Novel strategy of skill lab training for parenteral injection techniques: a promising opportunity for medical students

Background: To set up an experimental pharmacology skill lab to facilitate training of specific modules for development of core competencies of parenteral drug administration and intravenous drip settings using mannequins for development of skills in administering injections for undergraduate medical students, which will be assessed using Objective Structured Practical Examination.Methods: High quality mannequins were procured from reputed companies in coordination with the biomedical engineering department of the tertiary care teaching institution. Sufficient number of multi-venous access arms, buttock injection model and models for subcutaneous and intradermal injections were obtained to facilitate individual training of 150 students in small groups during practical classes according to the checklist for the procedure. Ethical committee approval was deemed unnecessary for this study as it was a part of curriculum development.Results: Students practiced the technique confidently, without the fear doing it in a patient. This gave them the opportunity to practice in a real human surface texture, which gave them better understanding about the depth and extent of insertion of devices. Moreover, they could easily follow the steps in the check list which enabled them to practice as per protocol.Conclusions: Because of the hands-on training the students receive, we have seen a greater trend toward self-learning and better adherence to the injection technique protocol. Hence mannequin-based learning can be considered as very effective in acquiring procedural skills under the new medical curriculum in India. However, considering the high initial investment and further need of constant maintenance, cost effective mannequins need to be introduced and popularized

Cost analysis of different brands of antianginal drugs available in India

Background: Ischemic heart diseaseis the most common cardiovascular disease in developed countries such as United States and Angina pectoris is the most frequent among them. If not managed adequately angina results in significant morbidity and mortality too due to the complications. Antianginal therapy is lifelong. Therefore, analysis of the price of drugs used in ischemic heart disease will help to improve patient compliance.Methods: Prices of various antianginal drugs of different strengths and combinations marketed by different companies was obtained from current index of medical stores. The variation between highest and lowest price of the same medication manufactured by various pharma companies and percentage variation in price for ten tablets was calculated.Results: In India, percentage variation in price for antianginal drugs was found to be: tablet isosorbide dinitrate (5 mg) 250%, glyceryltrinitrate (6.4 mg) 24.44%. In calcium channel blockers group, tablet amlodipine 10 mg shows maximum price variation of 1045%, closely followed by 5 mg of amlodipine with a variation of 1040%, while 120 mg of diltiazem shows the least variation of 262%. In beta-adrenergic receptor blockers group, tablet atenolol 50 mg shows maximum price variation of 563%, whereas 100 mg of extended release metoprolol shows the least variation of 42%.Conclusions: To increase the benefit to the patient and reduce drug in compliance, doctors should be trained to be familiar from internship period itself about the brand names of cost-effective drugs with good safety profile for a long period

Changes in protein profile and RNA content of Apis mellifera worker pupa on parasitization with Tropilaelaps clareae

Tropilaelaps infestation of Apis mellifera pupa caused reduction in total protein concentration of the infested pupa. This may be due to protein feeding by mite. The additional protein fractions observed by SDS-PAGE and the difference in the nature of free amino acids suggested synthesis of newer proteins perhaps related to the stress response of the host. This opinion is strengthened by the increase in concentration of RNA ( 184.580±36.987 in non-infested pupa and 293.402±50.329 in infested pups) observed in the present study which was responsible for increased transcription of genes encoding antiparasite peptides as reported by other workers

Hypolipidemic effect of sitagliptin, voglibose and glimepiride in combination with metformin in patients with type 2 diabetes mellitus at a tertiary care teaching hospital: a comparative study

