Spatiotemporal analysis of drug-resistant TB patients registered in selected districts of Karnataka, South India: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) depicts heterogeneous spatial patterns with geographical aggregation of TB cases due to either ongoing person-to-person transmission or reactivation of latent infection in a community sharing risk factor. In this regard, we aimed to assess the spatiotemporal aggregation of drug-resistant TB (DR-TB) patients notified to the national TB program (NTP) from 2015 to 2018 in selected districts of Karnataka, South India. METHODS: This was a cross-sectional study among DR-TB patients notified from Dakshina Kannada, Udupi, and Chikamagalur districts of the state of Karnataka. Clinico-demographic details were extracted from treatment cards. The registered addresses of the patients were geocoded (latitude and longitude) using Google Earth. Using the QGIS software, spot map, heat maps and grid maps 25 km2 with more than the expected count of DR-TB patients were constructed. RESULTS: Of the total 507 patients studied, 376 (74%) were males and the mean (standard deviation) age of the study participants was 41.4 (13.9) years. From 2015 to 2018, the number of patients increased from 85 to 209 per year, the area of aggregation in square kilometers increased from 113.6 to 205.7, and the number of rectangular grids with more than the expected DR-TB patients (> 1) increased from 12 to 47. CONCLUSIONS: The increase in the number of DR-TB patients, area of aggregation, and grids with more than the expected count is a cause for concern. The NTP can use routine programmatic data to develop maps to identify areas of aggregation of disease for targeted TB control activities.

Evaluation of Adverse Drug Reaction Profile of Drugs Used as First-Line Antiretroviral Therapy.

BACKGROUND AND OBJECTIVES: The objective was to study the adverse drug reaction (ADR) profile in HIV patients receiving first-line antiretroviral therapy. METHODS: This was a prospective, observational study that included 171 HIV patients with a follow-up at six months. Demographic details, medical history, details of HIV infection including most recent CD4 count, details of antiretroviral therapy, and other concomitant medication were recorded. Adverse drug reactions were elicited by reviewing patient records and also by interviewing the patient/attendants directly. RESULTS: 171 patients completed the study out of which 88 (51.5%) were males and 83 (48.5%) were females. The study subjects included HIV-positive, treatment naïve patients who were started on treatment regimens recommended by the NACO guidelines. The ADRs observed were a fall in haemoglobin or absolute anaemia in response to zidovudine, nonspecific symptoms like headache, and a nonspecific feeling of being unwell in response to tenofovir, stavudine, and efavirenz; dyslipidaemia, pancreatitis, peripheral neuropathy, and lactic acidosis in response to stavudine; generalised rash in response to nevirapine and one case of nephrotoxicity to efavirenz. Majority of the ADRs satisfied the 'probable' category (60.1%), and the rest were "possible". ADRs to zidovudine and nevirapine superseded all others. INTERPRETATION AND CONCLUSION: Gastrointestinal effects were the most commonly observed group of ADRs, with nausea being the most common ADR, the others being gastritis and diarrhoea. The other ADRs included rash, hepatotoxicity, blood dyscrasias like anaemia, neutropenia, and thrombocytopenia, and fatigue. Few cases of lactic acidosis, peripheral neuropathy, headache, lipoatrophy, and pancreatitis were reported.

Can Metabotropic Glutamate Receptor 7 (mGluR 7) be a Novel Target for Analgesia?

INTRODUCTION: The present study was carried out to study the role of metabotropic glutamate receptor 7 (mGluR7) using its agonist, N,N'-bis(diphenylmethyl)-1,-ethanediamine (AMN082) for nociceptive stimuli, in animal models. By conducting this research, we aim to introduce a novel target for acute pain management. OBJECTIVE: To study the role of metabotropic glutamate receptor 7 (mGluR7), in analgesia, using mGluR7 agonist AMN082 in animal models. MATERIALS AND METHODS: Swiss albino mice of either sex, weighing 20-30gm were used for the study. The animals were divided into 3 groups with 6 mice in each group: Control or Normal group received 0.5% methylcellulose in normal saline; Standard group received the drug tramadol HCl at 40mg/kg; and test group received drug AMN 082 at 5mg/kg. All the drugs were administered by intraperitoneal route. Hot plate test and Tail flick test were done to evaluate the analgesic effect of the drug. Reaction time for the end points in both the models were noted before drug administration at 0 min and after drug administration at 15, 30,60,90 and 120 min. Statistical analysis was done using One-Way-ANOVA followed by Tukeys post hoc test. p-value was considered significant at ≤ 0.05. RESULTS: The group that received AMN082 showed significantly lesser reaction time compared to normal and standard groups in both the analgesia models. CONCLUSION: The mGluR 7 stimulation by an agonist AMN082, did not show analgesic effect but induced hyperalgesia in response to thermal nociceptive stimuli.

The perceptual preferences in learning among dental students in clinical subjects.

INTRODUCTION: VARK is a questionnaire which was developed by Neil Fleming (www.vark.learn.com), who was a teacher and an educator in New Zealand, with respect to the perceptual preferences in learning. V stands for Visual- the students learn best from pictures, graphs and diagrams. A stand for Aural - the students learn best from spoken words, lectures and discussions. R stands for Reading - the students learn best from reading and writing texts. K stands for Kinesthetic - the students learn best when they move their bodies and manipulate things with their own hands. AIM: The aim of the recent study was to investigate the learning styles among the dental students in our clinical set up. METHOD: The VARK-questionnaire contains 13 multiple-choice- questions with four possibilities to select an answer. Each possibility represents one of the four modes of perception. But, one can select more than one answer for each question, which is necessary for the identification of the poly modal modes of perception and learning. This is also a psychometric problem when an attempt is being made to state a measure of the reliability of the questionnaire. The VARK-questionnaire was distributed among 100 students and we received filled forms from only 70 students. This sample size represented a 70% response rate from the students in the class and it was markedly above the level which was required to make conclusions about the student preferences for receiving and processing information. The students spent about 10 minutes in an ordinary lesson to fill in the questionnaire. The students' register numbers and names were used in the study and no blinding was practised. We analyzed their learning styles with their performances in the university exams. STUDY DESIGN: This was a questionnaire based clinical study. RESULTS: The responses from the students in our University where classified into the multi-modal (VARK), tri-modal (VRK, VAK, VAR, ARK), bi-modal (VR, VA, VK, RK) and the uni-modal (V, A, R.K) categories. The results showed that the subjects had a higher preference for multimodal learning. CONCLUSION: With our preliminary data, we conclude that the students in our clinical set up preferred a multimodal and a more of kinesthetic method of learning. To meet their needs, variations in the teaching, learning and the examination must be implemented. If not, the students with a high kinesthetic preference for perception and learning may be at the losing end.

A Critical Evaluation and Comparison of Antimicrobial Prophylaxis in Elective Surgeries Across three Hospitals.

OBJECTIVES: 1. To evaluate and compare the pattern and rationality of prophylactic antimicrobial therapy in elective surgeries. 2. To evaluate and compare the adherence of hospitals to the standard guidelines on prophylactic antimicrobial therapy. METHODOLOGY: A total of 150 patients each from a government hospital (group I), medical college teaching hospital (group II), and corporate hospital attached to the institution (group III) who had undergone elective, non-complicated surgery were included. The number & types of antimicrobials used along with duration were noted. Rationality was assessed on the basis of Kunin's criteria, ASHP guidelines & SIGN guidelines. Statistical analysis was done using appropriate tests. RESULTS: Cephalosporins were the most commonly used antimicrobials in all three groups (52.6%,85.7% & 84.8% respectively) followed by nitroimidazoles. Antimicrobial prophylaxis was appropriate in only 14.1%, 23.3% & 32.9% cases in the three groups respectively (p<0.01).The most common problem was prolonged duration of administration in 50.3%,58% & 45% respectively. The implementation of prophylaxis with respect to regimen & duration was erroneous in 20.1%, 12.7% & 4.7% respectively (p<0.01). CONCLUSION: The rationality & regimen of antimicrobial prophylaxis was comparatively better in the corporate hospital followed by medical college hospital and the government hospital. The present study calls for an urgent review on rational use of antimicrobials for prophylaxis in all the 3 hospitals.

The pain management in orthodontics.

Pain and discomfort are the frequent side-effects of the orthodontic therapy with fixed appliances. The people who experience orthodontic pain are likely to self-medicate with nonprescription pain relievers before seeing the dentist. It is imperative for an orthodontist to address questions that might arise in a clinical setting from the viewpoint of the clinicians and the patients/parents. This article will provide an overview of the current management strategies which are employed for alleviating orthodontic pain.

Evaluation of health literacy status among patients in a tertiary care hospital in coastal karnataka, India.

INTRODUCTION: People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy. The objective of this study is to assess the health literacy status among patients who are able to read and understand English attending a tertiary care hospital by using Rapid Estimate of Adult Literacy in Medicine [REALM] technique and to compare the health literacy levels to educational status and other baseline characteristics. MATERIAL AND METHODS: A widely used word recognition method [REALM] was used to assess the HL status of 200 patients attending a tertiary care hospital in Southern India. The number of correctly pronounced words was used to assign a grade-equivalent reading level. Scores 0 to 44 indicate reading skills at or below the 6th grade level, scores from 45 to 60 represent skills at the 7th or 8th grade level, and scores above 60 indicate skills at the high-school level or higher. RESULTS: HL status was found below adequate level in more than 50% of the patients. Younger age group showed better HL scores compared to those aged more than 25 years. General education level or the medium of education does not truly reflect HL levels as brought out in the study. Even those with postgraduate qualification had poor HL skills. CONCLUSION: The study was carried out to find out the HL levels among patients attending a tertiary care hospital. It was assumed that the general education levels may not reflect true HL status. In view of the results of this study it can be concluded that patient's HL skills should not be taken for granted and adequate attention should be paid in educating and briefing patients whenever patients are required to interpret and understand health care related documents.

Evaluation of hepatoprotective activity of Ginkgo biloba in rats.

The mechanism of hepatoprotective effects of Ginkgo biloba (GB), an herbal preparation with wide variety of therapeutic application, on paracetamol (Pcml) induced hepatic damage in rats has been investigated. GB treatment restored the marker enzyme levels indicating the in vivo protective effects against Pcml induced liver damage both in preventive and curative aspects. GB also reversed the increased TBARS levels, and elevated the GSH content of the liver. The results obtained from the study indicate hepatoprotective nature of GB, which might be due to its ability to prevent lipid peroxidation and replenishing the gllutathione level. The effects of GB were comparable to that of silymarin.