A comparative randomized controlled parallel group study of efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia

Background: The objective of the current study was to compare the efficacy and tolerability of labetalol versus methyldopa in the treatment of mild preeclampsia.Methods: We carried out a prospective randomized controlled parallel group study on 100 outpatients of Obstetrics and Gynaecology Department of Government Medical College, Patiala, a tertiary care teaching hospital. Pregnant patients (20-40 weeks gestational age) newly diagnosed with blood pressure (BP) of ≥140/90 mm Hg were included in the study. All patients with systolic BP (SBP) ≥160 mm Hg and diastolic BP (DBP) ≥110 mm Hg after 20 weeks of gestation, history of hypertension, renal diseases, diabetes mellitus, epilepsy, and thyroid diseases were excluded from the study. After taking the informed consent, 50 patients each were randomized to either of the two treatment arm-oral labetalol or oral methyldopa. Difference in the BP measurements at the time of admission and at the time of delivery were analyzed by applying paired t-test. For intergroup analysis, we applied independent t-test using SPSS version 16. A p<0.05 was regarded as significant.Results: Both methyldopa and labetalol cause significant fall in SBP, DBP and mean arterial pressure (MAP) in their groups (p<0.001). However, when we compared both groups it was labetalol, which causes significant fall in MAP as compared to methyldopa (p<0.001). The incidence of adverse effects like hypotension, headache, and sedation were also less in labetalol group.Conclusion: Labetalol has an upper edge over methyldopa in control of BP during pregnancy with minimal adverse effects

A review on thimerosal: an irreplaceable element of long-term immunisation strategy in low income countries

Thimerosal, an organic-mercury (Hg) compound containing 49.55% Hg by weight, is added to vaccines as a preservative permitting formulation of multi-dose vaccine vials. Being a derivative of ethylmercury, it has been linked with autism as a possible risk factor based on the assumption that exposure to ethylmercury would have similar neurotoxic effects as another mercurial compound, methylmercury. In 1999, AAP issued a joint statement emphasising the removal of thimerosal from vaccines. Subsequently, several studies have been conducted; those showing positive association between thimerosal exposure and autism have been recognised to be fraught with methodological flaws. On the other hand, many well controlled studies have failed to find any such causal relation and there are others that have clearly demonstrated a much favourable kinetic profile of ethylmercury as compared to methylmercury. Owing to the lack of data, AAP retired its original statement in 2002. Recently, thimerosal has been exempted from regulation by Minamata Convention on Mercury resulting in the continued use of low cost thimerosal containing vaccines in low income countries which cannot afford to run their immunisation program using single dose thimerosal free vaccines, that comparatively cost much higher, as is the case in high income countries. Some bodies view this as a discrimination on the basis of wealth of a nation and have opposed this decision. This review presents various studies regarding the causal association between thimerosal containing vaccines and autism. The current evidence fails to support any such association. Hence this review supports the exemption of thimerosal from regulation and also justifies its use in LICs for uninterrupted vaccination of the most vulnerable population

Factors Influencing Acceptance Of Contraceptive Methods

Research Problem: What are the factors influencing acceptance of contraceptive methods. Objective: To study the determinants influencing contra­ceptive acceptance. Study design: Population based cross - sectional study. Setting: Rural area of East Delhi. Participants: Married women in the reproductive age group. Sample:Stratified sampling technique was used to draw the sample. Sample Size: 328 married women of reproductive age group. Study Variables: Socio-economic status, Type of contraceptive, Family size, Male child. Outcome Variables: Acceptance of contraceptives Statistical Analysis: By proportions. Result: Prevalence of use of contraception at the time of data collection was 40.5%. Tubectomy and vasectomy were most commonly used methods. (59.4%, n - 133). Educational status of the women positively influenced the contraceptive acceptance but income did not. Desire for more children was single most important deterrent for accepting contraception. Recommendations: (i)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Traditional method of contraception should be given more attention. (ii)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Couplesshould be brought in the contraceptive use net at the early stage of marriage

Evaluation of the knowledge, attitude and the practice of pharmacovigilance among the interns and doctors in a tertiary level care teaching hospital in Northern India

Background: Adverse drug reaction (ADR) is defined by world health organization (WHO) as “a response to a drug, which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease or for the modification of physiological function. The objective of this study was investigating the knowledge, attitudes and practices of doctors and interns to ADR reporting and reasons for underreporting of ADRs.Methods: It was a questionnaire-based, cross-sectional study. Questionnaires was designed, validated by doing a pilot study, administered to doctors and interns working in a teaching hospital with an ADR monitoring center. This questionnaire was administered to randomly select 500 faculty members, interns and the resident doctors for inclusion in the study, out of which only 209 responded. The study was approved by institutional ethics committee, government medical college Patiala. Only those who gave their consent to participate were included in the study. The data was analysed by using the statistical package for social sciences (SPSS) statistical software, version 20.Results: Only 20 % faculty members and 51% interns were aware of AMC in our institute. Legal inquiry/action involved for reporting an ADR was the main worry while reporting an ADR for faculty member (68%). Lack of time to report ADR was the main reason given by Interns (22%) and not knowing to whom and where to report was the main reason given by Interns PGs (40%). Awareness of postgraduate residents (90%) was overall better than faculty and interns.Conclusions: There is a great need to create awareness and to promote the reporting of ADR amongst interns and doctors, which will lay a solid foundation for these healthcare professionals to be involved in quality pharmacovigilance

A retrospective study of antimicrobial resistance pattern of Pseudomonas aeruginosa isolates from urine samples over last three years (2013-2015)

Background: Problem of antibiotic resistance is compounding day by day because of overuse and misuse of antibiotics. There is no systematic national surveillance of antibiotic resistance and insufficient data is available to quantify the problem in our country. This study aims at studying the changing pattern of antimicrobial resistance of Pseudomonas aeruginosa isolates from patients of urinary tract infections over last three years.Methods: A retrospective, record based study carried out based on the records of C/S (Culture sensitivity) reports of indoor patients, during past three years (2013 - 2015). The types of organisms causing urinary tract infections were noted and the drugs still effective for the Pseudomonas aeruginosa were noted.Results: Pseudomonas aeruginosa is inherently resistant to many antimicrobial agents. Analysis of the results year wise indicated that the lowest percentage of resistance manifested against imipenem was 14%, 24.48% and 20.99% for the years 2013-2015. Resistance for fluoroquinolones decreased over the three consective years from 84.67% (2013) to 78.27% (2015). Over the successive years, the resistance to ceftriaxone tends to increase from 80% (2013) to 92.59% (2015). C/S reports showed on an average 69% were resistant to aminoglycosides. Multi drug resistant pseudomonas percentage resistant to fluoroquinolones, third generation cephalosporines and aminoglycosides were 78% (2013), 78.33% and 80.33% (2015) over the consective years.Conclusions: The antimicrobial resistance patterns are constantly evolving and vary from region to region it has become a necessity to do constant antimicrobial sensitivity surveillance. This will help clinicians to provide safe and effective empirical therapies

Analysis of cost of medical therapy in patients of metabolic syndrome: an observational study

Background: The objective of the study was to analyze cost of medical therapy in patients of Metabolic syndrome.Methods: This was an observational study. The study was conducted by enrolling patients of the outpatient department of Medicine of Rajindra Hospital, Government Medical College, Patiala, Punjab. A total of 100 patients diagnosed with Metabolic syndrome were enrolled in the study. The total daily cost of the therapy was calculated by adding the direct cost of individual drugs taking in consideration the frequency of the drug. The daily cost of therapy was then extrapolated to calculate the monthly as well as annual cost of therapy.Results: The mean age of patients was 58.27±10.32 years. Out of a total of 100 patients, there were 57 female and 43 male patients, indicating a female preponderance of the disease. The average individual daily cost of medical therapy is INR 44.56 which upon extrapolation gives monthly and annual cost of INR 1336.90 and INR 16264.40 respectively. The cost of treatment in males is costlier than females (INR 50.09 in males versus INR 40.22 in females). The cost of treatment of age 31-40 years is INR 27.90 while it INR 36.97, 48.16 and 50.75 for age groups 41-50, 51-60 and 61-70 years. The various components of metabolic syndrome viz. diabetes mellitus, hypertension and dyslipidemia contribute differently to the cost of therapy. Daily cost of medical therapy for diabetes mellitus is INR 18.57 while for hypertension and dyslipidemia are INR 10.25 and INR 6.13 respectively.Conclusions: Chronic diseases like metabolic syndrome have a huge share of the healthcare budget. Given the fact that it is a lifestyle disease, its prevalence is likely to swell in the coming decades. Hence, formulation of preventive and innovative treatment guidelines is of utmost importance

Communicable behavior of non-communicable diseases

Communicability of non- communicable diseases can be explained using the prototype of non- communicable diseases. The concept can be further extended to other non- communicable diseases. Diabetes mellitus (DM) is regarded as the prototype of non-communicable diseases. Its subtype, type 2 DM is usually associated with obesity. Obesity, in turn, can be attributed to deranged eating habits and lack of physical activity. Eating habits of a person bears a close resemblance to the parental eating habits. Other factors contributing to obesity like alcoholism can also be transmitted from parents to child. Smoking, another factor implicated in DM, can be picked as a habit from peer group as well as family. All these factors implicated directly or indirectly in the pathogenesis of DM are actually components of lifestyle. These lifestyle components can be transmitted both in an inter-generation and intra-generation fashion. And so the chances of transmission of DM (a lifestyle disease) in the same fashion cannot be ruled out

A study to evaluate compliance in patients of diabetes mellitus in a North-Indian tertiary care hospital

Background: The objective of the study was to determine level of adherence and recognize various causative factors which can affect the compliance in the diabetic patients.Methods: This was an observational study. The study was conducted by enrolling patients of the outpatient department of Medicine of Rajindra Hospital, Government Medical College, Patiala, Punjab. To assess adherence, a questionnaire was administered to the patients - Morisky Medication Adherence Scale (MMAS) -8 item questionnaire. The various factors affecting compliance was determined by a researcher made questionnaire.Results: Out of a total of 100 subjects, age range extended from 18 years to 80 years. The mean age was 57.52±12.33years. 51% of patients were females and 49% was males. Analysis of MMAS- 8 item scores of patients showed that 52% of patients had low adherence, 29% had medium while 19% had high adherence to the treatment. Only 30% patients were compliant i.e. with HbA1C value of 7 or less while 70% patients were non-compliant i.e. with HbA1C value of more than 7.Conclusions: Compliance to medical treatment is influenced by a myriad of factors. In order to promote compliance, it is necessary to increase awareness about the disease, possible complications and treatment guidelines among patients as well as their family members.

A study to determine socio demographic corelates of reproductive tract infection amongst women of reproductive age group

Background: Reproductive tract infection (RTI) is a public health problem, especially in developing country like India. The associated odium with this reproductive morbidity is often a stumbling block in seeking health care. The aim was to study the prevalence of RTI symptoms and its socio-demographic corelates.Methods: A cross-sectional study was undertaken in the rural field practice area of department of community medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to September 2018. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The prevalence of self-reported reproductive tract infections was found to be 41.2%. The prevalence was more in lower socio-economic classes, and it was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.Conclusions: The reproductive tract infections prevalence is found to be considerably high in the women of reproductive age group. The frequency was higher among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health