Pramukh Swami Medical College

Karamsad, India

Pramukh Swami Medical College

Karamsad, India
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Dhanani J.V.,G K General Hospital | Chauhan L.N.,Pramukh Swami Medical College
Journal of Pharmacology and Pharmacotherapeutics | Year: 2012

Objective: To compare the efficacy and safety with a fixed dose of two parenteral iron preparations, iron sucrose complex and iron sorbitol citric acid as per the current practice. Materials and Methods: A prospective randomized open label study was conducted. In this study, 60 pregnant women with hemoglobin less than 8.5 g/dl received a fixed dose of either IV iron sucrose or IM iron sorbitol citric acid therapy. The efficacy of the therapy was assessed by laboratory parameters such as hemoglobin, hematocrit, MCV, MCH, and serum ferritin level after 14 and 28 days. To assess the safety, adverse drug reactions with both the therapies were recorded. Results: Hemoglobin concentration increased significantly (P < 0.001) with respect to time in both the groups. The rise in the hemoglobin level in third and fourth weeks was significantly higher in iron sucrose (0.92 g/dl) than iron sorbitol citric acid therapy (0.56 g/dl). There was no significant change in the rise of the serum ferritin level after both the therapies. Adverse events were common with iron sorbitol citric acid therapy. However, no serious adverse drug reactions were observed. Conclusions: No significant difference in the efficacy of both of the therapy. However, adverse events and dropout rates were much more common in the group of pregnant women who received iron sorbitol citric acid.

PubMed | Civil Hospital Campus, Pacific Medical College & Hospital and Pramukh Swami Medical College
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient.To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing.A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing.Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage.Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patients age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively.As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

Prajapati A.,Lambda Therapeutic | Ganguly B.,Pramukh Swami Medical College
Journal of Pharmacy and Bioallied Sciences | Year: 2013

Aim: Study was aimed to assess the accuracy of drug dose and its frequency in patients with renal dysfunction in a tertiary care hospital. Materials and Methods: This was a retrospective observational study. Patients > 18 years old, with the serum creatinine (SCr) level > 1.4 mg/dl were included. Drugs prescribed to these patients were recorded in case record form. Drugs for which the dose was adjusted according to the clinical response to therapy, not according to SCr level (i.e., angiotensin converting enzyme inhibitors, diuretics, B blockers, anti-diabetics, etc.) were not taken into consideration. Based on the creatinine clearance which was calculated by Cockroft-Gault formula, dose and frequency of prescribed drugs were assessed using «Drug prescribing in renal failure-dosing guidelines for adults, 4 th edition» and by another literature. Data was analyzed using Statistical Product and Service Solutions by IBM corporation version 17.0 software. Results: Total 278 indoor patients were screened, out of which 205 patients included. Total drugs prescribed to the patients were 1338 with the average of 6.53 drugs per patient. Out of these 180 (13.45%) drugs needed dose adjustment. Among them only 34 (18.89%) drugs were adjusted appropriately, and rest 146 (81.11%) were not adjusted. The most common group of drug that need dose adjustment was anti-microbials (144, 80%) with levofloxacin as individual drug. Conclusion: This study emphasizes the importance of patients with renal dysfunction and implementing appropriate dose adjustments. This study also suggests intervention such as on-line information to assist dose guidelines and participation of clinical pharmacologist could improve patient outcome.

Patel T.A.,Pramukh Swami Medical College
Indian journal of public health | Year: 2011

A cross-sectional study was conducted in a rural area of Anand District, Gujarat to measure the efficiency of immunization sessions and to identify the reasons for missing a vaccine in a session. Caregivers of infants aged less than one year and in need of any vaccine as per routine immunization schedule were interviewed by a house-to-house survey after immunization session was completed. Efficiency of immunization session was 66.7%. Reasons for 'missed' vaccination were prior reminder not given (32.9%, P<0.01); mother's forgetfulness (26.6%); unavailability of vaccine (15%). Higher birth order (OR=2.86; 3.16-2.56), mother's current residence at father's home (OR=3.17; 3.53-2.81) were associated with 'missed' vaccination. There are barriers in health care system such as lack of prior reminder and unavailability of vaccines which should be assessed and eliminated.

Gor A.P.,Pramukh Swami Medical College | Saksena M.,Pramukh Swami Medical College
Journal of Pharmacology and Pharmacotherapeutics | Year: 2011

Objectives: To identify the ADRs due to NSAIDs and to know how to monitor the drug′s effect. Materials and Methods: A descriptive study was undertaken in the Orthopedic Outpatients Department of a tertiary care teaching hospital. Hundred patients were enrolled in this study to observe the risk of adverse drug reactions (ADRs) due to NSAIDs. All the ADRs were further analyzed in relation to age and sex, type of drug and its pattern. Probability scale was used for the causality assessment of the ADRs. Results: 26% of the 100 patients developed ADR due to NSAIDs. There was not much of a difference in the number of the ADRs in relation to the gender. Diclofenac was the highest prescribed drug (65 patients), followed by paracetamol (12), nimesulide (10), ibuprofen (6), piroxicam (5) and Etoricoxib (2). Diclofenac accounted for the maximum number (73%) of ADRs, followed by nimesulide (16%), paracetamol (7%), and Etoricoxib (4%). Conclusion: Pharmacovigilance improves recognition of ADRs by the medical students. It allows the treating physician to identify the ADR associated with drugs, in particular, with the ones considered relatively safe and with those commonly prescribed by the medical and non-health professionals.

Gupta E.S.,Ruchi Hospital | Sheth S.P.,Pramukh Swami Medical College | Ganjiwale J.D.,Pramukh Swami Medical College
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Prevalence of Vitamin B12 deficiency has increased in community in recent time. Possibility is raised for new and yet unidentified factors being associated with this increased prevalence. One of these factors frequently questioned is use of Reverse Osmosis (RO) processed water for drinking. Aim: We aimed to study association of use of RO processed water for drinking with Vitamin B12 deficiency. Materials and Methods: This cross-sectional study was done at tertiary care centre of Western India. Total 250 participants were recruited after excluding those participants with known factors responsible for Vitamin B12 deficiency. Information about gender, type of diet, milk intake and duration, dairy product intake, use of RO water and Vitamin B12 level was collected. Results: Total 70 (28%) participants out of 250 were having Vitamin B12 deficiency. Forty (50.6%) of 79 participants using RO water were Vitamin B12 deficient against 30 (17.5%) of 171 using other sources. Logistic regression analysis showed independent association between use of RO water and Vitamin B12 deficiency. Although association of male gender, milk quantity of less than 100 ml per day and duration of RO water intake with occurrence of Vitamin B12 deficiency was found statistically significant in univariate analysis, logistic regression analysis did not show significant association. Conclusion: Use of RO processed drinking water was associated with Vitamin B12 deficiency. This being cross- sectional study, further longitudinal studies with large sample size and taking confounding factors into consideration, are required to establish this association. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.

Desai S.,Pramukh Swami Medical College | Lakhani J.D.,Pramukh Swami Medical College
Journal of Association of Physicians of India | Year: 2013

Aims and Objectives: To assess morbidity and mortality as well as to prognosticate the patients by using SOFA and APACHE II scores of patients with sepsis, severe sepsis and multi-organ dysfunction syndrome (MODS) in rural setup ICU. Material and Methodology: We carried out prospective study on patients with sepsis as per ACCP guidelines and analysed their clinical and microbiological profile. We calculated SOFA score on day 1, 3 and 7. APACHE II score was also calculated on day of admission. We used both the scores for predicting the outcome. Results: The mortality rate was 48% in our study group which had alarming proportion of MODS patients (78%). The most common organ involved was lung and the most common organism causing sepsis was Klebseilla. On day 3, the mortality rate of patients with SOFA score less than nine was 9.1%, while the mortality rate of patients with score more than nine was 78%. The trend of mean SOFA score was progressively declining in survivor group. The mean APACHE II score was marginally higher in non-survivor group compared to survivor group, however the difference was not statistically significant. Conclusions: Serial measurement of SOFA score during first week is very useful tool in predicting the outcome. The APACHE II score on day of admission was not reliable in predicting the mortality rate in this study and we believe that it may need modification in set up like ours. © JAPI.

Anjaneyan G.,Pramukh Swami Medical College | Gupta R.,Pramukh Swami Medical College | Vora R.,Pramukh Swami Medical College
National Journal of Physiology, Pharmacy and Pharmacology | Year: 2013

Background: ACDRs (Adverse cutaneous Drug Reactions) is a major problem in drug therapy and is one of the leading causes of morbidity and mortality in health care. Aims & Objective: To study the clinical pattern, most common offending drugs & relation between absolute eosinophil count & various ACDRs. Materials and Methods: The prospective observational study was carried out from April 2010 to March 2011 in the Dermatology department at a rural based tertiary care hospital in all patients irrespective of age and sex suspected of having drug reactions seen during the period of one year after taking their written consent. Results: Out of total 100 cases (51 males and 49 females), most common affected age group was 21-30yrs and most common presenting complaint was itching (37%). The most common ACDRs were maculopapular rash (25%) followed by fixed drug eruptions (23%) and urticaria (22%). Antimicrobials were the most common drug group incriminated in 54% followed by NSAIDs in 23% and anticonvulsants in 11%. Diclofenac, AKT, phenytoin and ciprofloxacin were the commonest incriminated drugs. Using the WHO guidelines for causality assessment, 9 were certain, 70 were probable and 21 were possible cases. Eosinophilia (AEC>500) was seen in 20% (15/74) cases. Conclusion: Physicians are expected to be well informed with common drug eruptions to diagnose them at the earliest, stop the offending drug and initiate the treatment at the earliest & also the patients should be counseled & educated regarding the importance of carrying the drug list.

PubMed | Pramukh Swami Medical College
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Fixed Dose Combination (FDC) is highly popular in the Indian pharmaceutical market and has been particularly flourishing in the last few years. Though rationality status is not clear, the pharmaceutical industry has been manufacturing and marketing FDCs.To assess rationality of FDCs enlisted in CDSCO list and marketing in India according to pharmacokinetic (FD) and pharmacodynamic (FD) reasoning and WHO rationality criteria.In this study, 264 FDCs marketed in India from 2009 to 2014 from CDSCO list 2014 were included. Assessment was done on the basis of following parameters: 1) Year and system of FDC; 2) Dosage form; 3) Number of Active Pharmacological Ingredient (API); 4) Schedule of FDC; 5) The presence of the FDC and its ingredients in the WHO Essential Medicine List 2013 and National Essential Medicine List, India 2011; 6) FD and PK parameters of APIs of combination; 7) PK and PD interaction; 8) Safety parameters of ingredients in combination. Descriptive statistics in terms of frequency counts and percentages were used for variables.Out of total 264 FDCs selected, maximum number of combinations (112) were approved in 2010. System wise selection showed 51 (19.31%) FDCs were from cardiovascular system followed by 46 (17.42%) from pain/musculoskeletal system. Oral dosage form was found to be maximum with 200 (75.75%) combinations. According to schedules, 154 (58.33%) combinations were categorized under schedule H. There were 210 (79.54%) FDCs that had two API which was found to be maximum, whereas, only 3 (1.13%) combinations had 5 API. We could find possible PK and PD interactions in between API of 10 (3.78%) and 73 (27.65%) combinations respectively on basis of standard textbooks and references. Similarly dose reduction in API was seen in 58 (21.96%) FDCs. There were 123 (46.59%) FDCs had chances of increased ADRs due to its API. Out of 264 combinations, 52 combinations were rational (6-9), 75 combinations were semi-rational (3-<6) and 137 combinations were found to be irrational (0<3).We could reveal that majority of combinations approved in last six years were found to be semi-rational and irrational. It is important to carry out detailed study in this area to establish the fact and increase rationality of combinations.

PubMed | Pramukh Swami Medical College
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Health Care Workers (HCWs) are at risk of occupational transmission of HIV, Hepatitis B and Hepatitis C, which can be minimized by following guidelines for standard precautions as well as taking Post Exposure Prophylaxis (PEP) measures. There are limited studies from India documenting details of PEP for HIV and Hepatitis B.We aimed to study the efficacy, tolerance, details of PEP regimens used among HCWs exposed to HIV and Hepatitis B as well as vaccination status and (Anti-Hepatitis B Surface Antigen) anti-HBS Antibody Titre Level Among HCWs exposed Hepatitis B.This retrospective observational study was done at a rural based tertiary care teaching centre of Western India.Hospital Infection Control Committee of our institute was maintaining a record of all reported incidences of HIV and Hepatitis B positive exposures since 2003. We analysed reported incidences of exposures to HIV and Hepatitis B positive source occurred during the period of January 2003 to December 2015.Of the total 96 exposures, 48 were to HIV and 48 were to Hepatitis B. Of the 48 exposures to HIV, PEP was warranted in 39. Of 39 exposures, only 14 (35.9%) received PEP within two hours. Basic regimen was used in 22 and expanded in 17 exposures. Only 12 (31.6%) reported side effects to PEP. Zidovudine based regimen was less well tolerated. All side effects were reported by female HCWs only. Of the 48 exposed to Hepatitis B, 33 (68.6%) were completely vaccinated. Out of 33, titre result was not available for eight. Three (12.0%) of remaining 25 were having low titre (<10mIU/ml) of anti-HBS antibody. Five of six with incomplete vaccination status demonstrated anti HBS antibody titre > 100mIU/ml. Of the 48, in 17 (35.4%) incidences no action was required; 23 (47.9%) were managed with booster dose of Hepatitis B vaccine and eight (16.7%) with Hepatitis B immunoglobulin. No cases of sero-conversion was reported either for HIV or Hepatitis B from available data.Inspite of high incidences of exposures to HIV or Hepatitis B positive source, good efficacy of PEP was observed with no sero-conversion. PEP for HIV was well tolerated; female HCWs were less tolerant. Study emphasized the need for creating awareness about timely reporting of incidence, achieving maximum vaccination against Hepatitis B for all HCWs and need for anti-HBS antibody titre.

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