Comparison of the safety and efficacy of intracervical Foleys catheter versus PGE2 gel for induction of labour at term

Background: Before the induction of labour cervical ripening is needed for the success of induction to reduce the complication and diminish the rate of cesarean section and duration of labour. Various mechanical methods like Foleys catheter are effective but not much popular because of infection and pharmacological preparations which have more side effects, are used for cervical ripening. Therefore study has been conducted to compare the efficacy and safety of intra cervical Foleys catheter versus PGE2 gel for induction of labour at term. The aims and objectives of this study was to success of induction of labour depends on the cervical status at the time of induction.Methods: A prospective comparative study was conducted in the department of obstetrics and gynecology, L.G. hospital (AMCMET Medical college), Ahmedabad, during period of July 2019 to December 2019. 100 patients at term with a Bishop’s score with various indications for induction were randomly allocated to receive (50 patients) intra cervical Foleys catheter or PGE2 gel (50 patients). Post induction Bishop’s score was noted after 6 hours, 12 hours, 24 hours. Statistical methods used were Student t test and Chi square test to statistically compare the two groups. Differences with a p value of <0.005 was considered statistically significant with confidence limit of 95%.Results: The groups were comparable with respect to maternal age, gestational age, parity, indication of induction and initial bishops score. Both groups showed significant change in the Bishops score, 5.10±1.55 and 5.14±1.60 for Foleys catheter and PGE2 gel, respectively, p<0.001. Fetal outcome was noted in NICU admission and fetal death. No significant difference between two groups.Conclusions: This study shows that both Foleys catheter and PGE2 gel were equally effective in pre induction cervical ripening

Prescribing pattern of analgesics used for postoperative pain and its correlate with patient and doctor satisfaction:

Background: Post operative pain is difficult to assessment and its management has been neglected at times. Moreover, the drug treatment involves administration of drug on as and when basis which leads to inadequate control. Methods: This observational, prospective study was conducted in 100 post-operative patients i.e., 50 each from surgery and orthopedics departments. Investigator enrolled post-operative patients within 24 hours of surgery and followed them for next 5 days or till hospital discharge, whichever was earlier. Analgesic prescribing pattern, self-assessment of pain, patient and doctor satisfaction using ASSIST questionnaire were recorded in Case Record Form and analysed. Results: Out of 100 patients, average number of analgesics prescribed post-operatively was 1.49±0.5 (baseline and all follow-up). 76.5% patients received NSAIDs which included diclofenac (44.29%) and paracetamol (30.87%). Opioids in the form of tramadol were prescribed in 23.49% patients. Mean least pain experienced by patients on day 1 was 2±0.75 which decreased to 1.32±0.63 on day 5. Mean worst pain decreased from 6.64±1.43 on day 1 to 3.38±1.17 on day 5. Average percentage of duration of severe pain was 35.2%±16.48 on day 1 which successively decreased to 16.32±8.26 on day 5. Average pain relief observed in 62.3% patients on day one increased to 80.88% on day 5. Patient satisfaction increased as pain score decreased (r=-0.73) and a strong positive correlation was observed between doctor satisfaction and patient satisfaction (r=0.91). Conclusions: Inadequate control of post-operative pain affects effective patient management and recovery. Incorporation of effective pain assessment scores in pain management is desirable

Knowledge, attitude and practice among consumers about adverse drug reaction reporting

Background: Background: Adverse Drug Reaction (ADR) reporting by consumers is quite low in India. Assessing knowledge and attitude of consumers regarding ADR reporting and observing practice of ADR reporting among them can help explore probable causes for underreporting of ADRs by consumers.Methods: This was a cross-sectional study conducted in a tertiary care teaching hospital using investigator-administered questionnaire and interviewing indoor patients of Surgery, Medicine, Obstetrics & Gynaecology and Dermatology departments. The questionnaire was prepared to assess knowledge, attitude and practice of consumers about ADR reporting. Data was analysed using mean, standard deviation and percentages.Result: A total of 820 consumers of medicines were included. It was found that 32.2% consumers were not aware that a drug can produce adverse effects. After being explained about adverse drug reactions, 94.6% consumers felt that adverse drug reactions should be reported. However, 98.8% consumers were not aware of Pharmacovigilance Programme of India. After consulting about consumer reporting programme, majority of respondents (96.1%) felt that the direct consumer reporting programme helps reporting of ADRs. Moreover, 93.7% of consumers were willing to use it to report ADRs in future. Consumers preferred the Telephonic method with a Toll free number for ADR reporting followed by informing a health care professional.Conclusion: Poor knowledge and awareness about ADR reporting is the major factor for low to nearly absent ADR reporting by consumers in India

An evaluation of the technique of use of metered dose inhaler administration in bronchial asthma children

Background: Inadequate understanding and performance of drug administration using metered-dose inhaler (MDI) in paediatric population affects therapeutic outcome. Hence, this study aimed to evaluate the impact of two educational interventional methods for usage of MDI in paediatric patients of bronchial asthma.Methods: This prospective, interventional study was done in paediatric asthma patients who were prescribed drugs with (MDI) with/without spacer at outpatient department of pediatrics. Patients were divided in group A (video) or group B (leaflet) as per random table method and method to use MDI was assessed by using checklist as per WHO guide to good prescribing at baseline. Investigator taught the technique by a video (group A) and leaflet (group B) to the selected population. Patients were followed up after 15 days and assessed for use of MDI using the same checklist. Data were analysed by using paired and unpaired ‘t’-test.Results: A total of 100 pediatric asthma patients were included in study group A (50) and group B (50). The average no. of steps (WHO checklist) followed was significantly improved at post intervention in both group A (with spacer, p<0.0001) as well as B (without spacer, p<0.05). Although average no. of steps followed were more in group A, no significant difference was found between two groups after intervention.Conclusions: As video is an audio-visual method of demonstration, and hence help us memorise the step of inhalational technique in pediatric patients. Repeated demonstration/education to patients/caregivers may improve the method of MDI usage

An intensive monitoring of adverse drug reactions in pediatric hospitalized patients of a tertiary care hospital

Background: Children are at a higher risk of therapeutic failure due to major difference in pharmacokinetic, pharmacodynamics of drugs, off-label use and divergence of their illness from adult. The safety of drugs used in adult patients cannot be extrapolated to a pediatric age group. Hence, this study aimed to evaluate the incidence and overall pattern of adverse drug reactions in pediatric patients hospitalized in pediatric wards at a tertiary care hospital in India.Methods: Pediatric patients up to 12 years hospitalized in two randomly selected pediatric units were enrolled and followed up daily till discharge. Detailed information of patients and ADRs (adverse drug reactions) if any were recorded from case records. ADRs were assessed for incidence, onset, duration, management, outcome, causality, severity, preventability, seriousness and risk factors. Appropriateness of drug treatment in patients with ADRs was analyzed using Phadke’s criteria. Data was analyzed using student’s t test, ANOVA and Chi square test.Results: A total of 700 patients were enrolled (mean age 3.95±0.12 years). A total of 66 ADRs observed in 58 patients. Intravenous (70.4%) being most common route for ADRs. The incidence of ADRs was 8.28%. Majority of ADRs occurred within 1 day, commonly affected skin and appendages followed by (28.78%), GI (25.75%) ADRs were frequently associated with antimicrobials (69.38%) and vaccines and sera (12.24%). Majority of reactions were mild (56%%), non-serious (77.2%), not preventable (95.4%), recovered completely at discharge (83.33%) and had possible (77.2%) causal association with suspect drug. Age group 0-3 years and prescription of ≥5 drugs were risk factors for occurrence of ADRs. Semi rational drug therapy was observed in 65.5% patients.Conclusions: Clinicians should be vigilant regarding occurrence of ADRs in pediatrics especially during the first week of hospitalization. Risk factors like 0-3 years of age and multiple drugs should be taken into consideration during treatment of these patients to help minimize adverse drug reactions

An analysis of the pharmacological management of respiratory tract infections in pediatric in-patients at a tertiary care teaching hospital

Objectives: To analyze the pharmacological management of respiratory tract infections in hospitalized pediatric patients. The economic burden of the disease and the adverse drug reactions occurring during the course of treatment have also been studied. Materials and Methods: It was a prospective, longitudinal, and observational study, carried out over a period of one-and-a-half years. The patients, aged one month to twelve years, diagnosed with respiratory tract infections (RTI), as confirmed by a pediatrician, were enrolled. Modified Kunin's criteria along with the guidelines set by the Indian Academy of Pediatrics (IAP) were followed for assessing the appropriateness of the antibacterials prescribed. The adverse drug reactions occurring during the course of the treatment were noted and the economic burden of the disease was calculated as direct and indirect costs. Results: A total of 201 patients were enrolled, of whom 46% were in the age group of one month to one year. The most common diagnosis was pneumonia (76%). The number of drugs and antibacterials prescribed per patient were 4.88 ± 1.57 and 1.85 ± 0.86, respectively. Antibacterials (37.7%), intravenous fluids (17.2%), respiratory medicines (16.6%), and analgesic/antipyretics (16.5%) were the common drug groups prescribed. Among the antibacterials, amoxicillin with clavulanic acid (47%) and cefotaxime (22%) were frequently prescribed. Appropriate antibacterial therapy was given in 42% of the cases. Salbutamol and a combination of Levosalbutamol and Ipratropium Bromide were the commonly prescribed respiratory medicines. Three adverse drug reactions (ADRs) were observed in indoor patients, all due to antibacterials. The economic burden of the disease was calculated to be Rs. 4925.14 or US$ 109.9 per patient. Conclusion: An overuse of antibacterials and respiratory medicines was seen in the study. Emphasis on proper diagnosis and treatment, education and availability of locally effective guidelines may help in a better and judicious use of drugs in children