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Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.
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Background: Cervical cancer ranks fourth in global cancer incidence and mortality among women. A comparison of the global trends in cervical cancer would help us to identify high focus regions and serves an opportunity to evaluate the impact of the screening programs. Hence, the current study was done to assess the global trend in the incidence of cervical cancer from 1993 to 2012 among individuals aged between 30 and 79 years. Methods: This secondary data analysis was conducted using the World Health Organization (WHO) Cancer Incidence data of five continents plus database (America, Asia, Europe, and Oceania) on the incidence of cervical cancer. Joinpoint regression was performed to determine the average annual percent change (AAPC) in cervical cancer incidence. We performed an age-period-cohort analysis to obtain age, period, and cohort-specific deviations and rate ratio (RR). Results: Out of the four regions studied, all the regions showed a declining trend in cervical cancer incidence. The maximum decline was found in Oceania (AAPC = ?3.3%) followed by America (AAPC = ?2.0%). There was a consistent rise in cervical cancer incidence across the age groups in all the four continents with the maximum burden among the elderly. All the regions showed a steady decline in the rate of cervical cancer through the periods 1998–2002 to 2007–2012. There was also a steady decline in cervical cancer incidence across the cohorts from 1923–1927 to 1978–1982 in all the regions except America. Conclusion: To summarize, cervical cancer incidence showed a declining trend globally, with the maximum decline in the Oceania region from 1993 to 2012.
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Background@#Shone’s syndrome is a rare complex congenital cardiac condition, characterized by a supra-valvular mitral ring, parachute deformity of the mitral valve, aortic stenosis, and coarctation of the aorta.Case: A 26-year-old parturient with partial Shone’s syndrome presented to our delivery unit in pulmonary edema. She underwent a scheduled cesarean section performed under a combined spinal-epidural anesthetic at 33 weeks. She had multidisciplinary input from the cardiac, obstetric, and anesthetic teams, which led to a good outcome. A review of the five published case reports of Shone’s syndrome in pregnancy is presented along with key findings. @*Conclusions@#Our case report and the review highlight the successful use of combined spinal-epidural anesthetic and provides guidance to the multidisciplinary team on the varied presentation and the optimum management of women with Shone’s syndrome during the peripartum period.
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Background@#Shone’s syndrome is a rare complex congenital cardiac condition, characterized by a supra-valvular mitral ring, parachute deformity of the mitral valve, aortic stenosis, and coarctation of the aorta.Case: A 26-year-old parturient with partial Shone’s syndrome presented to our delivery unit in pulmonary edema. She underwent a scheduled cesarean section performed under a combined spinal-epidural anesthetic at 33 weeks. She had multidisciplinary input from the cardiac, obstetric, and anesthetic teams, which led to a good outcome. A review of the five published case reports of Shone’s syndrome in pregnancy is presented along with key findings. @*Conclusions@#Our case report and the review highlight the successful use of combined spinal-epidural anesthetic and provides guidance to the multidisciplinary team on the varied presentation and the optimum management of women with Shone’s syndrome during the peripartum period.
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Sheep and goats, being hardy and prolific in their growth, play a crucial role in cultural and socioeconomic life of rural poor under privileged people in Afro-Asian countries by providing meat, milk, wool and hide to them. Gastrointestinal helminthic infections are worldwide problem in ruminants. They results considerable loss in them causing mortality and poor production. Various helminthes types like trematodes, cestodes and nematodes are prevalent in different climates and geographical regions depending on rearing systems, intermediate host’s availability and management practices. Epidemiology of helminthic diseases, though variable at times, is determined by various factors like treatment, climate and poverty (socio-economic and traditional practices). The study oversees gastrointestinal helminthic challenges in goats and sheep faced in Afro-Asian region in last decade. Methodology involves exhaustive exercise of screening and massive literature hunt which included published research, both abstracts and full length papers on the subject in last 10 years in addition to authors own observations. The diseases like Fasciolosis, Dicrocoelosis, Amphistomosis in trematodes, Monieziosis, Avitellinosis in cestodes and Haemonchosis, Trichostronglylosis, Oesophagostomosis, Trichuriosis, Strongyloidosis in nematodes were still serious challenges in the region threatening the small ruminant production. Frequent reports on Marshallgia, Ostertagia, Nematodirus, Stilesia, Thysaniezia spp. from this region showed emerging threats. Infections like Camelostrongylus, Graphidiops, Parabronema and Skrjabinema spp. were scarcely distributed. The paper reviews scientific work and developments of last 10 years on occurrence, distribution and epidemiology of common gastrointestinal helminthic infections of sheep and goats in Afro-Asian region with future research prospective in light of newer scientific approaches
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Background: Hyperglycaemia and hyperlipidaemia seen in diabetes mellitus result in oxidative stress and pose significant risk of cognitive decline that may lead to Alzheimer’s disease. Approved anti-diabetic drugs have so far failed to demonstrate anti-oxidant and anti-hyperlipidemic activity, apart from saroglitazar. Therefore, this study was done to find a suitable anti-diabetic drug that possesses anti-hyperglycaemic, anti-oxidant and anti-hyperlipidemic activities and can reverse cognitive decline.Methods: Emblica officinalis (250 mg/kg, p.o. and 500 mg/kg, p.o.) and Murraya koenigii (250 mg/kg, p.o. and 500 mg/kg, p.o.) were chosen to study these activities in Wistar rats. Diabetes was induced by single intraperitoneal injection of streptozotocin [STZ] (50 mg/kg). Fasting blood glucose levels and lipid profile were measured on day 1 and day 30 of the experiment. Cognitive function was assessed by measuring transfer latency (TL) on elevated plus maze, step-down latency (SDL) on passive avoidance apparatus and retention latency (RL) and quadrant time (QT) in Morris water maze. Oxidative stress was assessed at end of study by measuring brain MDA and GSH levels. Cholinergic marker of cognition, AChE was measured in brain at end of study.Results: Both E. officinalis and M. koenigii showed dose dependent anti-hyperglycemic, anti-hyperlipidemic and anti-oxidant effects in diabetic rats with 500 mg/kg dose showing significantly higher effect. Both 250 mg/kg and 500 mg/kg dose of E. officinalis and M. koenigii partially reversed cognitive decline in diabetic rats by day 30.Conclusions: 500 mg/kg p.o. dose of E. officinalis or M. koenigii has potential to reverse cognitive decline in diabetic patients.
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Background: Painful diabetic neuropathy is a common complication of long standing diabetes mellitus. Amitriptyline is commonly used to treat painful diabetic neuropathy. Pregabalin has been shown to be effective in the treatment of painful diabetic neuropathy with lesser adverse effects. Sustained release (SR) of pregabalin has the advantage of once daily dosing and a better patient compliance. Hence, this study was planned to compare the efficacy and safety of pregabalin-SR with amitriptyline in painful diabetic neuropathy.Methods: It is a prospective, open labelled, randomized controlled study. A total of 80 patients diagnosed with painful diabetic neuropathy based on Diabetic neuropathy symptom score and Michigan neuropathy screening instrument, were randomized into two groups to receive amitriptyline and pregabalin SR. Amitriptyline was started at 25mg OD and pregabalin SR 75mg OD for 6 weeks with optional dose titration. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up.Results: All patients had significant improvement in pain relief in both the treatment groups. The median VAS (visual analogue scale) score was slightly higher in pregabalin SR group (25 vs 22) however it was not statistically significant. Intergroup comparison did not show any significant differences between the treatment groups. Good and moderate pain relief were noted in 37(92.5%) and 3(7.5%) patients on amitriptyline and 36 (90%) and 4 (10%) patients on pregabalin SR respectively. The common adverse effects reported in amitriptyline group were drowsiness (27.5%) and dry mouth (17.5%) and in pregabalin-SR group were drowsiness (15%) and dizziness (5%). No serious adverse event was reported in either of the groups.Conclusions: In patients with painful diabetic neuropathy both amitriptyline and pregabalin-SR are equally effective in alleviating pain and improving the patient’s general condition, but pregabalin-SR has the advantage of fewer adverse effects and convenient dosage timing.
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Background: Adverse drug reactions (ADRs) have become frequent cause for hospitalization and are coming up as an economic burden on health systems. Identification of ADRs and their reporting pattern can provide useful information for their management. Hence, this study was planned to evaluate causality and pattern of ADRs in a tertiary care hospital.Methods: The present study was undertaken in a tertiary care teaching hospital. A total of 200 ADRs reports collected in the ADR monitoring centre were analysed. The WHO definition of an ADR was adopted as well as WHO scale for causality assessment was used. Evaluation of the data was done for various parameters which included drug groups causing ADRs, body systems affected in ADRs, reporters and seriousness of reactions.Results: Overall occurrence of ADRs was slightly more in males (58%). Skin (72%) was the most commonly affected organ system. Antimicrobials (47%) were the drug group most commonly involved in ADRs. The causative drug was withdrawn for the management of the ADR in the majority (86%) of the patients. Upon causality assessment, majority of the ADRs were rated as probable (83.5%). Almost all of the reports were contributed by clinicians (99%).Conclusions: The causality assessment and pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital set up elsewhere, although there are few differences. The study results revealed opportunities for interventions in ADR management especially for the preventable ADRs to ensure safer drug use.
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The present study was conducted to evaluate the spontaneous ADR monitoring in a tertiary care hospital. A total of 150 ADRs reports were collected. The WHO definition of an ADR was adopted. Evaluation of the data was done for various parameters which included types, severity and seriousness of reactions. Naranjo score was used for causality assessment. Overall occurrence of ADRs was more in males. Type A reactions (77%) accounted for majority of the reports. Gastrointestinal system (33%) was the most commonly affected organ system. Antibiotics (32%) were the drug class most commonly involved in ADRs. The suspected drug was withdrawn for the management of the ADR in the majority (82%) of the reports. Upon causality assessment, majority of the ADRs were rated as possible (64%). Mild and moderate reactions accounted for 23 and 65% of ADRs, respectively. The pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital set up elsewhere, although there are few differences. Our evaluations revealed opportunities for interventions especially for the preventable ADRs to ensure safer drug use.
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A number of medical schools throughout the world have tried to downsize the basic sciences, but studies have shown that teaching of basic sciences is of importance for the clinical years that lie ahead. While some students endorse this finding, others want instruction in these sciences to be limited in terms of content and time. With the increasing cost of medical education and healthcare, medical schools the world over are trying to contain expenditure on the teaching of the basic sciences. In India, too, instruction in these sciences has been curtailed. This trend may need to be reviewed and the new challenges in this area must be addressed. Natl Med J India 2015;28:137–40