Knowledge and perception towards pharmacovigilance and adverse drug reactions reporting among medical students at a teaching hospital in South India

Background: Pharmacovigilance and adverse drug reactions monitoring has become an integral part to ensure patient safety. Targeting the younger doctors for sensitization towards pharmacovigilance is the key to ensure practice of ADR reporting in clinical practice. The objective of the study is to understand and assess the knowledge and perception of students towards pharmacovigilance and adverse drug reactions reporting.Methods: The study included undergraduate medical students of second, pre-final and final years of Mysore Medical College. A validated and standardized KAP based questionnaire was distributed to all students. Willingness to answer and complete the questionnaire was considered as consent.Results: The questions were statistically analysed individually and compared. Q1-Q10 compared knowledge towards pharmacovigilance, Q11-Q20 on the attitude and Q21-Q23 on the practice of ADR reporting. 325 questionnaires were distributed of which only 280 consented (second year - 114, pre-final - 98, final - 68). 112(49.1%), 137(69.9%) and 79(58.1%) of the three groups respectively knew what pharmacovigilance and ADR is. 79.8%, 76.5% and 75% knew who can report ADRs while 18.4%, 32.7% and 33.8% did not know what ADRs to report. 73(64.1%); 93(81.6%), 18(18.4%); 69(70.4%), 13(19.1%); 37(54.4%) knew the existence of AMC in the institute and the PvPI respectively. More than 92% agreed that ADR reporting is necessary. Majority (>90%) agreed that PV and ADR reporting should be taught to all health care students while 28%, 30% and 54% said that it was not well covered in their curriculum.73(64%), 51(52%) and 63(93%) were not familiar with the ADR reporting form.Conclusions: Pharmacovigilance and ADR reporting needs to be made compulsory, have better, interesting ways to learn and understand it, so that the students can practice it with confidence in their clinical practice

Comparison of impact of undergraduate teaching program to assess the knowledge and attitude towards pharmacovigilance and adverse drug reporting among undergraduate medical students at a teaching medical institute in South India

Background: Pharmacovigilance has become an important tool to ensure the safety of patient in recent years. To ensure right practice of pharmacovigilance, proper understanding is very essential and the medical colleges with the undergraduate teaching program become a vital platform to educate and train the medical students towards pharmacovigilance. This study compares the impact of teaching program of the undergraduate curriculum in assessing the knowledge and attitude of the undergraduate medical students towards pharmacovigilance.Methods: The study includes 158 undergraduate medical students of second year being trained in pharmacology at Mysore Medical College. A validated and standardized questionnaire was distributed to all the students twice, once during their 3rd term (pre-sensitization) and the second time during their 5th term (post sensitization). Willingness to answer and complete the questionnaire was considered as consent.Results: The pre and post sensitization questionnaires were analyzed individually. A decrease from 114 to 90 students (15.19 % decrease) willing to complete the questionnaire was seen. The mean total knowledge score was 6.37±1.90 during the pre-test as compared to 6.35±1.78 in the post test analysis. An overall increase was seen with the knowledge of ADRs and pharmacovigilance. Only 18.4% knew of the presence of an ADR monitoring center in the institute pre-test which increased to 64.4% post sensitization. 81.6% answered rightly the type of ADRs that needs to be reported as compared to the 67.3% pre-sensitization. The overall attitude towards ADR reporting was seen to be in the right direction, with 71% saying that pharmacovigilance covered adequately in the curriculum. Voluntary reporting attitude increased from 74.6% to 88%. 70% of the students feel ADR reporting as a professional obligation, while only 54% felt so pre-sensitization.Conclusions: Pharmacovigilance should be included in the curriculum with more hours dedicated to teaching. Various interesting methods should be implemented to train and made aware of its importance to ensure patient safety on a global scale

Cost-effectiveness of newer anti-emetics in the prevention of chemotherapy induced nausea and vomiting: a pharmaco-economic study analysis

Background: Chemotherapy induced Nausea and Vomiting (CINV) is one the most common adverse effects associated with chemotherapeutic management of carcinoma breast. Preventing CINV becomes a vital part in treatment of these cancer patients for better compliance. The conventional regimen of newer 5-HT3 receptor antagonist and dexamethasone along with newer agents - Aprepitant, a NK-1 receptor antagonist and a recently approved atypical antipsychotic, Olanzapine have shown better control of CINV. These newer agents are effective but also very expensive.Methods: The study included carcinoma breast patients scheduled for chemotherapy (n = 55 in each group) who either received aprepitant or olanzapine or a combination of both as the anti-emetic regimen. Considering Cost-Effectiveness Analysis (CEA), the cost included was the cost of anti-emetic agents (sponsor’s perspective) and outcome measured as control of nausea and vomiting - as Complete Protection (CP), Complete Response to Best (CRB) and Incomplete Response (IR) for acute (0-24 hours) and delayed (24-120 hours) phases. The cost effectiveness(CE) ratio for emesis and CINV free days were calculated.Results: CP was seen better during the acute period than the delayed period. With Aprepitant, delayed CRB and IR was seen with 13 (23.6%) and 10 (18.2%) subjects. 16 (29.1%) showed IR with Olanzapine during the delayed period.The average number of Emesis and CINV free days were 4.65, 4.51, 4.89 and 3.38, 3.96, 4.15 for the three groups respectively. The cost required to achieve 1 emesis and 1 CINV free day per subject in the 3 groups was INR 351.19, INR 27.20, INR 339.54 and INR 483.36, INR 30.94, INR 400.60 respectively.Conclusions: The newer anti-emetic even though being expensive at cost, pharmacoeconomically provide better outcomes and seem to have better control rates than the conventional regimen

Performance analysis of grid-tied photovoltaic system under varying weather condition and load

Model and simulation of the impact of the distribution grid-tied photovoltaic (PV) system feeding a variable load with its control system have been investigated in this study. Incremental Conductance (IncCond) algorithm based on maximum power point tracking (MPPT) was implemented for the PV system to extract maximum power under different weather conditions when solar irradiation varies between 250W/m2 and 1000W/m2. The proposed system is modelled and simulated with MATLAB/Simulink tools. Under different weather conditions, the dynamic performance of the PV system is evaluated. The results obtained show the efficacy of the proposed MPPT method in response to rapid daytime weather variations. The results also show that the surplus power generated is injected into the grid when the injected power from the PV system is higher than the load demand; otherwise, the grid supplies the load

Maternal and perinatal outcome in severe pre-eclampsia and eclampsia: a study of 120 cases at a tertiary health care center in Western India

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. Pre-eclampsia accounts for the majority of referrals in a tertiary care center as it stands one of the major causes of maternal and perinatal morbidity and mortality. It complicates 6-10% of all pregnancies. In India, they account for the third most important cause of maternal mortality. Patients with PIH are at a greater risk of abruptio placenta, cerebrovascular events, organ failure and DIC. Fetuses are at a greater risk of IUGR, preterm birth, small for gestational age and IUD. This study aimed to determine the maternal and perinatal outcomes of hospitalized pregnant cases with severe preeclampsia and eclampsia.Methods: This was a single year retrospective study conducted in a tertiary care center of Western India from May 2019 to May 2020. Maternal and perinatal outcomes were analyzed among the severe preeclampsia and eclampsia groups.Results: A total 52 (43.33%) of the cases were in the age group of 21-25 years, 64 (53.33%) were primigravidae and the majority were referred from peripheral hospitals. Liver function tests were deranged in 26.68% of the patients and 32.5% had abnormal renal function. Labetalol was the most commonly used antihypertensive and magnesium sulphate was the anticonvulsant used in all the cases. Lower segment caesarean section was the mode of delivery in 62 (51.67%) of the cases. Commonest maternal complication was atonic PPH (12.5%). There was one maternal mortality due to aspiration pneumonia. 85 (70.83%) of the babies needed NICU admission. There were 5 (4.16%) perinatal deaths.Conclusions: Accessible health care and health education and awareness regarding antenatal check-ups for all women will lead to early detection of severe preeclampsia. Prompt treatment and management of its complications will certainly improve the maternal and fetal outcome

Comparison of functional outcomes and complications of conservative management verses surgical fixation with a locking compression plate in the treatment of displaced middle third clavicular fracture

Background: About 3 to 5 percent of all fractures are clavicle fractures, which account for 45 percent of fractures at the shoulder. While fractures of the lateral and medial thirds of the clavicle account for 15% and 5% of all clavicle fractures, respectively, middle third fractures account for 80% of all clavicle fractures.Methods: patients were divided into two groups at random. Patients selected for conservative treatment with figure of eight Clavicle Brace and arm sling/pouch were treated with the brace immediately and for surgical intervention with locking plating. Constant and Murley's scoring system was used to check for signs of healing and functional improvementResults: The 40 patients in the current study include 20 with a new fracture of the mid-third clavicle who underwent surgical treatment with clavicular locking compression plate and screws and 20 who underwent conservative treatment with a figure-eight clavicle brace and arm pouch/sling. There was a statistically significant difference in the Constant and Murley score between the surgical group and the conservative group.Conclusions: According to the present study, patients with a displaced mid-third clavicle fracture may benefit more from surgery than from conservative treatment.

