Hydroxychloroquine for Primary Progressive Multiple Sclerosis.

OBJECTIVE: Primary progressive multiple sclerosis (PPMS) does not respond well to immunomodulatory or immunosuppressive treatment. Chronic activation of microglia has been implicated in the pathophysiology of PPMS. The antimalarial drug hydroxychloroquine (HCQ) reduces the activity of human microglia and has neuroprotective effects in vitro. METHODS: We conducted a single-arm, phase II futility trial of 200 mg oral HCQ twice daily for 18 months. In an effort to investigate disability worsening in the absence of overt focal inflammation, we excluded participants with contrast enhancing lesions on a screening magnetic resonance imaging (MRI). The primary end point was ≥20% worsening on the timed 25-foot walk measured between 6 and 18 months of follow-up. RESULTS: Based on original trial data, 40% of the cohort were expected to worsen. We used a Simon 2-stage design to compare a null hypothesis of 40% of the cohort worsening against the one-sided alternative of 20%. Using a 5% type 1 error rate and 80% power, HCQ treatment would be deemed successful if fewer than 10 of 35 participants experienced clinically significant worsening. The study met its primary end point, as only 8 of 35 participants worsened between 6 and 18 months. HCQ was overall well-tolerated, with adverse events in 82% and serious adverse events in 12% of participants. All serious adverse events were unlikely related to HCQ use. INTERPRETATION: HCQ treatment was associated with reduced disability worsening in people with PPMS. HCQ is a promising treatment candidate in PPMS and should be investigated further in randomized controlled clinical trials. ANN NEUROL 2021;90:940-948.

The association of co-morbid asthma and overweight/obese status with healthcare utilization and caregiver perception of health in children 4-17 years, a NHANES study.

OBJECTIVE: Asthma and obesity are two of the most common chronic childhood illnesses. The purpose of this study was to better understand the relationship between co-morbid asthma and obesity in children aged 4-17 and whether it impacts the caregiver's perception of health and/or healthcare utilization. METHODS: This was a secondary analysis of the National Health and Nutrition Examination Surveys (NHANES) datasets from 2007 to 2018. Cumulative logistic regression models were used to analyze the caregiver's perception of health, received healthcare, and overnight hospital stay as dependent variables. Asthma and weight status were included as covariates, with adjustment for age, income, head of the household's education, gender, race, and insurance. RESULTS: The sample included 15,386 children. When looking at weight status in addition to asthma, compared to caregivers of children with current asthma and normal weight, caregivers of children with current asthma and with obesity are more likely to perceive their children as having worse health (OR = 1.73, 95%CI = [1.30, 2.32], p = 0.0003), and are more likely to have more frequent healthcare utilization but the results did not reach a statistical significance. CONCLUSIONS: Caregiver's perception of overall health was worse in caregivers of those with co-morbid obesity/asthma than in caregivers of children with asthma alone. This indicates that caregivers of children with co-morbid asthma and obesity have insight into their children's condition and may be primed for discussion and counseling in the healthcare setting.

Bluff Indicators in Medical and Dental Tele-Consultation: A Review.

The global lockdowns have resulted in the popularisation of tele-consultation. Also the anxiety about dental visits and hospital-acquired infections in patients and incidences of dishonesty are increased. Tele-consultation includes patient data collected on phone calls, text messages, and video calls. Bluffing or providing false information is one of the dark realities of clinical practice. Dishonesty might affect the treatment success and spread of contamination. During normal and epidemic eras, skills for honesty and bluff identification are required during tele-consultation to protect patients and doctors from hospital-acquired infection in further one-to-one treatment meetings.

Epidemic dynamics in census-calibrated modular contact network.

Network-based models are apt for understanding epidemic dynamics due to their inherent ability to model the heterogeneity of interactions in the contemporary world of intense human connectivity. We propose a framework to create a wire-frame that mimics the social contact network of the population in a geography by lacing it with demographic information. The framework results in a modular network with small-world topology that accommodates density variations and emulates human interactions in family, social, and work spaces. When loaded with suitable economic, social, and urban data shaping patterns of human connectance, the network emerges as a potent decision-making instrument for urban planners, demographers, and social scientists. We employ synthetic networks to experiment in a controlled environment and study the impact of zoning, density variations, and population mobility on the epidemic variables using a variant of the SEIR model. Our results reveal that these demographic factors have a characteristic influence on social contact patterns, manifesting as distinct epidemic dynamics. Subsequently, we present a real-world COVID-19 case study for three Indian states by creating corresponding surrogate social contact networks using available census data. The case study validates that the demography-laced modular contact network reduces errors in the estimates of epidemic variables.

The impact of sensitizing 1st year undergraduate medical students to research methodology.

BACKGROUND: Research is a core essential component of evidence-based medicine. The current study was undertaken to sensitize the undergraduate medical students the concept of biomedical research to sharpen their clinical skills. MATERIALS AND METHODS: This educational interventional study was done with a systemic random sample of 120 medical students in a tertiary care hospital. A workshop on biomedical research was conducted by the institutional ethics and medical education committee members followed by group activity regarding how to write the protocol of a research study. The protocols were then assessed using prestructured checklist by facilitators and feedback from the students and facilitators were assessed using student t-score. RESULTS: The pretest (5.86 ± 1.75) scores and posttest scores (11.82 ± 2.47) of multiple choice questions and open-ended questions showed statistically significant difference. The feedback of students showed that 49.48% of students strongly agreed that contents discussed in the workshop were adequate, 61.85% agreed about better understanding of the topics of the workshop, 60.80% agreed that their queries and doubts are cleared, 53.6% agreed that the workshop motivates them to do research, and 44.3% agreed that they will attend the similar workshops in future. The protocols submitted by groups of students using the checklist showed 26%-80% scores. CONCLUSION: The student's knowledge on research methodology was significantly improved and teaching basic research methods to medical students at an early stage motivates the student to do research.

Disaggregating Asian Race Reveals COVID-19 Disparities Among Asian American Patients at New York City's Public Hospital System.

OBJECTIVES: Data on the health burden of COVID-19 among Asian American people of various ethnic subgroups remain limited. We examined COVID-19 outcomes of people of various Asian ethnic subgroups and other racial and ethnic groups in an urban safety net hospital system. METHODS: We conducted a retrospective analysis of 85 328 adults aged ≥18 tested for COVID-19 at New York City's public hospital system from March 1 through May 31, 2020. We examined COVID-19 positivity, hospitalization, and mortality, as well as demographic characteristics and comorbidities known to worsen COVID-19 outcomes. We conducted adjusted multivariable regression analyses examining racial and ethnic disparities in mortality. RESULTS: Of 9971 Asian patients (11.7% of patients overall), 48.2% were South Asian, 22.2% were Chinese, and 29.6% were in other Asian ethnic groups. South Asian patients had the highest rates of COVID-19 positivity (30.8%) and hospitalization (51.6%) among Asian patients, second overall only to Hispanic (32.1% and 45.8%, respectively) and non-Hispanic Black (27.5% and 57.5%, respectively) patients. Chinese patients had a mortality rate of 35.7%, highest of all racial and ethnic groups. After adjusting for demographic characteristics and comorbidities, only Chinese patients had significantly higher odds of mortality than non-Hispanic White patients (odds ratio = 1.44; 95% CI, 1.04-2.01). CONCLUSIONS: Asian American people, particularly those of South Asian and Chinese descent, bear a substantial and disproportionate health burden of COVID-19. These findings underscore the need for improved data collection and reporting and public health efforts to mitigate disparities in COVID-19 morbidity and mortality among these groups.

Obesity, Inflammation, and Mortality in COVID-19: An Observational Study from the Public Health Care System of New York City.

Severe obesity increases the risk for negative outcomes in patients with coronavirus disease 2019 (COVID-19). Our objectives were to investigate the effect of BMI on in-hospital outcomes in our New York City Health and Hospitals' ethnically diverse population, further explore this effect by age, sex, race/ethnicity, and timing of admission, and, given the relationship between COVID-19 and hyperinflammation, assess the concentrations of markers of systemic inflammation in different BMI groups. A retrospective study was conducted in hospitalized patients with COVID-19 in the public health care system of New York City from 1 March 2020 to 31 October 2020. A total of 8833 patients were included in this analysis (women: 3593, median age: 62 years). The median body mass index (BMI) was 27.9 kg/m2. Both overweight and obesity were independently associated with in-hospital death. The association of overweight and obesity with death appeared to be stronger in men, younger patients, and individuals of Hispanic ethnicity. We did not observe higher concentrations of inflammatory markers in patients with obesity as compared to those without obesity. In conclusion, overweight and obesity were independently associated with in-hospital death. Obesity was not associated with higher concentrations of inflammatory markers.

The Effect of Speed and Rotation for Protaper File Systems on Postobturation Pain in a Single Visit and Multiple (Two) Visits in Root Canal Therapy: An In Vivo Study.

INTRODUCTION: The basic idea of a root canal treatment is to alleviate the pain and heal the infection within the infected tooth, which can be resolved in a single visit or multiple visits in root canal therapy. Therefore, in this article, an in vivo comparison of single visits and multiple visits using different rotation and speed for two Protaper universal design file systems is done on the basis of time taken and incidence of pain. MATERIALS AND METHODS: One hundred single-rooted premolars with irreversible symptomatic pulpitis were assigned to two groups of 50 patients each using the odd-even method, GA to be treated endodontically in a single visit and GB to be treated endodontically in multiple visits. Each group was further divided into two subgroups of 25 patients each on the basis of two different variations of speed and rotation for two Protaper file systems of the same design, GA1 (Hand Protapers) and GA2 (Rotary Protapers), GB1 (Hand Protapers) and GB2 (Rotary Protapers), respectively. After proper biomechanical shaping and cleaning, obturation was done with Gutta-percha cones and Ah plus sealer using Fast Pack obturation pen for warm vertical compaction. The pain was measured by a 100 mm modified visual analogue scale, and time was measured using a stopwatch. RESULTS: At 6-h intervals, post-obturation pain was more in single-visit root canal therapy than multiple-visit root canal therapy (P < 0.01). Single-visit rotary Protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1) (P < 0.05). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2) (P > 0.05). Preoperative pain significantly influences the post-obturation pain. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 statistical Analysis Software. CONCLUSIONS: The presence of preoperative pain can significantly influence the presence of postoperative pain. Most of the pain in both single-visit and multiple-visits root canal therapy occurred in the first 48 h after obturation, which decreases thereafter. Single-visit rotary protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2). Presence of sealer puff influences the duration of pain.

Repurposing Domperidone in Secondary Progressive Multiple Sclerosis: A Simon 2-Stage Phase 2 Futility Trial.

OBJECTIVE: To assess whether treatment with the generic drug domperidone can reduce the progression of disability in secondary progressive multiple sclerosis (SPMS), we conducted a phase 2 futility trial following the Simon 2-stage design. METHODS: We enrolled patients in an open-label, Simon 2-stage, single-center, phase 2, single-arm futility trial at the Calgary Multiple Sclerosis Clinic if they met the following criteria: age of 18 to 60 years, SPMS, screening Expanded Disability Status Scale score of 4.0 to 6.5, and screening timed 25-ft walk (T25FW) of ≥9 seconds. Patients received domperidone 10 mg 4 times daily for 1 year. The primary outcome was worsening of disability, defined as worsening of the T25FW performance by ≥20% at 12 months compared to baseline. This trial is registered with ClinicalTrials.gov (NCT02308137). RESULTS: Between February 13, 2015, and January 3, 2020, 110 patients were screened, 81 received treatment, and 64 completed follow-up, of whom 62 were analyzed. The study did not meet its primary endpoint: 22 of 62 (35%) patients experienced significant worsening of disability, which is close to the expected proportion of 40% and above the predefined futility threshold. Patients with higher prolactin levels during the study had a significantly lower risk of disability progression, which may warrant further investigation. Domperidone treatment was reasonably well tolerated, but adverse events occurred in 84% and serious adverse events in 15% of patients. CONCLUSIONS: Domperidone treatment could not reject futility in reducing disability progression in SPMS. The Simon 2-stage trial model may be a useful model for phase 2 studies in progressive MS. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT02308137. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in individuals with SPMS participating in a futility trial, domperidone treatment could not reject futility in reducing disability progression at 12 months.

Effective Control against Broadleaf Weed Species Provided by Biodegradable PBAT/PLA Mulch Film Embedded with the Herbicide 2-Methyl-4-Chlorophenoxyacetic Acid (MCPA).

Biodegradable mulches are considered a promising alternative to polyethylene-based, nonbiodegradable mulch for sustainable agriculture. In the present study, a bioactive 2-methyl-4- cholorophenoxyacetic acid/poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (MCPA-PHBV) conjugate blended with biodegradable poly(butylene adipate-co-terephthalate/polylactide (PBAT/PLA) was developed and used as mulch under controlled condition greenhouse pot experiment with fava bean (Vicia faba) as the nontarget crop species. The objectives were to examine the effectiveness of sustained-release of MCPA herbicide from biodegradable mulch for broadleaf weed suppression and to assess any adverse effects of the herbicide on the nontarget species (fava bean). The energy-dispersive X-ray spectroscopy analysis (EDS) suggests that a substantial quantity of the herbicide was released from the biodegradable mulch which effectively killed the broadleaf weed species even at 1% MCPA concentration. However, the higher concentrations of the herbicide adversely affected several physiological parameters of fava bean growth and development. Stomatal conductance decreased, while leaf temperature subsequently rose (at MCPA concentrations 5, 7.5, and 10%). The quantum yield of the Photosystem II (PSII) indicates that the photosynthetic efficiency was also restricted at concentrations 7.5% and 10%. Evidently, this slow-release herbicide system worked efficiently for broadleaf weed control but at higher concentrations, resulted in adverse physiological effects on the nontarget crop species. This study has demonstrated that biodegradable mulches containing MCPA herbicide are able to effectively inhibit the growth of broad leaf weed species and may be of potential importance in a wide variety of horticultural and agricultural applications.

Trends in Maternal Mortality Ratio in a Tertiary Referral Hospital and the Effects of Various Maternity Schemes on It.

OBJECTIVE: To analyze the trend in maternal mortality ratio in a tertiary care centre and the effect of various maternity schemes on it. MATERIALS AND METHODS: Retrospective analysis of all maternal deaths occurring in the Guru Gobind Singh Medical College & Hospital, Faridkot, Punjab, India was done from Jan 2010 to Dec 2012. Every maternal death was scrutinized from various aspects like direct cause of death, age, locality, antenatal care and gestational age. RESULTS: The total number of deliveries has risen from 957 in 2010 to 1063 in 2012 at the same time the maternal mortality ratio has increased from 835.94 in 2010 to 2054.55 per one live birth in 2012. Haemorrhage (24.12%) and sepsis (18.9%) were the most common causes of death followed closely by pregnancy induced hypertension including eclampsia (15.5%). Anemia (12.06%) contributed to the most common indirect cause of death. CONCLUSION: Implementation of the various maternity schemes has had no significant impact on the profile of dying mothers. There is a need to stress the importance of good antenatal care in reducing Maternal Mortality Ratio.

Prolapse of fallopian tube through abdominal wound after caesarean section mimicking scar endometriosis: a case report.

INTRODUCTION: Prolapse of the fallopian tube after hysterectomy is a rare but known complication. Cases of prolapse of the fallopian tube through the vaginal vault have been reported after abdominal, vaginal or laparoscopic hysterectomies. This is the first case report to the best of our knowledge on the prolapse of a fallopian tube through an abdominal wound after caesarean section. CASE PRESENTATION: We report a case of the prolapse of the fimbrial end of a fallopian tube through an abdominal scar after caesarean section mimicking scar endometriosis. A 24-year-old primipara South Asian woman of Punjabi ethnicity presented to our institute with a fleshy mass protruding through her abdominal scar and bleeding from the mass during menstruation for the past 5 months. She underwent a caesarean section 6 months earlier for breech presentation. Her history revealed she had wound dehiscence on the sixth postoperative day. The major portion of her wound healed in 1 month leaving a 2 cm area in the middle of her vertical scar. An abdominal examination revealed a 2×2 cm fleshy mass protruding through the middle part of her infraumbilical abdominal scar. At the time of the surgery we found that the fimbrial end of her left fallopian tube was protruding through her abdominal scar. CONCLUSION: Awareness of this complication may prevent improper management of wound dehiscence and such complication causing prolonged agony to the patient.

To study the efficacy and safety of doxophylline and theophylline in bronchial asthma.

BACKGROUND: Asthma is a non communicable chronic disease prevalent all over the world. Two commonly used methylxanthines, theophylline and doxofylline were compared in the study in stable asthmatic patients at recommended doses by various spirometric lung function tests with forced expiratory volume at second one (FEVI) between 50 to 80% of predicted FEVI. MATERIALS AND METHODS: A total of 100 patients were divided in two groups. Group I was administered 300 mg theophylline twice a day and Group II was administered doxofylline 400 mg twice a day orally for six weeks. Spirometric variables symptom score, and adverse effects were recorded at the baseline level and after six weeks of therapy. Data was compared and analysed statistically. RESULTS: The spirometric values of forced expiratory volume in 1 second (FEVI), forced vital capacity (FVC), and FEV1/FVC showed a statistically significant improvement over base line with the use of both theophylline as well as doxophylline, but were not statistically different from each other. There was a statistically significant improvement in peak expiratory flow rate (PEFR) after six weeks of treatment with doxophylline compared to theophylline. It was found that the doxophylline has a better safety profile as compared to theophylline. Adverse events occurred in a greater proportion of patients in the theophylline group. CONCLUSION: In the study it was concluded that both theophylline and doxofylline improved the lung function tests and symptoms in patients of mild Bronchial Asthma, but doxofylline has a better profile in terms of safety.

Malignant mixed germ cell tumour of ovary--an unusual combination and review of literature.

Mixed germ cell tumours of the ovary are malignant neoplasms of the ovary comprising of two or more types of germ cell components. Most of the malignant mixed germ cell tumours consists of dysgerminoma accompanied by endodermal sinus tumours, immature teratoma or choriocarcinoma. There are only few case reports of mixed germ cell tumours with different combinations of malignant components. We report a very rare case of mixed germ cell tumours consisted of malignant components of endodermal sinus tumour, emryonal carcinoma, and benign component of teratomatuos and trophoblastic differentiation. This is the first case report in the literature with both benign and malignant component of type described to best of our knowledge. Patient was an 18 year old girl, who presented with pain abdomen, abdominal mass and irregular bleeding. Ultrasound and CT scan showed a huge mass with solid and cystic component. Tumour markers i.e alpha feto- protein (AFP), human chorionic gonadotropin (hCG), lactate dehydrogenate (LDH) and Ca-125 were raised. We performed fertility sparing surgery by preserving one ovary, tube and uterus. Conclusion: Malingnant mixed germ cell tumours of ovary are highly aggressive neoplasm and early intervention and fertility sparing surgery is required for any adolescent girl presenting with rapidly enlarging pelvic mass.

Comparative study of electrocardiographic changes in patients of acute mania receiving verapamil or lithium carbonate.

AIM: TO compare the ECG changes in patients of acute mania receiving verapamil and lithium carbonate. OBJECTIVES: Verapamil used in resistant manic patients not responding to any drug therapy, should be considered for its side effects on cardiovascular system. It causes bradycardia and myocardial infarction in risk patients. So it is important to take clinical and other relevant history and do ECG before the patient to put on verapamil drug therapy. MATERIALS AND METHODS: Patients with acute mania were randomized to receive lithium (n =25) or verapamil (n=25) in a 4-wk double-blind comparative study. Both groups were homogeneous with regard to demographic and disease variables. After giving first dose of verapamil, patients were observed for any cardiovascular side effects and ECG changes during the study. The study parameters were recorded at the baseline, after 7 d and 28 d of trial medication. STATISTICAL ANALYSIS: The Unpaired t-test was used for comparing baseline data in two groups and paired t-test was used for the interval data. A level of less than 5% value of p was considered statistically significant. RESULTS: Both treatment groups showed no major differences in ECG changes during the trial except for the heart rate and T wave changes. The study showed that verapamil produces more bradycardia and T wave depression than with lithium in the treatment of mania. CONCLUSION: The baseline electrocardiogram should be done and heart rate should be monitored during the treatment.

Waist related anthropometric measures - simple and useful predictors of coronary artery disease in women.

AIM: To compare the waist related anthropometric measures like waist circumference, waist-to-height ratio (WHtR), waist - hip ratio (WHR) and body mass index (BMI) as predictors of coronary artery disease (CAD) in women. METHODS: The study included 88 women aged 40-80 years. Waist circumference, hip circumference, height, weight, age, and other covariates were collected by questionnaire. The primary endpoint was incident coronary heart disease that was reported by physician. The data was analyzed statistically using χ(2)-test for quantitative data and student t-test. The significance of the results as determined in 95.0% confidence interval. RESULTS: The mean age was 59.07 ± 11.53 in the study group and 54.36 ± 10.84 in the control group. The waist circumference in the study group was higher (95.443 ± 11.187) than the control group (74.886 ± 6.672) (p < 0.001). The mean waist to hip ratio (WHR) was 0.96 ± 0.08 in the study group and 0.78 ± 0.06 in the control group (p < 0.001). The mean waist to height ratio (WHtR) was 0.62 ± 0.07 in the study group and 0.48 ± 0.04 in the control group (p < 0.001). Waist derived measures were superior to BMI in predicting CAD. The unadjusted AUC (95% Confidence Interval) was 0.008 (0.006-0.095) for WHtR, 0.001 (0.00 0.002) for waist - hip ratio, and 1 (0.323-1.766) for body mass index. CONCLUSION: Waist related anthropometric measures are important predictors as CAD risk factors among middle-aged and older women, as compared to BMI.

HCV and pregnancy: prevalence, risk factors, and pregnancy outcome in north Indian population: a case-control study.

OBJECTIVES: The study was carried out to investigate the prevalence, risk factors, and Pregnancy outcome in anti-HCV-positives pregnant women admitted for delivery in the Department of Obstetrics & Gynecology of Guru Gobind Singh Medical College and Hospital, Faridkot between January 2010 and January 2013. SETTING: Department of obstetrics and Gynaecology of GGS Medical College and Hospital, Faridkot. MATERIAL AND METHODS: A case-control study design was selected for the study. A total of 1412 pregnant women presenting in the labor room of our hospital between January 2010 and January 2013 were subjected to anti-HCV testing by third generation ELISA. Age, parity, and gestational age-matched controls were taken from the women delivering during the same time frame who tested negative for hepatitis C. All the subjects and controls were non-reactive for HIV and HBsAg as well. Risk factors and pregnancy outcome were compared with the control group. Approval was taken from ethic committee of the institute. The women who consented to participate in the study were evaluated on the basis of a questionnaire for the presence of risk factors of hepatitis C and pregnancy outcome. Women with the known previous liver disease were excluded from the study. Data were analyzed using SPSS for Windows version 16.0. p < 0.05 was considered significant. RESULTS: Forty patients tested positive for anti-HCV antibodies among 1,412 patients subjected to anti-HCV testing during study period. 40 patients were taken as controls, who were negative for anti-HCV antibodies. Prevalence of HCV during pregnancy was 2.8 % in our study. Among the risk factors studied, previous surgery and blood transfusion were the statistically significant risk factors. There was history of previous major surgery in 16 cases versus 4 controls and was statistically significant (p value 0.002) at p < 0.05. History of blood transfusion was present in 4 versus 2 among cases and controls, respectively, and statistically significant (p value 0.004) at p < 0.05. Sexual transmission was not the risk factor as none of the spouse of the pregnant women was positive for HCV antibodies. Neonatal outcome was similar in both groups. Pregnancy complications i.e., Pregnancy-induced hypertension and antepartum hemorrhage were significantly higher in study group compared to control group. CONCLUSION: Incidence of hepatitis C virus infection in pregnancy is 2.8 %. Surgical procedures, blood transfusion, are the major risk factors for transmission. There are no identifiable risk factors in 35 % of cases. Pregnancy complications like Pregnancy-induced hypertension and antepartum hemorrhage are more common in HCV-positive mothers. Neonatal outcome is not affected. Universal screening of all pregnant women should be done for HCV as many patients may not have any risk factor.

