Impact of regulatory spin of pioglitazone on prescription of antidiabetic drugs among physicians in India: A multicentre questionnaire-based observational study.

Background & objectives: Pioglitazone was suspended for manufacture and sale by the Indian drug regulator in June 2013 due to its association with urinary bladder carcinoma, which was revoked within a short period (July 2013). The present questionnaire-based nationwide study was conducted to assess its impact on prescribing behaviour of physicians in India. Methods: Between December 2013 and March 2014, a validated questionnaire was administered to physicians practicing diabetes across 25 centres in India. Seven hundred and forty questionnaires fulfilling the minimum quality criteria were included in the final analysis. Results: Four hundred and sixteen (56.2%) physicians prescribed pioglitazone. Of these, 281 used it in less than the recommended dose of 15 mg/day. Most physicians (94.3%) were aware of recent regulatory events. However, only 333 (44.8%) changed their prescribing pattern. Seventeen of the 416 (4.1%) physicians who prescribed pioglitazone admitted having come across at least one type 2 diabetes mellitus patient (T2DM) who had urinary bladder carcinoma, and of these 13 said that it was in patients who took pioglitazone for a duration of more than two years. Only 7.8 per cent of physicians (n=58) categorically advocated banning pioglitazone, and the rest opined for its continuation or generating more evidence before decision could be taken regarding its use in T2DM. Interpretation & conclusions: Majority of the physicians though were aware of the regulatory changes with regard to pioglitazone, but their prescribing patterns were not changed for this drug. However, it was being used at lower than the recommended dose. There is a need for generating more evidence through improved pharmacovigilance activities and large-scale population-based prospective studies regarding the safety issues of pioglitazone, so as to make effectual risk-benefit analysis for its continual use in T2DM.

Perception, awareness and practice of research-oriented medical education among undergraduate students of a medical college in Kolkata, West Bengal.

BACKGROUND: The addition of research-oriented medical education (ROME) to the existing curriculum could promote logical thinking, rapid literature search and a better understanding of research methodology. Creation of research temperament could lead to innovations in healthcare. We assessed the perception, awareness and practice of ROME among undergraduate students. METHODS: We conducted a cross-sectional survey among 234 students of R.G. Kar Medical College, Kolkata selected by the simple random sampling technique. Data were collected using a pre-designed, pre-tested, validated questionnaire by direct interviews. RESULTS: The mean (SD) perception score was 44.2 (5.03). Students from outside West Bengal (p=0.05), women (p=0.03) and students whose parents were doctors (p=0.01) had significantly higher scores. Students in the second and fourth semesters had a better perception than those in the sixth and eighth semesters. Awareness of research fellowships granted to undergraduate students such as the Indian Council of Medical Research-Short-term studentship (ICMR-STS) was low among the second semester students (13.9%), but more than half (59.3%) of the students in the eighth semester were aware (difference across semesters, p<0.001). Awareness about journals, conferences and 'research bodies promoting student research' was low. Students in the senior semesters spent more time on research (6th semester 72.2% and 8th semester 88.9%) than those in the junior semesters (2nd: 66.7% and 4th: 77.8%; difference across semesters, p=0.03). About 3% of students participated in extracurricular research and/or had presented work at a conference. CONCLUSION: There is a good perception about the need for research but a lack of awareness of the why and how, as well as hardly any practice of ROME among medical students of this medical college.

Drug utilization pattern in pregnant women in rural areas, India: cross-sectional observational study.

AIM: The aim of this study was to evaluate the drug-utilization trend of pregnant women in rural areas of central India. MATERIALS AND METHODS: This was a prospective, observational study using a questionnaire, face-to-face interview and a prescription audit. RESULTS: The majority of the subjects were primigravida (51.4%), from the lower socioeconomic group (71.3%) and with poor formal education. Although the drugs prescribed for them per prescription (2.66) were within rational limits, there was scope for improvement in generic (21%) and essential drugs (18%), antibiotics (9.6%) and injections (10.97%). CONCLUSIONS: Morbidity and mortality during the antenatal period occur due to different factors. Regular drug-utilization studies following the guidelines of the World Health Organization and information, education and communication factors related to drug use by pregnant women can be improved.

Drug use behaviour of pregnant women in rural India.

OBJECTIVE: To evaluate the drug use habit of pregnant women in villages of central India. METHODS: An observational, cross sectional study was conducted among six hundred fifty pregnant women from different randomly selected villages of Wardha district of central India through interviews on medicine use behaviour and evaluation of prescriptions. RESULTS: Pregnant women of younger age group from lower socio economic status constituted the majority of the study population. Major portion (97.7) of this socioeconomically backward population followed the doctor's advice as far as dose, frequency and duration of the drug was concerned. The antenatal mothers were of the opinion that, if the instructions on the drug envelop or foil was in written in the local language, it could be more helpful for them. CONCLUSION: Majority of the study population used drugs or medicines regularly but some mothers were reluctant. This indicated that even in this age of advancement of scientific knowledge, all antenatal mothers were not conversant with the advantages of drug use.

Oral insulin: an update.

Insulin, either in its intravenous or subcutaneous forms, remains the standard therapy for virtually all type-1 diabetes and many of the type-2 diabetes patients in its advanced stages. With advancement of injection techniques, insulin therapy has become much more patient-friendly than ever. Still there is vast area of unmet needs regarding current practice of insulin therapy. Insulin injections are associated with poor compliance, weight gain, fears of hypoglycemia and adverse effects of systemic hyperinsulinemia. So, a search for oral insulin tablet which may closely mimic the physiological insulin secretions has always been there. This review intends to briefly describe the existing barriers of oral insulin delivery and strategies to overcome those. It also highlights the recent human studies and tries to find out the future of oral insulin in clinical context.

Polypharmacy and comorbidity status in the treatment of type 2 diabetic patients attending a tertiary care hospital: An observational and questionnaire-based study.

PURPOSE/AIM: Diabetes mellitus is associated with several comorbid conditions. Thus, often, diabetic patients are prescribed multiple drugs. Although multiple drugs help to combat various diseases, they also increase the propensity of drug interactions and adverse drug reactions. The present study thus tried to evaluate the comorbid conditions and concurrent medications associated with type 2 diabetic patients. It also aimed to address patient compliance for the medications provided to them. MATERIALS AND METHODS: This was a cross-sectional observational study conducted for 2 months - January-February 2017. Data were collected from prescriptions of the patients and also by interviewing the willing patients, attending the Diabetic Clinic of R. G. Kar Medical College, Kolkata, India. RESULTS: During the study period, 150 patients were interviewed and their prescriptions were studied. Out of 150 patients, 69 (46%) were males and 81 (54%) were females. The mean age of the study population was 51.5 (±0.78) years. The present study evaluated that 83.3% (125) of the study population suffered from at least one comorbid conditions, the most common being hyperlipidemia (70.7%) and hypertension (47.3%). The average number of drugs prescribed is 4.72 (±0.11) per prescription. Metformin was prescribed to 96% of the patients. The concurrent medications recommended included hypolipidemics (72%), antihypertensives (68%), drugs for peptic ulcer (34.7%), and antiplatelets (10.7%). CONCLUSION: The present study thus concluded that diabetic patients suffer from a number of comorbid conditions, most commonly, cardiovascular problems. The comorbidity increased with the age. The level of polypharmacy was also high, thereby increasing the pill burden for the patients.

Ayurpharmacoepidemiology en Route to Safeguarding Safety and Efficacy of Ayurvedic Drugs in Global Outlook.

Ayurpharmacoepidemiology is a new field developed by synergy of the fields of clinical pharmacology, epidemiology, and ayurveda. It will use the effects of ayurvedic medicinal products on large populations to describe and analyze the practices, evaluate the safety and efficacy, and carry out medicoeconomic evaluations. Good pharmacoepidemiology practices in ayurveda is projected to assist with issues of ayurpharmacoepidemiologic research. The embraced good pharmacoepidemiology practices guideline in this viewpoint will be able to provide valuable evidence about the health effects of ayurvedic herbs/drugs and consider different fields like pharmacovigilance, pharmacoeconomics, and drug discovery with ayurvedic reverse pharmacology approach, also pass out significant data for further basic sciences study in ayurveda biology, ayurgenomics, ayurnutrigenomics, and systems biology. Several unanswered questions about ayurvedic drug use and informed interventions or policies that can be addressed by informatics database, which will eventually demonstrate the credibility and rationality of ayurceuticals in the future.

A Study on Association between Common Haematological Parameters and Disease Activity in Rheumatoid Arthritis.

INTRODUCTION: Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease where assessment of disease activity is essential for management of patient. Currently, many composite scoring systems are used for evaluation of disease activity but they are mainly clinical-based. As several haematological parameters are altered due to systemic inflammatory process in RA, this study was intended to evaluate role of common haematological parameters to assess disease activity in RA. AIM: To find out the association of disease activity of Rheumatoid Arthritis (RA) with platelet count, Mean Platelet Volume (MPV) and Haemoglobin (Hb) level so that these cost-effective haematological parameters can be used as additional factors to assess disease activity. MATERIALS AND METHODS: This hospital based cross-sectional study was done on newly diagnosed patients of RA along with age and sex matched healthy control population. Patients suffering from malignancies, renal failure, diabetes mellitus or RA patients on drug therapy were excluded. Clinically, disease activity of RA was measured using DAS 28-3 Score (Modified Disease Activity Score using three variables- tender joint count, swollen joint count and ESR). Haematological parameters were measured by automated cell counter. RESULTS: Total 80 cases were selected (60 female and 20 male). 48 patients with high disease activity (DAS 28-3>5.1) were labelled as Group-A and 32 with low to moderate disease activity (DAS 28-3 ≤5.1) as Group- B. Mean platelet count of patients of group A and group B were 4.53 lac/cmm and 2.17 lac/cmm respectively (p <0.001). MPV mean in group A and B were 11.86 fl and 10.19 fl respectively (p <0.001). Mean Hb (g/dl) was 10.05 and 12.25 for group A and B respectively (p=0.001) for male patients while in females it was 10.12 and 11.91 for group A and B, respectively (p=0.003). Mean platelet count and MPV in control population were 2.07 lac/cmm and 9.4 fl, respectively while mean Hb (g/dl) was 13.31 (male) and 12.01 (female). CONCLUSION: In our study it was observed that Hb is significantly lower in patients with high disease activity whereas platelet count and MPV are significantly higher with high disease activity compared to patients with low to moderate disease activity.

Antidiabetic and antioxidant activity of Rhizophora mucronata leaves (Indian sundarban mangrove): An in vitro and in vivo study.

BACKGROUND: Rhizophora mucronata is a salt-tolerant true mangrove which is widely distributed in Indian mangrove forest and traditionally used to treat diabetes and other health ailments. AIM: The aim of this study is to elucidate the role of Indian variety of R. mucronata leaves on glucose impairing metabolism during diabetes by in vitro and in vivo methods. MATERIALS AND METHODS: The ethanolic fraction of R. mucronata leaves extract (RHE) was assessed for DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging and in vitro anti-diabetic action through α-amylase and α-glucosidase activity assessment. Oral glucose tolerance test (OGTT) and insulin sensitivity test (IST) were assessed and their counteraction with RHE (100 and 200 mg/kg, p.o) and glibenclamide (10 mg/kg, p.o) in streptozotocin (STZ) (50 mg/kg, intravenous) induced hyperglycemic rats were also monitored for 28 days. The data were analyzed statistically using t-test. RESULTS: RHE dose-dependently inhibited α-amylase and α-glucosidase enzymes and lowered the area under the curve (AUC) for glucose on both OGTT and IST. RHE also significantly (p < 0.01) controlled glycemic index and thereby reducing diabetic complications as assessed by lipid profiles, atherogenic index, and coronary index in STZ rats. CONCLUSION: RHE at doses of 100 and 200 mg/kg/day for 28 days provided a significant decrease in diabetes complications and metabolic impairment.

Detection of arecoline by simple high-performance thin-layer chromatographic method in Indian nontobacco pan masala.

Chewing the habit of blended pan masala containing areca nut with or without tobacco is a common practice in the Indian subcontinent. Arecoline, a pyridine alkaloid presence in areca nut alarmed for oral carcinogenesis and strictly prohibited in the western world. However, in India using blended pan masala is very popular among young and old individuals. In this context, we aimed to detect arecoline in Indian blended nontobacco pan masala sold in Kolkata using a simple densitometric high-performance thin-layer chromatographic (HPTLC) method and for alarming their use in common people. Eleven popularly Indian blended nontobacco pan masala were collected from the territory of Kolkata and isolated arecoline, following solvent extraction method derived for pyridine alkaloid. The quantitative analysis of arecoline was measured using automated software-based HPTLC instruments and validated the method according to International Conference on Harmonization guidelines. Arecoline was detected in all 11 blended nontobacco pan masala samples in a range of minimum 130 to maximum 415 µg/g dry samples. Arecoline is hazardous carcinogenic compound, so the use of Indian blended nontobacco pan masala should be restricted. Further, the method was found suitable for routine quantitative analysis of arecoline in areca nut containing substances.

Quality of life and treatment satisfaction observed among Indians with diabetes foot ulcers undergoing ayurvedic adjunct therapy.

The purpose of the study was to assess the health-related quality of life and treatment satisfaction of diabetes patients (n = 36) with foot ulcers undergoing insulin and ayurvedic adjunct therapy. Retrospective hospital based cross-sectional design considered patients with diabetes foot ulcers undergoing 4-week treatment with insulin and ayurvedic combinatorial therapy. The Audit of Diabetes Dependent Quality of Life Questionnaire and Diabetes Treatment Satisfaction Questionnaire were completed for the assessment. The mean duration of diabetes among participants was 9.32 ± 5.3 years. Assessment of Diabetes Treatment Satisfaction Questionnaire (total treatment satisfaction) score was found to be 26.0139 ± 5.20369, and Audit of Diabetes Dependent Quality of Life Questionnaire (average weighted impact) score was -3.0819 ± 1.83003. Relationship with diabetes complications showed that Audit of Diabetes Dependent Quality of Life Questionnaire score (P = .383) had no relationship, but Diabetes Treatment Satisfaction Questionnaire score (P = .039) showed significance. Integrated approaches for diabetes foot ulcer management with insulin and ayurvedic management have a favorable impact on patient-perceived quality of life.

Ayurveda in changing scenario of diabetes management for developing safe and effective treatment choices for the future.

Ayurveda described diabetes mellitus (DM) as Madhumeha. This ancient evidence-based system of medicine enumerated various herbs and formulations for its management, which needs scientific validation. Whereas translational "bedside to bench" approach in biomedical research is an upcoming concept, its application in traditional and complementary medicine can be interesting. The intersecting concepts in the field Ayurveda and translational research needs "omics" approach. The Ayurvedic biology concepts about DM have its close relations with present systems biology approach. Metabolic changes causing tissue damage connected with genetic and immunological irregularities leading to insulin resistance coincide with ancient knowledge. Combinatorial therapy according to Prakriti type as elucidated by Ayurgenomics should be carried on for further research. "Bedside to bench" approaches in research utilizing metabolomics and pharmacogenomics approach can be a major step towards changing the therapeutic strategy towards diabetes. Prameha which is described as the pre-diabetic state is a novel concept in Ayurvedic etiopathogenesis, while metabolomic parameters like lipid level in urine can be a thrust area of research to have a pre-diabetic screening method in high-risk populations. This tradition-guided research paradigm can open up novel opportunities in traditional knowledge-inspired systems biology and drug discovery against diabetes.

A questionnaire-based survey to ascertain the views of clinicians regarding rational use of antibiotics in teaching hospitals of Kolkata.

OBJECTIVES: The objective was to assess the views of clinicians in teaching hospitals of Kolkata regarding the use of antibiotics in their own hospitals, focusing on perceived misuse, reasons behind such misuse and feasible remedial measures. MATERIALS AND METHODS: A total of 200 clinicians from core clinical disciplines was approached in six teaching hospitals of Kolkata through purposive sampling. A structured, validated questionnaire adopted from published studies and modified to suit the responding population was completed by consenting respondents through face-to-face interaction with a single interviewer. Respondents were free to leave out questions they did not wish to answer. RESULTS: Among 130 participating clinicians (65% of approached), all felt that antibiotic misuse occurs in various hospital settings; 72 (55.4% of the respondents) felt it was a frequent occurrence and needed major rectification. Cough and cold (78.5%), fever (65.4%), and diarrhea (62.3%) were perceived to be the commonest conditions of antibiotic misuse. About half (50.76%) felt that oral preparations were more misused compared to injectable or topical ones. Among oral antibiotics, co-amoxiclav (66.9%) and cefpodoxime (63.07%) whereas among parenteral ones, ceftriaxone and other third generation cephalosporins (74.6%) followed by piperacillin-tazobactam (61.5%) were selected as the most misused ones. Deficient training in rational use of medicines (70.7%) and absence of institutional antibiotic policy (67.7%) were listed as the two most important predisposing factors. Training of medical students and interns in rational antibiotic use (78.5%), implementation of antibiotic policy (76.9%), improvement in microbiology support (70.7%), and regular surveillance on this issue (64.6%) were cited as the principal remedial measures. CONCLUSIONS: Clinicians acknowledge that the misuse of antibiotics is an important problem in their hospitals. A system of clinical audit of antibiotic usage, improved microbiology support and implementation of antibiotic policy can help to promote rational use of antimicrobial agents.

Exploratory study on the ayurvedic therapeutic management of cerebral palsy in children at a tertiary care hospital of karnataka, India.

Cerebral palsy (CP) is the leading cause of childhood disability affecting cognitive function and developments in approximately 1.5 to 3 cases per 1000 live births. Based on Ayurvedic therapeutic principles, CP patients were subjected to Abhyanga (massage) with Moorchita Tila Taila (processed sesame oil) and Svedana (fomentation) with Shastikashali Pinda Sveda (fomentation with bolus of drugs prepared with boiled rice). Study group received Mustadi Rajayapana Basti (enema with herbal decoction) and Baladi Yoga (a poly-herbo-mineral formulation), while the placebo group received Godhuma Vati (tablet prepared with wheat powder) and saline water as enema. Treatment with Mustadi Rajayapana Basti and Baladi Yoga improved the activities of daily life by 8.79%, gross motor functions by 19.76%, and fine motor functions 15.05%, and mental functions like memory retention got improved by 15.43%. The placebo group showed an improvement of 0.21% in daily life activities, 2.8% in gross motor, and 2.4% in fine motor functions. Mustadi Rajayapana Basti and Baladi Yoga proved to be more supportive in improving the motor activities and gross behavioral pattern. Further clinical trials are required to evaluate and validate the maximum effect of the combination therapy in a large sample with repetition of the courses for longer duration.

Histologic and morphometric study of human placenta in gestational diabetes mellitus.

AIMS: The aim was to study morphometry, site of umbilical cord insertion and histological changes in placentae of women with gestational diabetes mellitus and compare the results with those of normal pregnancies and observe the perinatal outcome. METHODS: It was an observational, correlational study of 130 placenta specimens collected from labour room and operation theatre of Department of Gynaecology & Obstetrics, Institute of Post Graduate Medical Education and Research, Kolkata. The subjects were mothers who attended antenatal clinic of the hospital regularly and delivered their babies in the same hospital. Cases were selected randomly, and divided in two groups: group A consisted of mothers having normal, uncomplicated pregnancy, group B consisted of mothers whose pregnancies were complicated by gestational diabetes mellitus. Morphometry, site of umbilical cord insertion and histological changes in placentae of all women were recorded. Perinatal outcome of the cases were also registered. The statistical methods used were chi-square test and Mann-Whitney U test. RESULTS: It was observed that the placentae of diabetic mothers were significantly bigger in size, weight, volume, area, thickness, diameter and circumference than those of normal mothers. Also, in diabetic mothers, there was significant increase in villous oedema, fibrin deposition, calcification and congestion of blood vessels. These placental changes were significantly correlated with birth weights of babies. Out of 70 mothers in Group B, 65 had live births, 5 had stillborn babies. CONCLUSIONS: Placentae of women with GDM showed several changes that may be associated with impaired functioning, leading to bad perinatal outcome.

Study of Proper use of Inhalational Devices by Bronchial Asthma or COPD Patients Attending a Tertiary Care Hospital.

OBJECTIVE: To examine the frequency of proper use of inhalation devices and influence of age and training on it. MATERIALS AND METHODS: One hundred and five subjects of bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD); aged between 18 to 75 y (mean ± SD; 46 ± 28.55) were studied. Subjects were enrolled over a period of three months. Data like weight, height and concomitant medications were recorded. It was an observational and questionnaire based study. Parameters were chosen to demonstrate the inhalational technique, errors committed in different steps of use & nature of medical, paramedical, nursing personals and others imparting training for use of inhaler device and time devoted for it. RESULTS: Of total 105 patients, 31 were using dry powdered inhalers (DPI), 50 on metered dose inhalers (MDI), and 24 on MDI with spacer devices. Among study population 83.81% were trained by healthcare professionals (doctors, nurse, pharmacists, paramedical or representatives of Pharmaceutical companies) and 16.19% are trained by general people. Among the MDI users (n=50) only 6%, 16.12% among the DPI users, 20.8%, among MDI with spacer users could use inhalers correctly. At 95% confidence limit there was significance of errors committed between DPI and MDI users (difference of SE is 2.56) and between spacer and MDI users (difference of SE 2.92). There was no difference found in regard of frequency of errors committed in taking different devices according to patient's socioeconomic, educational background and trainer. CONCLUSION: It was concluded that use of MDI with spacer most convenient method. Doctors often did not have sufficient time to train patients regarding proper technique of inhaler use. With ever increasing and widespread use of inhalers patients' education is becoming more important. Proper training will surely make these drugs more effective and cost benefit ratio more favourable.

Evaluation of virulent multidrug resistant Klebsiella infection status in a tertiary care hospital in Eastern India.

Klebsiella especially Klebsiella pneumoniae is gaining renewed interest because of emergence of multidrug resistance among klebsiellae associated with infections.These are now being recognised as one of the major threats to effective management of patients in hospital, especially in developing country like India. Pathogenic mechanism of klebsiella Infections are associated with virulence factors such as capsule and mucoid phenotype, etc. The present study was designed to determine the virulence factors and antibiogram of klebsiellae, isolated from various clinical specimen in a tertiary care hospital of West Bengal, India. A total of 2370 clinical specimens which include blood, urine, wound swab, sputum were processed for isolation and identification of klebsiella to the species level. For each klebsiella isolate demonstration of capsule was done by capsule relief stain and detection of mucoid phenotype was done by string test. Antibiogram was studied by Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The results showed that klebsiella species were isolated and identified from 139 clinical samples (5.9% prevalence rate) among which 4 (2.9%) were Klebsiella oxytoca and the remaining 135 Isolates (97.1%) were Klebsiella pneumoniae. Out of 139 klebsiella isolates, capsule was demonstrated in 118 (84.9%) and 116 (83.4%) were positive for string test. Antibiogram revealed that most of isolates of Klebsiella pneumoniae were multidrug resistant.

Adjunct therapy of Ayurvedic medicine with anti tubercular drugs on the therapeutic management of pulmonary tuberculosis.

BACKGROUND: Pulmonary tuberculosis (PTB) is an age old disease described in Vedic Medicine as 'Yakshma'. Later on, in Ayurveda it earned a prefix and found way into mythology as 'Rajayakshma'. After the discovery of streptomycin, the therapeutic management of PTB received a major breakthrough. The treatment module changed remarkably with the formulation of newer anti-tubercular drugs (ATD) with appreciable success. Recent resurgence of PTB in developed countries like United States posed a threat to the medical community due to resistant strains. Consequently, WHO looked toward traditional medicine. Literature reveals that Ayurvedic treatment of PTB was in vogue in India before the introduction of ATD with limited success. Records show that 2766 patients of PTB were treated with Ayurvedic drugs in a tertiary care hospital in Kolkata in the year 1933-1947. OBJECTIVES: To evaluate the toxicity reduction and early restoration by adjunct therapy of Ayurvedic drugs by increasing the bio-availability of ATDs. MATERIALS AND METHODS: In the present study, treatment response of 99 patients treated with ATD as an adjunct with Aswagandha (Withania somnifera) and a multi-herbal formulation described in Chikitsa-sthana of Charaka samhita i.e. Chyawanprash were investigated. Hematological profile, sputum bacterial load count, immunoglobulin IgA and IgM, blood sugar, liver function test, serum creatinine were the assessed parameters besides blood isoniazid and pyrazinamide, repeated after 28 days of treatment. RESULTS: The symptoms abated, body weight showed improvement, ESR values were normal, there was appreciable change in IgA and IgM patterns and significantly increased bioavailability of isoniazid and pyrazinamide were recorded. CONCLUSION: This innovative clinical study coupled with empowered research may turn out to be promising in finding a solution for the treatment of PTB.

Placental changes associated with maternal anaemia

The present study aimed to assess the morphological and histological changes of placentas associated with maternal anaemia (mothers with Hb level <11 g/dl). The study was conducted in Bankura Sammilani Medical College, West Bengal, India for a period of six months. Placentas collected from cases of maternal anaemia (Hb < 11 g/dl) were forty (40) and those collected from control mothers were thirty (30). All the deliveries were at full term (37-42 weeks) and in the antenatal periods were without any complications or diseases. Macroscopic and microscopic analyses of the placentas were done and these findings were compared. Statistical analysis was performed by using t-test for comparing the mean values of fetal weights, placental weights, placental indices and placental volumes of the maternal anaemia group with those of control group. It was observed that the mean fetal weight of pregnancy with anaemia group was less than those of the control group. The mean placental weight and mean placental volume in pregnancy with the anaemia group were more than the control group. Also, the mean placental index of the maternal anaemia group was higher than that of the control group. Light microscopy revealed increased fibrin deposition, increased syncytial knotting, more avascular villi with incomplete trophoblastic lining, stromal fibrosis, intervillous haemorrhage and cytotrophoblastic cell proliferation in placentas of anaemic mothers as compared to those of the controls. We concluded that maternal anaemia resulted into bigger, heavier placentas and smaller fetuses, whereas placental morphological changes showed signs of chronic hypoxia and placental insufficiency

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