Awareness of adverse drug reactions in third M.B.B.S students practicing self-medication

Background: Students self-medicate but the extent of their knowledge regarding potential adverse drug reactions (ADRs) to drugs consumed by them is not known. This has many implications. This study has attempted to evaluate this knowledge in third MBBS students practicing self-medication.Methods: In this cross-sectional study, a self-designed, pretested questionnaire was presented to third MBBS students in a teaching hospital. Information sought:-Demographic data, self-medication drugs used within last one month, indication, duration, awareness and expected ADRs for the drugs consumed. Results were calculated as percentages.Results: 79 out of 87 third MBBS students present on the day of study were presented with questionnaire all attempted it; giving a response rate of 100%. Within the last one month 31 (39.24%) had self-medicated. There was no significant difference in self-medication between male and female students. Medication was used for adequate duration (93.87%) and for apparently correct indications (81.6%) by most students. Main group of drugs consumed were NSAIDs including antipyretics (42.59%), antibiotics (18.53%) and antihistaminics (16.66%). Fourteen (45.16%) students said they were aware of potential ADRs to the consumed drugs and 13 (43.93%) listed expected ADRs correctly .Although a wide range of drugs were consumed, the number of ADRs mentioned were few and its spectrum limited. 11 (35.48%) students mentioned only one ADR. No student mentioned more than two ADRs. Dyspepsia (56.25%) was most common ADR stated.Conclusions: Considering the wide range of drugs consumed, the numbers of ADRs mentioned were few and their spectrum limited indicating scope for improvement

Knowledge, attitude and practice of adverse drug reaction reporting among teaching and nonteaching hospital physicians

Background: Knowledge, attitude and practice (KAP) analysis may provide insight into the reasons associated with reporting of adverse drug reaction. Therefore study was carried out to investigate knowledge, attitude and practice of adverse drug reaction reporting and identify factors affecting reporting of adverse drug reactions among physicians in a teaching (THPs) and non-teaching hospital/s (NTHPs).Methods: This was a questionnaire based cross sectional study. 6 items on knowledge, 3 on attitude and 1 on practice were scored and mean KAP score calculated. The score was graded as: 0-5 low, 6-8 moderate, 9-10 high. Factors influencing reporting of ADRs were studied. Chi square and student’s unpaired t test were used to study statistical significance intergroup.Results: Out of 102, 61 were THPs and 41 NTHPs. KAP scores were similar in both groups. Both groups believed in reporting all ADRs to new and old drugs. Most did not know where to obtain a form/ if an ADR monitoring centre existed in town. Most were ready to report an ADR to ADR monitoring centre while very few had actually reported. Most were unaware how and where to report. THPs seemed more concerned about being considered negligent in duty and had difficulties identifying ADRs correctly.Conclusions: Groups had moderate knowledge, attitude and practice (KAP) score but there is scope for improvement. Attitude to reporting is positive. Concerns regarding blame for negligence in duty, difficulty in identifying ADRs, how and where to report exist. There is a need to create awareness among physicians and address these factors

Immediate impact of an educational intervention on knowledge of use of disinfectants in nurses

Background: Adequate disinfection and sterilization is crucial to prevent hospital acquired infections, this requires knowledge of various types of disinfectants and of the categories of medical and surgical devices. Nurses play a key role in supervising the use of disinfectants. Hence, they are an important target group for educational interventions for rationalization of disinfectant use. We conducted an educational intervention in nurses, related to rational use of disinfectants. The objective was to evaluate the immediate impact of this intervention on change in knowledge of nurses.Methods: This was a questionnaire‑based pre‑ and post‑test cross‑sectional study. The questions were formulated to test nurses’ ability to (1) categorize commonly used medical and surgical devices (MSDs) (2) categorize disinfectants as high, intermediate and low level disinfectants (3) to evaluate their knowledge about different aspects of disinfectant use. Results of pre and post‑test were calculated as a percentage and Z test for difference between proportions was applied to test the statistical significance.Results: A total of 72 nurses filled the pre‑test and 70 the post‑test. Percentage of correct responders for classification of MSDs improved as follows‑critical (77.77% pre‑test to 95.71% post‑test), semicritical (18.05‑54.28%), noncritical (41.66‑72.85%). Percentage of correct responders for classification of disinfectants improved from pre‑ to post‑test glutaraldehyde (48.61‑88.57%), Hydrogen peroxide (30.55‑72.85%), benzalkonium (33.33‑58.57%). Identification of chlorine concentration required for cleaning floors improved from 38.88% to 70%. There was a significant improvement seen post‑test to items related to different aspects of disinfectant use.Conclusion: A positive immediate impact was observed, but there is a need for continuing education with interventions focused on various aspects of disinfectant use