UTILIZATION OF UNSERVICEABLE STRAWBERRIES FOR PRODUCTION OF ELLAGIC ACID AND ITS ENHANCEMENT BY ASPERGILLUS NIGER

Objective: Use of Aspergillus Niger (616) for the fabrication of ellagic acid from unserviceable strawberry as a substrate which is readily and chiefly available from Agro-industries and farm waste.Methods: The ellagic acid content was determined by HPLC method which shows a higher concentration of ellagic acid (143.085+1.669 ppm) after fermentation of 96 h at 35 °C. DPPH assay was carried out for antioxidant activity of ellagic acid.Results: Results designated that ellagic acid has higher antioxidant activity as compared with ascorbic acid.Conclusion: Existing study exposes that this agro waste and farm waste can be used at commercially for the production of ellagic acid which has enormous medicinal properties.Keywords: Ellagic acid, Raw strawberry, DPPH assay, Aspergillus Niger, Fermentation, and HPL

Shot noise-mitigated secondary electron imaging with ion count-aided microscopy

Modern science is dependent on imaging on the nanoscale, often achieved through processes that detect secondary electrons created by a highly focused incident charged particle beam. Scanning electron microscopy is employed in applications such as critical-dimension metrology and inspection for semiconductor devices, materials characterization in geology, and examination of biological samples. With its applicability to non-conducting materials (not requiring sample coating before imaging), helium ion microscopy (HIM) is especially useful in the high-resolution imaging of biological samples such as animal organs, tumor cells, and viruses. However, multiple types of measurement noise limit the ultimate trade-off between image quality and the incident particle dose, which can preclude useful imaging of dose-sensitive samples. Existing methods to improve image quality do not fundamentally mitigate the noise sources. Furthermore, barriers to assigning a physically meaningful scale make these modalities qualitative. Here we introduce ion count-aided microscopy (ICAM), which is a quantitative imaging technique that uses statistically principled estimation of the secondary electron yield. With a readily implemented change in data collection, ICAM nearly eliminates the influence of source shot noise -- the random variation in the number of incident ions in a fixed time duration. In HIM, we demonstrate 3x dose reduction; based on a good match between these empirical results and theoretical performance predictions, the dose reduction factor is larger when the secondary electron yield is higher. ICAM thus facilitates imaging of fragile samples and may make imaging with heavier particles more attractive

Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) in predicting systemic inflammatory response syndrome (SIRS) and sepsis after percutaneous nephrolithotomy (PNL)

The objective of this prospective observational study was to assess the clinical significance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) as potential biomarkers to identify post-PNL SIRS or sepsis. Demographic data and laboratory data including hemoglobin (Hb), total leucocyte count (TLC), serum creatinine, urine microscopy and culture were collected. The NLR, LMR and PLR were calculated by the mathematical division of their absolute values derived from routine complete blood counts from peripheral blood samples. Stone factors were assessed by non-contrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden (Volume = L x W x D x pi x 0.167), location and Hounsfield value and laterality. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Of 517 patients evaluated, 56 (10.8%) developed SIRS and 8 (1.5%) developed sepsis. Patients developing SIRS had significantly higher TLC (10.4 +/- 3.5 vs 8.6 +/- 2.6, OR 1.19, 95% CI 1.09-1.3, p = 0.000002), higher NLR (3.6 +/- 2.4 vs 2.5 +/- 1.04, OR 1.3, 95% CI = 1.09-1.5, p = 0.0000001), higher PLR (129.3 +/- 53.8 vs 115.4 +/- 68.9, OR 1.005, 95% CI 1.001-1.008, p = 0.005) and lower LMR (2.5 +/- 1.7 vs 3.2 +/- 1.8, OR 1.18, 95% CI 1.04-1.34, p = 0.006). Staghorn stones (12.8 vs 3.24%, OR 4.361, 95% CI 1.605-11.846, p = 0.008) and long operative times (59.6 +/- 14.01 vs 55.2 +/- 16.02, OR 1.01, 95% CI 1.00-1.03, p = 0.05) had significant association with postoperative SIRS. In conclusion, NLR, PLR and LMR can be useful independent, easily accessible and cost-effective predictors for early identification of post-PNL SIRS/sepsis.Manipal Academy of Higher Education, Manipa

The Effects of a Glutamine-Free Diet on Tumor Progression and the Immune Landscape of the Ovarian Tumor Microenvironment

https://openworks.mdanderson.org/sumexp23/1053/thumbnail.jp