A prospective study of antimicrobial utilization in post-operative care unit of a teaching hospital in South India

Background: Surgical site infections, a common cause of morbidity and mortality in hospitalized patients can be prevented using an antimicrobial agent (AMA) as prophylaxis. Inappropriate use of AMA leads to antimicrobial resistance.Methods: A prospective study was conducted on 208 patients in Owaisi Hospital and Research Centre (OHRC) for a period of 6 months on post-surgical patients admitted in the postoperative care unit. Included in the study were post-operative patients aged 18 years and above, who were willing to participate in the study. Data related to demography of the patients and the AMAs used in these patients was collected and analysed.Results: Majority of the patients belonged to the age group 50 to 59 years (32%) followed by 40 to 49 age group (23%). Male patients (54%) were more than females. Common route of administration was intravenous (89%) and the most common dosing frequency was thrice a day (54%). Most AMAs were used in combinations. Metronidazole (62%) was the most commonly prescribed AMA, followed by ceftriaxone (55%).Conclusions: Cephalosporins were the preferred antimicrobials for surgical prophylaxis of aerobic infections prescribed in 74% of cases, while metronidazole was used as the primary antimicrobial agent to prevent anaerobic infections. AMA utilization needs to be continuously evaluated in post-operative units of the surgery departments in order to promote rational prescribing to decrease morbidity, cost of therapy and to contain the problem of developing AMA resistance in the region

Potentiation of anticonvulsant effect of phenytoin by celecoxib against maximum electroshock induced convulsions in albino rats

Background: Epilepsy, a chronic neurological disorder affects more than 1% of world population. Despite the availability of a number of antiepileptics, refractoriness to them exists in approximately one third of cases worldwide. Induction of cycloxygenase and increased levels of proinflammatory meditators are seen in epilepsy. P-glycoprotein upregulation due to phenytoin was found to contribute to its pumping out of cell, leading to refractoriness to phenytoin therapy. Also, cycloxygenase-2 inhibitors were found to prevent P-glycoprotein upregulation. Since cycloxygenase-2 inhibition decreases levels of proinflammatory cytokines responsible for neuroinflammation, this study aims to evaluate anticonvulsant effect of celecoxib and also to investigate whether it potentiates the anticonvulsant effect of phenytoin.Methods: Maximum electroshock seizures (MES) were induced in Albino rats using electroconvulsiometer to evaluate tonic convulsions, identified by tonic hind limb extension (THLE) in rats. A delay in onset of THLE and a reduction in duration of THLE were taken as deciding parameters to ascertain anticonvulsive activity. Rats randomly divided into groups, received pretreatment with celecoxib at 3 doses (10, 20, 40 mg/kg), phenytoin (6.25 mg/kg), phenytoin (12.5 mg/kg) and combination of phenytoin (6.25 mg/kg) with celecoxib (ED50, i.e. 20 mg/kg), before inducing MES seizures and findings compared to control group.Results: Celecoxib (20 and 40 mg/kg) showed significant anticonvulsant effect by MES test. Also, its combination with phenytoin caused significant decrease in the duration of THLE when compared to phenytoin alone at the same dose.Conclusions: The results of this study indicate that celecoxib potentiates the anticonvulsant effect of phenytoin

Evaluation of anticonvulsant effect of celecoxib, a selective cyclooxygenase-2 inhibitor in experimentally induced convulsions in albino rats

Background: Cyclooxygenase-2 (COX-2) exists as the inducible form of the cyclooxygenase enzyme, the levels of which are elevated in inflammatory conditions. COX-2 is located in regions of brain like hippocampus and cerebral cortex. When induced, COX-2 forms prostaglandin E2 (PGE2), which is responsible for CNS excitation, in turn leading to generation of seizures. COX-2 inhibitors by preventing the formation of PGE2 may serve as effective anticonvulsants. Since none of the anti-epileptics in current use are able to cure the patient of the seizures, a search for newer anti-epileptics is warranted. The present study assesses the anti-seizure activity of celecoxib against experimentally induced convulsions in Albino rats.Methods: Two models of experimentally induced convulsions in Albino rats were used: 1) maximum electroshock seizure (MES) test model and 2) pentylenetetrazole (PTZ) test model. 30 rats were taken for each method and randomly assigned to 5 groups (N=6). 1st group served as control group, which received normal saline intra-peritoneal. 2nd, 3rd and 4th groups received celecoxib in doses of 10, 20 and 40 mg respectively through intraperitoneal route. The 5th group received the standard drugs phenytoin sodium (12.5 mg/kg) and sodium valproate (100 mg/kg) through intraperitoneal route in MES and PTZ models respectively.Results: Celecoxib showed significant anticonvulsant effect with all 3 doses in MES model and with 2 doses (20 and 40 mg/kg) with PTZ model.Conclusions: The results of this study indicate that celecoxib has anticonvulsant effect in albino rats

A cross-sectional study evaluating the awareness of pharmacovigilance among MBBS interns of a teaching hospital in south India

Background: Spontaneous reporting is the backbone of any pharmacovigilance programme. The pharmacovigilance programme of India, started in 2010 has not seen considerable success, owing to underreporting of adverse drug reactions (ADRs). This can be attributed to a lack of awareness of pharmacovigilance among the healthcare professionals. This study was conducted with the aim to evaluate the level of knowledge, awareness, attitude and practice of pharmacovigilance among interns of a teaching hospital.Methods: An observational, cross-sectional study was done among interns of a teaching hospital. A predesigned Questionnaire was distributed among 150 interns, from which 138 completed questionnaires were considered. The questionnaire consisted of 16 questions dealing with knowledge, awareness, attitude and practice of pharmacovigilance. Data was analysed and presented as percentage of respondents.Results: 71% interns correctly identified the definition of pharmacovigilance. However, their awareness was deficient, in particular about the existence of an ADR monitoring centre in their own institution (33%). The rate of ADR reporting was immensely inadequate (12 %), which is a matter of utmost concern and requires immediate attention. The factors discouraging them from reporting ADRs were insufficient knowledge about the reporting procedure and a lack of time to report.Conclusions: Interns lacked the required level of awareness, attitude and practice of pharmacovigilance, which needs to be resolved instantly by organizing frequent training sessions. Continued medical education programmes and workshops may be helpful in increasing their awareness and consequently to improve the rate of spontaneous ADR reporting

The role of breathing techniques in the management of asthma: a systematic review

Objective: To determine the effectiveness of breathing techniques in the management of asthma. Method: The systematic review was conducted from July 2021 to August 2022, and comprised search on PubMed, Google Scholar, and MEDLINE databases using the population-intervention-control-outcomes format and Boolean operators. Relevant randomised controlled trials published in the English language in the preceding 10 years were included. The last literature search was done on January 15, 2022. To evaluate the bias in studies, the Cochrane risk of bias tool was used. PEDro scale was used to assess the quality of the trials analysed. Results: Of the 250 studies initially identified, 11(4.4%) random controlled trials were analysed in detail. The quality of methodology was high, and the studies reported significant improvement with the use of breathing techniques in symptoms of asthma and quality of life along with a decrease in the use of bronchodilators. Conclusion: Literature supported the use of breathing techniques in the management of asthma. Key Words: Asthma, Breathing technique, Physiotherapy, Quality of life, Symptoms of asthma

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Potentiation of anticonvulsant effect of phenytoin by celecoxib against maximum electroshock induced convulsions in albino rats

Background: Epilepsy, a chronic neurological disorder affects more than 1% of world population. Despite the availability of a number of antiepileptics, refractoriness to them exists in approximately one third of cases worldwide. Induction of cycloxygenase and increased levels of proinflammatory meditators are seen in epilepsy. P-glycoprotein upregulation due to phenytoin was found to contribute to its pumping out of cell, leading to refractoriness to phenytoin therapy. Also, cycloxygenase-2 inhibitors were found to prevent P-glycoprotein upregulation. Since cycloxygenase-2 inhibition decreases levels of proinflammatory cytokines responsible for neuroinflammation, this study aims to evaluate anticonvulsant effect of celecoxib and also to investigate whether it potentiates the anticonvulsant effect of phenytoin.Methods: Maximum electroshock seizures (MES) were induced in Albino rats using electroconvulsiometer to evaluate tonic convulsions, identified by tonic hind limb extension (THLE) in rats. A delay in onset of THLE and a reduction in duration of THLE were taken as deciding parameters to ascertain anticonvulsive activity. Rats randomly divided into groups, received pretreatment with celecoxib at 3 doses (10, 20, 40 mg/kg), phenytoin (6.25 mg/kg), phenytoin (12.5 mg/kg) and combination of phenytoin (6.25 mg/kg) with celecoxib (ED50, i.e. 20 mg/kg), before inducing MES seizures and findings compared to control group.Results: Celecoxib (20 and 40 mg/kg) showed significant anticonvulsant effect by MES test. Also, its combination with phenytoin caused significant decrease in the duration of THLE when compared to phenytoin alone at the same dose.Conclusions: The results of this study indicate that celecoxib potentiates the anticonvulsant effect of phenytoin.</jats:p

A prospective study of antimicrobial utilization in post-operative care unit of a teaching hospital in South India

Background: Surgical site infections, a common cause of morbidity and mortality in hospitalized patients can be prevented using an antimicrobial agent (AMA) as prophylaxis. Inappropriate use of AMA leads to antimicrobial resistance.Methods: A prospective study was conducted on 208 patients in Owaisi Hospital and Research Centre (OHRC) for a period of 6 months on post-surgical patients admitted in the postoperative care unit. Included in the study were post-operative patients aged 18 years and above, who were willing to participate in the study. Data related to demography of the patients and the AMAs used in these patients was collected and analysed.Results: Majority of the patients belonged to the age group 50 to 59 years (32%) followed by 40 to 49 age group (23%). Male patients (54%) were more than females. Common route of administration was intravenous (89%) and the most common dosing frequency was thrice a day (54%). Most AMAs were used in combinations. Metronidazole (62%) was the most commonly prescribed AMA, followed by ceftriaxone (55%).Conclusions: Cephalosporins were the preferred antimicrobials for surgical prophylaxis of aerobic infections prescribed in 74% of cases, while metronidazole was used as the primary antimicrobial agent to prevent anaerobic infections. AMA utilization needs to be continuously evaluated in post-operative units of the surgery departments in order to promote rational prescribing to decrease morbidity, cost of therapy and to contain the problem of developing AMA resistance in the region.</jats:p

A cross-sectional study evaluating the awareness of pharmacovigilance among MBBS interns of a teaching hospital in south India

Background: Spontaneous reporting is the backbone of any pharmacovigilance programme. The pharmacovigilance programme of India, started in 2010 has not seen considerable success, owing to underreporting of adverse drug reactions (ADRs). This can be attributed to a lack of awareness of pharmacovigilance among the healthcare professionals. This study was conducted with the aim to evaluate the level of knowledge, awareness, attitude and practice of pharmacovigilance among interns of a teaching hospital.Methods: An observational, cross-sectional study was done among interns of a teaching hospital. A predesigned Questionnaire was distributed among 150 interns, from which 138 completed questionnaires were considered. The questionnaire consisted of 16 questions dealing with knowledge, awareness, attitude and practice of pharmacovigilance. Data was analysed and presented as percentage of respondents.Results: 71% interns correctly identified the definition of pharmacovigilance. However, their awareness was deficient, in particular about the existence of an ADR monitoring centre in their own institution (33%). The rate of ADR reporting was immensely inadequate (12 %), which is a matter of utmost concern and requires immediate attention. The factors discouraging them from reporting ADRs were insufficient knowledge about the reporting procedure and a lack of time to report.Conclusions: Interns lacked the required level of awareness, attitude and practice of pharmacovigilance, which needs to be resolved instantly by organizing frequent training sessions. Continued medical education programmes and workshops may be helpful in increasing their awareness and consequently to improve the rate of spontaneous ADR reporting

A Prospective Observational Study on Pattern of Poisoning Cases Reported to Emergency Department of a Teaching Hospital in South India

A prospective observational study of 12 months duration was conducted in a teaching hospital on 278 cases of acute poisoning reported to emergency department from October 2018 to October 2019. Data regarding patient demographics, type of poisoning agent, duration of hospital stay and outcome were collected and analyzed. The common poisoning agents ingested were organophosphate compounds (41%), drug overdose (36%), Rodenticide (9%), House cleaning agents (6%), Mosquito repellents (4%), Corrosives (1%) and Kerosene (1%). Common drug overdose leading to poisonings were sedatives (9%), followed by nonsteroidal anti-inflammatory agents (4%). Of the 278 patients, 87 (31%) were males below 30 years of age. A major number of the patients worked as labourers (27%) and farmers (17%) and most were illiterate (36%). Suicide (79%) was found to be the major reason for poisoning. Acute poisoning is a major public health issue, especially among younger population and less educated. Analyzing the trends in poisoning in south India periodically will assist the healthcare workers and policy makers to device suitable management and effective prevention strategies like educational interventions about insecticide handling and establishing poison information centres.</jats:p