Knowledge, attitude and practice of pharmacovigilance among undergraduate medical students in a teaching hospital of South Kerala, India

Background: Prompt reporting and monitoring of adverse drug reactions (ADRs) is necessary to enhance patient safety. This study was conducted to take steps to promote ADR reporting culture in medical students.Methods: 75 undergraduate Medical students from different batches were given a 20 item structured questionnaire containing 10 questions on Knowledge, 5 questions on Attitude, 4 questions on Practice of Pharmacovigilance and a general question for suggesting the causes of underreporting of ADRs. They were requested to fill up the questionnaire. Each correct response was given a score of 1 and responses were graded. Statistical analysis was done and results expressed in percentage. Using ANOVA and Post hoc analysis, scores of knowledge, attitude and practice were also compared between the batches.Results: Mean age was 22.01 +/- 1.438 years. 62.7% were females. Mean Knowledge score was significant (6.573+/- 0.3832). Final year students had better knowledge among the three batches. All students had positive attitude. However, the mean difference in practice scores was statistically significant between all groups. Lack of knowledge regarding where and how to report ADRs, lack of training in ADR reporting, lack of time due to busy schedules and fear of legal issues were suggested as causes of underreporting of ADRs.Conclusions: Good knowledge, Positive attitude and Poor practice were noticed among undergraduate Medical students towards Pharmacovigilance. Hence students should be familiarised with ADR detection and reporting through Project works and training programmes

Utilization pattern of antidepressants in psychiatry wards of a tertiary care hospital in South Kerala, India

Background: Depression is an important public health problem causing impairment of social, occupational and other important areas of function. This study was done to evaluate the utilization pattern of antidepressants in the psychiatry wards of a tertiary care centre in South Kerala.Methods: This retrospective study was carried out in a tertiary care centre of South Kerala from January to March 2016 among 52 inpatients treated with psychotropic drugs for different psychiatric ailments. Data was collected from their case records and analysed using Microsoft excel 2010. Results were expressed in proportions.Results: Case record review of 52 patients showed that married persons and females suffered more from depression (69.2%). Bipolar disorder was the most common diagnosis (80.8%). Selective serotonin reuptake inhibitor (SSRI) was the most commonly prescribed antidepressant followed by atypical antidepressants. Escitalopram was the most commonly prescribed SSRI, followed by Sertraline. 86.5% required antipsychotics for controlling their psychotic symptoms. One fourth of the patients had hypothyroidism. 7.69 % patients required Electroconvulsive therapy (ECT). 5.7% patients developed adverse drug reactions like cogwheel rigidity, neurolept malignant syndrome and Valproate induced hyperammonemia.Conclusions: Most common diagnosis was bipolar illness with majority requiring sodium valproate as treatment. SSRI was preferred among antidepressants. Prompt diagnosis, use of appropriate psychotropic drugs and psychotherapy can improve the quality of life in these patients

Cost variation analysis of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation

Background: Several brands of antihypertensive drugs are available in the Indian market with huge price variations. This study was undertaken to find out the percentage cost variation and cost ratio of antihypertensive drugs acting through renin angiotensin aldosterone axis modulation.Methods: Costs of different brands of renin angiotensin aldosterone axis modulatory drugs with antihypertensive action for the same dosage form and strength were found out using current index of medical specialties-134, July-October 2016. The maximum and minimum price of different brands of each drug was noted. Data was entered in Microsoft excel 2010. Percentage cost variation and cost ratio was calculated for each drug.Results: 16 antihypertensive drugs were analysed. Most of them were tablets. Ramipril and Valsartan were available as capsules also. Among tablets, percentage cost variation was highest for Atenolol 12.5 mg (683.93%) and least for Bisoprolol 2.5 mg (3.6538%). Valsartan capsules (160 mg) had no difference in the costs between the available 2 brands. Cost ratio ranged from 1.04 to 7.84 among the tablet form of drugs.Conclusions: There is a huge difference in the cost of antihypertensive drugs manufactured by different companies in the same strength and dosage form. To promote rational drug use and cost effective therapy, it is essential to create an awareness among clinicians regarding the availability of multiple brands for these drugs and the discrepancies in their costs

