Assessment of knowledge and practice of community pharmacy personnel on diabetes mellitus management in Kathmandu district: a cross sectional descriptive study

Background

Pharmacists are the most reachable healthcare professionals to many chronically ill patients. It has been found that pharmacists see patients with diabetes up to five times more often than any other healthcare provider. Therefore, to provide quality health care to patients it is important that they have appropriate knowledge and practice on diabetes mellitus management. Thus, this study was conducted to assess the knowledge and practice of diabetes mellitus management among community pharmacy personnel involved in retail community pharmacies of Kathmandu.

Methods

Three hundred and fifteen community pharmacies, selected by systematic random sampling were surveyed by using pre-validated self-administered questionnaires. The first set of questionnaire evaluated the community pharmacy personnel’s diabetes knowledge based on a pre-validated 20-item questionnaire. The second set of questionnaire documented about the practice of community pharmacy personnel on diabetes mellitus management which contained 22 questions. Data was entered in EPI Data and analyzed by using SPSS version 20.

Results

This survey demonstrated that 76.5 % respondents had poor knowledge and 86.4 % had negative practice on diabetes mellitus (DM) management. Only 26.2 % respondents had good knowledge as well as good practice. 31.4 % of respondents had poor knowledge as well as poor practice on DM management.

Conclusions

Laws and regulations regarding community pharmacy personnel need to be implemented. There should be more advanced and experiment based training. Additionally, the provision for further education curriculum in pharmacy education should be implemented which should intensively include disease and proper management. Guidelines covering diabetes care should be distributed and implemented throughout community pharmacies.

A cytomorphometric analysis of the oral mucosa in patients with type 2 diabetes mellitus

Background:  Although many of the pathological conditions of oral mucosa are clinically distinguishable, most lesions require a definitive diagnosis. This article tried the use of exfoliative cytology as an alternative tool in the screening, diagnosis and follow-up of diabetes mellitus.Materials and Methods: After rinsing the mouth with normal saline, slides were prepared from buccal mucosa and dorsum of tongue and fixed in 95% ethyl alcohol. The slides were stained with Papanicolaou stain and Acridine orange. Fifty clearly defined cells in each slide were visualized under light microscope for cytomorphometric analysis of cells using Image J software and under fluorescence microscope for assessment of nuclear alterations like micronuclei, nuclear budding, binucleation, multinucleation and karyorrhexis.Results: Statistically significant increase in Nuclear area BM (p = 0.000057), Nuclear Area Tongue (p= 0.0000113), total Nuclear Area (p= 000079), Cellular Area BM (p= 0.0475), Cellular Area Tongue (p= 0.0105), Total Cellular Area (p= 0.00496), Cytoplasmic Area Tongue (p= 0.00358), Total Cytoplasmic Area (p= 0.00268) were obtained from epithelial cells in the diabetic group when compared with the control group. Also the epithelial cells from the diabetic group showed features such as nuclear budding, micronuclei, binucleation, karyorrhexis and perinuclear halo. Conclusion:  The objective demonstration of cytomorphometric and nuclear alterations by the oral exfoliated cells indicate the presence of cytological changes in the oral mucosa of diabetic patients despite the apparently normal clinical appearance. Hence, cytomorphometric analysis would aid the health professional as an additional non-invasive tool for the screening and monitoring of Diabetes Mellitus.

Assessment of Candidal carriage in patients with Type II Diabetes Mellitus

Background: It is generally acknowledged that patients with diabetes mellitus are more susceptible to fungal infections, particularly with Candida albicans. Oral infection by Candida can result in a number of clinical lesions, including median rhomboid glossitis (central papillary atrophy), denture stomatitis, squamous cell carcinoma, Radiation therapy, immunocompromised status, etc. Different studies have shown that patients with diabetes mellitus have increased frequency of oral candidal carriage and increased risk of candidiasis, which is related to poor metabolic control, neutrophil dysfunction, reduced salivary flow, high glucose concentration in blood and saliva and in medications.Materials and Methods: Subjects of both the groups were given 10 ml of sterile normal saline and asked to rinse the mouth for one minute. The subjects were then asked to return the oral rinse in a sterile clean, broad-mouthed container which was capped, labelled and taken to the laboratory. The samples were then inoculated onto the culture medium (Sabouraud’s dextrose agar with Chloramphenicol) with minimal delay (within 6-8 hours of collection of oral rinse). Candidal colonies were counted and compared with non-diabetics.Results: Statistically significant increase in colony forming units (p=0.0324) were obtainedin patients with diabetes mellitus.Conclusion: The results indicate significant increase in colonization and carriage of candida in the oral cavity among diabetics when compared with non-diabetics. However, further research using larger samples is required which may lend credibility to the suggestion of increased candidal CFUs in diabetics serving as a surrogate marker of serum glucose levels.Journal of Pathology of Nepal (2015) Vol. 5, 733-738

