Effectiveness of a module to promote competency in adverse drug reaction reporting in undergraduate medical students

Background: Adverse drug reaction (ADR) under-reporting is a hindrance to the implementation of Pharmacovigilance Program of India. This is essentially due to lack of ADR reporting culture among healthcare professionals. Thus, study was conducted to assess and enhance awareness about ADRs and strengthen reporting among medical undergraduates.Methods: This is an interventional crossover study. A total of 140 students of 2nd professional, MBBS were included and divided into two groups of 70 each. In phase 1, group A was given a didactic lecture (DL) on ADR and pharmacovigilance. Group B was also given DL with an addition of a case narrative exercise and they were asked to fill an ADR form. Both groups were assessed based on an MCQ questionnaire for knowledge and skill. After 15 days of washout period, groups were crossed and reassessed. Feedback from students was taken on a 5 point Likert’s scale.Results: The mean scores of batch A without case was 17.5±3 out of a total score of 25 marks, which showed improvement with case narrative and mean increased to 19.6± 2.4 (p 0.05). Similarly, Batch B showed improvement as well and the mean 17.7±3.1 score without case narrative increased to 19.2±2.7 (p <0.05). Student’s perception of the effectiveness of module-based teaching was positive.Conclusions: Case narrative in addition to didactic lecture enhanced awareness and may strengthen ADR reporting culture among the medical students

Comparison of the efficacy and safety of Glimepiride and Glipizide as add-on therapy with metformin in patients of type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder carrying an enormous burden of morbidity and mortality because of its characteristic complications, many of which are preventable with strict glycaemic control. Initial management of T2DM consists of non-pharmacological interventions; it those fail, an oral anti-diabetic drug, most typically metformin, is started. Combination therapy is initiated only when monotherapy fails to achieve glycaemic control. Glipizide and glimepiride, a second and a third generation sulphonylurea respectively, are the commonest drugs added to metformin when the latter fails to achieve euglycaemia on its own. Aims and Objectives of the study were to compare the efficacy and safety of glimepiride and glipizide as add-on therapy to metformin in patients of uncontrolled T2DM.Methods: This prospective, observational and analytical study was conducted by the Department of Pharmacology among patients attending the Internal Medicine OPD of a tertiary-care hospital. Fifty patients were assigned to two groups of 25 patients each: Group A - Glimepiride + Metformin and Group B - Glipizide + Metformin. Patients were followed up for three months. Data were analysed by Student's t-test.Results: There was a significant decrease in the HbA1c, FBS and 2h-PPBS in both groups. However there was no significant difference between the two groups during the three-month period of follow-up.Conclusions: The combination of glimepiride and metformin is just as effective and safe as the combination of glipizide and metformin in patients not controlled on monotherapy with metformin

Evaluating the antiproteinuric efficacy of cilnidipine in diabetic kidney disease

Background: Diabetic kidney disease is a life threatening and disabling complication of uncontrolled diabetes mellitus. Clinical proteinuria is a well-established marker of renal dysfunction. A dual L/N-type calcium channel blocker cilnidipine dilates the afferent and efferent arterioles of the glomerulus decreasing the intraglomerular pressure and showing antiproteinuric effects. The present study was conducted to assess the antiproteinuric efficacy of cilnidipine in patients of diabetic kidney disease.Methods: This interventional study was conducted on 50 patients of both genders aged 18 years and above with diabetic nephropathy (stage-2 to stage 4) visiting the medicine OPD at HIMS, Dehradun over a period of six months, the patients were given tablet cilnidipine (5-20 mg) once or twice a day. Baseline urine protein creatinine ratio (UPCR), serum creatinine and the estimated glomerular filtration rate (eGFR) was recorded at baseline and repeated after a period of 12 weeks. The end point was the decrease in UPCR after a period of 12 weeks. Students-paired T test was used for analysing the intragroup data.Results: After 12 weeks of treatment with cilnidipine, a significant reduction was observed in the urinary protein creatine ratio (mean±SD) from 3.2±1.23 at baseline to 3.09±1.09 respectively (p<0.05). Along with this there was also a reduction in the in serum creatinine which was significant (p<0.05) as well as an increase in the eGFR value which was also statistically significant (p<0.001).Conclusions: Cilnidipine reduces the UPCR as well as improves the kidney function in patients with diabetic kidney disease

Evaluation of Internet Generations on Wireless Network: A Survey

In the recent era, the demand of the internet is increasing. The Internet is global computer network that provide the sharing of data and information. Internet is useful in every field. It modifies the way of working, living style and contributed positive impact on our life. With the raising of the demand new tools and technologies are developed. The internet is classified in various generations depends on the functionality and key features. In this paper the generations of the internet and functionality are discussed. The internet has 1.0, 2.0, and 3.0 that provides internet protocols. Internet 4.0 and 5.0 are grownup and it works on wireless and sensor network devices. With the development of new generation the data rate, flexibility, Quality of service, performance and many other features are improved. In this survey focus on the features, techniques and tools provided by each generation

Quality of prescriptions in hospitalized children suffering from acute and persistent diarrhoea

Background: Diarrhoea is a major public health problem in children worldwide. It continues to be a major health challenge, especially in developing countries, despite the availability of regularly updated standard treatment guidelines. Non-compliance to such guidelines by the physicians has been a long standing story. The treatment is often marred with incapacitating prescription of drugs besides neglecting even the basic tenets of good prescribing. As a result, the quality of such prescriptions for diarrhoeal disorders in children remains poor. To gauge the magnitude of this problem in this setup towards possible corrective measures, the study was aimed to audit prescription practices in the management of acute and persistent diarrhoea in hospitalised children up to five years of age.Methods: An observational study was conducted in 100 patients of either gender in the age group up to 5 years admitted with acute and persistent diarrhoea. A detailed medical history from the parents/guardians and the details of prescription from the time of admission till the discharge of the patient were obtained. Quality of prescriptions was analysed using prescription quality index (PQI) tool, a validated comprehensive tool described by Hassan et al in 2010. Based on this tool, prescription with the total PQI score of ≤ 31 were interpreted as poor quality, scores with 32 to 33 as medium quality and scores 34 to 43 as high quality with a possible maximum score of ‘43’.Results: Based on the PQI tool for 100 children, 60 prescriptions were found to be of poor quality. Only 2 prescriptions were of medium quality, whereas 38 prescriptions were in high quality range. Average mean±SD score of prescriptions with poor quality was 25.2±1.48, ranging from 21 to 31. The mean±SD of prescriptions with medium quality was observed to be 32±0 and for prescriptions of high quality was 38.07±2.28. The total average mean score of all prescriptions was 30.23±6.50. Poor quality prescriptions were particularly observed for the patients with the diarrhoea with No dehydration.Conclusions: Prescription appropriateness in spite of available guidelines continues to be a big challenge in the adequate management of patients with diarrhoeal disorders under the age group of five years in a tertiary care centre in India

Cardio-Vascular Complications of Hydroxychloroquine Use: Can Impact COVID-19 Pandemic

As the coronavirus pandemic is on the rise, many compounds with anti-viral properties are under investigation. Hydroxychloroquine (HCQ) being the daily debated daily during this COVID-19 pandemic is an immunomodulatory drug which has been used for indications like malaria, systemic lupus erythematosus and arthritis. Although some researchers have claimed its effectiveness against coronavirus, it results in proarrhythmic effects and drug-induced long QT syndrome. These cardiac issues while using hydroxychloroquine, have limited its use against coronavirus. A literature search was performed, and general safety information of this drug was collected. It can be concluded that this drug leads to cardiovascular events, heart disease, hypotension, tachycardia, and QT interval prolongation, sometimes in combination with other drugs and should be prescribed to the patients only after thoroughly estimating its benefit risk ratio

Knowledge attitude and practice of pharmacovigilance among nursing professionals in a tertiary care teaching hospital in Dehradun, Uttarakhand

Background: Pharmacovigilance deals with identification, assessment and prevention and reporting of adverse drug reaction (ADR), play a pivotal role in ensuring safe use of drugs. However, in spite of having well established ADR reporting system in India and worldwide, the ADR underreporting is a big challenge till date. It is therefore very important to assess the level of awareness of Pharmacovigilance among healthcare professionals to identify the factors affecting ADRs reporting. The objective of the study was to evaluate knowledge, attitude and practice of pharmacovigilance among nursing professionals in a tertiary care teaching hospital in Dehradun, India.Methods: It was a cross sectional observational study conducted at HIMS over a period of 1 year. Nursing professionals who work in internal medicine, Surgery, PAC and intensive care unit (ICU) were included in this study. A self-administered questionnaire comprising of 15 items related to ADRs and Pharmacovigilance programme of India (PvPI) activity was provided to them and sufficient time to fill the questionnaire was given. The completely filled questionnaire was collected and data was analyzed using SPSS ver.20.0.Results: A total of 415 participants were included in the study. The mean age of the participant was 28.52 years. The number of female was more than male participants. Majority of participant (56%) couldn’t answer the meaning of pharmacovigilance. Only 25% participants were aware about ADR reporting process to ADR monitoring centre (AMC). Although majority of the participants understand the necessity of ADR reporting and aware about AMC centre and PvPI, but most of them showed unfamiliarity about ADR reporting form and previous experience of any kind of ADR. The most common reason for not reporting the ADR was difficulty in deciding the nature of adverse effects (AE) (44%) followed by lack of time (30%). Majority of participant (67%) denied any previous pharmacovigilance training and almost all (98%) have shown their interest in PvPI training.Conclusions: Nursing professionals in our hospital may lack adequate knowledge about ADR reporting and may need more education and training on the National Pharmacovigilance System and ADR reporting process

Are preeclampsia and small for gestational age baby could be predicted by placental location?

Objective: Preeclampsia is one of the major cause of maternal and perinatal mortality and morbidity. The pathophysiology is complex and involves multiple organs. The purpose of this study was to find out whether the placental laterality as a predictor of preeclampsia and small for gestational age baby.Methods: This was prospective observational study conducted from February 2015 to December 2015, in a tertiary care hospital of Delhi. 347 antenatal patients attending obstetrics OPD without high risk factors were enrolled. After enrolment 50 patients were lost to follow up and 27 not delivered in our hospital. Ultrasonography for placental localization was done at 18-24 weeks of pregnancy. Patients were followed till delivery for pregnancy outcomes such as preeclampsia, small for gestation age (SGA) baby and mode of delivery. Placenta locations were divided into lateral (either right or left) and central (anterior, posterior or fundal).Results: Out of 347, a total of 270 patients were analysed, 39 (14.4%) had lateral placenta and among them 17 (43.5%) developed preeclampsia and 24 (61.5%) had small for gestational age baby (p<0.001). 231 (85.5%) had central placenta and among them 49 (21.2%) developed preeclampsia and 63 (27.2%) had small for gestational age baby (p <0.001).Conclusions: Laterally located placenta had significant association with preeclampsia and small for gestational age babies

Comparative efficacy of pregabalin and baclofen in the rodent chronic constriction injury model of neuropathic pain

Background: Neuropathic pain is associated with prolonged disability and is usually not responsive to conventional analgesics like NSAIDs and opioids. Even the recommended first-line drugs are effective in less than 50% patients. Thus, drugs with different mechanisms of action are needed. Baclofen, a GABA-B agonist has shown benefit in different types of neuropathic pains and is compared against pregabalin.Methods: The sciatic nerve was ligated in 2 groups of 6 rats each as per the chronic constriction injury model of neuropathic pain on day 0. After 14 days the effect of single doses of pregabalin (30mg/kg) and baclofen (5mg/kg) intraperitoneally were assessed over a 2 hours period. Thermal and mechanical hyperalgesia were assessed as measures of neuropathic pain by the hotplate and pin-prick method respectively.Results: Significant thermal and mechanical hyperalgesia was produced 14 days after sciatic nerve ligation in both the groups (p <0.05). Both pregabalin (p <0.001) and baclofen (p <0.01) were effective in decreasing thermal hyperalgesia throughout the two hours study period, but pregabalin was more effective as compared to baclofen (p <0.05) at 30, 60 and 120minutes. Both the drugs produced a significant decrease in mechanical hyperalgesia (p <0.01) throughout the study period. Again, pregabalin was the more effective drug (p <0.05) at all time points.Conclusions: Significant thermal and mechanical hyperalgesia was seen 14 days after sciatic nerve ligation. Both pregabalin and baclofen were effective in reversing the hyperalgesia, but pregabalin was the more effective of the two drugs at all time points