Vol 7 Issue 1 April 2019-September 2019

Abstract: Breast cancer is ranked number one cancer among Indian females. Primary choice of treatment for cancer is chemotherapy and it is associated with toxic effects. Incidence and magnitude of adverse drug reactions (ADRs) in patients will differ accordingly.  Characterizing ADRs  can help in optimizing the treatment regimen.

Methods: Patients enrolled according to inclusion criteria.Assesed for incidence of ADRs and characterized the ADRs by using Naranjo Adverse Drug Reaction Probability Scale questionnaire, WHO-UMC causality assessment system questionnaire, ADR Severity Assessment Scale (Modified Hartwig and Siegel) questionnaire and ADR Preventability Assessment Scale (Modified Schumock and Thornton) questionnaire.

Result: A total of 96 patients were enrolled in the study. The most common ADR caused by Herceptin, Docetaxel, cyclophosphamide, 5- fluorouracil were Anorexia and the second most common ADR was discoloration of nail. Allergic reactions, pancytopenia and weakness were major in Epirubicin, carboplatin, Adriamycin, Paclitaxel and Gemcitabine. Majority of the ADRs were preventable, mild and possible.

Keywords: Adverse drug reactions, Chemotherapy.

Title: INCIDENCE AND CHARACTERIZATION OF ADVERSE DRUG REACIONS IN PATIENTS RECEVING CHEMOTHERAPY FOR BREAST CANCRE

Author: Alireza Agahi, Legimol PS, Binai k Sankar, Khalid PK, Pawan Gupta

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: A 5-year-old boy reports to the hospital for follow-up with a history of corneal injury. He was advised to get a dilated eye examination with 1% cyclopentolate hydrochloride eye drops instillation. After 15 minutes of the procedure, the mother noticed abnormal behaviour in the child. Upon admission to the emergency department with restlessness, carphologia, mouth opening, talking to himself and unresponsive to mother`s commands, his pupils were dilated 6-8mm with no reflex, heart rate was 100 beats/min, respiratory rate was 24 cycles/min. No convulsions, loss of consciousness, altered gait, fever. Serum glucose level and blood count were normal and no sensory deficits or cerebellar signs. Patient was referred to psychiatry department followed where he was identified with toxicity symptoms like delirium, hallucination, agitation, tachycardia, altered memory, pupils non-reactive to light. Since delirium symptoms gradually decreased, brain CT was not performed. The child was managed with intravenous fluid. Recovery was spontaneous within 8 hours. The pupils remained dilated for three days. He was discharged after 1 day.

Keywords: Cyclopentolate Delirium Toxicity Psychosis Mydriatics.

Title: Topical Cyclopentolate Induced Acute Psychiatric Side Effects in a Paediatric Patient

Author: Sunaina Sunil Anand

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Chorea is a movement disorder that causes involuntary, unpredictable body movements. Rheumatic Chorea (RC) is the most common form of autoimmune chorea and is also known as Sydenham’s  Chorea (SC). It often affects children over the age of 5 years and adolescence, characterized by uncoordinated movements, muscular weakness, stumbling and falling, slurred speech, difficulty concentrating and writing and emotional instability. A 13 years old male patient came with the complaint of involuntary movements of upper limb and lower limb, speech abnormalities and facial grimacing which are characteristic symptoms of Rheumatic Chorea.

This study points out the need for careful evaluation of such cases as it affects different organs and systems in the body. Careful clinical monitoring and appropriate supportive care can help to relieve the suffering of patients and improve their quality of life.

Keywords: Rheumatic Chorea, Sydenham’s Chorea, Autoimmune.

Title: CASE REPORT ON RHEUMATIC CHOREA

Author: Pawan Gupta, Sandhya Thapa, Sharon P Shaji

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: While maternal and child mortality in India is widely discussed and analysed subject, components of health system, historical approach of policy development etc., remain largely overlooked. The review article provides comprehensive insight of maternal and child health and also a holistic view of the health system components mainly associated with maternal and child health. Maternal and child health is discussed in terms of mortality rates and health systems is discussed based on 6 basic building blocks defined by World Health Organization (WHO); health infrastructure, health workforce, health information system, essential medicines and health finance. The article is based on information and data from national health surveys (NFHS, SRS, DLHS), peer reviewed research papers, government reports etc. Data was analysed at temporal as well as geographical scale to understand and explore the trends and state wise disparity in maternal and child health care status, services, infrastructure and finance in India.

Keywords: Maternal and Child health, Health system, spatial variation, India.

Title: A historical review and current perspective of Maternal and Child health in India

Author: Kranti S. Vora, Parth A. Tailor, Shahin Saiyed, Susanna Abraham Cottagiri

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Length of stay (LOS) is one of the most common predictors of increasing or decreasing medical and non-medical costs relevant to hospital care; higher the LOS is, higher will be the costs to the patients, their families and to the healthcare system. Reducing LOS saves hospitalization costs as well as intangible costs. The aim of the research was to analyze the factors influencing length of stay in hospitalized diabetes mellitus patients. In a 3-month-long observational study, 136 patients were studied. Demographic data, laboratory data and other relevant information were collected from patients’ case-sheets, prescriptions and by direct interaction with patients, physicians, nurses and carers. Follow-up was conducted on a daily basis. Average length of stay (ALOS) for 136 subjects was 8.2 days. ALOS was found to be higher in females (8.41 days) than in males (7.97 days). The study also indicated an increase in LOS with increasing age. For the age-group 20-39 years, ALOS was determined as 7 days and the same for the age groups 40 - 59 years, 60 - 79 years and 80 - 99 years were 7.4 days, 8.9 days and 19.5 days, respectively. Patients with single co-morbidity had a higher ALOS (8.77 days) than that of patients with multiple co-morbidities (7.3 days). Infectious diseases (p=0.0107) and cardiovascular diseases (p=0.0371) predicted higher LOS than other co-morbidities. Logistic regression analysis also revealed significantly high odds ratio for hepatic diseases. Hyponatremic patients exhibited a significantly higher ALOS (8.5 days) than patients without hyponatremia (7.6 days). The ALOS (13.25 days) for T1DM patients was found to be higher than other groups. Newly diagnosed cases of T2DM had a shorter ALOS (7.85 days) than known cases of T2DM (8.41 days). Patients receiving only insulin had a higher ALOS of 9.2 days, while patients receiving combinations of insulin and OHA had a shorter ALOS of 6.93 days. Clinical pharmacists are not only in charge of optimizing drug therapy for the patients, but they are responsible for improving health outcomes by studying non-therapeutic aspects of hospital care as well and suggesting or implementing appropriate changes in order to reduce the costs related to therapy and to improve mental and physical status of patients. The study demonstrates the importance of clinical pharmacist’s thorough examination of institutional factors, social factors and patient’s individual factors for achieving improvement in therapy and reduction in length of stay.

Keywords: Diabetes mellitus, hyperglycemia, length of stay, hospitalization.

Title: ANALYSIS OF FACTORS INFLUENCING LENGTH OF HOSPITAL STAY IN DIABETIC PATIENTS

Author: Niladri Chakraborty, Saroj Kumar Yadav, Danial Esfandiari, D Sai Harsha Vardhan, Dr. Kannan G

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Achieving optimal medication-taking behavior is of central importance in diabetes resolution. It is the result of a healthy collaboration between the healthcare provider and the patient. Social support plays a role in diabetes-specific quality of life and self-care activities. It encompasses multiple dimensions that differentially influence specific diabetes health-related outcomes and behaviors. Certain social support interventions are known to affect self-care activities and outcomes in diabetic patients. Social influences dictate dietary as well as medication-taking behaviors. They are of central importance in diabetes care. Having adequate understanding of adherence and social influences is vital for improving outcomes. This study was performed to assess medication adherence and social influences in diabetes inpatients.  A self-designed questionnaire was employed to assess medication adherence in patients previously diagnosed with DM, who were already on medication and to collect information related to social influences. The patients were identified from their case report forms. The patients previously diagnosed with DM or their carers were asked 5 questions for assessment of adherence to anti-diabetic medications prior to their admission to the hospital. For assessing social influences, the patients were asked 3 questions related to their family influences. Our findings emphasize on the need to conduct a serious intervention in drug use by improving patients’ compliance to physicians’ prescription. We encourage the use of novel techniques to mitigate the compliance problems in diabetic patients. 56% patients reported that one or more member(s) in their family apart from themselves had DM. 63.4% patients admitted that their family members were aware of their DM. 35.8% patients reported that their family members encouraged them to indulge in physical activity and diet control. It is necessary to counsel family members regarding the importance of early diagnosis of DM, the warning signs for DM and the need to indulge in regular exercise and diet control to prevent or mitigate DM.

Keywords: Self-care, medication adherence, diabetes mellitus, social influences, family influences.

Title: Assessment of medication adherence and social influences among hospitalized diabetic patients

Author: D Sai Harsha Vardhan, Niladri Chakraborty, Danial Esfandiari, Saroj Kumar Yadav, Dr. Kannan G

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Stevens-Johnson Syndrome (SJS) is a serious systemic allergic reaction with a characteristic rash involving the skin and mucous membranes including the buccal mucosa, conjunctiva, and genital areas. The incidence of SJS is estimated 1-6 cases per million person-years. The disease is included in the category of severe cutaneous adverse reactions (SCAR). A 43 years old male patient who was on phenytoin for seizure disorder since 6 months, presented with erythromatous rashes all over the body, conjunctivitis and mouth ulcers which are typical symptoms of SJS.

We hope that his case report helps to create awareness to the health care professionals as it highlights the importance of adopting vigilant approach while prescribing anti-epileptics.

Keywords: Stevens-Johnson Syndrome; Phenytoin; Hypersensitivity.

Title: CASE REPORT ON PHENYTOIN INDUCED STEVENS-JOHNSON SYNDROME

Author: Sandhya Thapa, Legimol PS, Sunaina Anand, Mr.Binai K Sankar, Dr.Vaishnavi Prasannan, Dr.Malini Muraleedharan

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Henoch Schonlein Purpura is the most common systemic vasculitis. In the majority of children, the outcome of Henoch Schonlein Purpura is excellent with spontaneous resolution of symptoms and signs. However, a small subset of patients will develop long term sequelae in the form of chronic kidney disease. HSP patients could have various clinical symptoms and rare complications knowing well the diversiform clinical features of HSP could help us to make the correct diagnosis and give right cure and nursing. This is a case of 6 years old female patient who came with chief complaints of red colour rashes over the lower limb since 20 days. She developed fever which was subsided in taking medication later she developed erythematous macule patches over the both legs B/L which was asymptomatic in nature and lesion gradually progress towards the proximal end involving the whole legs and thighs B/L. This condition is often treated with steroids as it modifies or stimulates hormone effects, often to reduce inflammation or tissue growth and repair. Supportive care like delivering fluids, medication or blood directly into a vein can be done.

Keywords: Henoch Schonlein Purpura; Rashes; Vasculitis; Children; Multiple Erythematous macular.

Title: A CASE HENOCH SCHONLEIN PURPURA-CASE REPORT

Author: Deepthi S A, Shree Harsha G

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Wolfram syndrome is a rare autosomal recessive disorder caused by mutations in WFS1, a gene implicated in endoplasmic reticulum and mitochondrial function. It is characterized by insulin-requiring diabetes mellitus and optic atrophy. An older name for the syndrome is  DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness). A 17 year old male patient, a know case of diabetes mellitus type I diagnosed 11 years back and significant for optic atrophy, diagnosed at age 11 which progressed to severe visual impairment over the following 6 years.

This study point up the need for careful evaluation of such cases having insulin dependent diabetes mellitus and optic atrophy. Wolfram syndrome affects different organs and systems in the body. Thus, multidisciplinary care by physicians and healthcare professionals from a range of disciplines is required. Careful clinical monitoring and supportive care can help relieve the suffering of patients and improve their quality of life.

Keywords: Wolfram syndrome; Optic atrophy; Diabetes mellitus; Deafness.

Title: A CASE OF WOLFRAM SYNDROME - CASE REPORT

Author: Glady Francis Mathew, Roshin Susan Gigi, Khalid PK

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Chronic obstructive pulmonary disease (COPD) is one of the major cause of disability and death all over the world.¹ COPD is a chronic disease which results in a progressive loss of airway function. According to World Health Organization (WHO) estimates, 65 million people have moderate to severe COPD. The major factors resulting in emergency hospitalization among COPD patients has been identified as poor adherence to medication and disease management programs. Adherence is crucial for optimizing clinical outcomes in COPD, with nonadherence resulting in a significant health and economic burden. AIM: To assess the medication adherence and to identify the problems associated with the use of Inhalers in COPD patients. METHODOLOGY: This study was an observational study conducted over a period of 6 months in a tertiary care hospital setting. Patients admitted in inpatient ward were involved in study and were briefed about the study and consent was obtained to participate in the study. Morisky Green Levine Medication Adherence Scale (MGL) and Test of Adherence to Inhalers (TAI) questionnaires were used in the study. RESULTS: A total of 92 patients participated in the study among which majority were male patients. The mean age of the study population was 65.35±9.67 years. MGL medication adherence scale showed that majority of patients had medium adherence (71, 77.17%) followed by low adherence (14, 15.21%). When the level of adherence and type of non-compliance to inhalers was assessed using the TAI questionnaire, result showed that majority of patients had poor adherence (68, 77%) and unconscious non-compliance (81,39%). CONCLUSION: Lack of medication adherence needs to be identified and addressed by using simplified treatment regimens, increasing patient knowledge about self-management, and enhancing provider skills in patient education, communication, and adherence counselling.

Keywords: COPD, Adherence, Inhaler.

Title: EVALUATING MEDICATION ADHERENCE AND INHALER USE IN COPD PATIENTS

Author: ROSHIN SUSAN GIGI, JEMMY JERRY JOHN, GEORGE MICHAEL, AZAM PIRI TAKBOLAGH, Dr. SAMBHU RAMESH

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Takayasu arteritis, also known as pulseless disease is a chronic inflammatory arteritis affecting large vessels, mainly the aorta and its main branches. Current incidence status reveals 106 patients over 16 years in India. The most common clinical findings are bruit, Hypertension, weak or absent pulses in extremities, widely varying blood pressure and dizziness. A middle aged women presented with complaints of giddiness, fever, and generalized body ache at multiple points, generalized weakness and visual disturbances. She meets all the criteria for diagnosis of takayasu arteritis (TA) and treated with specific treatment for TA and preventive medications of complications.

Title: CASE REPORT ON TAKAYASU ARTERITIS

Author: Legimol ps

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Epilepsy is a chronic disorder of the brain that affects people worldwide and most common pediatric neurological disorder. The incidence of seizures is highest, 5 % of children experience convulsion during the first 5 years of life, with decreasing frequency in older age. Parent’s attitude and practice towards children with epilepsy are greatly influenced by the degree of their knowledge. Seizure in childhood may interfere with familial life, sleep and social life of parents, imposing tremendous stress and anxiety of parents. AIM: To evaluate knowledge, attitude and practice of caregivers in children with epilepsy towards the health condition. Methodology: This is a cross-sectional observational study conducted for a period of 6 months in a tertiary care hospital setting. The caregivers of the patients were briefed about the study and consent was obtained to be recruited in the study. A structured 31-item questionnaire was designed to examine knowledge, attitudes and practice towards children with epilepsy. Results: A total of 86 caregivers were enrolled in the study based on the inclusion and exclusion criteria, out of which 52% were female and 48% were male. The mean age of our study subjects was found to be 9.30 ± 4.63yrs. The factors like family history, birth order, type of seizure were assessed in our study. Assessment of knowledge, attitude and practice were done using self-designed questionnaire. On an average their quantum regarding the disease was found to be as knowledge 54%, attitude 69%, practice 76%.  CONCLUSION: Most of the caregivers are unaware of the exact risks associated with epilepsy. Even though considerable respondents had satisfactory knowledge, attitude and practice regarding epilepsy, many of them don’t seek appropriate preventive or corrective measures due to various factors.

Keywords: Parent; Knowledge; Attitude; Practice; Child; Pediatric; Epilpesy.

Title: ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF CAREGIVERS IN CHILDREN WITH EPILEPSY

Author: Harsha Vardhan Reddy A, Tezan Karki, Deepti, Dr. Sambhu Ramesh, Dr. Suhas Reddy C

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Diabetes is the most common form of hereditary condition and can develop at any age. Physiotherapists have been exploring different forms of exercise intervention, like balance exercise, resisted exercise, aerobic exercise. Despite the number of studies showing evidence on particular intervention towards outcome measure, evidences are still needed for proving usefulness of balance training as a treatment for of diabetic patients.

Objective: To evaluate the efficacy of exercise intervention with improving balance in patient with diabetes.

Intervention: 51 individuals with diabetes were included and allocated to three groups (n=17). Groups were administrated with Resisted exercise, Balance exercise along with Conventional therapy and Conventional therapy alone for 4 weeks (5 days per week). Functional Reach Test Score and Balance Evaluation Test Score were used to assess changes between baseline and post intervention.

Results: The Control group (Group C) was associated with significant greater changein balance than Group A and Group B. The Scores of the functional reach test, have shown a significant change in all the three groups with (p < 0.05) but, the changes in scores of BES Test were not significant.

Conclusion: There was no additional effect of adding resisted therapy or balance therapy over conventional therapy on improving balance in Diabetic population.

Keywords: Diabetes, Balance, Diabetic Neuropathy, Functional Reach Test, Tuning fork, Romberg Test, Resisted Exercise, Balance Exercise, Balance Evaluation System Test.

Title: COMPARATIVE OF BALANCE EXERCISE AND RESISTED EXERCISE VERSUS RESISTED EXERCISE IN PATIENT WITH DIABETES TO IMPROVE BALANCE AND QOL (QUALITY OF LIFE)

Author: DR. NENSI VAIBHAV GANDHI

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: While maternal and child mortality in India is widely discussed and analysed subject, components of health system, historical approach of policy development etc., remain largely overlooked. The review article provides comprehensive insight of maternal and child health and also a holistic view of the health system components mainly associated with maternal and child health. Maternal and child health is discussed in terms of mortality rates and health systems is discussed based on 6 basic building blocks defined by World Health Organization (WHO); health infrastructure, health workforce, health information system, essential medicines and health finance. The article is based on information and data from national health surveys (NFHS, SRS, DLHS), peer reviewed research papers, government reports etc. Data was analysed at temporal as well as geographical scale to understand and explore the trends and state wise disparity in maternal and child health care status, services, infrastructure and finance in India.

Keywords: Maternal and Child health, Health system, spatial variation, India.

Title: A historical review and current perspective of Maternal and Child health in India

Author: Kranti S. Vora, Parth A. Tailor, Shahin Saiyed, Susanna Abraham Cottagiri

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Moringa oleifera Lam. is a multiuse tropical tree that is used for food, medicine. and several other purposes. Almost all the parts of this plant: root, bark, gum, leaf, fruit, flowers, seed and seed oil have been used for various ailments in indigenous medicine. Some part of the moringa plant is reported to possess a recombinant protein in it. The seed for instance is able to flocculate Gram-positive and Gram-negative bacteria cells. The seed could also act directly on microorganism by being bacteriostatic. Moringa contains antimicrobial peptides that could disrupt the cell membrane or inhibit essential enzymes in microorganism. In this study, the active agents in the leaves and roots were extracted with both ethanol and water. The extracts were then tested for antibacterial activity using the agar well diffusion method. MIC was determined by the tube dilution technique and their activity determined. The phytochemical ethanol extract was found to contain Spirochin, Moriginine, Catechol Tannins, Steroids and Triterpenoids, Saponins, Anthraquinones, Alkaloids, Reducing sugars, Pterygospermin in different concentrations. The Aqueous extract yielded Spirochin, Moriginine, Saponins, Anthraquinones, Alkaloids, Reducing sugars, Pterygospermin. The Moringa oleifera stem and root extracts demonstrated a strong antimicrobial property against all the tested clinical isolates (Klebsiella pneumonia, Pseudomonas aeruginosa, Escherichia coli and Candida albicans). The plant extract also showed antimicrobial activity against all the test organisms, with the zones of inhibition ranging from 5-28 mm in diameter at varying concentrations.  The fungi (Candia albicans) was more susceptible to the extracts with a zone of inhibition of 28 mm and remarkably better than ciprofloxacin, the positive control with a zone of inhibition of 25 mm on the Candida albicans.  In this study, the root extracts of Moringa oleifera had a better effectiveness than the stem while exhibiting high antimicrobial potential on both fungi and bacteria.

Keywords: Phytochemical Analysis, Antimicrobial Effects, Moringa Oleifera, Plant Extracts, Clinical isolates.

Title: Comparative Antimicrobial Effects of Ethanolic and Aqueous Extracts of the Stem and Root of Moringa oleifera on some Clinical Isolates (Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Candida albicans)

Author: Akpoka A. O., Erifeta G., Akinyeye A. J., Solanke E. O., Izevbuwa, O. E.

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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