Comparison of analgesic, anti-inflammatory and anti-pyretic efficacy of diclofenac, paracetamol and their combination in experimental animals

Background: Various combinations of analgesics antipyretic drugs are available in the market for treatment of various musculoskeletal disorders and pain relief. Diclofenac and paracetamol combination is most commonly used combination and its rationality is questionable. The objective of this study was to compare the analgesic, anti-inflammatory and anti-pyretic activities of diclofenac, paracetamol and their combination.Methods: Experimental animals were divided into 4 different groups – control, diclofenac, paracetamol and their combination. Analgesic activity was compared by using tail-clip method in rats and writhing test in mice, anti-inflammatory activity was compared by carrageenan paw edema method using plethysmometer and anti-pyretic action was compared using TAB vaccine induced pyrexia and measuring the rectal temperature. Different doses of diclofenac (1mg/kg and 2mg/kg) and paracetamol (10mg/kg and 20mg/kg) used and same doses were used in combination group.Results: Diclofenac sodium (1mg/kg) showed significantly higher analgesic activity using tail-clip and writhing method compared to paracetamol (10mg/kg) (p<0.0001) and the combination group (p<0.05). Diclofenac sodium (2mg/kg) showed significantly higher analgesic activity using tail-clip and writhing method compared to paracetamol (20mg/kg) (p<0.0001) and the combination group (p<0.1). Diclofenac has no significant difference in anti-inflammatory activity using carrageenan induced paw edema when compared to the combination group (p<0.1) for both doses. But diclofenac when compared to paracetamol for anti-inflammatory effect, it was highly significant (p<0.0001 and p<0.0004) for both doses at 1st and 3rd hour. Paracetamol 20mg/kg was superior antipyretic (p<0.05,0.01 and 0.01 ) when compared to the combination group at 1hr, 2hr and 3hr duration after injecting TAB vaccine.Conclusion: Diclofenac and paracetamol combination was either equal or inferior in all three activities studied as compared to the individual drugs

Study of potential drug-drug interactions between benzodiazepines and four commonly used antiepileptic drugs in mice

Background: Benzodiazepines (BZD) is one of the commonly used drug groups for certain neurological diseases. As sometimes, the anti-epileptic drugs (AEDs) may be used concomitantly with BZD there is a potential for drug-drug interactions. Study aimed to study potential drug-drug interactions between four commonly used AEDs (phenytoin, carbamazepine (CBZ), phenobarbitone, sodium valproate) and BZD (diazepam, clonazepam) in mice using maximal electroshock seizure (MES) method and pentylenetetrazole (PTZ) method.Methods: Adult male albino mice were divided into four different groups of six animals each and anti-epileptic activity was assessed using MES method and PTZ method. Group I acted as a control, Group II received any one of the four AEDs (phenytoin, CBZ, phenobarbitone or sodium valproate) in sub-effective doses, Group III received diazepam or clonazepam alone, Group IV received a combination of diazepam or clonazepam with any one of the AEDs.Results: In MES method, the groups receiving combination of diazepam with phenytoin and CBZ showed significant protection compared to the control group (p<0.01 and p<0.02), respectively. However, diazepam in combination with sodium valproate and phenobarbitone did not show any significant protection compared to the control group and individual antiepileptic group. All the four antiepileptic showed significant protection against MES seizure in combination with clonazepam when compared to control group. In PTZ method, combination of sodium valproate with clonazepam showed significant protection compared to control group (p<0.02). However, this was not observed with diazepam-valproate combination.Conclusion: Clonazepam potentiates the action of all the four anti-epileptics while diazepam potentiates only phenytoin and CBZ against MES seizures. Clonazepam but not diazepam potentiates the action of sodium valproate against PTZ seizures

Kondisi Ruh Ketika Tidur dalam Al-Qur’an (Kajian Surah Az-Zumar Ayat 42 Menurut Imam Al-Qurthubi)

Ruh merupakan salah satu hal gaib yang berada di dalam jasad sebagai penyebab adanya hidup, yang mana sering kali menjadi perbincangan bagi ia yang penasaran. Ketika ruh dikaitkan dengan fenomena tidur, maka akan timbul pertanyaan bagaimana kondisi ruh ketika seseorang tertidur? Ada pula yang berpikir lebih panjang mengenai hal apa saja yang diperlihatkan Allah kepada ruh seseorang yang sedang tidur? Dengan menggunakan metode kualitatif dan pendekatan yang bersifat deskriptif, maka mekanisme penelitian tersebut dapat menghasilkan data berupa istilah tertulis yang bersifat kepustakaan (library search). Penelitian ini dilakukan demi mengungkap dan menyingkap tabir terkait kondisi ruh seseorang ketika tidur menurut Imam Al-Qurthubi, yakni penafsiran terhadap Qur’an Surah Az-Zumar ayat 42. Dalam ayat ini, Imam Al-Qurthubi menyatakan bahwasanya ruh seseorang yang sedang tidur berada pada genggaman Allah Swt. dan akan dikembalikan lagi agar seseorang tersebut terbangun. Namun ada pengecualian bagi orang yang mati, yaitu ruh tersebut tidak dikembalikan lagi. Selanjutnya ayat ini juga memiliki tanda-tanda kebesaran Allah Swt. bagi orang-orang yang mau menelaah ayat-ayat Nya

Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study

Background: Use of anti-emetic drugs in pediatric population is often warranted, but choice of drug remains questionable within pediatricians. Objective of current study is: to study prescribing pattern and to calculate cost of antiemetic drug therapy in pediatric wards.Methods: A prospective, observational study was conducted in pediatric wards of a tertiary care hospital of over 14 month’s duration. Institutional ethics committee approval was obtained and written informed consent of parents/guardians was taken. Data of any pediatric patient receiving anti-emetic agent were included in the study.Results: A total of 218 prescriptions were collected. Mean age of patients was 4.39±3.16 (range 4 months to 12 years). Gastroenteritis was the most frequently diagnosed disease in 137(63%) patients. Domperidone was prescribed in 52.4% and ondansetron in 47.6% children. Oral liquid dosage formulation was prescribed in 109 (48.4%) followed by solid dosage form 47 (20.9%). Mean cost of domperidone therapy was 25.34±6.55 INR and for ondansetron it was 36.62±17.94 INR.Conclusions: Gastroenteritis was most frequent indication for use of anti-emetics. Domperidone pharmacotherapy was cheaper and most frequently prescribed than ondansetron

Knowledge and attitude among Indian medical students towards thalassemia: a study in Delhi NCR

Background: Thalassemia can easily be prevented by awareness, education, screening, premarital genetic counselling and prenatal diagnosis. There are only a handful of articles on knowledge and awareness about thalassemia among general population or parents of thalassaemic children. Aims and objectives was to evaluate the level of awareness, knowledge and attitudes of medical students towards thalassemia as well as to analyse the differences if any between the first year and second year MBBS students and their correlation with various socio-demographic parameters.Methods: This was an institutional based cross sectional observational descriptive study regarding knowledge and attitude of first and second year MBBS students about thalassemia using a pre-designed, structured, self-administered questionnaire. Data was analyzed using SPSS software version 17. Values of p<0.05 were considered significant.Results: Mean knowledge scores of second year MBBS students compared to first year MBBS were 11.73±1.78 versus 10.8±1.92, the difference being statistically significant, however, the difference between mean attitude scores was not found to be significant. There was no effect of age, gender, region or Kuppuswamy’s socio-economic class on the knowledge or attitude of MBBS students towards thalassemia.Conclusions: Majority of the MBBS students had good knowledge and positive attitude towards thalassemia. To confirm the observations, large scale studies need to be conducted comprising of different study populations. Screening for thalassemia should be made mandatory, as part of medical examination, at entry to a medical college so that the medical college students are sensitized and can spread awareness among general population

Lamellar body count as a predictor of neonatal respiratory distress syndrome in preterm premature rupture of membranes

Background: Lamellar bodies are present in amniotic fluid and their quantity increases with increased gestational age. Preterm premature rupture of the membranes (P-PROM) is one of the most common complications of pregnancy and is a major cause of preterm deliveries and thus the important cause of RDS. Fetal pulmonary maturity can be assessed by direct or indirect measurement of surfactant phospholipids secreted by the fetal lungs into amniotic fluid. Lamellar body count (LBC) has been introduced as an alternative to other methods.Methods: The study’s prime aim is to establish LBC as a predictor of RDS in P-PROM. We included pregnant women with P-PROM and gestational age between 28 weeks and 37 weeks and singleton live pregnancy. The lamellar body counting from amniotic fluid was done with the use of a standard hematology cell counter, sysmex KX-21. There was statistically significant co-relation between lamellar body count and period of gestation (by applying ANOVA).Results: Lamellar body counts were significantly less in cases of RDS as compared to non RDS cases.Conclusions: LBC count was selected among all other tests because the test can be performed with equipment found in most clinical analysis laboratories and is reliable in predicting fetal lung maturity

First aid knowledge among health assigned teachers of primary schools

Background: Every parents of a child knows that it is hard enough to keep their child safe at home but when child goes off to school there is a whole new set up of challenges. Parents totally entrust their children to the schools. They rely on the teachers as their second parents in the institute for learning. They know for a fact that their educators will want no harm to come their way. While they are busy working, they fully believe that their children are well cared for. On the other hand, the teachers have the responsibility to keep an eye on their students. They should make sure that they are comfortable and secured within the four walls of their school. This then calls for their ability to handle even the most stressful situations. So much more, the school staff, especially the health teacher has to be equipped with the knowledge of first aid.Methods: Non-experimental survey study was conducted to assess the knowledge of first-aid among Health assigned teacher working in selected schools of Dehradun city. Using purposive sampling technique 40 samples of different schools of Dehradun city was adopted to select the area.Results: Result shows that the majority of health assign teachers were having average knowledge about first aid i.e. 29 (72.5%) and 10 (25%) were having good knowledge and 1 (2.5%) was having poor knowledge regarding first aid. Majority of participant were female 21 (52.5%). The educational status of most participants was post graduate (67.5%). Majority of the schools were private 25 (62.5%). There is no significant association between socio-demographic variables i.e. Gender, level of schools, year of experience as a health assigned teacher and education provided by teacher, but qualifications of teachers and type of schools was found to have a significant association.(p> 0.05).Conclusions: First aid is the assistance given to any person suffering a sudden illness or injury, with care it is provided to preserve life and to prevent the condition from worsening, and for promoting recovery. It is important that health assigned teachers are equipped with strong, professional competencies. In order for health promotion actions to be sustainable in schools, teachers must be capable, competent and skilled health educators. As they are at prime position to contribute to a nations health gain through the provision of health education for future adults. Based on findings we can say that the health assigned teachers are having average knowledge regarding first aid. Therefore, the health assigned teachers must be equipped with appropriate and upgraded knowledge

Inappropriate surgical chemoprophylaxis and surgical site infection rate at a tertiary care teaching hospital

OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation

Inappropriate surgical chemoprophylaxis and surgical site infection rate at a tertiary care teaching hospital

OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation