Rational prescribing practice assessment among resident doctors in a tertiary care teaching hospital: a questionnaire based observational study

Background: One of the important factors in health policy is recognised to be rational use of medicines (RUM). Physicians can influence the health and well-being of patients by prescribing appropriate drug in right doses and they should be taught to prescribe rationally at the earliest of their professional carrier.Methods: This cross-sectional, questionnaire-based study was carried out in SMHS hospital which is a tertiary-care teaching hospital associated with Government Medical College, Srinagar, Jammu and Kashmir, India.Results: Out of 106 resident doctors enrolled in the study, 96.2% respondents were aware about the term essential medicines of India, and 47.6% had National List of Essential Medicines of India available at their work place. When the participants were questioned about the term RUM only 17% of them responded positively, but majority of the resident doctors (88.67%) were aware about the ingredients of the drugs they use to prescribe. Though only 3.7% of our participating doctors always use essential medicines during their prescription writing but majority of them (96.22%) would always use to inform the patient regarding disease, drug therapy and monitoring of drug therapy.Conclusions: Considering the fact that respondents are future prescribers they should be aware of all aspects about RUM and improper knowledge in certain areas of RUM is a matter of concern that needs to be addressed

Investigating the benefits of molecular profiling of advanced non-small cell lung cancer tumors to guide treatments.

In this study we utilized data on patient responses to guided treatments, and we evaluated their benefit for a non-small cell lung cancer cohort. The recommended therapies used were predicted using tumor molecular profiles that involved a range of biomarkers but primarily used immunohistochemistry markers. A dataset describing 91 lung non-small cell lung cancer patients was retrospectively split into two. The first group's drugs were consistent with a treatment plan whereby all drugs received agreed with their tumor's molecular profile. The second group each received one or more drug that was expected to lack benefit. We found that there was no significant difference in overall survival or mortality between the two groups. Patients whose treatments were predicted to be of benefit survived for an average of 402 days, compared to 382 days for those that did not (P = 0.7934). In the matched treatment group, 48% of patients were deceased by the time monitoring had finished compared to 53% in the unmatched group (P = 0.6094). The immunohistochemistry biomarker for the ERCC1 receptor was found to be a marker that could be used to predict future survival; ERCC1 loss was found to be predictive of poor survival

Frequency and pattern of gynecological problems of adolescent girls attending outpatient department, department of obstetrics and gynecology, Bangabandhu Sheik Mujib Medical University, Bangladesh

Background: Adolescent is a stage of development tangent, like a bridge of childhood and adulthood. It is the healthiest age group of our society which is almost 20% of our total population. World health organization (WHO) defines adolescents are in the 10-19 year in age group. One of the major physiological changes that take place in adolescent girls is the onset of menarche, which is often associated with problems of irregular menstruation, excessive bleeding and dysmenorrhea.Methods: This cross-sectional observational study was carried out in 668 female adolescent aged 10-19 years irrespective of their marital status visiting the OPD of obstetrics and gynecology department of BSMMU. All data was analyzed using SPSS program version 22.0.Results: Results were expressed in frequencies or percentages. Of the 668 adolescent girls, 418 (62.6%) had different type of menstrual disorder. Of these 418 cases about 127 (30.38%) of them were a case of puberty menorrhagia, 109 (26.07%) cases were oligomenorrhoea and 91 (21.77%) were amenorrhea. Other presentations were pre-vaginal discharge, vulval itching, lower abdominal pain, dysuria, feeling lump in lower abdomen, mastalgia, feeling lump in the breast, discharge from breast, acne, hirsutism.Conclusions: This study shows more than half of adolescent girls are having menstrual disorder. Adolescent gynecology needs increased awareness and greater attention to improve the quality of their life. Setting up a separate adolescent clinic is necessary for efficient management of adolescent problem

Malignant ectopic thyroid tissue with distant metastasis: a case report

Introduction: Ectopic thyroid tissue is the most common form of thyroid dysgenesis. But primary malignant transformation in ectopic thyroid tissue is quite a rare entity, with follicular malignancy being the dominant form at ectopic sites. Very infrequently, malignant ectopic thyroid tissue can present with metastasis to lymph nodes. But we report a case of malignant ectopic thyroid tissue over manubrium sterni with distant metastasis. Case presentation: A 42-year-old Pakistani female presented with gradually increasing swelling on anterior aspect of manubrium sterni for last 6 months. She had no goitre and was clinically and biochemically euthyroid. Rest of systemic exam was also unremarkable. CT chest showed a circumscribed soft tissue density mass arising from sternum, measuring 3.9×3.9 cm, causing erosions of anterior, right lateral and posterior walls of sternum. Trucut biopsy of the sternal mass proved it to be thyroid tissue with follicular differentiation and occasional mitotic figures. Multiple nodules were also noted in thyroid gland in US neck. She underwent total thyroidectomy and excision of ectopic thyroid tissue over manubrium sterni. Extensive histopathological examination of primary thyroid gland showed benign nodular hyperplasia with no evidence of malignancy. Ectopic thyroid tissue showed minimally invasive follicular thyroid carcinoma with tumor size of 3.2×2.3 cm. Her postoperative 21-day biochemical profile showed TSH 22.345 μIU/ml (0.4–4.2), serum thyroglobulin 88.3 ng/ml, and anti-TG antibodies Conclusion: We describe the first case of its kind having malignant ectopic thyroid with metastasis to spine and ilium. Such cases may impose difficulties in their treatment decisions

Reaction of Groundnut Advanced Breeding lines to Groundnut Bud Necrosis Disease

Forty advanced breeding lines were evaluated for reaction to Groundnut bud necrosis orthotospovirus (GBNV) in the field and greenhouse in Hyderabad, India during2013 rainy season. Results from natural infection showed eight resistant, 24 moderately resistant and eight moderately susceptible genotypes. There were no genotypes pertaining to highly resistant, susceptible and highly susceptible disease reaction grade. Greenhouse screening with mechanical sap inoculation showed all genotypes highly susceptible at 1:10 infected virus extract dilution, whereas at 1:100, two genotypes were moderately resistant, four moderately susceptible, ten susceptible and 24 highly susceptible. There were no genotypes pertaining to highly resistant and resistant disease reaction grade even at 1:100 infected virus extract dilution

ESBL determination and antibacterial drug resistance pattern of Klebsiella Pneumoniae amongst patients at PIMS Islamabad

Background: A number of life threatening infections due to various bacterial pathogens are major cause  of death in Pakistan. In a situation like the other developing countries, there is a general increase in the  drug resistance due to the irrational use of the antibiotics. The present study was carried out to evaluate the prevalence and development of resistance in Klebsiella pneumoniae against commonly used antibiotics.Methods and Materials: A total of 200 samples from different wards of the hospitals were received by the pathology laboratory of Pakistan Institute of Medical Sciences, Islamabad, which comprised of urine  65, blood 50 and other miscellaneous samples from various sources. Klebsiella pneumoniae was isolated and characterized using morphological, cultural, and biochemical methods and were further confirmed by using commercially available API 20E kit. The isolates were subjected to culture sensitivity test using  Kirby Bauer disc diffusion method.Results: The organism was found to be the most prevalent Gram-negative bacilli. K. pneumoniae showed  highest resistance against coamoxiclav and cephalosporins.Conclusion: The study revealed that ESBL producing strains were resistant to most of the beta-lactam antibiotics. This trend therefore has become a significant problem and can be controlled with continued surveillance or monitoring for rationally improved antibiotics usage, in order to prevent the drug resistance and re-emergence of infection.Key words: Klebsiella pneumoniae, ESBL (Extended-spectrum beta-lactamase), API (Analytical Profile Index