Vol 6, Issue 3, Jul-Sep, 2016

The World Health Organization (WHO) Global Atlas of Palliative Care at End of Life highlights a pressing need for palliative care services worldwide. For every 100,000 adults, 377 require palliative care at the end of life, totaling around 20 million individuals annually, with 69% being adults and 6% children. Predominantly, 78% of adults needing palliative care reside in low and middle-income countries, with non-communicable diseases such as cardiovascular conditions, cancer, and chronic obstructive pulmonary disorders being the primary causes. Similarly, 98% of children requiring palliative care are in low and middle-income countries. It's estimated that 37.4% of all deaths worldwide necessitate palliative care. Research indicates that early implementation of palliative care at the time of diagnosis can improve survival rates, demonstrating the potential to alleviate suffering and extend meaningful life for patients. In India alone, approximately 6 million people may require palliative care annually, with 60% of annual deaths attributed to prolonged suffering from advanced illnesses. Despite this significant need, only 1% of individuals requiring palliative care in India currently receive it. This situation is anticipated to exacerbate as the population continues to age, with a growing prevalence of incurable non-communicable diseases like cancer. Urgent efforts are required to address this escalating global health challenge and ensure adequate access to palliative care services for all in need.

Guillain—Barre syndrome (GBS) is the most common and severe acute paralytic polyradiculoneuropathy. Since its initial description by Guillain, Barre and Strohl in the year 19161 there has been a huge expansion in the knowledge of this potentially treatable disorder. 2016 marks the centenary year of GBS. It was conventionally described as an acute onset ascending pure motor demyelinating illness with areflexia. It has an annual incidence of 1/1000,000 across several studies.1 It can occur at any age with a slight male preponderance1 and with seasonal variations. 4 However with ever growing knowledge in last 100 years the clinical spectrum under this umbrella has also expanded and several subtypes based on histopathology and neurophysiology have emerged. The various forms of GBS are Acute Inflammatory Demyelinating Polyneuropathy (AIDP), Acute Motor Axonal Neuropathy (AMAN), Acute Motor and Sensory Axonal Neuropathy (AMSAN), Miller Fisher Syndrome(MFS).2 AIDP is the more common in the western world while AMAN is more common in Asian subcontienent (in Japan and China).1 Other variants like pandysautonomia, pure ataxic GBS, pharyngeal- cervical-brachial GBS, bibrachial onset GBS and isolated bulbar palsy2 have also been described. Few cases may have retained reflexes, positive babinski sign, papilloedema1 and transient bladder involvement.

Background: Researchers have described empathy as a cognitive attribute, which means it predominantly involves understanding another person’s concerns. It has also been described as an affective or emotional characteristic, which implies that it primarily involves feeling another person’s pain and suffering. Because empathic patient interactions by dentists are associated with improved patient outcomes, self-reported declines in empathy during dental student training are a concern. Aim: To measure empathy levels among 3rd year, 4th year undergraduate students and interns studying in dental colleges of Bangalore city and to investigate the differences in empathy scores based on gender and year of dental training. Methodology: A cross sectional descriptive research was undertaken among 800 dental students (3rd year, final year and interns) to measure the empathy levels using Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) questionnaire containing 20 items answered on a 5-point Likert scale (strongly agree, agree, neutral , disagree and strongly agree). The data was analyzed using SPSS 21. Results: Out of 800(100%) dental students, 300 (37.5%) were males and 500 (62.5%) were females with the mean age of males and females 22.93 ± 1.72 and 21.87 ± 1.28 respectively. The mean empathy scores with respect to age was more for 21-22 yrs whereas based on gender, empathy scores were more for males and there was not much difference found with the empathy scores with respect to fourth year students and interns. Conclusion: This cross-sectional study explored differences in empathy among dental student groups in the context of existing evidence that empathy declines as students progress through dental course. Key words: Dental, Empathy, Patients, Students, Under-graduates.