End tidal CO2 level (PETCO2) during laparoscopic surgery: comparison between spinal anaesthesia and general anaesthesia

Background: Laparoscopy is a procedure which involves insufflations of the abdomen by a gas, so that endoscope can visualise intra abdominal content without being in direct contact with viscera or tissues. Its advantages are small incisions, less pain, less postoperative ileus, short hospital stay compared to traditional open method. Monitoring of end tidal carbon dioxide (PETCO2) and hemodynamics is very necessary during Laparoscopy surgery. This study is conducted to find out effects of CO2 insufflation on parameters like PETCO2, Mean arterial pulse pressure, SPO2 under spinal anaesthesia and general anaesthesia in ASA I and ASA II patients.Methods: The present study was conducted in the department of anaesthesiology from December 2014 to September 2015.This study was a prospective, randomized controlled, single blind. Each group consisted of 30 patients having Group A and Group B as patient undergoing laparoscopic surgery under Spinal anaesthesia and General anaesthesia respectively. Preoperatively patients in Group A (Spinal anaesthesia) given inj. Midazolam 0.3mg/kg IM 45 before surgery and Group B (General anaesthesia) inj. pentazocin 0.3mg/kg, inj. promethazine 0.5mg/kg, inj. Glycopyrrolate 0.004 mg/kg IM 45 before surgery. In operation theatre, intra operative pulseoximetre, ECG, SPO2, Heart rate (HR), Mean arterial pulse pressure and PETCO2 monitoring done. Amount of CO2 insufflated noted.Results: It was found from present study that in both group there was significant progressive rise in PETCO2 after CO2 insufflation, with peak at 30 min and thereafter plateau till the end of procedure (avg. duration 45-60 min). In group A i.e. laparoscopic surgery under spinal anaesthesia with (spontaneous respiration) the rise in PETCO2 was significant as compared to the group B i.e. laparoscopic surgery under general anaesthesia with controlled ventilation. The heart rate increased after CO2 insufflation in both the group, but it was significant in group A. The increase in SBP, DBP, MAP were less in group A as compared to group B. SPO2 showed no significant changes and it remained above 97% in all patients throughout surgery. All values come to baseline 15 min after insufflation.Conclusions: From the present study it can be concluded that balanced general anaesthesia using IPPV with moderate hyperventilation, as the preferred anaesthetic technique for laparoscopic surgery

Evaluation of brimonidine-timolol fixed combination in patients of primary open-angle glaucoma

The aim of present study was to compare the efficacy and safety of fixed combination of brimonidine and timolol with individual components used as monotherapy in patients of primary open angle glaucoma. Patients were randomly assigned to receive brimonidine or timolol or brimonidine-timolol fixed combination, with 30 patients in each group. The mean reduction in intraocular pressure in brimonidine, timolol, and brimonidine-timolol group were 4.29 ± 1.97 mm Hg, 4.34 ± 1.21 mm Hg, and 5.54 ± 1.87 mm Hg respectively at 2 weeks and 4.86 ± 1.16 mm Hg, 5.42 ± 1.50 mm Hg, and 7.36 ± 2.58 mm Hg respectively at 6 weeks. When values of mean reduction in intraocular pressure were compared between brimonidine-timolol fixed combination with brimonidine and timolol, it was found to be statistically significant ( P < 0.05) at 2 weeks and highly significant (0.001) at 6 weeks. The overall frequency of adverse effects was similar in all three groups