A questionnaire based survey on knowledge, attitude and practices of medical practitioners regarding the prescribing of medications during pregnancy

Background: Prescribing during pregnancy requires careful estimation of risk/benefit ratio for the mother and her baby. Both, underestimation and overestimation can produce undesirable maternal and fetal outcomes hence the present study was undertaken to assess the knowledge, attitude and practices (KAP) of medical practitioners related to the prescribing of medications during pregnancy.Methods: A preformed structured questionnaire was administered to 41 medical practitioners. Multiple choice questions (MCQs) and yes/no type questions were used to assess their knowledge. Likert type questions studied their attitude and practices. Their perception of teratogenic risk of medications was evaluated using a visual analogue scale. The data so obtained was analyzed using descriptive statistics.Results: Completed questionnaires were returned by 76% of the survey participants. Among whom only 24% felt highly confident while others were less confident or unsure regarding their prescribing ability during pregnancy. 90% of the respondents reported that a disease should not be untreated or undertreated due to fear of teratogenicity. 81% exhibited good knowledge of the FDA pregnancy categorization of drugs and more than 80% were aware of the teratogenic risk associated with valproic acid, lithium, isotretinoin, warfarin & thalidomide. The perceived risk of teratogenicity (mean) suggested for them was 33, 52, 52, 43 & 62 percentage respectively.Conclusions: Most respondents exhibited a healthy attitude and a fairly sound knowledge, except for their perception of risk associated with individual drugs which was much higher than what is mentioned in the literature. Educational interventions may help to increase the awareness leading to better and confident prescribing

Evaluation of anti-parkinsonian activity of Elaeocarpus ganitrus on haloperidol induced Parkinson’s disease in mice

Background: Elaeocarpus ganitrus (Family: Elaeocarpaceae), has been used for the treatment of depression, convulsions and asthma. The existing literature is lacking in studies showing anti-parkinson effect of E. ganitrus. There is increased concern about the side-effects of conventional medicine in the treatment of Parkinson’s disease (PD). Hence E. ganitrus having anti-oxidative property may be a safer alternative.Methods: To evaluate the anti-parkinson effect of E. ganitrus, rota rod and catalepsy bar tests were used. Assessment of oxidative stress was done by measuring the malondialdehyde (MDA) and reduced glutathione (GSH) levels in the striatal region of the brain. One-way ANOVA was used to detect statistical significance, followed by post-hoc Tukey test.Results: E. ganitrus (200 and 400 mg/kg, p.o.) pretreated groups significantly increased the retention time in rota rod test (p<0.001) and significantly decreased the latency period in catalepsy bar test (p<0.001), when compared with haloperidol treated group alone. E. ganitrus (200 and 400 mg/kg, p.o.) pretreated groups showed significant anti-oxidative effect by causing a decrease in brain MDA levels (p<0.001) and a significant increase in GSH levels (p<0.001).Conclusions: Oxidative stress plays a vital role in the pathophysiology of PD. The results of this study conclusively show that E. ganitrus has anti-oxidant activity and neuroprotective activity in haloperidol experimental model of PD

Optimum spacing between grooved tubes: an experimental study

An experimental study on the optimum spacing between grooved tubes is reported in this paper. Two grooved tubes having a pitch of 10 mm and 15 mm and a plain tube were considered for the heat transfer analysis. The spacing between two tubes with the same pitch was varied from 10 mm to 35 mm with a step size of 5 mm. The velocity of air flowing over the tube surfaces was changed from 0.4 m/s to 1 m/s using a blower fan. Based on Nusselt number (Nu) the optimum spacing between the tubes was decided. The optimum spacing between grooved tubes of pitch 10 mm and 15 mm was compared with that of plain tubes. From the experimental analysis, it was noticed that with an increase in air velocity (increase in Reynolds number) the tube surface temperature reduced irrespective of any tube considered. Nu increased with an increase in air velocity for all the tubes. The important conclusion drawn from the present study was that there exists a limiting spacing (optimum) between the tubes above which no change in Nu was observed. The spacing of 30 mm was found to be the optimum spacing between the tubes irrespective of its surface geometry modifications

Pattern of drug use in psoriasis inpatients in the department of dermatology at a tertiary care teaching hospital

Background: The pattern of drug use in people hospitalized with a primary diagnosis of psoriasis has never been studied previously in India. The aim of the study was to characterize the prescription pattern of people admitted to hospital with psoriasis so that rational prescribing could be promoted among dermatologists.Methods: Case files belonging to 32 patients, admitted in the Department of Dermatology with psoriasis, of a tertiary care teaching hospital in Kerala, over a period of 1-year were retrieved with the assistance of the medical records department. The data thus obtained was analyzed using descriptive statistics.Results: The average age of patients who were admitted with psoriasis was 49.9 years, and their average duration of hospital stay was 7.96 days. A total of 296 formulations were prescribed to 32 patients. Out of 296 formulations, only 10 (3.37%) were generic and rest 286 (96.62%) branded. Fixed dose combinations consisted of 32.43% (96/296) of the prescribed formulations. Psoriasis vulgaris (56.25%) was the most common cause for admission. Of all the prescribed medications, 4 (1.35%) did not contain clear instructions for the route of administration. Strength was clearly mentioned in only 89 (30%) of the preparations. In 98% of the prescriptions, the exact dose was missing.Conclusions: The study reveals various deficiencies which exist in the prescribing pattern of drugs for management of psoriasis. Educational interventions among the doctors as well as students should be carried out to promote rational drug use.

Study on clinical features and factors associated with thickness of chronic subdural hematoma in adult

Patients with chronic subdural hematoma encounter certain difficulties in diagnosis, especially in elderly, due to the characteristically non-specific symptoms and signs. Early diagnosis and proper operative treatment, on the other hand, results in complete recovery in most of the cases. In this study, the clinical features and factors of 31 patients with chronic subdural hematoma, associated with the thickness of chronic subdural hematoma were analyzed. The mean age was 62 ± 13.9 years. The maximum hematoma thickness in the axial CT scan was 25 mm. The thickness of hematoma obtained from axial plain CT had a positive relationship with the patient’s age where r=0.895 and p&lt;0.001 signifies that the thickness of hematoma increased with the increasing age. But the hematoma thickness was not related to co-morbidity such as diabetes mellitus, hypertension and ischemic heart disease. The presentation of the patient with higher hematoma thickness with hemiparesis was statistically significant and with lower thickness with headache and vomiting

Boundary layer flow of nanofluid over an exponentially stretching surface

The steady boundary layer flow of nanofluid over an exponential stretching surface is investigated analytically. The transport equations include the effects of Brownian motion parameter and thermophoresis parameter. The highly nonlinear coupled partial differential equations are simplified with the help of suitable similarity transformations. The reduced equations are then solved analytically with the help of homotopy analysis method (HAM). The convergence of HAM solutions are obtained by plotting h-curve. The expressions for velocity, temperature and nanoparticle volume fraction are computed for some values of the parameters namely, suction injection parameter α, Lewis number Le, the Brownian motion parameter Nb and thermophoresis parameter Nt

Bleeding disorders in the tribe: result of consanguineous in breeding

<p>Abstract</p> <p>Objective</p> <p>To determine the frequency and clinical features of bleeding disorders in the tribe as a result of consanguineous marriages.</p> <p>Design</p> <p>Cross Sectional Study</p> <p>Introduction</p> <p>Countries in which consanguinity is a normal practice, these rare autosomal recessive disorders run in close families and tribes. Here we describe a family, living in village Ali Murad Chandio, District Badin, labeled as haemophilia.</p> <p>Patients & Methods</p> <p>Our team visited the village & developed the pedigree of the whole extended family, up to seven generations. Performa was filled by incorporating patients, family history of bleeding, signs & symptoms, and bleeding from any site. From them 144 individuals were screened with CBC, bleeding time, platelet aggregation studies & RiCoF. While for PT, APTT, VWF assay and Factor VIII assay, samples were kept frozen at -70 degrees C until tested.</p> <p>Results</p> <p>The family tree of the seven generations comprises of 533 individuals, 63 subjects died over a period of 20 years and 470 were alive. Out of all those 144 subjects were selected on the basis of the bleeding history. Among them 98(68.1%) were diagnosed to have a bleeding disorder; 44.9% patients were male and 55.1% patients were female. Median age of all the patients was 20.81, range (4 months- 80 yrs). The results of bleeding have shown that majority had gum bleeding, epistaxis and menorrhagia. Most common bleeding disorder was Von Willebrand disease and Platelet functional disorders.</p> <p>Conclusion</p> <p>Consanguineous marriages keep all the beneficial and adversely affecting recessive genes within the family; in homozygous states. These genes express themselves and result in life threatening diseases. Awareness, education & genetic counseling will be needed to prevent the spread of such common occurrence of these bleeding disorders in the community.</p

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold &gt;75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold &lt;0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold &lt;1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill &amp; Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Pancreatic enzyme replacement therapy in patients with pancreatic cancer: A national prospective study

Objective: UK national guidelines recommend pancreatic enzyme replacement therapy (PERT) in pancreatic cancer. Over 80% of pancreatic cancers are unresectable and managed in non-surgical units. The aim was to assess variation in PERT prescribing, determine factors associated with its use and identify potential actions to improve prescription rates. Design: RICOCHET was a national prospective audit of malignant pancreatic, peri-ampullary lesions or malignant biliary obstruction between April and August 2018. This analysis focuses on pancreatic cancer patients and is reported to STROBE guidelines. Multivariable regression analysis was undertaken to assess factors associated with PERT prescribing. Results: Rates of PERT prescribing varied among the 1350 patients included. 74.4% of patients with potentially resectable disease were prescribed PERT compared to 45.3% with unresectable disease. PERT prescription varied across surgical hospitals but high prescribing rates did not disseminate out to the respective referring network. PERT prescription appeared to be related to the treatment aim for the patient and the amount of clinician contact a patient has. PERT prescription in potentially resectable patients was positively associated with dietitian referral (p = 0.001) and management at hepaticopancreaticobiliary (p = 0.049) or pancreatic unit (p = 0.009). Prescription in unresectable patients also had a negative association with Charlson comorbidity score 5–7 (p = 0.045) or >7 (p = 0.010) and a positive association with clinical nurse specialist review (p = 0.028). Conclusion: Despite national guidance, wide variation and under-treatment with PERT exists. Given that most patients with pancreatic cancer have unresectable disease and are treated in non-surgical hospitals, where prescribing is lowest, strategies to disseminate best practice and overcome barriers to prescribing are urgently required