Comparison of metabolic effects of glimepride and sitagliptin with metformin in patients suffering from type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is one of the major causes of mortality & morbidity, and patient’s with better control of glycaemic parameters have lesser chronic complications associated with it. Though monotherapy with metformin is first choice for T2DM but is effective in less than 50% of patient and they should be managed with two drug therapy. Both Glimepiride and Sitagliptin are effective with metformin but there has been no study done in this region hence, we planned to study comparison of effects of glimepiride and sitagliptin with metformin in patient of T2DM.Methods: This prospective, open-label, randomized study was done in all patient diagnosed with T2DM, not adequately managed by metformin alone. The patient was divided into two group G (Glimepiride with Metformin) and Group S (Sitagliptin with Metformin) and had a follow up at 3 and 6 months. The biochemical parameters were assessed at 12 weeks and 24 weeks.Results: The result of this study show that both glimepiride and sitagliptin with metformin significantly (p<0.05) lowered both the fasting blood sugar as well as postprandial blood glucose at 3 and 6 months. Glimepiride was more effective in lowering (p<0.05) the plasma glucose at 3 months but both the drugs had comparable result at 6 months. This study also showed that glycosylated haemoglobin was lowered in both groups at three and six months as compared to Day 0 (p<0.05), with glimepiride having better control of glycosylated haemoglobin at 3 months with both groups having comparable result at 6 months.Conclusions: To conclude, this study compared effects of sitagliptin and glimepiride on glycaemic parameters in patients of T2DM and found that both drugs had comparable results

A comparative study for efficacy and safety of low doses of clonidine for hemodynamic stability in patients undergoing laparoscopic cholecystectomy

Background: This randomized prospective double-blind study was designed to evaluate the efficacy and side effects of low doses clonidine for perioperative haemodynamic stability and postoperative recovery.Methods: Patient’s with ASA grade I–II undergoing laparoscopic cholecystectomy were randomized into three groups of 30 patients each. All patients received either normal saline 10 ml (Group I) or 0.8 µg/kg (Group II) or 1 µg/kg (Group III) over duration of 180 seconds, 10 min prior to laryngoscopy and intubation. Anaesthesia was induced with 1% propofol (2 mg/kg) and maintained with nitrous oxide 60% in oxygen and isoflurane. The parameters assessed at various time intervals were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and sedation score.Results: Both doses of clonidine proved to be effective in perioperative haemodynamic stability. Clonidine 0.8 mcg/kg was as effectve and safer to Clonidine 1 mcg/kg for attenuatíon of the hemodynamíc responses to laparoscopy. There were no significant differences in the parameters of recovery between groups.Conclusions: Significant hemodynamic derangements can occur during laproscopic cholecystectomy at intubation, pneumoperitoneum and extubation. These were effectively attenuated by premedication with 0.8 mcg/kg and 1 mcg/kg of intravenous clonidine. Dose of 1 mcg/kg though found to be effective but produced adverse effects in form of hypotension and bradycardia

Comparison of computer simulation and graphical illustration for teaching experimental pharmacology to undergraduate students

Background: Nowadays, medical schools all over the world are incorporating newer methods of teaching experimental pharmacology like computer simulation, besides using graphs, charts, didactic lectures. The present study compared the effectiveness and acceptance of two commonly used methods, namely, computer simulation and graphical illustration in teaching experimental pharmacology to undergraduate medical students.Methods: 90 students of 2nd Prof MBBS were divided into 2 groups and were given either computer simulation or graphical illustration via a cross-over design at two settings, which was followed by a post-test for that particular session. Feedback was taken from the students and the faculty. The data obtained was analyzed using descriptive statistics.Results: The average marks scored by the students in sessions using CAL (67.8%) was significantly high (p=0.008) as compared to teaching by graphical illustrations (60.4%). 71% of students found CAL improved their learning skills better than graphical illustrations. 85% students and 80% faculty agreed that there should be a judicious mixture of CAL and graphical illustrations for a better understanding of drugs.Conclusions: CAL is a beneficial and effective learning tool in teaching experimental pharmacology. For better understanding, graphical illustrations should be used as an adjuvant to CAL

A study to determine the knowledge and level of awareness of medical undergraduates about herbal medicines and herb-drug interactions

Background: The increasing usage of herbal medicines worldwide has increased the probability of co-administration of herbal and allopathic medicines. This may lead to serious safety concerns, including herb-drug interactions (HDIs). Many HDIs may be overlooked due to poor doctor-patient communication about herbal drug usage probably because of lack of knowledge of herbal medicines and HDIs among physicians. The study was thus planned to identify the knowledge and awareness of medical students regarding the use of herbal medicines and about HDIs, to help improve the teaching skills and curriculum development for medical students.Methods: 286 medical students of 2nd, 3rd and 4th year MBBS course completed the study. All the participants were asked to fill a self-administered questionnaire consisting of 15 questions which included both open-ended and close-ended questions related to age, sex, knowledge, awareness and usage of herbal medicines and about herb-drug interactions. Data was analyzed and expressed as counts and percentages.Results: Majority (95.45%) of the students were aware of the fact that herbs can be used as medicines. They were most familiar with the herbs tulsi, neem, turmeric, aloe, ashwagandha and ginger. 46.85% consider herbal medicines to be risk free, and majority (55.6%) were not aware of the fact that herbs can cause herb-drug interactions. Media and elderly family members were their most common sources of information regarding herbal medicines. Majority (75.17%) would prefer allopathic medicines over herbal medicines. Only 23.07% always informed the physician about their usage of herbal medicines, although most (84.96%) felt that history regarding use of herbal medicines should be taken. Majority were not aware of the regulatory status of herbal medicines.Conclusions: Lack of knowledge and awareness of medical students about herbal medicines and herb-drug interactions was seen in the study. There is a need to inform the students of allopathic system of medicine about the adverse outcomes of herbal medicines and the knowledge about herb-drug interactions should be a part of the medical curriculum

A cross sectional study of knowledge, attitude and practices of medical students regarding COVID-19 in Northern India

Background: Practicing preventive measures essential to control the spread of infection and possessing the required knowledge, attitude and practices (KAP) towards COVID-19 could possibly affect the behavior and perception of medical students towards the disease which must be observed and studied. Studies have been conducted to assess medical students’ willingness to volunteer in the ongoing COVID-19 pandemic, but not many have focused on their level of pandemic preparedness and eligibility to volunteer. Our study explored the knowledge, attitude and practices of medical students, and also helps to develop effective action plans regarding the reopening of medical colleges in India. Material and methods: This cross-sectional observational study was done in a tertiary care center in North India on Medical and Dental undergraduate students spanning across all professional years after they gave a written informed consent. A self-designed questionnaire was established based on published literature. The study questionnaire consisted of four sections - socio-demographics of students, knowledge, attitudes/beliefs and practice-based statements about COVID-19. Results: 238 students participated in this study and for majority (79.4%) of students the major source of information for gaining knowledge towards COVID-19 was social media. All students were aware that COVID-19 spreads through droplet infection, 94.1% responded that people with chronic illnesses were at high-risk of infection and 91.2% and 88.2% reported that fever and dry cough were the main symptoms of COVID-19 respectively. The majority of students disagreed that they would avoid isolation (n=147), and the students also disagreed on aspect of keeping the report confidential if a near one is affected (n=140). Though there were no statistically significant differences (p&lt;0.05) in the level of knowledge, attitude and practices found between students studying in different professional years. Conclusion: To conclude, the results of our study showed that major source of information for gaining knowledge for COVID-19, was through social media. The students demonstrated a satisfactory level of knowledge, attitude and practices for the prevention of COVID-19

Brief Report - Laryngeal Mask Airway Vs Endotracheal Tube to Facilitate Bedside Percutaneous Tracheostomy in Critically Ill Patients: A Prospective Comparative Study

