The study of causes, mode of delivery in intrauterine fetal death and associated complications

Background: Intra uterine fetal death (IUFD) is defined as the baby born with no signs of life at or after 28 weeks of gestation. It is important to diagnose the cause in order to avoid further recurrence and to treat any maternal associated factors. The aim of the present study was to calculate incidence of IUFD in our hospital and know the causes, mode of delivery, associated complications. So we can take measures to prevent them in future.Methods: The retrospective study was conducted in the department of Obstetrics and Gynecology in Kanachur Medical College, Mangalore from January 2017 to January 2020. The women with confirmed diagnosis of IUFD on Ultrasound and beyond 28 weeks of gestation were included in the study.Results: In the study period, total 2026 patients delivered, of which 40 cases were IUFD, hence our incidence rate was 19.74 per 1000 population. 62.5% cases were multigravida. 15% had previous history of abortions while 5% previously had IUFD. In 37.5% cases, the cause was unknown, followed by 22.5% having pregnancy induced hypertension. Anemia contributed to 17.5% and placental causes in 12.5%. 10% of the women had PPH. One patient had sepsis, followed by acute renal failure and later died of multi organ failure.Conclusions: All the causes are not preventable, many of them can be identified early in pregnancy and thus IUFD can be prevented. All the high risk pregnancies should undergo antenatal fetal surveillance and should have frequent ante natal visits to reduce IUFD rates

Potential anti-seizure activity of atorvastatin in rat models of seizure

Background: Atorvastatin belongs to the class of Hypolipidemic statins. Increasing evidence indicates that statins are neuroprotective in several conditions, including stroke, cerebral ischemia and traumatic brain injury. However, only scanty and controversial reports are available on anticonvulsant action of statins. The present study therefore aims at exploring the influence of atorvastatin on seizures as compared to standard anticonvulsants phenytoin and sodium valproate in Wistar rats.Methods: Rats were divided into 8 groups (n=6), each treated intraperitoneally (i.p) with atorvastatin, phenytoin or sodium valproate in their therapeutic equivalent doses. Their effects were evaluated on seizures induced by maximum electroshock seizure (MES) and pentylenetetrazole (PTZ). Hind limb extension (HLE) in MES model, number of seizures, duration of seizure, number of myoclonic jerks and time for onset as well as recovery from seizures in PTZ model were monitored. Statistical analysis was done using Kruskal-Wallis ANOVA and Mann-Whitney U test for significance.Results: Atorvastatin failed to protect rats against HLE in MES seizure model. However, atorvastatin significantly prolonged seizure onset time (p<0.0547), decreased seizure number (p<0.0082), seizure duration (p<0.0547) and recovery time (p<0.0040) in PTZ model indicating its potential antiepileptic activity in PTZ model.Conclusions: Atorvastatin exhibited protection against seizures only in PTZ seizure model. Hence, it could possess anti absence seizure activity. This needs to be established with further systematic animal and clinical studies

A KAP study of pharmacovigilance among junior residents and interns of a tertiary care hospital

Background: Pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug-related problems. An “adverse drug reaction” is any noxious, unintended and undesired effect of a drug, which occurs at a dose used in humans for prophylaxis, diagnosis, therapy or modification of physiological functions. Reporting of adverse events and adverse drug reactions is the commonest method utilized for generating safety data. Lack of awareness about Pharmacovigilance is one of the most important causes of such under-reporting. Spontaneous reporting system is considered the main mechanism of pharmacovigilance study for gathering information about ADRs. Hence this study was undertaken to assess the knowledge, attitude and practice regarding Pharmacovigilance among junior residents and interns in a tertiary care hospital.Methods: A cross-sectional study was carried out in 134 doctors using pre-validated 20 item questionnaire with details of participant’s information followed by questions regarding knowledge, attitude and prescribing practice of pharmacovigilance was used as a tool, administrated to all the resident doctors and the collected data was analysed.Results: Our study revealed that knowledge about pharmacovigilance was not adequate to JRs and INTs. Survey results revealed that the knowledge of pharmacovigilance among doctors 63 (88.73%) JR and 49 (77.78%) INTs had a knowledge score of less than 50%. This shows that only few doctors are aware about the pharmacovigilance programme. The assessment of questionnaire based on attitude regarding pharmacovigilance shows that 21 (29.58%) JR and 17 (26.98%) of INTs had attitude score of 70% and above. The attitude score was less compared to the knowledge score of JRs and INTs. 52 JR and 58 INTs stated that they have not been trained on how to report ADRs and basic orientation about pharmacovigilance which hinders the process of practicing pharmacovigilance. Conclusions: For the success of Pharmacovigilance programmes only knowledge and attitude regarding Pharmacovigilance is not enough as is evident from our study. Success of Pharmacovigilance programmes depend also upon the effective practice of Pharmacovigilance by healthcare professionals

Cancer awareness among females of urban slums in their reproductive age group

Background: Cancer is major public health problem affecting millions of people worldwide. The prevalence of cancer is increasing in developing world due to increase in life expectancy, increased urbanization and adoption of western life styles. Thus, the present study was carried out to assess the extent of awareness towards cancer among women of urban slums in their reproductive age group. Methods:Community based cross sectional study was carried outby interviewing women of reproductive age group residing in urban slums using pre-designed and pre-tested proforma to assess awareness towards cancer. Descriptive statistics was applied to assess the awareness level and the association between two attributes was calculated bychi-square test. Results: A total of 182 women were interviewed. Out of which 39.56% were in 20-24 years age group. 46.15% were housewives and most of them belonged to middle class families. Though the knowledge regarding cancer, especially about modes of transmission, symptoms and laboratory diagnosis was found satisfactory but was accompanied by misconceptions. 71.43% women were aware about its prevention, mostly by changing life styles and by getting screening done at regular intervals. Conclusion: Thus, impetus has to be laid upon screening regarding cancer during reproductive age group and enlightenment of the women about cancer screening centres available at the hospitals, so as to heighten the knowledge of facilities for a better reproductive life

Study of acceptance of post-abortal contraception in a tertiary care centre

Background: Unsafe abortions is causing about 8% of maternal deaths in India. So, it’s important to use contraception not only for spacing but also to prevent unintended pregnancies. It is well known that fertility is resumed in the immediate cycle following an abortion. Post abortal contraception is very important in preventing pregnancies in the immediate post-abortal period. This study was intended to know the acceptance of post-abortal contraception in women coming for medical termination of pregnancy (MTP) or following spontaneous abortion in tertiary care centre. Thus, it is vital to know the choices made by them, to know the method accepted so that it will be helpful in bringing awareness in those who do not opt for post-abortal contraception. Aims and objectives were to study the acceptance rate of post-abortal contraception. Also, to study the method of contraception accepted.Methods: It was a retrospective cohort study from 2018 to 2020 done in Vani Vilas hospital, BMCRI, a tertiary hospital. A total of 2273 patients were enrolled in the study. Data was collected from both 1st trimester and 2nd trimester abortion patients (spontaneous/induced) from the Comprehensive abortion care register. The acceptance and method of contraception accepted was studied. Inclusion criteria were-women coming to tertiary centre for abortion (spontaneous/induced) to Vani Vilas hospital. Exclusion criteria were-Molar pregnancy and Ectopic pregnancy. Demography, educational status, details of spontaneous or induced abortions, parity and gestational age at abortion, the acceptance and methods of contraception accepted were studied.Results: A total of 2273 patients were included in the study of which 738 were MTP and 1535 were cases of spontaneous abortion. 912 (40.12%) were primigravidae and 1361 (59.87%) were multigravida. Various methods of contraceptives were accepted by 1973 (86.80%) patients, whereas 300 (13.19%) did not opt for any method of contraception. Of 1973 patients,176 (7.7%) underwent sterilization.Conclusions: The acceptance rate of post-abortion contraceptive methods was good. Acceptance of COCs and LARC was almost similar in this study. Immediate acceptance of contraception in the post-abortal period is very crucial in reducing unintended pregnancies and abortions hence family planning services after abortion need to be strengthened

Prescribing pattern of ophthalmological medication in geriatric inpatients of a tertiary care hospital

Background: Older people are potentially at greater risk of medication error. Gaining insight into the prescribing pattern especially in eye diseases as they are a common problem in elderly, in order to identify prescribing related problems is the fundamental step in improving the quality of prescription and patient care.Methods: Prescriptions fulfilling inclusion criteria were collected from hospital Medical record department (MRD) and analyzed using the World Health Organization (WHO) core prescribing indicators for rationality of prescriptions.Results: Among 811 prescriptions analysed, 52.7% (428) were of male patients, those aged 60-70 years were 77.2% (626) and patients with only cataract constituted 77% (625). Prescriptions with oral antibiotics were 57.1% (334); topical antibiotics were 35.8% (429) and topical analgesics 46.2% (553). Out of 1182 FDCs noted, 59% (479) were found to be rational and 34.6% (281) were from Essential Medicines List 2014. Only 2% (61) drugs were prescribed using generic name while 64.06% (1606) of drugs were from the WHO Model List of Essential Medicines (April 2015). Average number of drugs per encounter was 3.7. Percentage of encounters with antibiotics was found to be 43.8% and no prescriptions with injections were noted.Conclusions: Although usage of antibiotics and topical drugs was conforming to WHO recommended standards, there is a need to improve prescription pattern by using generic names and drugs from Essential Drug List

DESIGN AND EVALUATION OF INTRAGASTRIC BUOYANT TABLETS OF VENLAFAXINE HYDROCHLORIDE

Objective: The present study was undertaken to prolong the release of orally administered drug. The aim is to formulate, develop, and evaluate theintragastric buoyant tablets of venlafaxine hydrochloride, which releases the drug in a sustained manner over a period of 12 hrs. Different formulationswere formulated using the polymers Carbopol 934 P, xanthan gum, hydroxypropyl methylcellulose (HPMC K100M) with varying concentration ofdrug: Polymer ratio of 1:1, 1:1.5, 1:2, in which sodium bicarbonate acts as gas generating agent, and microcrystalline cellulose as a diluent.Methods: The tablets were prepared by direct compression and evaluated for tablet thickness, weight variation, tablet hardness, friability, in vitrobuoyancy test, in vitro drug release and Fourier transform infrared spectroscopy. Formulations were evaluated by floating time, floating lag time and in vitro drug release. Dissolution profiles were subjected for various kinetic treatments to analyze the release pattern of drug.Results: It was found that drug release depends on swelling, erosion, and diffusion, thus following the non-Fickian/anomalous type of diffusion.Formulation F8 was considered as an optimized formulation for gastro retentive floating tablet of venlafaxine hydrochloride. The optimizedformulation showed sustained drug release and remained buoyant on the surface of the medium for more than 12 hrs. As the concentration of HPMCK100M increases in the formulation the drug release rate was found to be decreased. The optimized formulation was subjected for the stability studiesand was found to be stable as no significant change was observed in various evaluated parameters of the formulation.Conclusion: It can be concluded that floating drug delivery system of venlafaxine hydrochloride can be successfully formulated as an approach toincrease gastric residence time, thereby improving its bioavailability. Â

A self-medicating scale and questionnaire based drug use survey and the effect of educational intervention among healthcare professional students

Background: Due to an array of reasons like easy accessibility and awareness about the available drugs, self-medication has steeply increased the already existent drug misuse. As the health professional students are exposed to all the information of drugs, it would be worthwhile to survey if this knowledge is misused to self-medicate. The present study was aimed at determining the impact of educational intervention on the prevalent attitudes and pattern of self-medication among medical, dental and nursing students as they constitute a vulnerable group for such practices.Methods: A total of 360 health professional students participated in the study. A validated questionnaire and self-medication scale (SMS) were used for the survey, before and after the educational workshop.Results: Of the 360 students 70% were females. 93.89% reported practicing self-medication, which reduced to 78.63% after the educational workshops. Average number of self-medication encounters before the workshop was 4.03±0.30. Analgesics were most commonly used. The modified SMS scores were significantly reduced (p<0.0001) after interventional workshops indicating that the enhanced knowledge, increased the reluctance to self-medicate and make students think twice before self-medicating so as to reduce such harmful, casual drug use habits.  Educational workshops statistically (p<0.0001) enhanced the participants knowledge of ADRs, OTC drugs, expiry date, package inserts etc. 77.78% nursing students were habituated to at least one drug which was significantly higher (χ2=20.45, p<0.0001) than that of medical and dental students taken together.Conclusions: Educational intervention reduces the evil of self-medication and enhances safe drug use habits among healthcare professional students