Students friendly medical examination

Undergraduate medical education is very vast area comprises of over dozen subjects and their evaluation through professional examination. In current scenario of modern life students are pressurized from every corners, economic burden, lack of proper teaching or friendly environment, senior and peer group pressure, love affairs are common issues during college life. Insecurity of job after completion of education will pose future financial fear. These are some common reasons enough to pressurized, therefore incidence of depression and suicidal tendencies are going on to be increases several folds among medicos. In current scenario of tough life, medical examination is always a burden. The professional exams of universities are the matter of their norms and regulation, but we have day-to-day assessment through-out duration; this is enough to moralize them and prepare before final professional examination

Buclizine- old wine in new bottle?

Buclizine is a first generation antihistaminic with some anticholinergic potential. This drug has specific pharmacological indications in allergy, morning sickness, migraine, motion sickness and insomnia with some or doubtful success. It is an obsolete drug of decline use due to better availability of second and third generation antihistamines.Buclizine, a forgotten drug used in past is now re-introduced as an appetite stimulant. Previously one of the counterpart “cyproheptadine” was used but currently banned from most part of the world due to untoward effects.The standard textbook of pediatrics has not mentioned buclizine as an appetizer. On the other side, no article published (Pub med search) in last few decades to favors this claim. This drug has no space in WHO essential medicine list probably due to doubtful safety.A scientific issue arises- Does children require appetite stimulant? Appetizers are never be a rational solution. They can be used as adjunct because of their placebo effect. Meanwhile placebo has limited role in children on behalf of other party (parents) involvement. Misperception about diet, feeding practice, dysfunctional ‘parent child interaction’ etc. needed proper counselling rather than prescribing an appetite stimulant.There may be risk, that buclizine to become “OTC” appetizer in future due to current promotional spurt by pharmaceutical. However, large scale multicentric clinical trials are needed before promotion of buclizine as pediatric appetite stimulant, with careful watch of pharmacovigilance perspective

Comparative analysis of efficacy and adverse effects of tacrolimus vs cyclosporine in chronic dry eye disease: a tertiary care hospital based study

Background: Dry eye disease (DED) is the very common and underdiagnosed ocular condition affecting vision, quality of life, and the outcomes of cataract or refractive surgery. Dry eye disease (DED), either alone or in combination with other conditions, is a frequent cause of ocular irritation that leads the patients to seek ophthalmic care. Due to a wide variety of presenting symptoms, it is often unrecognized and this causes great frustration of the patient and treating physician. While these symptoms often improve with appropriate treatment, usually in majority of the cases the disease may not be curable. Aim of the study was to compare the efficacy of tacrolimus and cyclosporine in dry eye disease.Methods: This was a single centred, 3 months prospective study. Patients with unilateral or bilateral dry eye disease and an ocular surface disease index score >12, atleast one eye with schirmer score <5mm and TBUT <10 s were enrolled in the study. The enrolled patients were randomly divided into two groups, twenty-five patients in Group 1 and twenty three patients in Group 2 completed the follow up. Group 1(n =25) who received 0.03% tacrolimus eye ointment twice daily for consecutive 3 months and Group 2 (n= 23) received 0.05% cyclosporine eye drops twice daily for consecutive 3 months the primary efficacy outcome was Schirmer score after 3 months. The secondary outcomes were TBUT and adverse effects.Results: After 3 months, both the treatment groups showed significant improvement in mean Schirmer score (p<0.001) and mean TBUT (p <0.0001). However, on comparing both the groups, mean Schirmer score and mean TBUT, results were comparable. No patient discontinued treatment because of minor ocular adverse effects.Conclusions: Dry eye patients demonstrated improvement in Schirmer score and TBUT after 3 months of treatment with tacrolimus 0.03% ointment and cyclosporine 0.05% eye drops

A prospective study to compare the efficacy of tacrolimus vs cyclosporine in vernal keratoconjunctivitis in children in India

Background: Vernal keratoconjunctivitis (VKC) is a chronic allergic conjunctival disease. Immunomodulatory drugs like cyclosporine is being used for its treatment. Tacrolimus is another immunomodulator drug that can be used in VKC. This study was done to compare the efficacy of tacrolimus and cyclosporine in VKC.Methods: This prospective study was conducted on 60 patients of either sex by dividing them into two groups. The first group was treated with cyclosporine (0.05%) ophthalmic eye drop and second group with tacrolimus (0.03%) ophthalmic ointment. Total five objective signs (hyperaemia, oedema, papillae, corneal involvement and tantra’s dot) and five subjective symptoms (itching, tearing, foreign body sensation, discharge and photophobia) data was collected and tabulated for statistical analysis.Results: Authors found TSSS in both groups decrease significantly (p <0.05 or p <0.01 or p <0.001) at all post periods as compared to respective predecessor periods except 4 weeks to 6 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Similarly, for each period, on comparing the mean TSSS between the groups TSSS between the groups at all periods does not differed statistically though at final evaluation (mean change from baseline to 8 weeks), it improved 5.2% more in tacrolimus group (83.7%) than cyclosporine group (78.5%). Similarly, TOSS also decreased at all post periods except 4 weeks to 6 weeks, and 6 weeks to 8 weeks in cyclosporine group and 6 weeks to 8 weeks in tacrolimus group. Improvement in scores was 11.6% more in tacrolimus (81.6%) than cyclosporine (70.0%). Cyclosporine eye drops are associated with burning sensation and redness of eyes while transient ocular irritation was only observed side effect with tacrolimus.Conclusions: The study found tacrolimus is clinically better drug for treatment of vernal keratoconjunctivitis than cyclosporine and is also cost effective

Comparative study to evaluate the anti-diabetic activity of commercially available extract of Tinospora cordifolia and Phyllanthus emblica in streptozocin induced diabetic rat

Background: Diabetes is a chronic metabolic disorder with significant socioeconomic impact on a developing country like India. Ayurvedic texts have mentioned Tinospora cordifolia (guduchi) and Phyllanthus emblica (amla) to possess antidiabetic properties. The study was conducted to evaluate the anti-diabetic activity of commercially available extract of these herbal plants in streptozocin induced diabetic rats and its comparison to standard antidiabetic drug glibenclamide.Methods: The study was carried out with albino rats of either sex weighing between 100-150 gm. All the rats were intraperitonially injected with 35 mg/kg of streptozocin in citrate buffer. Blood glucose was estimated after 1 week high fat diet and rats having blood glucose >200 mg/dl were considered diabetic and included in further study. They were divided into 6 groups of 6 rats each. Six groups were given different interventions as distilled water (which were control rats), Tinospora cordifolia extract low dose (200 mg/kg/day), Tinospora cordifolia extract high dose (400mg/kg/day), Phyllanthus emblica extract low dose (200 mg/kg/day), Phyllanthus emblica extract high dose (400 mg/kg/day) and standard drug glibenclamide (0.6 mg/kg/day). All the rats received allocated drugs for further 6 weeks. Blood glucose was measured every 2 weeks till the end of sixth weeks by glucose-oxidase method.Results: In both low as well as high dose groups, Tinospora cordifolia and Phyllanthus emblica showed significant reduction (P <0.01) in plasma glucose levels from fourth week onwards.Conclusions: Commercially available extract of Tinospora cordifolia and Phyllanthus emblica have significant anti-diabetic activity in streptozocin induced diabetic rats

Is pregabalin better than gabapentin in treatment of neuropathic pain? An observation-based study at tertiary care centre of North India

Background: The present study was undertaken to assess the efficacy of pregabalin and gabapentin in treatment of neuropathic pain at a government tertiary care hospital of Uttar Pradesh, India. Due to indiscriminate use of drugs for treatment of neuropathic pain, selection of an effective drug is need of hour.Methods: Out of 130 patients, 62 patients were given pregabalin and 68 were given gabapentin. Douleur Neuropathique 4 questionnaire (DN4) which was used to diagnose patients of neuropathic pain. Efficacy of drug was based on their capability to decrease neuropathic pain at regular intervals.Results: On comparing the efficacy of drugs by their ability to decrease neuropathic pain, there was a significant difference when comparing pregabalin and gabapentin, pregabalin being statistically significant than gabapentin.Conclusions: On the basis present study efficacy of pregabalin 300 mg once daily brought better improvement of symptoms and sign than that of gabapentin 600 mg administered once daily dose. So pregabalin is a better drug than gabapentin

Analysis of antimicrobial susceptibility pattern of ocular infections at Regional Ophthalmic Institute in India

Background: Ocular infections are a result of alteration in the normal microbial flora of eye. They are not only responsible for increase in morbidity varying from self-limiting trivial infection to sight threatening infection but also blindness.Methods: Patients with ocular infections were recruited at Regional Institute of Ophthalmology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh. Bacterial profile in ocular infections and susceptibility pattern to commonly used antibiotics were analyzed amongst these patients. The isolated organism was then identified by colony morphology, gram stain and biochemical test following which in vitro susceptibility test was performed by Kirby-Bauer disc diffusion method and interpreted clinically.Results: Staphylococcus aureus and coagulase negative Streptococcus were most common etiological agents of ocular infections in the present study.  It was observed that bacterial isolates were highly (in 100% of cases) susceptible to vancomycin and chloramphenicol among gram positive organisms. Gram negative organisms showed higher susceptibility to moxifloxacin, tobramycin and gentamycin. Pseudomonas was seen to have sensitivity towards ceftazidime and cefazolin.Conclusions: The present study gives an insight into use of ocular antimicrobials in northern India. These findings illustrate the need for constant bacterial surveillance before starting empirical treatment

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Comparative study to evaluate the anti-diabetic activity of commercially available extract of Tinospora cordifolia and Phyllanthus emblica in streptozocin induced diabetic rat

Background: Diabetes is a chronic metabolic disorder with significant socioeconomic impact on a developing country like India. Ayurvedic texts have mentioned Tinospora cordifolia (guduchi) and Phyllanthus emblica (amla) to possess antidiabetic properties. The study was conducted to evaluate the anti-diabetic activity of commercially available extract of these herbal plants in streptozocin induced diabetic rats and its comparison to standard antidiabetic drug glibenclamide. Methods: The study was carried out with albino rats of either sex weighing between 100-150 gm. All the rats were intraperitonially injected with 35 mg/kg of streptozocin in citrate buffer. Blood glucose was estimated after 1 week high fat diet and rats having blood glucose >200 mg/dl were considered diabetic and included in further study. They were divided into 6 groups of 6 rats each. Six groups were given different interventions as distilled water (which were control rats), Tinospora cordifolia extract low dose (200 mg/kg/day), Tinospora cordifolia extract high dose (400mg/kg/day), Phyllanthus emblica extract low dose (200 mg/kg/day), Phyllanthus emblica extract high dose (400 mg/kg/day) and standard drug glibenclamide (0.6 mg/kg/day). All the rats received allocated drugs for further 6 weeks. Blood glucose was measured every 2 weeks till the end of sixth weeks by glucose-oxidase method. Results: In both low as well as high dose groups, Tinospora cordifolia and Phyllanthus emblica showed significant reduction (P <0.01) in plasma glucose levels from fourth week onwards. Conclusions: Commercially available extract of Tinospora cordifolia and Phyllanthus emblica have significant anti-diabetic activity in streptozocin induced diabetic rats. [Int J Basic Clin Pharmacol 2016; 5(4.000): 1641-1646

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundRegular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.FindingsThe leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.InterpretationLong-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere