EVALUATION OF SELF-MEDICATION PRACTICE IN SECOND YEAR UNDERGRADUATE STUDENTS AT A MEDICAL COLLEGE IN SOUTH GUJARAT

Objectives: Self-medication is the use of medicines by owns self without proper consultation. The practice of self-medication has increased, especially in medical students. Hence, this study was carried out to evaluate the self-medication practices among 2nd year undergraduate students of our institute. Methods: This was a cross-sectional and observational study conducted among the 2nd year MBBS students for 1 month. The study comprised a pre-approved and pre-validated questionnaire in English consisting of two sections: Section 1 included questions regarding demographic details of the students and whether they practiced self-medication in the past 1 year. If they responded with a yes, they were asked to fill Section 2 which had questions about the details of their self-medication practice. The questionnaire was administered by the faculty of the pharmacology department after taking written informed consent. Only completely filled questionnaires were evaluated. The results were expressed using mean and percentages. Results: 139 questionnaires were analyzed. About 80.58% students practiced self-medication. Female students (87.18%) were self-medicating more than male students (72.13%). Majority of the students who practiced self-medication obtained the medicine from the pharmacy (78.57%) and used it for 7 or fewer days. Analgesics (90.18%) were the most common group of drugs used followed by antipyretics. The most common indication was pain or headache (87.50%). Minor illness (73.21%) was the most common reason for self-medication. Conclusion: The practice of self-medication was quite high in the 2nd year MBBS students of our institute. They lack awareness regarding the safe and rational use of medicines

Role of combination bortezomib and pegylated liposomal doxorubicin in the management of relapsed and/or refractory multiple myeloma

The first in class proteasome inhibitor bortezomib (B) received its initial regulatory approval for therapy of patients with multiple myeloma (MM) in the relapsed/refractory setting. Modulation of proteasome function, however, is also a rational strategy for chemosensitization, and a variety of agents have shown synergistic activity with bortezomib pre-clinically, including anthracyclines. This formed the basis for evaluation of a regimen of bortezomib with pegylated liposomal doxorubicin (PLD). PLD+B, in a phase I study, induced a predictable and manageable toxicity profile, and showed encouraging anti-MM activity. In a recent international, randomized phase III trial, PLD+B demonstrated a superior overall response rate and response quality compared to bortezomib alone, as well as a longer time to progression, duration of response, progression-free survival, and overall survival. Sub-analyses revealed benefits in almost all clinically relevant subgroups, including several which would be considered to have high-risk disease. These findings have led to the establishment of the PLD+B regimen as one of the standards of care for patients with relapsed and/or refractory myeloma. Efforts are now underway to build on this combination further by adding other active anti-myeloma agents. In this review, we will discuss the role of PLD+B as an important addition to our therapeutic armamentarium for patients with MM

A prospective study of USG guided pigtail catheter drainage in management of liver abscess

Background: Treatment of the liver abscess of any etiology has evolved in the recent years. Percutaneous drainage of liver abscess has been an important advancement in the treatment of pyogenic liver abscesses. Aim: to evaluate and assess response, morbidity and complication rates of percutaneous pig tail catheter drainage in treatment of liver abscess.  Methods: During a period of 27 months, 25 patients with liquefied liver abscess ≥5x5 cm underwent percutaneous drainage under sonographic guidance.Results: 18 had solitary abscess, while 7 had multiple abscesses. Pigtail catheters of various sizes (10 F or 12 F) were introduced in these patients using the Seldinger technique. The volume of pus drained ranged from 150 to 400 ml, while the period of catheter drainage ranged from 6 to 17 days. Complications were minor and included catheter blockage in 2 patients and tract pain in 8 patients. There was no mortality associated with this procedure. This study shows a success rate of 96% (successful treatment in 24 out of 25 patients).Conclusion: Percutaneous catheter drainage of liver abscesses is successful with a low morbidity and mortality and should be the first line of management in liquefied moderate to large sized liver abscesses.

Laparoscopic Appendectomy Outcomes on the Weekend and During the Week are no Different: A National Study of 151,774 Patients

Background: The "weekend effect” is defined as increased morbidity and mortality for patients admitted on weekends compared with weekdays. It has been observed for several diseases, including myocardial infarction and renal insufficiency; however, it has not yet been investigated for laparoscopic appendectomy in acute appendicitis—one of the most prevalent surgical diagnoses. Methods: The present study is based on the Nationwide Inpatient Sample (NIS) from 1999 to 2008. The following outcomes were compared between patients undergoing laparoscopic appendectomy for acute appendicitis admitted on weekdays versus weekends: severity of appendicitis, intraoperative and postoperative complications, conversion rate, in-hospital mortality, and length of hospital stay. Unadjusted and risk-adjusted generalized linear regression analyses were performed. Results: Overall, 151,774 patients were included, mean age was 39.6years, 52.6% (n=79,801) were male, and 25.3% (n=38,317) were admitted on weekends. After risk adjustment, the conversion rate was lower [odds ratio (OR): 0.94, p=0.004, number needed to harm (NNH): 244], whereas pulmonary complications (OR: 1.12, p=0.028, NNH: 649) and reoperations (OR: 1.21, p=0.013, NNH: 1,028) were slightly higher on weekends than on weekdays. Overall postoperative complications (OR: 1.03, p=0.24), mortality (OR: 1.37, p=0.075) and length of hospital stay (mean on weekday: 2.00days, weekends: 2.01days, p=0.29) were not statistically different. Conclusions: The present investigation provides evidence that no clinically significant "weekend effect” for patients undergoing laparoscopic appendectomy exists. Therefore, hospital or staffing policy changes are not justified based on the findings from this large national stud

Cholecystectomy Concomitant with Laparoscopic Gastric Bypass: A Trend Analysis of the Nationwide Inpatient Sample from 2001 to 2008

Background: Gallstone formation is common in obese patients, particularly during rapid weight loss. Whether a concomitant cholecystectomy should be performed during laparoscopic gastric bypass surgery is still contentious. We aimed to analyze trends in concomitant cholecystectomy and laparoscopic gastric bypass surgery (2001-2008), to identify factors associated with concomitant cholecystectomy, and to compare short-term outcomes after laparoscopic gastric bypass with and without concomitant cholecystectomy. Methods: We used data from adults undergoing laparoscopic gastric bypass for obesity from the Nationwide Inpatient Sample. The Cochran-Armitage trend test was used to assess changes over time. Unadjusted and risk-adjusted generalized linear models were performed to assess predictors of concomitant cholecystectomy and to assess postoperative short-term outcomes. Results: A total of 70,287 patients were included: mean age was 43.1years and 81.6% were female. Concomitant cholecystectomy was performed in 6,402 (9.1%) patients. The proportion of patients undergoing concomitant cholecystectomy decreased significantly from 26.3% in 2001 to 3.7% in 2008 (p for trend < 0.001). Patients who underwent concomitant cholecystectomy had higher rates of mortality (unadjusted odds ratios [OR], 2.16; p = 0.012), overall postoperative complications (risk-adjusted OR, 1.59; p = 0.001), and reinterventions (risk-adjusted OR, 3.83; p < 0.001), less frequent routine discharge (risk-adjusted OR, 0.70; p = 0.05), and longer adjusted hospital stay (median difference, 0.4days; p < 0.001). Conclusions: Concomitant cholecystectomy and laparoscopic gastric bypass surgery have decreased significantly over the last decade. Given the higher rates of postoperative complications, reinterventions, mortality, as well as longer hospital stay, concomitant cholecystectomy should only be considered in patients with symptomatic gallbladder diseas