Introduction: Pseudomonas aeruginosa is a bothersome pathogen on the rise and prone to developing resistance during treatment. Hospitalized patients are especially prone to its detrimental effects. Aims: To determine the prevalence and antimicrobial susceptibility pattern of Mono therapy and combination therapy of Cefepime in Pseudomonas aeruginosa isolates obtained from patients at a tertiary care hospital in Karachi, Pakistan. Methods: This study was conducted at a university-affiliated, urban teaching hospital. During a 2-year period (January 2013 to December 2015), all hospitalized patients with a positive blood culture for P. aeruginosa were eligible for this investigation, amounting to a sample size of 634, and a cross sectional study was performed. Standard microbiological methods were used to identify the clinical isolates. The isolates were cultured on chocolate and MacConkey agar. Results: Throughout the duration of this study, 634 isolates of P. aeruginosa were cultured. Positive cultures were then tested against the following drugs: Cefepime, Meropenem, Amikacin and Ciprofloxacin. Cefepime was 76.2% (483) sensitive for isolates while the age and sex relationship analysis showed that isolates gathered from 0-18 year old females were 94.6% sensitive to Cefepime. Around 63.25% isolates were sensitive to the combination of Cefepime and Amikacin while the combination offering the least resistance was that of Cefepime and Ciprofloxacin (7.1%). Conclusions: P. aeruginosa isolates show a progressive trend of resistance to Cefepime. Cefepime when used in combination with Ciprofloxacin, potentially will be more effective than monotherapy with Cefepime. Key words: P. aeruginosa, Cefepime, B-lactam, Susceptibility pattern, Antimicrobials, Karachi.

Introduction: Bronchial asthma is a chronic airway disease that affects a significant children population with limitation of their activities and school absenteeism. The objective of the present study was to assess the knowledge and attitude of the parents towards the disease in their children. Materials and Methods: A hospital based cross-sectional study was conducted in Pulmonary Medicine department in a tertiary care hospital with diagnosed asthmatic children and their parents were enrolled. Two questionnaire one comprising clinical aspects including etiology and other regarding knowledge and attitude among parents regarding asthma were administered. Results: A total of 150 children with confirmed diagnosis of asthma were included in this study. On an average, each child had already visited 3 doctors prior to coming to us. Out of 150 patients, 77% parents were ignorant regarding disease etiology, 41% parents thought that their disease is fatal, 54% parents were reluctant to accept the diagnosis of asthma. Regarding precipitating factors, 46% parents attributed the disease exacerbations due to multiple causes. Almost half of the parents had sought alternative for of medicine for management of disease with nearly one-third opting for homeopathic treatment. Oral medications were preferred by 79% patients, while inhalers were used by only 21% of children. The compliance rate in using inhalation therapy in children was very low. Conclusion: Asthma awareness among parents of asthmatic children is inadequate. Controller medications and aerosol therapy is underused and unnecessarily blamed. Awareness raising strategies are needed in community. Patient education program should augment awareness; eliminate social stigma, and misconcepts in the community regarding bronchial asthma. Key words: Asthma in children, Asthma knowledge, Attitude, Practices, Parents.

Background: Practice of self-medication with over-the-counter (OTC) medicines is considered as responsible self-medication and is a topic of growing interest among researchers and health policy makers. Aim: The study aims to find the overall prevalence and factors associated with self-medication among adults in the urban area of Udupi taluk. Settings and Design: Community based cross-sectional study design in the urban area of Udupi taluk. Methods and Materials: In a community-based cross- sectional study, data was collected from 290 adults selected from each ward of urban area of Udupi taluk using single stage cluster sampling technique with proportional allocation method. An interview schedule was used for the collection of data. The data was analyzed using SPSS, version 15 (Chicago, IL). Results: The overall prevalence of self-medication use including allopathic, traditional, homeopathic medicines and home remedies in urban area of Udupi was found to be 35.9 %. (95% CI: 30-41).The various socio-demographic factors like age group, marital status, education and occupation as well as socio-economic status were found statistically associated with selfmedication ( p<0.05). Health-related characteristics like presence of health professional in the family, knowledge of OTC medicines and its responsible use were also found to be statistically significant ( p<0.05). Accessibility of medicines from the pharmacy without prescription (p=0.007), obtaining quick relief p=0.034 and avoiding crowds while visiting doctors p=0.041 were found to be statistically significant reasons for self-medication. Conclusion: Prevalence of self-medication in the urban area of Udupi taluk was comparable to other studies conducted in India. Self-medication as a practice is emerging as an important public health subject; however, the onus is on providing much needed health education and partnership with pharmacists to empower individuals to make informed decisions. Key words: Over-the-counter, Self-medication, Non-prescription, Prevalence, Medicines.

Objectives: To assess the usage of drugs during pregnancy in the OBG Department at a tertiary care teaching and research hospital in Bangalore city, India. Materials and Methods: Data was retrieved from participant’s (n = 250) case sheets of OBG department, on daily basis during a period of 7 months. Data was collected during their visit to the hospital and admission for safe confinement, which included demographic details, list of drugs taken, categorization of drugs based on USFDA, ATC and class of drugs were recorded along with the precautions that has to followed while taking these drugs. Results: Mean age was found to be 24.51 ± 3.81 years with 52% of participants having school level education, 91.21% were housewives, 32.4% had medical conditions, 76% of them practiced self-medication with 77.2% using OTC drugs, 1.2% of the study participants had diabetes mellitus before pregnancy and 4% developed gestational diabetes. Classification based on USFDA categorization as well as the Anatomical and Taxonomical Classification showed that majority of drugs prescribed in our study belonged to the USFDA Category B which are safe to be prescribed during pregnancy, such as anti-infectives (70.4%) followed by anti-diabetics (27.5%) and anti-anaemics (26.3%). Drugs belonging to the category X which are supposed to be contraindicated during pregnancy were not prescribed. Conclusion: Knowledge about consumption of drugs during pregnancy and its effect on the foetus is important. Hence, a pharmacist can play an important role in reducing the ill-effects of drugs by educating the women on self-medication and the use of drugs during pregnancy. Keywords: ATC classification, Bangalore city, Foetal health, Medication use, USFDA categorization.

Introduction: Assessment of drug use pattern using the World Health Organization (WHO) drug use indicators is a vital step to promote rational drug usage. The objective of the study was to assess the prescription format and adherence to WHO core prescribing indicators in urban health centre, Chetla. Methods: A descriptive, cross-sectional study was conducted to determine the current prescribing practices at Urban Health Centre, Chetla. Total 360 new prescriptions prescribed by doctors at outpatient department (OPD) were selected on 2 working days per week for a period of 3 weeks, i.e. total 6 working days using census method. Result: The average number of drugs prescribed per encounter or mean was 2.14(SD 1.058) and the percentage of prescriptions with an antibiotic or injection was 39.4% and 8.6% respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 69.3% and 85.5% respectively. Prescriptions prescribed with fixed dose combination were 46.5% and out of which 87% was approved by drug standard control organization, Govt. of India. Complete diagnoses in the prescriptions were written in 7.2% prescriptions only. Conclusion: On the basis of the finding of this study, the prescribing practices for antibiotic showed deviation from the standard recommended by WHO. Drug use evaluation should be done for some of the antibiotics to check whether they were appropriately prescribed or not. On the other hand, polypharmacy, generic prescribing and prescribing from EDL were also not as per WHO standard. Key words: Audit, OPD, Core prescribing indicators, Drugs by generic name, Essential drug, list, Fixed dose combination.

Introduction: The Indian textile industry is one of the largest in the world and accounts for 21% of the total employment generated in the Indian economy.1 The current burden of occupational health diseases is estimated to be around 18 million cases.2 Objectives: To study the pattern of diseases which are common among textile workers. Methods: A descriptive study was conducted among 179 women working in a textile industry in Puducherry. After obtaining informed consent, data was collected using a structured questionnaire. This was followed by systemic examination of Sensory systems (visual acuity testing using Snellen’s chart, hearing tests using Tuning fork), Respiratory system (using Peak Expiratory Flow Meter) and Musculoskeletal system (Straight leg raising test and others). Data was analyzed using SPSS version 19:IBM. Results: 70% of the participants belonged to the age group 21-40 years and more than half of the women were employed for 5-9 yrs. One fourth of the subjects had complaints of musculoskeletal problems such as joint pain, myalgia and chronic low backache. Respiratory infections and other complaints were also reported. Nearly 40% of the study subjects had myopia, 3% had abnormality in hearing and Peak Expiratory Flow Rate was reduced in 53% of cases. Conclusion: The present study shows that myopia is common among the workers, along with abnormal lung function, which indicates a need for, preplacement and periodic medical examination to rule out ophthalmic and pulmonary morbidities. Key words: Morbidity pattern, Female textile workers, Pondicherry, South India, Visual problems.

Background: Sikkim is a northeastern state of India, located in the Himalayas with migratory population from neighboring states and Nepal. Although there is high prevalence of human immunodeficiency virus (HIV) and Hepatitis B and C virus (HBV and HCV) in other northeastern states of India, currently, this information is lacking in Sikkim’s adolescent population, which inspired the researchers to conduct this study. Methods: This is a cross-sectional study with 490 adolescent participants between the age group of13–20 years. Schools/colleges and the participants were randomly selected. Blood samples of selected participants were collected after their interview and were tested for anti- HIV, hepatitis B surface antigen, and anti-HCV. Findings: Mean age of the participants was 16.96 years. Only 1 (0.2%) participant was positive for HBsAg, and none was positive for anti-HIV and anti-HCV. About 92 (18.78%), 90 (18.37%), 79 (16.12%), and 12 (2.45%) participants had respectively undergone tattoo/body piercing, invasive (medical) procedure, shared personal items, and had received blood transfusion but none of them provided information on their use of injectable drugs. A total of 33 (6.73%) participants expressed their involvement in heterosexual relation, of which 29 (29/215, 13.49%) were boys and 4 (4/275, 1.45%) were girls (p<0.01). Among them, 13(13/33, 39.39%) participants expressed their involvement with multiple sexual partners and16 (16/33, 48.49%) participants had taken protective measures. None of the girls provided history about their partner taking any protective measures. Interpretation: To the best of our knowledge, this is the first study reporting on the prevalence of HIV, HBV, and HCV in the adolescent population of Sikkim. Our results indicate that there is a very low prevalence of HBV and absence of HIV and HCV infections in the studied population. However, the studied population is at risk of acquiring these infections and therefore necessary steps must be taken to prevent the transmission of these viruses. Funding: Indian Council of Medical Research. Key words: HIV, HBV, HCV.

Aims: To demonstrate the DNA sequences of Acanthamoeba castellanii strain using molecular genomic DNA extraction and polymerase chain reactions. Materials and Methods: Genomic DNA extraction: Four 5 μm thick sequential sections were cut from the formalin-fixed paraffin embedded tissue sample. The micro-sections were placed in a micro-centrifuge tube. Sections were de-paraffinized using 300 μl of mineral oil and incubated at 90°C for 20 minutes to dissolve the wax. The tissue was digested with 50 μg/ ml proteinase K at 48°C and incubated overnight. Genomic DNA (gDNA) was extracted from the solution by adding an equal volume of chloroform/isoamyl alcohol (24:1) to the tube. The gDNA was determined using Nanodrop ND-1000 Spectrophotometer. Polymerase chain reaction (PCR) assay: PCR assay was carried out on the extracted gDNA to amplify a target sequence of 161bp using Bioneer AccuPower® PCR PreMix in a reaction volume of 20 μl containing 1U of Top DNA polymerase, 250 μM dNTPs, 10 mM Tris‑Hcl (pH 9.0), 30 nM Kcl, 1.5 mM MgCl2, 25 pmol each of the two primers—forward— Aca16Sf1010 (5’-TTATATTGACTTGTACAGGTGCT-3’) and reverse—Aca16Sr1180 (5’-CATAATGATTTGACTTCTTCTCCT- 3’) and the template DNA. Results: PCR analysis/sequence analysis and alignment: The amplification of the 16S small subunit ribosomal RNA gene produced an expected band, which is 161bp in size. A nucleotide BLAST search was carried out at NCBI to ascertain what the sequence was. The forward and reverse sequences showed great similarity with the same sequence as given by Acanthamoeba castellanii strain sequence ID: gb|AF479520.1| 16S small subunit ribosomal RNA gene. Conclusion: The high index of suspicion for Acanthamoeba species in this index case presenting histologically as granulomatous amoebic encephalitis was confirmed by molecular polymerase chain reaction as Acanthamoeba castellanii. Key words: Acanthamoeba castellanii, Granuloma, Amoebic Encephalitis, Polymerase chain reaction, Molecular analysis, Nucleotide sequencing.