Background: The prevalence of coronary artery disease has been increased in diabetic dyslipidemia; hence the present study would like to compare the dyslipidemic effects of Sitagliptin, Voglibose, and Glimepiride in combination with Metformin in type 2 diabetes mellitus patients.Methods: This study was a Prospective, Randomized Clinical trial conducted at SRM medical College Hospital and Research centre. Potheri, Kancheepuram District in diabetic outpatient department after obtaining approval from Institutional Ethics Committee. The patients receiving antidiabetic drugs were divided into three groups. Patients received Metformin with Sitagliptin were grouped as I, Metformin with Voglibose were named as Group II and Metformin with Glimepiride were marked as Group III. Based on the inclusion and exclusion criteria, in each group, 40 patients were assigned as per simple randomization method. The level of lipid profile and BMI was evaluated at the end of 6 months.Results: There was a significant reduction of Total Cholesterol (TC) in Group II and Group III (p value- <0.001, <0.006). Group I showed significant elevation of HDL-C level with the p value of <0.03. Group III showed significant reduction of Triglyceride (TG) level with the p value of <0.04, significant reduction of Low Density Lipoprotein Cholesterol (LDL-C) level with the p value of <0.02 and significant reduction in Very Low Density Lipoprotein Cholesterol (VLDL-C) level with the p value of <0.05. There was no significant reduction in Body Mass Index (BMI) among the groups. On multiple comparisons, Group III showed higher efficacy in reducing TC, TG, LDL-C and VLDL-C levels.Conclusions: The results of this study were analysed and it could be concluded as Metformin with Glimepiride combination (Group III) showed significant reduction of TC, TG, LDL-C and VLDL-C levels

Study of adverse drug reactions in a tertiary care teaching hospital

Background: Adverse drug reactions (ADRs) are the recognized dangers of drug treatment and can arise with several groups of drugs. The purpose of this study was to identify and assess ADRs in inpatients of a tertiary care teaching hospital in Potheri.Methods: A prospective spontaneous reporting was carried out in a tertiary care teaching hospital, Potheri for a period of eight months. The causality assessment of the reported ADRs was done using the Naranjo causality assessment scale. The severity of ADRs was classified as mild, moderate or severe according to the modified Hartwig and Siegel scale.Results: A total of 62 ADRs were reported with male preponderance (51.6%). Majority of ADRs was from General Medicine and General Surgical departments in which the most affected organ systems were the skin (69.4%) and the gastrointestinal system (8.1%). The most frequent drugs causing ADRs were antibiotics (53.2%) in which type B reactions were more compared to type A. The severity assessment showed that most of them were mild reactions (51.6%). Causality assessment revealed that 61.3% of the reactions were probable, possible (30.6%), definite (8.1%) and no reactions were unlikely.Conclusions: The study accomplished that ADRs are widespread and a few of them raised the healthcare expenditure due to the increased hospital stay. The reporting of ADRs to regional pharmacovigilance centres should be encouraged to ensure drug safety

PRESCRIPTION PATTERN OF PROPHYLACTIC ANTIMICROBIAL AGENTS USED IN PREOPERATIVE PATIENTS AT A TERTIARY CARE TEACHING HOSPITAL

Objective: This study was designed to analyze the prescription pattern of prophylactic antimicrobial agents used in preoperative patients.Methods: A descriptive observational study was done at a tertiary care teaching hospital in Potheri from July to December 2013 after obtaining of Institutional Ethics Committee clearance.Results: Total 284 patients were included in this study, out of which 141(49.6%) were females and 143(50%) were males. In the department of general surgery, the very commonly used antimicrobial agents were cefotaxime (81%) followed by cefoperazone sodium (42%). In the orthopaedics department, the frequently used antimicrobial agents were cefoperazone and sulbactam (39%) followed by cefazolin (29%). Most commonly used antimicrobial agent was cefotaxime (100%) in gynaecology department.Conclusion: Antimicrobial prophylaxis is helpful in declining the frequency of post-operative infections. This study explained about the various antimicrobial agents used prior to surgeries. Practitioners must prescribe an antibiotic based on their hospital antibiotic policy

