Practice of self-medication of mifepristone-misoprostol drug combination for medical abortion

Most medical abortion protocols require women to take mifepristone in the hospital setting. The rate of complete abortion up to 63 days’ gestation with mifepristone and misoprostol was reported to be 92-95% using the Food and Drug Administration-approved regimen.1,2 In a recent study, the completion rates of 96-97% was reported in early pregnancy, including pregnancies up to 63 days’ gestation.3 Women choosing medical abortion must consent to undergo vacuum aspiration or dilatation and curettage in cases of incomplete abortion.Medical methods for first trimester abortion have been demonstrated to be both safe and effective. Regimens that combine mifepristone with a prostaglandin analogue such as misoprostol are more efficacious than a prostaglandin alone. Mifepristone, (RU 486, a substitute 19- norethisterone derivative)by blocking the progesterone receptors causes estrogen dominance and results in intrauterine fetal death. Simultaneously, it sensitizes the uterus to the activity of the prostaglandin. Thus, a combination of these two drugs is significantly more efficacious for termination of early pregnancy when compared to mifepristone given alone. A regimen that includes mifepristone in a dosage of 200 mg administered orally, followed by misoprostol in a dosage of 800 µg vaginally administered 48 hrs after mifepristone, and is highly effective for medical abortion up to 63 days gestation. This regimen is reported to be the best in most of the studies and moreover mifepristone serum levels do not increase proportionally with increasing oral doses.4In a study conducted by Schaff et al., it was observed that the success rate was seen in 96-97% of women who were prescribed a combination of mifepristone and misoprostol by authorized personnel at the hospital.3 Women are commonly advised to return for one or more follow-up visits, after 10-14 days because in cases of incomplete abortion she can be managed either expectantly, with an additional dose of misoprostol, or with an aspiration procedure. Women may be given the option of home administration of misoprostol after the initial clinic visit.5However, the use of mifepristone – misoprostol combination for medical abortion used as self-medication, is rising due to changing socio-cultural practices and increased awareness among women for the termination of early pregnancy up to 63 days. It is observed that many women indulge in the practice of self-medication for termination of pregnancy. They take medicines either from local pharmacists, nurses, on advice of relatives, friends, husband, neighbors, newspaper articles, radio, television, magazines or any other such unauthorized sources for termination of pregnancy which mostly leads to incomplete abortion or many complications. It is observed that only few number of women have complete abortion with self-medication from an unauthorized source and moreover they suffer from pain and heavy bleeding when compared to normal menstrual flow. It is noticed that now-a-days, these drugs are used irrationally and nonjudiciously. Women are thus advised to take proper regimen of mifepristone and misoprostol under the guidance of an authorized practitioner and if they still fail to abort, then they have to undergo surgical evacuation that is, vaccum aspiration for termination of pregnancy

Use of polycarbonate plastic products and human health

As plastic and plastic products are being used in day to day at the cost of environment pollution, the human and wild life health and has become a global concern. Researchers found link between abnormal liver enzymes in the people and Bisphenol-A (BPA). Changes in insulin resistance, reproduction system, cardiovascular and brain function are also reported. BPA is used in the production of epoxy resins, polycarbonate resins, and polyester resins. BPA can leach out of certain plastic products including variety of modern goods, reusable food storage containers, eyeglass lenses, white dental fillings, sealants, medical equipments etc. In the body, BPA behaves as an estrogen receptor agonist and mimics estrogen hormone. Bisphenol-A (BPA) is a widespread endocrine-disrupting chemical (EDC) used as the base compound in the manufacture of polycarbonate plastics. Children and unborn and new born babies are at high risk of unwanted effects of BPA. Children suffer from chronic exposure to bisphenol A with manifestation of gastrointestinal problems, adrenal stress, immune dysfunction, toxic over load and neurological disorders. Some study in Japan has observed that more BPA can leach from polycarbonate products that have been scratched or is more than 4 years old or used bottles that have been subjected to bottle brushing or dishwashing and sterilization. People exposed to higher levels of BPA due to use of plastic food and beverages containers are more likely to develop cardiovascular diseases, diabetes and metabolic disorder. Recent studies have suggested that BPA exposure may have a role in the development of weight gain, insulin resistance, pancreatic endocrine dysfunction, thyroid hormone disruption, and several other mechanisms involved in the development of diabetes. Urinary BPA levels are found to be associated with diabetes mellitus independent of traditional diabetes risk factors. There is a concern of exposure of BPA to pregnant women that can affect the development of offspring in the womb. It is considered that women may be placing their fetuses at the risk by having dental sealants applied during pregnancy. Public should be educated about the use of plastic and plastic products which can prove to be hazardous and risk factor to many health problems of human and wild life

Lornoxicam versus diclofenac sodium in acute renal colic: a prospective randomized trial

Background: Acute renal colic is excruciatingly painful event, opioid analgesics and nonsteroidal anti-inflammatory drugs remain the mainstay of treatment for acute renal colic. This study compares diclofenac and lornoxicam in their efficacy to relieve pain of renal origin.Methods: Prospective, randomized, double blind clinical study including eighty patients with renal pain admitted in emergency department of a tertiary care teaching hospital. Parameters were observed at baseline and after 15, 30, 60, 180 minutes and 5hrs of drug treatment. The efficacy of the drug was measured by observing: Pain score, onset & duration of action, rescue drug use, global patient and physician impression.Results: Both drugs are effective in relieving pain of renal origin (p<0.05) and maintaining it over time as well. When decrease in value of  pain score compared between two groups at various interval there was statistically significant (p<0.05) decrease in pain score only at 15 minutes in lornoxicam group showing this slightly more effective in early phase compared to diclofenac. In either group there is no statistically significant difference regarding onset of action, duration of action and side effect profile.Conclusions: Both the drugs are equally effective and safe in renal colicky pain with added advantage of lornoxicam being more effective in early period

LORNOXICAM: A REVIEW OF ITS THERAPEUTIC POTENTIAL IN DIFFERENT CLINICAL STUDIES

Lornoxicam is a member of the oxicam group of nonsteroidal antiinflammatory drugs (NSAIDs), producing analgesic and antipyretic effects  through the non-selective inhibition of cyclo-oxygenase-1 and -2. Besides its inhibitory effect on COX1 and COX-2 peripheral receptors, is also increases endogenous dinorphin and beta-endorphin levels promoting central analgesic and anti-inflammatory effects. Recently, lornoxicam has been introduced in Indian market in oral, intravenous and intramuscular formulations.  Lornoxicam is completely absorbed after oral administration, reaching peak plasma concentrations of 280 mg/L within 2.5 hours after a 4 mg dose.  After intramuscular injection maximum plasma concentrations are achieved after approximately 20-25 minutes. Lornoxicam is extensively metabolished in liver by cytochrome P4502DC9 to inactive metabolite 5’-hydroxy-lornoxicam. The mean elimination half life is 3 to 4 hours. There is plenty of literature available on the effect of lornoxicam on chronic and acute pain management. These preliminary finding require confirmation in further comparative studies. Key words:- lornoxicam, analgesic, anti inflammatory drugs

TO STUDY COMPLIANCE OF ANTENATAL WOMEN IN RELATION TO IRON SUPPLEMENTATION IN ROUTINE ANTE-NATAL CLINIC AT A TERTIARY HEALTH CARE CENTRE

