Opinion of doctors about unmet needs of rural diabetics

Background: India is home to nearly 62 million diabetics - second only to China which has over 92 million diabetics. The main challenges for screening for diabetes and its complications in rural India are inadequate health care resources, lack of awareness and illiteracy among patients, limited physicians and paramedical staff trained in diabetes, lack of awareness among doctors as to who can legally practice diabetes in India. The present study was undertaken to explore the opinion of various doctors regarding diabetic care in rural India.Methods: The present study was conducted in Navodaya Medical College, Raichur and Mamata Medical College, Khammam. A cross-sectional study design was used to perform a multicentre survey from April 2015 to September 2015. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS). Content and construct validation of the questionnaire was done by a panel containing subject experts, epidemiologists and a statistician. Following which the questionnaires were sent to different set doctors by print outs, email and via online survey tools.Results: All the doctors who were involved in the study had different opinion. MBBS doctors are more aware than BHMS/BAMS/BUMS doctors about the minimum degree required doing a diabetic practice legally in India. Both the group of doctors believed that the needs of diabetic population in rural India are not properly addressed; the reason behind this was lack of qualified doctors (according to majority of BHMS/BAMS/BUMS doctors) and lack of awareness among the rural patients (according to MBBS doctors). Both the doctors believe that MBBS doctors with some fellowship courses in diabetes can manage diabetes effectively (except serious complications).Conclusions: Both the doctors believe that MBBS doctors with some fellowship courses in diabetes can manage diabetes effectively (except serious complications). In India only MD (general medicine) and endocrinologists are technically qualified to treat diabetes. MCI should come forward and recognize the fellowship courses by regularizing them with proper guidelines and protocol set up for the institution providing such courses and allow those doctors to practice in rural areas, so that diabetics’ needs are addressed properly

Evaluation of antipyretic activity of alcoholic extract of Murraya koenigii leaves in rabbits

Background: The present study was carried out to evaluate the antipyretic activity of alcoholic extract of Murraya koenigii leaves in rabbits by using PGE1 induced hyperpyrexia method. We found that not much work has been done on the antipyretic effect of this plant.Methods: Laboratory breed New Zealand strains of rabbits of either sex weighing 1000-1500 gm were used in the study. The animals were divided into five groups (n=6). The rabbits of all the groups were made febrile by injecting misoprostol (PGE1) subcutaneously in the dose of 100 mcg/kg.  For group 1 and 2, normal saline 2ml/kg as control and aspirin 28mg/kg as standard were given respectively. Alcoholic extract of Murraya koenigii leaves in the doses of 200, 400 and 800mg/kg were administered in remaining three groups respectively. Rectal temperatures were recorded with help of digital thermometer for every 30 min after drug treatment.Results: Alcoholic extract of Murraya koenigii produced highly significant (p<0.001) antipyretic effect in 400 and 800 mg/kg doses. But onset of action was fast with 800mg/kg dose.Conclusions: This study concludes that Alcoholic extract of Murraya koenigii has fast onset of action and also exhibited sustained anti pyretic action in New Zealand rabbits

Opinion of doctors about unmet needs of rural diabetics

Background: India is home to nearly 62 million diabetics - second only to China which has over 92 million diabetics. The main challenges for screening for diabetes and its complications in rural India are inadequate health care resources, lack of awareness and illiteracy among patients, limited physicians and paramedical staff trained in diabetes, lack of awareness among doctors as to who can legally practice diabetes in India. The present study was undertaken to explore the opinion of various doctors regarding diabetic care in rural India.Methods: The present study was conducted in Navodaya Medical College, Raichur and Mamata Medical College, Khammam. A cross-sectional study design was used to perform a multicentre survey from April 2015 to September 2015. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS). Content and construct validation of the questionnaire was done by a panel containing subject experts, epidemiologists and a statistician. Following which the questionnaires were sent to different set doctors by print outs, email and via online survey tools.Results: All the doctors who were involved in the study had different opinion. MBBS doctors are more aware than BHMS/BAMS/BUMS doctors about the minimum degree required doing a diabetic practice legally in India. Both the group of doctors believed that the needs of diabetic population in rural India are not properly addressed; the reason behind this was lack of qualified doctors (according to majority of BHMS/BAMS/BUMS doctors) and lack of awareness among the rural patients (according to MBBS doctors). Both the doctors believe that MBBS doctors with some fellowship courses in diabetes can manage diabetes effectively (except serious complications).Conclusions: Both the doctors believe that MBBS doctors with some fellowship courses in diabetes can manage diabetes effectively (except serious complications). In India only MD (general medicine) and endocrinologists are technically qualified to treat diabetes. MCI should come forward and recognize the fellowship courses by regularizing them with proper guidelines and protocol set up for the institution providing such courses and allow those doctors to practice in rural areas, so that diabetics’ needs are addressed properly

Antimicrobial Prescription Pattern in ENT Outpatient Department in a Tertiary Care Teaching Hospital, Telangana, India

Introduction Otorhinolaryngological infections are very common in adults and in children also. These infections are caused by various microorganisms and to treat these infections, antimicrobial agents are used frequently. As irrational use of antimicrobials leads to the development of antibiotic resistance and it is a big threat to the society, the present study was planned to get awareness among the practitioners regarding the antimicrobial prescription pattern. Aim To study the prescription pattern of antimicrobial agents in outpatient department of otorhinolaryngology in a tertiary care teaching hospital. Materials and Methods An observational study was planned over a period of 8 months from July 2019 to February 2020 in ENT outpatient department (OPD) at Mamata General Hospital, Khammam in Telangana. In total, 562 prescriptions were collected. Patient's details, probable diagnosis, prescribed medication details such as generic name, dose, and dosage forms were taken. The collected data was analyzed and the conclusions were drawn using descriptive analysis. Results Total number of prescriptions were 562. The majority of the prescriptions belonged to the 21 to 40 years of age group. Males were included more than females (males 320 and females 242). Chronic suppurative otitis media (CSOM) (16.2%) was the commonest infection. Most commonly prescribed antimicrobial was amoxicillin and clavulanic acid combination (26.17%), followed by cefpodoxime with clavulanic acid (21.9%) and ciprofloxacin (19.06%). In 371 (66.01%) prescriptions, only one antimicrobial was prescribed, whereas in 36 (6.40%) prescriptions no antibiotic was given. The average number of drugs per prescription was 3.18 and the average number of antimicrobials per prescription was 1.25. Tablet form (52.9%) was the commonest dosage form and most of the drugs were prescribed by generic name (74.06%). Conclusion The present study though prescription pattern of antibiotics and adherence to the hospital formulary by the physicians in the hospital is encouraging, still there is a chance in reducing the number of drugs prescribed per patient. The findings of this study will be useful to prescribe antimicrobials rationally so that the patient and health care system on the whole will be benefited

ADVERSE DRUG REACTIONS WITH SECOND LINE ANTIRETROVIRAL DRUG REGIMEN

Acquired immunodeficiency syndrome (AIDS) is a disease of the human immune system caused by the human immunodeficiency virus (HIV). Because of treatment failure with first line ART, second line ART is being instituted in 10 Centers of excellence in our country, Gandhi hospital being one of them.Aims &amp; Objectives: The aim of this study is to gain knowledge on the profile of ADR associated with second line ARV drugs, the burden of adverse drug reactions of second line ART in our setup and factors associated with it, with the ultimate goal of improving the tolerability and effectiveness of HIV treatment.Material &amp; Methods: Institution based cross sectional study conducted using review of clinical records and follow up of adult patients started on second line ART from May 2010 to April 2011 at GANDHI Hospital. All adult AIDS patients of either sex aged greater than or equal to 20 years who were registered for second line anti-retroviral treatment at GANDHI Hospital were included in the study. The clinical records of study subjects were reviewed retrospectively for ADRs. Information on patient's details, the WHO clinical staging of the disease at the start of ART, duration of treatment, drug details, nature of the adverse drug reactions, severity, outcome, and results of investigations performed were collected using a data collection format (Annex I). Data were collected from May 2010 to April 2011.Results: 58 cases were included in the study. 58 cases were included in the study. Among the total 58 patients who were on second line ARV drugs, ADRs were reported in 44 (75.86percent) patients (Table 3). The most frequently observed ADRs were nausea (12.25percent), followed by insomnia (10.29percent), loss of appetite (9.31percent) malaise (7.35percent) and vomiting (7.35percent). Out of the 44 patients who developed ADRs, 20 (45.45 percent) patients were grade II, whereas grade I and III ADRs occurred in 9 (20.45percent) and 15 (34.09percent) of the patients respectively. Grade IV was reported in none of the patients. No ADRs were noted in 14 (24.14percent) patients. Out of 44 patients who had ADRs, 32 patients (72.73percent) had less than 5 ADRs and 12 patients (27.27percent) had more than 5 ADRs.Conclusion: Second line anti-retroviral drugs are expensive, and the majority of the world's infected individuals do not have access to medications and treatments for HIV and AIDS. Though second line ART regimens are associated with mild to moderate ADRs, these are most effective regimens as they improved  CD4 counts and reduced viral load significantly.Keyword: NACO, HIV, Immunodeficiency, Second line, Side effects, Regimen, Reportin

CROSS-SECTIONAL STUDY TO ASSESS THE KNOWLEDGE ATTITUDE PRACTICE OF PHARMACOVIGILANCE AMONG THE DENTISTS IN AN INDIAN TERTIARY CARE TEACHING DENTAL HOSPITAL IN SOUTH INDIA.

Objectives:&nbsp; To assess the knowledge, attitude, and practices (KAP) about Pharmacovigilance in Interns, Postgraduates, and Faculty in a tertiary care teaching dental hospital. Methods: A self-governed knowledge, attitude, practice (KAP) survey questionnaire was conducted among interns, postgraduates, and faculty in a tertiary care teaching dental hospital. The KAP questionnaire consists of a total of 20 questions about pharmacovigilance. Results: A total of 58 interns,26 postgraduates, and 42 faculty have participated in this study. Question 1 inquired about the definition of pharmacovigilance and 31 (53.45%) interns, 20 (76.92%) postgraduates, and 34 (80.95%) faculty were given correct responses. Question 11 queried about WHO online database for reporting ADRs. Response rates for Question 11 from interns was 20(34.48%), postgraduates were 15(57.69%) and faculty was 26(61.90%). Question 20 quizzed regarding training on how to report Adverse Drug Reactions (ADR) in which 22(37.93%) interns, 24(92.30%) postgraduates, and 42(100%) faculty stated that they were trained on how to report ADR. Conclusion: The majority of interns, postgraduates, and faculty had good knowledge, attitude, and practice about pharmacovigilance. Comparatively, faculty had more knowledge, attitude, and practice about pharmacovigilance among interns, postgraduates, and faculty. Prime reasons for underreporting ADR were a shortage of time to report and the difficulty in concluding whether ADR occurred

Long-term outcomes after local excision and radical surgery for anal melanoma: Data from a population database

PURPOSE: Anal melanoma is rare and associated with a poor outcome. Previous studies that have reported outcomes after surgical treatment are limited by both small number of participants and treatment at single centers only. This study evaluates survival of patients undergoing surgery for anal melanoma from a prospective, population-based database. METHODS: Characteristics and survival of patients undergoing rectal resection or local excision for anal melanoma of the anus, anal canal, and overlapping region of the rectum from 1982 to 2002 were obtained from the Surveillance, Epidemiology and End Results database and compared. RESULTS: A total of 160 patients were included in the study. Details of previous surgical procedures were available for 109 of the study patients: 60 (55%) underwent local excision and 49 (45%) rectal resection. Patients who underwent local excision were significantly older (73.5 vs 65.1 years, P <.001), whereas those who had undergone rectal resection had a greater proportion of regional disease (73.5% vs 16.7%, P <.001). The median survival of the 2 groups was similar (rectal resection vs local excision: 17 vs 28 months, P =.3). Rectal resection and local excision were associated with similar survival for patients in both regional (P =.6) and localized (P =.95) stages. Outcomes for patients who were appropriately pathologically staged after rectal resection depended on localized vs regional stage (5-year survival: 43.1% vs 12.5%, P =.17). Survival for patients in localized and regional stages who underwent rectal resection was similar to that for patients with corresponding clinical stage who underwent local excision. CONCLUSION: Survival of patients with anal melanoma is similar after local excision or rectal resection irrespective of whether patients have localized or regional stage of disease. \ua9 The ASCRS 2010

A Comparative Study on the General and Otolaryngological Manifestations of COVID-19 in the Hospitalized Population of the Telangana Region During the First and Second Waves

Introduction Some common symptoms of coronavirus disease 2019 (COVID-19) are fever, cough, and shortness of breath. But ear, nose, and throat (ENT) manifestations such as loss of smell and taste are also very common