To analyze the Impact of Serial Prescription Audits with Active Feedback on Quality of Prescription Behaviour.

MATERIAL AND METHODS: A serial prescription audit in four cycles (three months each) was conducted at Jhalawar Medical College and Hospital and at Chintpurni Medical College and Hospital for two years, one year in each hospital. One cycle included the prescriptions which were collected by using a digital camera from the outdoor patients department every month (n=250 per month), for three months regularly. A baseline prescription audit, as a cross-sectional survey, was done on the last date of the first month. Re-audits were done on the last date of the 2(nd) and 3(rd) months, which concluded one cycle. One cycle was followed by three months of no prescription audit. In total, four cycles were completed in two years. The parameters which were observed were- (a) the formats of the prescriptions (b) the WHO drug core indicators and (c) the legibility of the prescriptions. The clarity of the prescriptions was decided upon by the consensus group. A continuous evaluation and a feedback process were carried out every month by analyzing the prescriptions, based on the extent of conformity to the "WHO Guide to Good Prescribing" and the updated list of the "WHO Essential Medicines." The data was analyzed by using the Chi-square test. RESULTS: There was a significant improvement in the formats of the prescriptions in terms of the quality of the completeness and the rationality at the end of the 2nd and 3rd months of each cycle. Similarly, the WHO drug core indicators improved with every re-audit in each cycle (p < 0.05). Overall, the total percentage of the core indicators significantly improved in the 2nd and 3rd months as compared to the 1st month in all the cycles (p < 0.05). The clarity of the prescriptions improved in the successive re-audits. There was a sudden decline in the improvement in all the parameters in the first month of the 2nd, 3rd and the 4th cycles as compared to that in the 2(nd) and 3(rd) months of the previous cycles. CONCLUSION: Serial prescription audits and an active feedback definitely improve the prescription behaviours in the therapeutic decision making. But discontinuing the prescription audits begins to reverse the improvement in the prescription behaviours.

An unusual case of vaginal myoma presenting with postmenopausal bleeding.

Vaginal leiomyomas are uncommon benign tumour with variable clinical presentation. These tumours arise most commonly from anterior vaginal wall. We report a case of 50-year old postmenopausal woman who presented with urinary retention, profuse vaginal bleeding and mass protruding into vagina. Local examination revealed a pedunculated mass attached to the posterior vaginal wall with vascular stalk one cm below the cervix. Mass was hanging outside vulva and vascular pedicle was profusely bleeding. The pedicle was ligated and tumour was excised. Subsequent histopathology revealed a vaginal myoma.

Role of acamprosate in sensorineural tinnitus.

UNLABELLED: Acamprosate with dual mechanism of action as glutamate antagonist and GABA agonist can be a potential target to decrease the severity of sensorineural tinnitus. OBJECTIVE: (1)To study the effectiveness of acamprosate in providing subjective relief and objective improvement in patients having tinnitus of sensorineural origin. (2) To evaluate the adverse events related to the use of acamprosate and also determine the change in quality of life (QOL) parameters. MATERIALS AND METHODS: The study was randomized double-blind, placebo controlled, crossover. Forty adult subjects (>18 years of age), of either sex with tinnitus of sensorineural origin, were administered either acamprosate 333 mg TDS or matched placebo for a period of six weeks followed by a washout period of one week. Drug therapy was switched for another six weeks in consonance with the crossover design. The effect of acamprosate and placebo on subjective relief and objective improvement was evaluated by using modified tinnitus severity, QOL scores and audiometry with tinnitus matching in frequency and loudness. RESULTS: At the end of the study, the drug had shown a statistically significant improvement in reducing the tinnitus score in 92.5% of the patients and placebo with an improvement in 12.5% of the patients. The drug was well tolerated without any serious drug reactions. CONCLUSION: Acamprosate is an effective drug in treating the severity of sensorineural tinnitus without causing much of the side effects.