BACKGROUND: Inadvertent puncture of endotracheal tube (ETT) cuff and accidental tracheal extubation are the potential life threatening complications during percutaneous dilatational tracheostomy (PDT). As an alternative to ETT, the laryngeal mask airway (LMA) has been used sporadically but no large study is available on its use. AIMS: To study the use of LMA during PDT on controlled ventilation in critically sick patients and compare its advantages and disadvantages in relation to ETT. SETTINGS AND DESIGN: This prospective, randomised, comparative study was conducted in intensive care unit of a super-speciality, tertiary care hospital. METHODS AND MATERIAL: The bedside PDT was performed in 60 critically ill patients using Ciaglia's kit. The patients received controlled ventilation of lungs either through ETT or LMA. The feasibility of the procedure and complications were compared in two groups. RESULTS: In LMA group, 33% of patients suffered with potentially catastrophic complications, e.g., loss of airway, inadequate ventilation of lungs leading to significant hypoxia, gastric distension and regurgitation. In ETT group there were 6.6% incidence of ETT impalement, 6.6% cuff puncture and 3.3% accidental tracheal extubation. Despite the technical difficulties (cuff puncture, etc.) the ETT technique was basically safe, whereas despite of the theoretical advantages the LMA technique rendered some patients at considerable risks of hypoxia and gastric regurgitation-aspiration. CONCLUSION: The LMA does not provide safe patent airway to facilitate bedside PDT in critically sick population on controlled ventilation. The ETT is safer for controlled ventilation and should be continued to secure the airway for this purpose until a better alternative is available

Case Based Learning: An Effective Teaching Learning Method in Pharmacology for MBBS Students

Introduction: Medical education in India is currently going through major changes by bringing competency based undergraduate curriculum (CBME) from 2019. CBME aim to train graduates to efficiently take care of the health needs of the society. Pharmacology is an important subject in MBBS curriculum and involves treatment and prevention of a disease. This study aimed to compare, Case based learning (CBL) and Didactic lecture (DL) in Pharmacology and also to evaluate the student perception and effectiveness of these teaching methods. Materials and Methods: Total 140 MBBS students participated in this study. Students were randomly divided into two groups. Group A &amp; B were exposed to CBL &amp; Didactic lecture respectively. Student’s knowledge of the topic was assessed before and after the sessions in both the groups. Student’s perception of teaching method was assessed by five-point Likert scale. Results: The scores of pre-session of multiple-choice questions were compared in both the groups. There was no significant statistical difference in the marks obtained between the CBL and didactic lecture group (p&gt;0.05). On comparing the scores post session between the groups, there was statistically significant difference between CBL and Didactic lecture group. The mean score was found to be higher in the CBL group. Most of the students strongly agreed that CBL improved their problem-solving ability, boosted confidence in clinical case scenario, improved communication skill and increased their interest in applied pharmacology as compared to didactic lecture. Conclusion: CBL is an effective teaching method and with student’s positive response and perception, it can be a good add-on teaching method in Pharmacology for MBBS students

Survey of side effects post 1st dose of COVID-19 vaccine and adherence of guidelines during vaccination procedure in a tertiary health care hospital in India

Introduction: Indian drug regulation authorities issued emergency approval to two vaccines and started the vaccine drive on 16th January 2021. Acceptance of COVID-19 vaccine is still an important aspect in the success of the vaccination drive in India. An important factor affecting the acceptance of Covid-19 vaccine is lack of sufficient data on its side effects. Material &amp; Methods: This was a cross sectional survey which was conducted among the people getting 1st dose of Covid-19 vaccine. A questionnaire-based feedback form was distributed to all the people getting 1st dose of covid-19 vaccine through social networking sites like E-mail and WhatsApp. The questionnaire consisted of questions focusing on side effects within 30 minutes, 30 minutes to 24 hours and after 24 hours of vaccination. The questionnaire also consisted questions related to vaccination procedure and overall satisfaction level about COVID-19 vaccination. Results: Out of total participants 522, 52.5% (275) were male and 47.3% (247) were females. It was noted that over 53.1 % did not encounter any side effects, while 20.4 % had tenderness, pain and warmth and 18.9 % had chills and felt feverish. Also, it was found on analysis that 187 respondents (35%) did not have experience any symptom after 24 hours of vaccination. Conclusion: The research work was done to analyse the side effects after 1st dose Covid-19 vaccine among the population of India at a tertiary care hospital. In this study it was found that after 1st dose vaccine side effects were mild and were settled within 1 to 2 days. Fever and pain at the site of injection were two most of the common symptoms seen within 24 hours. Lot of people are anxious of getting vaccination done due to fear of getting serious side effects, but as per the findings of these study side effects were not serious. Vaccination centre was able to follow the standard guidelines as per the protocol made by the government, which is an important step in transmission of infection, proper storage of vaccine and also help in observation of any side effect during first 30 minutes post vaccination. This study will help in awareness among the general population regarding the commonly found side effects post Covid-19 Vaccine and help in the increasing the acceptance of the COVID-19 vaccine