blood glucose levels. New Delhi participants were also the least physically active and had elevated lipids levels, suggesting a high prevalence of metabolic syndrome.</p> <p>Conclusions</p> <p>A high percentage of participants complied with study procedures including biological sample collection. Epidemiologic expertise and sufficient infrastructure exists at these three sites in India to successfully carry out a modest sized population-based study; however, we identified some potential problems in conducting a cohort study, such as limited number of facilities to handle biological samples.</p

A cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India

<p>Abstract</p> <p>Background</p> <p>The role of diet in India's rapidly progressing chronic disease epidemic is unclear; moreover, diet may vary considerably across North-South regions.</p> <p>Methods</p> <p>The India Health Study was a multicenter study of men and women aged 35-69, who provided diet, lifestyle, and medical histories, as well as blood pressure, fasting blood, urine, and anthropometric measurements. In each region (Delhi, n = 824; Mumbai, n = 743; Trivandrum, n = 2,247), we identified two dietary patterns with factor analysis. In multiple logistic regression models adjusted for age, gender, education, income, marital status, religion, physical activity, tobacco, alcohol, and total energy intake, we investigated associations between regional dietary patterns and abdominal adiposity, hypertension, diabetes, and dyslipidemia.</p> <p>Results</p> <p>Across the regions, more than 80% of the participants met the criteria for abdominal adiposity and 10 to 28% of participants were considered diabetic. In Delhi, the "fruit and dairy" dietary pattern was positively associated with abdominal adiposity [highest versus lowest tertile, multivariate-adjusted OR and 95% CI: 2.32 (1.03-5.23); P_trend= 0.008] and hypertension [2.20 (1.47-3.31); P_trend< 0.0001]. In Trivandrum, the "pulses and rice" pattern was inversely related to diabetes [0.70 (0.51-0.95); P_trend= 0.03] and the "snacks and sweets" pattern was positively associated with abdominal adiposity [2.05 (1.34-3.14); P_trend= 0.03]. In Mumbai, the "fruit and vegetable" pattern was inversely associated with hypertension [0.63 (0.40-0.99); P_trend= 0.05] and the "snack and meat" pattern appeared to be positively associated with abdominal adiposity.</p> <p>Conclusions</p> <p>Cardio-metabolic risk factors were highly prevalent in this population. Across all regions, we found little evidence of a Westernized diet; however, dietary patterns characterized by animal products, fried snacks, or sweets appeared to be positively associated with abdominal adiposity. Conversely, more traditional diets in the Southern regions were inversely related to diabetes and hypertension. Continued investigation of diet, as well as other environmental and biological factors, will be needed to better understand the risk profile in this population and potential means of prevention.</p

Rhenium and yttrium ions as antimicrobial agents against multidrug resistant Klebsiella pneumoniae and Acinetobacter baumannii biofilms

© 2019 The Authors. Letters in Applied Microbiology published by John Wiley & Sons Ltd on behalf of Society for Applied Microbiology. Antimicrobial resistance presents major global concerns to patient health. In this study, metal ions of molybdenum, rhenium, yttrium and thallium were tested against bacteria in planktonic and biofilm form using one strain of Klebsiella pneumoniae and Acinetobacter baumannii. The antimicrobial efficacy of the metal ions was evaluated against the planktonic bacterial strains using minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations, whilst the efficacy of the metal ions against biofilms was tested using a crystal violet biofilm assay. Live Dead staining was used to visualize the antimicrobial activity elicited by the metal ions on the bacterial cell. The results showed that higher concentrations of the metals were required to inhibit the growth of biofilms (72·9 mg l −1 to 416·7 mg l −1 ), in comparison to their planktonic counterparts. MICs of the metal ions (<46·9 mg l −1 ) (planktonic cells) did not affect biofilm formation. Overall, rhenium and yttrium were effective antimicrobial agents. Molybdenum demonstrated the greatest level of biotoxicity. When taking into account these results and the known toxicity of thallium, it is possible that rhenium or yttrium ions could be developed as effective biocidal formulations in order to prevent transmission in healthcare environments. Significance and Impact of the Study: The metal ions, molybdenum, rhenium, thallium and yttrium were tested against both Klebsiella pneumoniae and Acinetobacter baumannii in planktonic and biofilm forms. This research demonstrated that all the metal ions may be effective antimicrobial agents. However, molybdenum induced high levels of cytotoxicity, whilst, there was no significant difference in the toxicity of the other metal ions tested. When considering the results for the antimicrobial efficacy and biotoxicity of the metal ions, in conjunction with the known toxicity of thallium in certain chemical compositions, it was concluded that overall rhenium or yttrium ions may be effective antimicrobial agents, one potential application may be utilizing these metal ions in hospital surface cleaning formulations

Thrombocytopenia in Pregnancy: An Observational study

Thrombocytopenia affects 7 to 15% of all pregnant women and is the second common haematological problem in pregnancy next only to anaemia. Thrombocytopenia in pregnancy occurs due to several causes, the commonest being gestational thrombocytopenia. As observed in the study, Gestational thrombocytopenia is always mild or moderate in severity and had its onset at any trimester of pregnancy. The second common cause of thrombocytopenia in pregnancy is due to some form of hypertensive disorder of pregnancy. In our study it was found to be due to severe preeclampsia followed by HELLP syndrome. Severe preeclampsia causes severe and moderate thrombocytopenia whereas HELLP syndrome causes mild and moderate thrombocytopenia. In all forms of hypertensive disorders of pregnancy, the importance of looking for thrombocytopenia is emphasised. Maternal effects of thrombocytopenia as observed in the study showed hemorrhage in the form of antepartum hemorrhage, post partum hemorrhage, miscarriages. The proper evaluation of cause of thrombocytopenia inpregnancy in the common order of occurrence is essential to anticipate and manage such complications