Background : The purpose of this study was to determine the compliance of the pregnant women and factors related to iron tablet consumption behavior among pregnant women. Response to  iron deficiency anemia  is related to the dose and schedule of a iron tablets and diet. Noncompliance reduces treatment benefits and is associated with poorer prognosis. Methods: A detailed questionnaire designed to assess the antenatal women compliance. Eight hundred  and sixty women of 16-30wks pregancy who received iron tablets daily for 90 consecutive days in Rohtak city of Haryana state. Results: The results showed that compliance among pregnant women, regarding iron supplementation, was observed by 80.47% women, non compliance was observed by 14.42 % while over compliance was observed only by 5.11% women. Compliance was better observed in educated patients as compared to uneducated i.e.62.14% versus 37.86%. The reasons for non compliance were side effects 29.03% , suffering from pregnancy complications and taking multiple drug supplements 22.58% , long term taking of iron tablets 19.35%, not liking pharmaceutical preparations 16.94%, forgetfullness 9.68% and not liking due to poor quality of iron tablet supplied by government were 2.42%.  Almost all the women believed that the doctor, pharmacist and nurse explained the instructions for intake of iron tablets and diet  to them and they followed those instructions. Conclusion: This study shows that  compliance is related to education of the pregnant women and proper explanation of instructions by doctor, pharmacist and nurses, help to improve the compliance but much can be done to improve existing iron supplementation programs in developing countries by ensuring that iron tablets of good quality are available at all levels of health care. Key Words: Compliance, Pregnant Women, Iron Deficiency Anemia

Bibliometric analysis of Indian Journal of Endocrinology and Metabolism

Background: Bibliometric analysis of the journal is a method to assess the research impact or research influence of that journal. This information can also be used to evaluate the influence/performance of a researcher and to provide a comparison between researchers. This work was aimed at performing bibliometric analysis of Indian Journal of Endocrinology and Metabolism (IJEM). Materials and Methods: The publications of year 2011-12 of IJEM were analyzed. Total number of articles published, type of articles, their authorship, and the coverage of various subspecialties was studied. The publications were also classified as Indian or foreign, from endocrine or nonendocrine departments and from academic or nonacademic institutions according to the institution of first author. Results and Conclusions: A total of 10 main issues and 7 supplementary issues were published in IJEM in year 2011 and 2012. These included a total of 605 publications, which depict a dramatic increase in the number of publications in last 2 years as compared to the previous years. Taking collectively, review articles were published in majority. Maximum number of articles was dealing with pancreas and metabolic disorders followed by thyroid. Other endocrine organs were given almost similar importance. Publications were largely originating from endocrine departments and from academic institutions. Although maximum number of articles were from India, but the publications from other countries are also on an increase. Thus, the widespread coverage of this journal suggests that IJEM has begun to represent global face of Indian endocrinology

The Availability of Essential Antimicrobials in Public and Private Sector Facilities: A Cross-Sectional Survey in a District of North India

(1) Background: There is a need to assess the availability of essential antimicrobials, as the availability of an antimicrobial is a critical element of its rational use. We aimed to assess the availability of antimicrobials listed in the National List of Essential Medicines 2015, India (primary list), and a selected (secondary) list comprised of agents indicated for commonly encountered infectious illnesses in various healthcare settings and to identify the reasons for their non-availability. (2) Methods: A cross-sectional survey of 25 public, private, and other sector pharmacies was carried out in Rohtak, a district of the North Indian state of Haryana, from April to June 2022. (3) Results: Most of the antimicrobials surveyed were optimally available in various sector pharmacies with the exception of benzathine benzylpenicillin, benzylpenicillin, cloxacillin, cefazolin, cefuroxime, cefadroxil, amphotericin B, and antimalarials. The most frequent reasons for limited availability were low demand, no prescriptions, and the non-listing of drugs in the state’s essential medicine list. (4) Conclusions: Enough evidence needs to be generated with respect to the status of availability of essential antimicrobials from different regions of India as well as other lower-middle-income countries to devise measures for ascertaining better availability of these agents, especially antibiotics at regional, national, and global scales

Retained Forceps: An Unusual Cause of Intestinal Obstruction

Medical errors during surgery are usually under-reported and not well studied. During the past decade, increased interest in medical malpractice has been shown by both the public and the authorities. A particularly high risk of medical errors is seen in emergency settings, unexpected change in procedure, or in patients with a high body mass index. Visually or acoustically controlled monitoring before wound closure are recommended to eliminate human error as thoroughly as possible. Prevention remains the key to solving the problem