Pattern of head injury in central India population

Background: In India, the developing economy and growing population simultaneously made a strong impact on increase in motor vehicle population. This increase in motorization has some adverse effects such as increase in road accidents with economic and functional loss. Head injury is the most common cause of mortality in road traffic accidents. The aim of this study was to know the incidence, pattern, mechanism, mode of head injury along with its distribution in relation to site of vault fracture and intracranial hemorrhage.Methods: Total 391 post-mortem cases of head injury were enrolled during study period. The information regarding age, sex, residence, marital status, date and time of time of accident and of death was gathered from police inquest report, relatives, dead body challan and clinical details from hospital records. During autopsy, detailed examination was carried out and data regarding both external and internal injuries were carefully recorded and analyzed.Results: The peak incidence of head injury was observed in the age group of 21-30 years. Most of deceased were from early age group and the male deceased were more than females. Majority victims of head injury were from road Traffic Accidents followed by fall from height, railway accidents and assault. Fissured fracture of vault was found in almost half cases. Subdural and subarachnoid hemorrhage were the most common one we encountered.Conclusions: Head injury due to RTA is well known public health problem causing death and disability. It is required from concerned government authority to take appropriate and immediate measures for reducing the incidence of head injury

Knowledge, attitude and practice of undergraduate medical students and interns towards pharmacovigilance

Background: Medicines had brought revolution in which diseases are treated and controlled. There are several examples in which using nonstandard medicines had led to death of many patients.Methods: A cross-sectional questionnaire based study in 200 undergraduate medical students, 150 medical students and 50 interns in a tertiary care hospital. There will be 50 each from II MBBS, III MBBS, IV MBBS and Interns.Results: The mean age was 23.68+1.64 years. In the elements of Pharmacovigilance, 5 students feel it is only detection, 4 for assessment, 1 for understanding, 5 for prevention and 142 (II:22, III:41, IV:36, Intern:43) all of the above elements while 43 don’t know about the elements of Pharmacovigilance. The factors that discourage from reporting ADR, among this did not know how to report was statistically significant compared to other factors. In students view on problems faced while reporting ADR, among them unawareness of the need to report an ADR and lengthy paper work were statistically significant. (69%) feel internet is the best reference aid to gather information on ADR to new medicines while (39.5%) prefer text books.Conclusions: The learning of PV should start as early as possible in medical school and should be frequently held to increase the Knowledge, attitude and practice of healthcare professionals regarding ADR’s monitoring

Paracetamol induced fixed drug eruption: a case report

Fixed drug eruption (FDE) is a type of drug-induced skin reaction pattern that characteristically recurs at the same skin or mucosal site. Paracetamol is one of the common drugs prescribed as analgesic–antipyretic agent in all age group of patients. FDE is a well-reported, but uncommon side-effect of paracetamol, usually the classic, pigmenting type most commonly found in children and adolescents. We present a case of 52 years old male patient who developed FDE over the glans penis following paracetamol use

Evaluation of teaching methods in pharmacology among MBBS students

Background: Pharmacology is one of the most important subjects in medical curriculum. It is basis of medical science and the foundation of treatment. The applied aspect forms the basis of clinical rational therapeutics.Methods: A cross-sectional study among 100 undergraduate medical students was undertaken after Institutional Ethics committee permission. Questionnaire was prepared from previous studies and validated by experts. These were administered to the participants after receiving their due consent.Results: The mean age of students was 21.31±2.93 years. There were 72% females and 28% males. The average rating given for Pharmacology subject was 7.95±1.16. Females (8.38±1.24) rated Pharmacology subject more than males (7.51±1.09). 62% liked combination of LCD and Blackboard for teaching. 34% felt group discussion was the ideal Teaching learning method for learning Pharmacology. The most interesting topic was General Pharmacology (31%) and ANS (45%) was the most difficult subject to understand. The most important topic in practical’s was 25% prescription writing and least was experimental graphs (2%). Preferred source to learn Pharmacology was combination of textbook and lecture (42%). 81% students liked integrated teaching of pharmacology with other subjects. 93% felt there should be more use of audiovisual aids, 91% wanted more of clinical pharmacology and 88% wanted more of group discussions. 91% felt calculation of pharmacokinetic parameters is clinically applicable.Conclusions: There is need to develop innovative teaching learning methods and include more of clinical pharmacology in the undergraduate pharmacology subject

The irrational fixed dose combinations in the Indian drug market: an evaluation of prescribing pattern using WHO guidelines

Background: Evaluation of the pattern of fixed dose combinations (FDCs) prescribing amongst the practitioners in a tertiary care hospital in Central India. Methods: Nine hundred and ninety four prescriptions, containing 639 FDCs were scrutinized in the tertiary care hospital. After excluding the total and the interdepartmental repetitions, the numbers of FDCs were 278, which were considered for final analysis. Inclusion criteria were FDCs from the major out-patient department (OPD) of the tertiary care hospital from January 2011 to December 2011. FDCs from the wards, casualty, infectious disease unit, intensive cardiac care unit (ICCU), tuberculosis and chest and HIV unit were excluded from the study. FDCs were analysed for the different pattern of prescribing and rationalism. Results were expressed as percentages. Results: Out of 639 FDCs, the most commonly prescribed FDCs were B complex (12.20%), pantoprazole plus domperidone (9.55%) and amoxicillin plus clavulanic acid (7.35%). Seventy percent of the FDCs were prescribed to the age group of 21-60 years. The FDCs were maximum from the department of medicine (25.59%), followed by surgery (15.47%) and ENT 13.69%. Out of 278 FDCs, only 5.4% were rational, and rest of the FDCs were irrational. Ninety five percent of all FDCs were brand names. The physicians were unaware of the active pharmacological ingredients (APIs) of 20.86% FDCs. Ninety two percent FDCs were available as over the counter (OTCs). Forty eight percent FDCs were costing from Rs. 0-50. There were 2.87% FDCs whose price was above Rs. 500.Conclusions: Irrational FDCs are prescribed by all the departments. Physicians were ignorant about the essential drugs and FDCs. Patients didn’t have access to rational medicines. Therefore, physicians and regulators should be alerted in time. Regulatory actions or government laws should be made mandatory. Availability and access to 348 essential medicines for basic health care should be the priority of the government. Implementation of central drug standard control organisations (CDSCO) guidelines on industries for manufacture of FDCs must be made compulsory

A PROSPECTIVE, OBSERVATIONAL STUDY OF ADVERSE REACTIONS TO DRUG REGIME FOR MULTI-DRUG RESISTANT PULMONARY TUBERCULOSIS IN CENTRAL INDIA.

Abstract Objective: 1) To assess the adverse drug reactions of second line anti-tubercular drugs used to treat Multi-drug resistant Tuberculosis (MDR TB) in central India on the basis of causality, severity and avoidability scales. 2) To study the relationship of type of MDR TB (primary or secondary) and presence of diabetes mellitus (DM) with mean smear conversion time. Material and Methods: A prospective, observational study was carried out on diagnosed multidrug resistant tuberculosis patients enrolled for DOTS‑Plus regimen at TB and Chest Disease Department from January to December 2012. They were followed for 9 months thereafter and encountered adverse drug reactions (ADRs) were noted along with the time of sputum conversion. The data were analysed by Chi-square or Fisher’s exact test and unpaired student’s‘t’ test. Results: Total 64 ADRs were reported in 55 patients out of total 110 patients (n = 110). As per the Naranjo causality assessment of ADRs, 7 patients had “definite” causal relation, 45 had “probable” causal relation and 3 had “possible” causal relation with drugs of DOTS Plus regime. As per the Hartwig’s severity assessment scale, there were total 7 ADRs in Level 1, 6 in Level 2, 33 in Level 3 and 9 in Level 4. Hallas avoidability assessment scale divided the ADRs as 3 being “Definitely avoidable”, 26 “Possibly avoidable”, 23 “Not avoidable” and 3 “unevaluable”. ). Mean sputum smear conversion time is significantly higher in patients with secondary type than that of primary type of MDR TB (p = 0.0001) and in patients with DM than those without DM (p <0.0001). Conclusion: ADRs were common in patients of MDR TB on DOTs-Plus drug regime. It was due to lack of availability of safer and equally potent drugs in DOTs-Plus drug regime compared to DOTS regime in non-resistant TB. The frequency and severity of ADRs can be reduced by strict vigilance about known and unknown ADRs, monitoring their laboratory and clinical parameters and instituting appropriate measures. Keywords: Adverse drug reactions, Avoidability, Causality, DOTs-Plus, MDR TB, Severity