Quality of multiple choice questions in undergraduate pharmacology assessments in a teaching hospital of Kerala, India: an item analysis

Background: Carefully constructed, high quality multiple choice questions can serve as effective tools to improve standard of teaching. This item analysis was performed to find the difficulty index, discrimination index and number of non functional distractors in single best response type questions.Methods: 40 single best response type questions with four options, each carrying one mark for the correct response, was taken for item analysis. There was no negative marking. The maximum marks was 40. Based on the scores, the evaluated answer scripts were arranged with the highest score on top and the least score at the bottom. Only the upper third and lower third were included. The response to each item was entered in Microsoft excel 2010. Difficulty index, Discrimination index and number of non functional distractors per item were calculated.Results: 40 multiple choice questions and 120 distractors were analysed in this study. 72.5% items were good with a difficulty index between 30%-70%. 25% items were difficult and 2.5% items were easy. 27.5% items showed excellent discrimination between high scoring and low scoring students. One item had a negative discrimination index (-0.1). There were 9 items with non functional distractors.Conclusions: This study emphasises the need for improving the quality of multiple choice questions. Hence repeated evaluation by item analysis and modification of non functional distractors may be performed to enhance standard of teaching in Pharmacology

A clinical study on nimesulide hepatotoxicity

Background: Hepatic injury can occur with the use of nimesulide, a non steroidal anti-inflammatory drug. This study was done to evaluate the hepatic and renal functions in patients with rheumatological complaints receiving nimesulide for 2 weeks.Methods: Fifty patients with rheumatological complaints treated at orthopaedic outpatient clinic of a tertiary care centre with nimesulide 100mg twice daily were enrolled in this study. The sociodemographic details, details of comorbidities, history of use of alcohol or tobacco, indication for treatment with nimesulide etc. were recorded in a predesigned proforma. All patients were followed up for two weeks and reviewed at the end of each week for any gastrointestinal adverse effects, changes in blood routine, liver function tests and renal function tests. Data collected was entered in Microsoft Excel 2010, analysed and results were expressed as mean and standard deviation.Results: Out of the fifty patients analysed, mean age was 39 years. 66 % were males. Among liver function tests, only serum albumin and serum aspartate aminotransferase (SGPT) were altered after treatment with nimesulide. Blood urea nitrogen, serum creatinine and blood routine remained normal. No gastrointestinal adverse effects were noted.Conclusions: Nimesulide produced changes in serum albumin and SGPT levels without prominent gastrointestinal or renal adverse effects

The genus Drepanolejeunea (Spruce) Schiffn. (Lejeuneaceae; Marchantiophyta) in the Western Ghats with special reference to Kerala

Diversity of the genus Drepanolejeunea (Spruce) Schiffn. of the family Lejeuneaceae in Kerala is discussed in detail. So far, 8 species have been reported from the Western Ghats, of which 6 occur in Kerala. This paper provides detailed descriptions of 5 of the species collected from Kerala during the present survey. Among these, Drepanolejeunea erecta (Steph.) Mizut. is new to the Western Ghats, D. fleischeri (Steph.) Grolle & Zhu, D. pentadactyla (Mont.) Steph. and D. ternatensis (Gottsche) Steph. are new records for Kerala

Bryophyte diversity in the Sacred Groves, with special reference to Vallikkattukavu of Kozhikode district in Western Ghats

The bryophyte diversity in the Vallikkattu kavu of Kozhikode district is enumerated along with the conservation of bryophytes in the sacred grove is discussed. This report represents many interesting finds such as Bryum retusifolium  var. heterophyllum Card. ex Gangulee a new record to Kerala and Ditrichum tortuloides Grout. is a new record for Peninsular India. The endemic species Fissidens kammadensis Manju et al. and the rare species Calymperes palisotti  Schwaegr. could be collected from this sacred grove

New national and regional bryophyte records, 59

Peer reviewe

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions