Journal of clinical and diagnostic research

Perception Of Nepalese Community Pharmacists Towards Patient Counseling And Continuing Pharmacy Education Program: A Multicentric Study

POUDEL A*,KHANAL S**,ALAM KADIR***, PALAIAN S****

Objective: To study the perception of community pharmacists towards patient counseling and continuing pharmacy education programs. Methods: A semi structured questionnaire was developed by the researchers. The research was carried out in six major cities in Nepal, namely Kathmandu, Pokhara, Biratanagar, Birgunj, Nepalgunj and Bhairahawa. The filled questionnaires were analyzed as per the study objectives. Results: Altogether, 60 community pharmacists were included. Among them, 88.33% (n=53) were male. More than 50 patients visit most of the community pharmacies [36.67% (n=22)] daily. Most of the dispensers [56.67% (n=34)] took 1-5 minutes for dispensing a prescription. In most of the pharmacies [56.67% (n=34)], there were 2-5 dispensers and the qualification of a majority of dispensers were orientation training. Most of them [56.67% (n=340] believed that counseling was necessary as it was their own duty, but however, 48.33% (n=29) said that it was necessary to increase patient compliance. Our finding suggests that 83.33% (n=50) of retailers were facing some problems during patient counseling. All participants were interested in the continuing pharmacy education program. Conclusion: On the whole, the community pharmacists had a positive response towards patient counseling. Our findings suggest the need for continuing pharmacy education programs in Nepal to strengthen the concept of patient counseling.

Clinical Profile Of Hyponatraemia In Adult Patients Admitted To Hamad General Hospital, Qatar: Experience With 53 Cases

RAHIL A I *, KHAN F Y **, AL BADRI M M ***

Background: There is limited information about the clinical profile of hyponatraemia in Qatar. Objectives: The aim of this study was to describe the clinical presentation and aetiology of moderate and severe hyponatraemia in patients admitted to Hamad general hospital. Patients And Methods: This descriptive observational hospital-based study was conducted at Hamad general hospital from June 2007 to July 2008; it involved all adult patients who were admitted to Hamad general hospital with moderate and severe hyponatraemia. Results: During the 12-month study period, 53 consecutive patients with moderate and severe hyponatraemia were admitted to Hamad general hospital. 33 (62.3%) were males and 20 (37.7%) were females). The mean age of the patients was 56± 20 years (range of 17-93 years). Females had a significantly higher mean age than males (63.9±16.9 versus 51.6±21.2, p = 0.02). Hyponatraemia due to extra-renal sodium loss was the most frequent cause of hyponatraemia, it was found in 18 (33.9%) patients; whereas the aetiology of hyponatraemia remained unknown in four patients. Of all, 31 (58.4%) patients had moderate hyponatraemia, whereas 22 (41.6%) patients had severe hyponatraemia. Impairment of consciousness was found in 13 (24.5%), it ranged from confusion to coma in 13 patients with impairment of consciousness, 10 (76.9%) had severe hyponatraemia and 3 (9.6%) had moderate hyponatraemia. Conclusions: Hyponatraemia due to extra-renal loss was the most frequent cause of hyponatraemia in our study; it was more prevalent among elderly patients than in younger patients. No significant gender related difference differences were found in the relative frequency rates. Moreover, no significant differences were found between moderate and severe hyponatraemia with respect to consciousness impairment.

Knowledge About AIDS Among Medical Students In Iran

KHODABAKHSHI B *, BESHARAT S **, MOHSENI K ***, BESHARAT M****

Young people are among the high risk group who are susceptible to sexually transmitted diseases. Several educational programs are scheduled to raise awareness about risky behaviours and to decrease the rate of the HIV pandemic. This cross sectional study showed that in young medical students, the level of awareness about HIV/AIDS increased during the years of academic education (not significant) and that males have a higher level of awareness than females. Higher awareness is desirable in this group due to their key role in the community.

Safety Evaluation Of Antitubercular Therapy Under Revised National Tuberculosis Control Programme In India

TAK D K *, ACHARYA L D **, GOWRINATH K***, RAO PADMA G M****, SUBISH P*****

Introduction: The World Health Organization declared tuberculosis (TB) as a global emergency in 1993. To intensify the efforts to control TB, the Government of India gradually replaced the National Tuberculosis Programme by the Directly Observed Short Course Therapy (DOTS) programme which is now known as the Revised National Tuberculosis Programme (RNTCP). Objectives: The present study was carried out to evaluate the safety of the DOTS therapy by monitoring adverse drug reactions (ADRs). Methodology: All the TB patients admitted at the DOTS centre Kasturba Hospital, Manipal, and at the DOTS Centre, Udupi, were enrolled as per the study criteria and were monitored for ADRs. The data were evaluated for patient demography, types of TB, types of DOTS treatment, incidence of ADRs, predisposing factors for developing ADRs and the types, onset, management and outcome of the ADRs. ADRs were also assessed for their causality and severity as per the standard algorithms. Results: Out of 94 TB patients, a majority of them were males (70%) and belonged to the age group of 18-40 years (52%). The incidence of ADRs was 17.02%. Gastritis was the most common ADR and multiple drug therapy was the major predisposing factor. We found that 28.51% of the total ADRs belonged to Type-A ADRs. In 87.1% of the cases, the suspected drug was continued in spite of the ADR, without any complications. On evaluation of the causality of ADRs, a majority of them were found to be ‘possible’ by both WHO and Naranjo’s scales. The severity assessment of ADRs showed that 31(51%) reactions were moderate and 30 (49%) were of the ‘mild’ nature. Conclusion: We found DOTS therapy to be safer. But regular monitoring is required for ADRs, so that certain percentage of ADRs can be prevented.

Clinical Manifestations Of Giardiasis In Iran

TAHERKHANI H*, SHARIATI S**, ABDOLAHI N***, ROSHANDEL GH****

Context: Giardiasis has multiple clinical manifestations and its prevalence is relatively high in the Hamadan province of Iran. Aims: This study was conducted to determine the most frequent clinical signs and symptoms of Giardiasis in the Hamadan province of Iran in 2006. Setting and Design: This was a descriptive cross sectional study. Methods and Material: Sixty four patients infected with Giardia were recruited. Anti-glidin anti-body and TTG tests were done to rule out celiac disease. Statistical Analysis Used: The data was entered into a computer and chi-square test was used for statistical analysis. Results: Out of total 64 cases, 26 were females. Giardiasis was most common in cases aged 16-20 years old (20.3%), in males (59.4%) and in patients with the educational status of primary school (31.25%). The most frequent symptom was abdominal pain (42.1%). Conclusion: We found that the clinical manifestations of Giardiasis are similar to that of other gastrointestinal diseases such as celiac. So Giardiasis should be considered as the most probable diagnosis in patients with gastrointestinal problems.

A Novel Approach To The Definitive Diagnosis Of Enzymopathies

APTE B. N.

Enzyme estimations are invariably carried out using synthetic chromogenic or fluorogenic substrates, which are structurally very simple as compared to the natural substrates. A defective enzyme resulting from mutation in the structural gene loses its activity on the natural substrates, leading to a genetic disease. Such an enzyme, at times, may still retain substantial catalytic activity on the synthetic substrate. If the enzyme activity falls within the normal range, the situation poses a problem in the diagnosis of the patient. To circumvent this situation, we have invented a novel approach which has enabled us to arrive at an unambiguous, definitive diagnosis of patients. Our novel approach will be presented here.

Effects Of Edible Oils In Type 2 Diabetes Mellitus

DINESHKUMAR B, MUKHERJEE S, PRADHAN R, MITRA A*, CHAKRABORTY C

The prevalence of Type 2 diabetes along with dyslipidaemia is increasing alarmingly in India and in some parts of South-East Asia. The causes of this malady are yet to be known though urban life-style and diet are considered to be the two most important factors. Indians are mostly lacto-vegetarians. The intake of fats and oils are less in the Indian diet. Edible oils act as important dietary sources of fats and oils. Some oilseeds are cultivated in India, while a portion is imported to satisfy the need of the population. Indians have a predilection towards fried items and a large portion of fat requirements are fulfilled through this habit. Oils have different biological effects in different conditions, especially in patients suffering from Type 2 Diabetes with dyslipidaemia. Hence, there is a need to have a comprehensive study of all these edible fats and oils in human beings, both in normal and in disease conditions. Our study highlighted the effect of different edible oils such as Sunflower oil, soyabean oil, sesame oil, groundnut oil, mustard oil, coconut oil, ghee and palm oil on humans and the results indicated that sesame oil has the most benefit, followed by mustard oil.

Pigmented Basal Cell Carcinoma – A Case Report

MARTIS JOHN J.S *, MARTIS J**, KAMATH G***, TAURO LF****, NAIK R*****

Basal cell carcinoma is the most common of all skin cancers and the most prevalent one among Caucasians (1). Pigmented basal cell carcinomas comprises 6% of all the basal cell carcinomas (2). We report here, a case of pigmented basal cell carcinoma in a 74 year old female.

A Rare Case Of Adenoid Cystic Breast Carcinoma In A 19-Year-Old Girl

AITHALA PS*, Rai RA**, SWETHADRI G K***, NAIK R****, KUDASOMANNAVAR R B*****

A 19-year-old-girl presented to us with a lump in the right breast. The FNAC of the lump was reported as a benign disorder. Wide local excision was performed and histopathological examination of the specimen revealed an adenoid cystic carcinoma of the breast. Subsequently, she underwent axillary nodal dissection which was found to be free of metastases. As adenoid cystic carcinoma breast has a favourable prognosis compared to other histological types, the specific characteristics and diagnostic criteria are to be adhered to, for early and accurate detection and subsequent management.

“A Case Of Malabsorption Syndrome (MAS) Due To Tropical Sprue”

SHAH V *,PATEL T**

Although tropical sprue is one of the common causes of MAS in Indian adults, it is mostly under diagnosed or misdiagnosed. Despite being easily treatable with tetracycline, inappropriate anti-tubercular treatment is most commonly given in tropical sprue. We report here, a case presented to our hospital, with recurrent diarrhoea, foul smelling stool and severe weight loss. Despite many antimicrobials, vitamins, oral and parenteral nutrition prescribed previously, the patient’s condition did not improve. We did some base line investigations and a small bowel biopsy. On account of the reports of all these tests, we presumed that his condition was tropical sprue and treated it with tetracycline for six months and followed him up regularly. He improved with therapy markedly.

Bowen´s Disease on the Anterior Abdominal Wall – A Case Report

MARTIS JOHN J. S.*, MARTIS J**, BHAT R M***, SHENOY D****.

Bowen’s disease is a squamous cell carcinoma in situ described in 1912 by John T. Bowen. It occurs predominantly in older individuals mainly on sun exposed areas. It affects both skin and mucous membranes and has the potential to progress into invasive squamous cell carcinoma. We report a case of Bowen’s disease on the lower anterior abdominal wall in a 68 year old female which was managed by wide excision and primary closure.

Osteoma Of The Frontal Bone: A Case Report

CHANDRA J*, PRASAD B R**, VEENA K M ***

Osteomas are slow growing benign tumours of osseous origin that can occur either superficially or intraosseously in any bone of the craniofacial complex. A case of an osteoma arising from the frontal bone of the skull and extending within the frontal sinus, is described here. The osteoma was treated using a surgical mode of management, after which the patient’s symptoms were relieved and there has been no recurrence of the lesion. This paper also discusses the various clinico-imaging features of the osteoma with a brief note on the surgical techniques.

Spigelian Hernia

GEORGE C *, TAURO LF **, DSOUZA C ***, HEGDE B R ****, KAMATH A *, RENT E***

Spigelian hernia is defined as a protrusion of a viscus or preperitoneal fat through a congenital or acquired defect in the spigelian fascia. Spigelian fascia is the part of the aponeurosis that lies between the semi lunar line and the lateral rectus muscle. Approximately 900 spigelian hernias, representing 1% to 2% of all abdominal wall hernias, have been reported in the world literature. Its true incidence is probably greater than the relatively small number of patients reported in the literature. The absence of typical hernia-type symptoms and the physician’s lack of experience with such hernias, make early recognition difficult. Ultrasound scan and CT scan can identify spigelian hernia. Surgical repair can be undertaken using either a direct approach, or laparoscopy. CT scan and laparoscopy help in early diagnosis and in avoiding complications. We report here, the case of a 63 year old female patient with a spigelian hernia who underwent open pre-peritoneal mesh repair.

Novel Aromatase Inhibitors

SHARMA R*, CHOPRA V S**, SHARMA C L***

Oestrogen receptors are expressed in 2/3rd of all breast cancers and the oestrogen mediated growth stimulation through these receptors causes the progression of hormone sensitive breast tumours. Tamoxifen has played a significant role in the treatment of metastatic and early breast cancers, as well as in preinvasive ductal carcinova in situ. The occurance of adverse effects like hot flushes, vaginal dryness, thromboembolism and endometrial cancer with the use of tamoxifen, together with the fact that some patients are refractory to treatment or may develop resistance, generated interest in the inhibition of oestrogen synthesis by aromatase inhibitors (AI) and inactivators . There are two types of AI- irreversible steroidal activators and reversible nonsteroidal imidazole-based inhibitors. The three novel third generation oral AI and inactivators like, anastrozole, letrozole and steroidal exemestane are very effective in reducing oestrogen levels in postmenopausal women, with minimum toxicity. Moreover, their long half life allows once daily administration, leading to better patient compliance. Inhibition of the aromatase system, in particular, with third-generation aromatase inhibitors and inactivators, appears to be associated with statistically significant improved survival of patients with advanced breast cancer, as compared to standard hormonal treatments. Introduction of the novel AI in the treatment of breast cancer has truly increased the hope of longer and better disease-free survival for these patients.

Framing Objective Criteria For Selection Of Medicines In A Nepalese Teaching Hospital: Initial Experiences

JHA N*, SHANKAR PR**, BAJRACHARYA O***, PIRYANI RM****

Inefficient and irrational use of medicines is a widespread problem at all levels of health care. (1) Per capita wastage from inefficiencies and irrational use tends to be greatest in hospitals. This is particularly worrisome, since resources are scarce and prescribers in the communities often copy hospital prescribers. Many of these sources of wastage could be reduced if some simple principles of drug management and use are followed. However, it is difficult to implement these principles because staff from many different disciplines is involved in different aspects of drug management and use. Often, there is no forum for these different disciplines to work together in developing and implementing appropriate drug policies.

Study Of The Hepatoprotective Activity Of The Ethanolic Extract Of The Pulp Of Eugenia Jambolana (Jamun) In Albino Rats

DAS S *, SARMA G **

Objective: To evaluate the hepatoprotective effect of the ethanolic extract of the pulp of Eugenia jambolana (EPEJ) on paracetamol (PCM)-induced hepatotoxicity in albino rats. Materials and Methods: Healthy albino rats (thirty in number) of either sex, weighing 100-150 gms, were randomly divided into five groups of six animals each. Group A (Normal control) and Group B (Paracetamol-treated control) received 5ml/kg/day of 3% gum acacia; Groups C and D received the ethanolic extract of the pulp of Eugenia jambolana 100mg/kg/day and 200mg/kg/day respectively and Group E received silymarin 100mg/kg/day. All formulations were given orally for ten days. Hepatotoxicity was induced in Groups B, C, D and E by giving a single dose of paracetamol (2gm/kg) orally on the eighthth day of the experiment. Liver function tests (serum levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total protein and albumin) and the histopathological examination (HPE) of the liver was done for all the five groups on the tenth day. Statistical Analysis: One-way ANOVA, followed by Dunnett’s multiple comparison test, were used for statistical analysis. Values of p < 0.01 were assumed to be significant. Results: Group B showed a significant (p<0.01) increase in all serum marker enzymes and total bilirubin and a significant (p<0.01) decrease in total protein, as compared to Group A. In comparison to Group B, Groups C and D showed significant (p<0.01) reduction in the serum levels of all liver enzymes and total bilirubin and an increase in the total protein. HPE studies showed fatty changes, necrosis and fibrosis in Group B, while in Groups C, D and E, histopathology was near normal. Conclusion: Thus, as revealed by the above study, the ethanolic extract of the pulp of Eugenia jambolana at 100 and 200mg/kg/day, possesses significant hepatoprotective activity in rats induced with hepatotoxin paracetamol.

In Vitro Assay Of Alpha Amylase Inhibitory Activity Of Indian Medicinal Herb Acalypha Indica

NIDDM Antidiabetic Activity Of Saponins Of Momordica Cymbalaria In Streptozotocin-Nicotinamide NIDDM Mice

FIRDOUS M**, KONERI R*, SARVARAIDU C H*, HARISH M*, SHUBHAPRIYA KH*

Objective: To evaluate the Type 2 anti-diabetic activity of saponins obtained from Momordica Cymbalaria in Streptozotocin–Nicotinamide Induced Type 2 diabetic mice. Materials and Method: Type 2 diabetes in BALB/c mice was induced by a single intra-peritoneal injection of Streptozotocin (100 mg/ kg, i.p), 15 min after the intra-peritoneal administration of Nicotinamide (240 mg/ kg, i.p). Hyperglycaemia was confirmed by elevated blood glucose levels determined on day 7 after the injection. The saponin mixture was obtained from the ethanolic extract of Momordica Cymbalaria. Saponins of MC (SMC) 175mg/kg,p.o/30 days and Metformin350mg/kg,p.o/30 days were administered to the Type 2 diabetic mice. At the end of the treatment, their serum was analyzed for glucose, cholesterol, triglycerides and insulin; The pancreas of each mouse was studied to check whether there were any histological changes. Result: Treatment of Type 2 diabetic mice with SMC (175mg/kg, p.o/30 days) and Metformin (350mg/kg,p.o/30 days) produced a significant fall in blood glucose (p<0.001), cholesterol (p<0.001), triglycerides (p<0.001) and an increase in the serum insulin level (p<0.001). Pancreatic islets and beta cells showed an increase in numbers. Conclusion: Saponins of MC have significant Type 2 anti-diabetic activity and the activity may be due to increasing insulin secretion, probably by the regeneration of pancreatic beta cells.

Image In Medicine- Laurence-Moon Bardet-Biedl Syndrome

SHAH V*

Altered Serum Total Sialic Acid, Lipid Peroxidation, Ceruloplasmin And Glutathione Reductase Levels In Patients With Carcinoma Of Prostate

SURAPANENI K M*, VISHNU PRIYA V**

Prescribing Practices Of Doctors In Rural And Urban India

SHARMA R *,KHAJURIA B **

Launch of “Flow Focus” – Clinical flow cytometry e-newsletter!

Dr Swaroop K Sood