Neonatal infections currently cause about 1.6 million deaths annually in developing countries 1 . Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 -February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs.
Objective of this prospective study was to assess the acquisition of prescribing skill of preclinicalmedical and dental undergraduate students. Prescription writing skills of 258 students of both firstand second year of MBBS and BDS students were analyzed through an objective structured practicalexamination. MBBS student of second year scored 85.01% and 92.82% respectively in physician anddrug related component whereas first year MBBS students scored 89.9% and 83.4%. BDS studentof first year scored 91.96% and 86.33% in physician and drug related components which is betterthan second year that scored 83.33% and 77.94% respectively. This study revealed that the studentsof both courses acquire prescribing skills to a limited extent during preclinical phase. Prescribingerrors were found both in physician and drug related components. To minimize the different form ofprescribing errors vigorous training in the internship period will help to minimize prescribing errorsand improve rational prescribing too.Key words: dental, examination, medical, objective, prescription, student
BackgroundIrrational use of drugs as well as inappropriate and over drug prescribing leads to unnecessary expenditures and emergence of resistant bacterial strains. Feedback intervention on drug prescribing habits and face to face educational intervention of prescription audit would be effective in rationalizing prescribing practices. ObjectiveTo measure the impact of educational feedback intervention on the prescribing behavior of dental surgeons. MethodsProspective audit of twelve hundred outpatients prescriptions in dental OPD at BPKIHS of those dental surgeon who attended the educational intervention session was collected randomly by trained persons on customized data collection sheet before and after educational intervention. ResultsA total 1200 prescription were collected, 300 before and 300 after intervention period at the internal of one month, three months and six months. Majority of the prescriptions (39.33%) contained four drugs but after intervention, prescriptions contained mostly one drug, 73% in first month, 78.67% in third month and 65.34% in six month. Mean number of drugs per prescription after intervention were decreased. There was increased number of generic names of drugs after intervention. Amoxicillin, Metronidazole, Chlorhexidine, Povidone iodine gargle, Nimesulide, Ibuprofen, Ibuprofen + paracetamol, and Paracetamol were most commonly prescribed by dental prescribers before and after intervention. Selection of antimicrobial was done on empirical basis which was correct because Amoxicillin concentration reaches effectively in gingival crevicular fluid and Metronidazole covered effectively against anaerobic bacteria were found in orodental infection. The uses of topical anti-infective preparation as irrigants of choice that can kill majority of micro-organisms found is root canal and dental tubules and minimize systemic use of antimicrobials. Nimesulide prescribing needs to be rationalized. ConclusionFeedback educational intervention of prescription audit is effective to improve their prescribing behaviors and rationalize drug utilization pattern for the benefit of the patients.
Introduction:Newer anticonvulsants have a neuromodulatory effect on pain perception mechanisms in a hyperexcitable and damaged nervous system.Aim:This study was designed to study the analgesic effects of gabapentin alone and in combination with lamotrigine and topiramate in experimental pain models.Materials and Methods:Adult albino mice (n=490) weighing 20–30 g and rats (n=130) weighing 100–200 g were injected intraperitoneally with gabapentin, lamotrigine, and topiramate alone and in different dose combinations. The hot-plate method, tail-flick method, capsaicin-induced mechanical hyperalgesia, and formalin assay were used to assess the antinociceptive effects.Results:Of the three antiepileptic drugs, when given separately, gabapentin was more efficacious than either topiramate or lamotrigine in all the pain models. Combination of 25 mg/kg gabapentin with 25 mg/kg topiramate was more efficacious (P<.05) than 50 mg/kg gabapentin alone in the capsaicin-induced mechanical hyperalgesia test. Similarly, 50 mg/kg gabapentin with 50 mg/kg topiramate or 5 mg/kg lamotrigine was more efficacious (P<.05) than 50 or 100 mg/kg gabapentin alone in late-phase formalin-induced behaviors.Conclusions:Combination of gabapentin with either lamotrigine or topiramate produced better results than gabapentin alone in capsaicin-induced mechanical hyperalgesia test and in late-phase formalin-induced behaviors.
Background: Eugenol is an essential component of many medicinal herbs. It is a member of the allylbenzene class of chemical compounds. Since years, it is being used in dental practice to relieve pain arising from pulpitis and dentinal hypersensitivity. There are few reports of anticonvulsant effect but further effects are less reported. Lack of comprehensive studies and data of eugenol on the central nervous system effects in animal models thus necessitates further research activities. Objective: To observe and evaluate various neuropharmacological effects like antinociceptive effect, anticonvulsant effect, effect on motor co-ordination, pentobarbital induced sleeping time and anxiolytic effect of eugenol in mice and rats. Methods: It was a quantitative experimental study done in the laboratory setting of the department of Clinical Pharmacology and Therapeutics. For each test, respective animal models were used. Animals were divided into three groups of six each, group I as control, group II as standard control and group III as test group. Results: Significant effects were observed in analgesic, anticonvulsant and sedative model whereas no significant effect as compared to control was observed in test of motor co-ordination and in behavioral models. Conclusion: This study shows eugenol to possess analgesic, anticonvulsant and sedative effect whereas it didn't have any effect on models of anxiety. Various target sites have been implicated but this study doesn't conclude a plausible mechanism behind all these observed effects.
Cavernous haemangioma of the uterine cervix is extremely rare. Fewer than 50 have been reported cases to date. A nulliparous term woman presented with a sensation of "something coming out" of her introitus. The mass was found to be large, 8 cm in diameter, and arising from the uterine cervix. It was clinically diagnosed as a cervical fibroid. The mass was surgically resected and was sent for histopathological study. Grossly, it was a wellcircumscribed, greyish-brown mass, measuring 6 x 7 x 8 cm. From the biopsy, the diagnosis that was made was cervical cavernous haemangioma. The patient later delivered a child by Caesarean section. Although cavernous haemangioma of the uterine cervix in pregnancy is a rare entity, it should be kept in mind as a differential diagnosis by clinicians.
To find out the pattern of dental diseases and drug utilization at dental out patientdepartment (OPD) of B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiarycare hospital. A prospective prescription audit was conducted for a period of 10 daysin the dental OPD and the data was analyzed using WHO drug indicators. The totalnumber of prescriptions analyzed were 279. Dental caries (37%), Periodontitis (14%)and chronic gingivitis (11%) were the most common diseases with a maximum incidencebetween the age groups of 9 to 40 years. Mean number of drugs per prescription was2.79. Of the total prescriptions, 223 (79.9%) had 314 antimicrobial agents (AMA)constituting 40.3% of total drugs prescribed. The mean number of antimicrobial agentsper prescription was 1.13. The most commonly prescribed antimicrobial agents wasamoxycillin (33.1%) followed by metronidazole (24.9%), doxycycline (17.2%) andtinidazole (12.7%). Fixed dose drug combination of amoxycillin + cloxacillin (26) andampicillin + cloxacillin (10) were prescribed in 36 of the prescriptions. Povidone iodinegargle (41.2%) was the most commonly prescribed oropharyngeal preparation followedby Chlorhexidine gluconate mouthwash (32.4%). Non- steroidal anti-inflammatoryagents (20.66%), multi-vitamins (19.51%) and oropharyngeal preparations (17.45%)constituted the rest of the drugs prescribed. Diclofenac (60.86%) was the mostcommonly prescribed among NSAIDs and fixed dose drug combination of ibuprofenand paracetamol was prescribed in 19 of the prescriptions. All drugs were given byoral route (except for gentamicin in one prescription) and were prescribed underbrand names. None of the prescriptions had instructions whether the drug should betaken before or after food. The results indicate that dental caries was the most commondental disease, anti-microbial agents were prescribed to majority of the patients andconstituted a little less than half of the total drugs prescribed. Commonly used anti-microbial agent was amoxycillin which in two thirds of the cases was prescribed as anfixed dose drug combination. The high incidence of anti-microbial agent prescribingmay be modified by a feedback to the prescribers.Key words: Dental morbidity, prescribing pattern, drug utilization, dental OPD,antimicrobial agents.
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