Objective:Ketamine administration is known to induce hemodynamic pressor response and psychomimetic effects which could be attenuated by appropriate premedication. The present study was designed to evaluate the effect of midazolam on hemodynamic stability and postoperative emergence phenomenon following ketamine anesthesia.Methods:This was a prospective observational study including 30 adult patients with American Society of Anesthesiologists physical grades I and II scheduled for elective short surgeries under ketamine anesthesia. Patients were premedicated with midazolam (0.02 mg/kg intravenously) before the ketamine induction (1 mg/kg intravenously). Demographic data and hemodynamic variables were observed during the perioperative period. Pain score by visual analog scale score and psychomimetic effects were recorded postoperatively.Findings:The mean ± standard deviation of heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate were decreased postoperatively (85.3 ± 11.4, 120.7 ± 8.2, 79.2 ± 5.5, 13.5 ± 1.8, respectively) compared to intraoperative period (88.53 ± 14.1, 123.83 ± 13.8, 83 ± 9.1, 14.13 ± 2.0, respectively). There was statistically significant decrease in systolic (P = 0.03) and diastolic (P = 0.002) blood pressure, but not with heart rate and respiratory rate. Eighty percent of patients had no pain at ½ hour and 1 hour, while this increased to 90% at 2 hours postoperatively. Mild emergence delirium was noted in 13.3% and 16.7% at ½ hour and 1 hour, respectively, which decreased to 13.3% at 2 hours. Dreams were noticed in 20%, 27% and 10% of patients at ½ hour, 1 and 2 hours after surgery, respectively.Conclusion:Midazolam premedication in ketamine anesthesia effectively attenuated the hemodynamic pressor response and postoperative emergence phenomenon. Hence, the combination of midazolam with ketamine can be safely used for short surgical painful procedures in adults.

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a b s t r a c tAdverse drug reactions are a major hazard of modern medicine. Fixed drug eruption, which is a cutaneous adverse drug reaction, is commonly seen with antimicrobials and analgesics. Here we report 37-year-old female with bullous fixed drug eruptions due to doxycycline administration.

Fixed drug eruptions (FDE) are the common dermatological adverse drug reaction accounts for 16–21% of all cutaneous drug reactions in India. Drugs most frequently implicated in FDE are antimicrobials, anticonvulsants, and nonsteroidal antiinflammatory drugs. Here, we report a rare case of bullous FDE due to ciprofloxacin followed by ofloxacin administration.

Background: Drug utilization pattern in pregnancy population provide insights regarding drug profile and interventional measures and also minimizes the inherent risk occurring due to unethical prescription.Methods: It was a prospective cross sectional study where prescription slips were collected. Further drugs were categorized according to the classification defined by US Food and drug Administration for pregnancy. Using Pre validated questionnaire the pregnant women were interviewed and parameters regarding knowledge about antenatal visit and contraception, self-medication practices were noted.Results: Among the total 365 participants, 81.4% had finish their high schooling and were in reproductive age group of 22-25. Study revealed predominant usage category- A drugs in I (95.5%), II (97.8%), III (96.4%) trimester. None of them received Category D or X drugs. Almost 100% and 98.6% in III and II trimester respectively received iron. Other drugs prescribed were calcium, anti-emetics, anti-ulcer, NSAIDS and antimicrobial. The awareness about Intra Uterine Contraceptive Devices and Oral Contraceptive Pills were 48.2% and 31.5% respectively. Unfortunately only 4.9% felt that drug use could be dangerous to foetus. 58.9% were aware about antenatal examination during pregnancy.Conclusions: Evaluation of drug utilization pattern periodically will minimize incidence of risk to foetus and mother during pregnancy.

Background: Antibiotic resistance has become a global threat in the field of medicine. Multiple causes like antibiotic abuse, irrational usage of antibiotics, over the counter availability of antibiotics etc., have been put forth as culprit leading to antibiotic resistance. The present study aims at evaluating the knowledge, attitude and behaviour of antibiotic usage and resistance among undergraduates in South Indian teaching hospital.Methods: A cross-sectional, questionnaire-based survey conducted in undergraduate MBBS students including 5th to 9th semester at Department of Pharmacology. The questionnaire comprised off: Demographic data; Knowledge including 12 questions using Four-point likert scale; Attitude and behaviours consisting of 8 questions of Yes/No type. Data were analysed in the software SPSS version 24.0. Association among categorical variable were analysed with Analysis of variance (ANOVA) followed by post hoc Bonferroni test.Results: Among 455, 382 students completed the survey instrument and the response rate was 87%. Statistically significant (p=0.002) results have been obtained for the correct responses of knowledge questionnaire. The order of “good knowledge” about antibiotic usage and resistance according to semesters are graded as VIII>VI>V. Unfortunately, there were no significant results seen with attitude and behaviour.Conclusions: The study concluded that, though there was adequate theoretical knowledge among undergraduate students however they lack in their attitude and behaviour regarding antibiotic usage and resistance. Therefore, they need to improve their attitude and behaviour over antibiotic usage and resistance.

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