Pharmaceutical drug promotion: perception and attitude of medical interns towards drug company interactions in a tertiary care teaching hospital

Background: Interactions of pharmaceutical industry with the physicians which are usually mediated through pharmaceutical representatives have a significant impact on physician decision-making. This interaction can start as early as medical school during their training and this is said to influence their prescribing behavior when they become physicians. Aims and objectives of the study was to evaluate the attitude of interns towards pharmaceutical companies interactions including accepting gifts, ethical issues and influence on clinical decisions and also to study perception of medical interns towards the accuracy of information provided by the medical representatives.Methods: This was a cross sectional questionnaire based study that was conducted among the medical interns of the teaching hospital attached to Mandya Institute of Medical Sciences, Mandya. The study was carried out between July and August 2016. A preformed structured questionnaire was distributed to the interns consenting to participate in the study. Completed questionnaires were collected, compiled and data was analyzed.Results: A total of 93 questionnaires were distributed and 90 interns responded (response rate 96.7%). About 44.4% respondents felt that accepting gifts from Drug Company would influence their own decision making. Only 26.6% of them were of the opinion that it is ethical to accept pharmaceutical company gifts. Majority of them felt that Medical Representatives exaggerate the benefits of medicines and downplay the risks and contraindications of medicine. About 32.2% of them were of the opinion that they would prefer to prescribe the drug from the companies offering them with gifts over those without. Majority of the respondents felt that the doctors should be offered with gifts by drug companies whenever their drugs are prescribed.Conclusions: Attitude of Medical Interns towards Drug Company interactions as observed suggests for training the budding doctors on appropriate drug company interactions to prevent the risks associated with promotional efforts of pharmaceutical companies.

Use of over the counter drugs in urban and rural populations of Mandya district: a cross-sectional study

Background: Over-the-counter (OTC) drugs are medicines which are sold directly to a consumer without a prescription. There is a big potential for misuse and abuse of such products. Over the counter (OTC) drugs are meant for self-medication and are of proved efficacy and safety. Their improper use and unable to follow the precautions due to lack of knowledge of their side effects and interactions could lead to serious complications, especially in children and elderly.Methods: This cross-sectional study was conducted using a pre-tested & semi-structured questionnaire. A total of 400 urban and 400 rural persons were interviewed for this study. 100 persons were interviewed in Mandya city and 50 each from the city in each of the 6 taluks. Data was entered in Microsoft Excel software and was analysed using Statistical Package for Social Sciences (SPSS) software. Chi-square test was used to calculate the difference in use among the urban and rural OTC drug users.Results: A total of 800 persons were interviewed regarding their use of OTC drugs, among them 400 were urban residents and 400 were rural residents of Mandya district. Of the 400 urban persons and rural persons, 310 respondents (77.50%) and 273 respondents (68.25%) reported the use of OTC in the recall period of the last 6 months respectively. The difference in the usage of OTC by urban adults was significantly more than that of rural adults.Conclusions: The proportion of the respondents who had practiced self-medication with OTC drugs is very high. The prevalence of self-medication with OTC drugs in our study was found to be 72.87% and is nearly same in both rural and urban population. As this study was conducted in a limited population in Mandya district, generalization of the study to all the population cannot be done, and it requires large study in all districts of Karnataka with adequate sampling methods

Study of analgesics usage in third trimester of pregnancy and its ill effects on pregnancy course and outcome

Background: Pregnancy is a special physiological state. Pregnancy care is one of the greatest challenges in medicine as it demands a special care in the use of drugs because of altered physiology. At least 10 percent of birth defects are thought to result from maternal drug exposures. NSAIDS are one of the most commonly used medications during pregnancy (17%) to treat painful events during pregnancy.Methods: A prospective observational study was conducted after taking approval from the Institutional ethical committee and study was conducted for a period of one year. Antenatal clinics and inpatients wards of department of obstetrics and Gynaecology were visited and all the pregnant women with exposure to analgesics during third trimester and at the time of labour were included in the study. Information regarding the analgesics exposure either prescribed by the physician or self-medicated was collected.Results: Total 1520 pregnant women were included in the study over a period of one year. Analgesic exposure was seen in 77.1% of pregnant women during labour. Most common analgesic used to relieve labour pain was tramadol. 22.9% pregnant women were exposed to analgesics during third trimester, among them exposure to paracetamol was observed in 14% of pregnant women and to tramadol in 8.9%. Indications for usage of these analgesics during pregnancy were fever with myalgia (45.8%), false labour pain (37%), and headache (11.4%).Conclusions: Study showed that there is a positive association between analgesics exposure during third trimester of pregnancy particularly to paracetamol exposure and preterm delivery. Association between paracetamol exposure and low birth weight was also observed in this study but this finding could be due to more number of preterm deliveries which could not be ruled out in this study. Further studies have to be conducted to confirm the association since there are only limited numbers of studies done till now

Analysis of medication errors in medicine ward of medical college teaching hospital, Mandya

Background: Medication errors are one of the most common types of medical error that is seen in hospitalised patients. Since medication error is one of the growing concerns of healthcare issue and have implications on patient safety, the purpose of this study was to identify medication error and in turn would help to create awareness among healthcare professionals and provide safety to the patients.Methods: Study was initiated after obtaining approval from the Institutional Ethics Committee. The study was done for a period of 1 year between June 2016 and May 2017. Clinical data and data regarding the medication that was prescribed, transcribed, dispensed, administered was collected and was analysed for various types of medication errors during the different stages of medication use process.Results: A total of 351 subjects were recruited in the study for assessing medication error. About 2,283 drugs were prescribed among 351 patients. Maximum number of drugs was administered through parenteral route (50.3%). Medication error was most common during the prescribing stage (51.4%) followed by transcribing stage (39.1%), administration stage (6.9%), and dispensing stage (2.6%). On an average 6 drugs were prescribed per patient. Total of about 5411 errors have occurred out of which 98.8% of errors were preventable, 1.2% of errors were non-preventable. Cardiovascular system (21.9%) and endocrine and renal system (21.9%) was commonly affected due to the medication errors.Conclusions: Medication errors are one of the commonest problems of the healthcare system should be identified and documented and their causes should be studied in order to develop systems that minimize the recurrence

Obstructive Sleep Apnea – Current Perpectives

Obstructive sleep apnea is a common sleep related breathing disorder. The demand for sleep medicine services has increased exponentially since the recognition of sleep apnea as a disease in the 1960s. The involvement of dentists in the treatment of sleep apnea has increased. It is important that dentists are aware of the problem of sleep disorders and the potential they have to help in their management

ANALYTICAL HIERARCHY PROCESS FOR IDENTIFICATION OF SUITABLE WATER HARVESTING SITE IN GEOSPATIAL ENVIRONMENT

Water is the prime requirement for agriculture, domestic uses and industrial production. In India the per capita available of water is decreasing at a higher rate due to impact of climate change and ever-increasing population. Rainwater harvesting is the technique which is being used in effective storing of surface runoff. There are various types of water harvesting structures namely check dam, farm pond, percolation tank, etc. However, identification of potential site for the construction of the particular water harvesting structure is bit difficult as it depends upon numerous parameters such as soil type, slope, water availability, land use and land cover of the site and the surrounding, etc. The guidelines such as Food and Agriculture Organization; Integrated Mission for Sustainable Development are available for selecting suitable site for water harvesting structures. As the site suitability analysis involves multiple parameters for decision making, in the present study, the selection of suitable site for check dam is made through analytical hierarchy process (AHP) in geospatial domain for Hatni watershed, Madhya Pradesh, India. As location for check dam construction is influenced by soil texture, slope of the terrain, land use land cover, stream order and water availability; these parameters were derived from remote sensing data and analysed. The slope and stream network layers were generated from the digital elevation model (DEM). Further, the influence of soil and water availability in identifying the suitable sites was studied through soil texture and curve number. Different parameters influence the site suitability analysis, therefore, in the present study, IMSD guidelines were used to assign weights to each parameter under consideration. The layers were assigned weights by AHP technique based on pairwise comparison. The layers were reclassified according to the weights, then overlay analysis has been done to get the final site suitability map. As remote sensing provides the synoptic coverage of the earth, it has been further utilised to study the impact of water harvesting structure on its surrounding. The land use land cover map of before and after the construction of water harvesting structure was analysed for change in vegetation condition. It was observed that the vegetative cover has increased after implementation of the water conservation measures. It may be concluded that the geospatial technology has immense potential in site suitability studies for water harvesting structures

Direct regional microvascular monitoring and assessment of blood brain barrier function following cerebral ischemia-reperfusion injury

Evans Blue (EB) is often used to evaluate Blood-Brain Barrier Damage (BBB) in cerebral ischemia, frequently by dye extraction. Herein we present a method that allows assessing regional brain microvasculature, distribution of EB and Fluorescent Isothiocyanate-Labeled Red Blood Cells (FITC-RBCs) in a rat model of acute cerebral Ischemia-Reperfusion (I-R). Wistar rats were subjected to 3 h of middle cerebral artery occlusion and then reperfused. At ~2.5 h of reperfusion, BBB opening was assessed by contrast enhanced magnetic resonance imaging. It was followed by injections of EB and FITC-RBCs that circulated for either 5 or 20 min. Regional microvasculature and tracer distributions were assessed by laser scanning confocal microscopy. Microvascular networks in stroke-affected regions networks were partially damaged with apparent EB extravasation. Brain regions were affected in the following order: preoptic area (PoA)\u3estriatum (Str)\u3ecortex (Ctx). EB leakage increased with circulation time in Str. Cells around the leakage sites sequestered EB. An inverse correlation was observed between low CBF rates recorded during MCA occlusion and post-reperfusion EB extravasation patterns. Accordingly, this approach provided data on brain regional microvascular status, extravascular tracer distribution and its cellular uptake. It may be useful to evaluate model-dependent variations in vascular injury and efficacy of putative vascular protective drugs in stroke

The relationship between white matter microstructure and self-perceived cognitive decline

Subjective cognitive decline (SCD) is a perceived cognitive change prior to objective cognitive deficits, and although it is associated with Alzheimer's disease (AD) pathology, it likely results from multiple underlying pathologies. We investigated the association of white matter microstructure to SCD as a sensitive and early marker of cognitive decline and quantified the contribution of white matter microstructure separate from amyloidosis. Vanderbilt Memory & Aging Project participants with diffusion MRI data and a 45-item measure of SCD were included [n = 236, 137 cognitively unimpaired (CU), 99 with mild cognitive impairment (MCI), 73 ± 7 years, 37% female]. A subset of participants (64 CU, 40 MCI) underwent a fasting lumbar puncture for quantification of cerebrospinal fluid (CSF) amyloid-β(CSF Aβ42), total tau (CSF t-tau), and phosphorylated tau (CSF p-tau). Diffusion MRI data was post-processed using the free-water (FW) elimination technique, which allowed quantification of extracellular (FW) and intracellular compartment (fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity) microstructure. Microstructural values were quantified within 11 cognitive-related white matter tracts, including medial temporal lobe, frontal transcallosal, and fronto-parietal tracts using a region of interest approach. General linear modeling related each tract to SCD scores adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile scores, APOE ε4 carrier status, diagnosis, Geriatric Depression Scale scores, hippocampal volume, and total white matter volume. Competitive models were analyzed to determine if white matter microstructural values have a unique role in SCD scores separate from CSF Aβ42. FW-corrected radial diffusivity (RDT) was related to SCD scores in 8 tracts: cingulum bundle, inferior longitudinal fasciculus, as well as inferior frontal gyrus (IFG) pars opercularis, IFG orbitalis, IFG pars triangularis, tapetum, medial frontal gyrus, and middle frontal gyrus transcallosal tracts. While CSF Aβ42 was related to SCD scores in our cohort (Radj2 = 39.03%; β = −0.231; p = 0.020), competitive models revealed that fornix and IFG pars triangularis transcallosal tract RDT contributed unique variance to SCD scores beyond CSF Aβ42 (Radj2 = 44.35% and Radj2 = 43.09%, respectively), with several other tract measures demonstrating nominal significance. All tracts which demonstrated nominal significance (in addition to covariates) were input into a backwards stepwise regression analysis. ILF RDT, fornix RDT, and UF FW were best associated with SCD scores (Radj2 = 46.69%; p = 6.37 × 10-12). Ultimately, we found that medial temporal lobe and frontal transcallosal tract microstructure is an important driver of SCD scores independent of early amyloid deposition. Our results highlight the potential importance of abnormal white matter diffusivity as an early contributor to cognitive decline. These results also highlight the value of incorporating multiple biomarkers to help disentangle the mechanistic heterogeneity of SCD as an early stage of cognitive decline