PATTERN OF ADVERSE DRUG REACTIONS IN A TERTIARY CARE TEACHING HOSPITAL: A CROSS-SECTIONAL STUDY

ABSTRACTObjective: The aim of this study was to carry out adverse drug reactions (ADRs) monitoring in various departments of a tertiary care teaching hospital.Methods: A cross-sectional study was conducted on ADRs reported in the hospital from December 2012 to May 2013 after obtaining InstitutionalEthics Committee approval.Results: A total of 40 ADRs were reported, 47.50% were males and 52.50% were females. The female adult population was 45%. The majority of ADRswere due to antimicrobial agents especially beta-lactam antibiotics (42.5%) followed by NSAIDs (7.50%). A maximum number of patients (75%)were reported with dermatological manifestations. The department of medicine reported the highest number of ADRs (37.5%). As per Naranjo'sprobability scale, 62.5% reports were assessed as probable. 62.5% reports were documented as mild according to Modified Hartwig's criteria forseverity assessment.Conclusion: This study was done to sensitize the practicing physicians on the importance of adverse drug monitoring and reporting.Keywords: Pharmacovigilance, Adverse drug reactions, Tertiary care teaching hospital, Antimicrobial agents

Adverse drug reactions in hospitalized patients in a tertiary care teaching hospital: analysis of the reported cases

Background: Adverse Drug Reactions (ADR’s) contributes to the burden of drug-related morbidity and mortality. ADRs are seen frequently in hospitals due to a variety of factors like complexity of diseases, drug interactions, polypharmacy, and possible negligence. The purpose of the study was to identify and assess ADR in various departments of a tertiary care teaching hospital.Methods: A prospective spontaneous reporting was carried out in a tertiary care teaching hospital during a period of four months from November 2016 to February 2017. All suspected spontaneous ADRs were assessed and the information was collected and analyzed by the pharmacologists for causality assessment using the Naranjo’s causality assessment scale.Results: A total of 30 ADRs were reported with female preponderance (70%). Majority of ADRs were from General Medicine and Oncology departments. The most affected organ systems were skin (80%) followed by the gastrointestinal system (13.3%). The most frequent drugs causing ADRs were antibiotics (56.3%) in which type B reactions were more compared to type A and followed by anticancer drugs (10%). The severity assessment showed that most of them were mild reactions (76.6%). Causality assessment revealed that 90% of the reactions were probable, 10% were possible and no reactions were unlikely.Conclusions: The study accomplished that ADRs are widespread and a few of them raised the healthcare expenditure due to increased hospital stay. The reporting of the ADRs to regional Pharmacovigilance centers should be encouraged to ensure drug safety

Analysis of adverse drug reactions encountered in a tertiary care hospital: a cross sectional study

Background: Adverse drug reactions are due to hazards of drug therapy and can occur with any class of drugs. The aim of this study was to evaluate and record adverse drug reactions reported from various departments of a tertiary care hospital.Methods: A Cross Sectional study conducted in a tertiary care hospital for a period of 4 months from March to June 2017 after Institutional Ethics Committee approval. ADRs reports collected and analyzed for causality, severity and preventability by international standardized scales.Results: A total of 38 ADR’s were reported during the study period with male predominance (58%). Most of the ADR’s (42%) were common in patients in the age group 19-39 years. More number of ADR’s were from Medicine (29%). Most commonly affected organ systems were skin (45%). The drugs mostly accounted were antibiotics (55%) especially Cephalosporins (33%). According to Naranjo’s causality assessment scale 74% of reactions were probable, 26% were possible, Modified Hartwig and Seigel severity assessment scale revealed 45% ADRs to be moderate, 42% were mild and 13% were severe, Modified Schumock and Thorton Preventability assessment scale which revealed 61% ADRs were not preventable, 32% were probably preventable,7% were definitively preventable.Conclusions: Adverse Drug Reactions are common and some of them resulted in increased healthcare cost due to need of some interventions and increased length of hospital stay. The health system should promote the spontaneous reporting of ADR’s. The proper documentation and periodic reporting to Pharmacovigilance Centres is required to ensure drug safety