Difficult journey from delivery to discharge, case of congenital diaphragmatic hernia

We report a case of congenital diaphragmatic hernia which was diagnosed prenatally for which surgical correction was done on second day of life. The child was discharged in 17 days and has resulted in good post repair condition of patient.

Prevention of Mother to Child Transmission (PMTCT) Program at Paropakar Maternity and Women’s Hospital: A Review

Aims: Vertical transmission from mother to fetus is the main route of HIVinfection among children. This study is an effort to review utilization of prevention of mother to child transmission (PMTCT) services by pregnant women seeking care in Paropakar Maternity and Women’s Hospital (PMWH). Methods: Case records of 165 pregnant women with HIV positive status who delivered at Paropakar Maternity and Women’s Hospital, Kathmandu from April 2005 to Dec 2011 were reviewed. Demographic profile of these women and interventions to prevent mother to child transmission (MTCT) including antiretroviral prophylaxis (ARV), mode of delivery, infant feeding practice as well as HIV status of their children were recorded. Results: Hospital records showed 109262 antenatal attendees and 120823 deliveries including 165 HIV infected women who delivered in this facility. Prevalence of HIV infection among antenatal attendees was 0.11 % and 0.13% in hospital deliveries. Migrant worker spouse (44.2%) was the main source of infection in their wives. Eighty eight (55.7%) out of 150 eligible women received ARV drugs and 97% babies received antiretroviral prophylaxis . Spontaneous vaginal delivery occurred in 60% women and caesarean section performed in the rest. While 60.8% women opted for exclusive breast feeding, remaining 39.2% chose formula feeding. For prophylaxis of opportunistic infection, Cotrimoxazole was given to 70.3% children. The incidence of HIV infection in babies born to HIV infected mother was 5.1%. Conclusions: Integrating PMTCT services into existing maternal and child health system can significantly reduce perinatal transmission of HIV infection to children. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11138 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 25-28

Bacterial Isolates and its Antibiotic Susceptibility Pattern in NICU

Background Neonatal sepsis is one of the major causes of morbidity and mortality among the newborns in the developing world. Objectives To determine the common bacterial isolates causing sepsis in neonatal intensive care unit and its antibiotic susceptibility pattern. Methods A one year discriptive prospective study was conducted in neonatal intensive care unit to analyse the results of blood culture and to look into the sensitivity of the commonly used antibiotics. Results The blood culture yield by conventional method was 44.13% with nosocomial sepsis accounting for 10.79%. 84.08% were culture proven early onset sepsis and 15.95% were late onset sepsis. Klebsiella infection was the commonest organism isolated in early, late and nosocomial sepsis but statistically not significant. Gram positive organisms were 39.36% in which Staphylococcus aureus was the leading microorganism followed by coagulase negative staphylococcus areus. Gram negative organisms were 60.64% amongst them Klebsiella was the most often encountered followed by Pseudomonas. The most common organism Klebsiella was 87.5% and 78.3% resistance to ampicillin and gentamycin respectively. Among gram negative isolates 87.5% and 77.2% were resistance to ampicillin and gentamycin respectively. Among gram positive isolates 58.5% and 31.5% resistance were noted to ampicillin and gentamycin respectively. Resistance to cefotaxim to gram negative and gram positive isolates were 87.34% and 59.35% respectively. Conclusion Klebsiella is most common organism which is almost resistance to first line antibiotics. Resistance to both gram negative and gram positive isolates among firstline antibiotics and even with cefotaxim is emerging and is a major concern in neonatal intensive care unit. DOI: http://dx.doi.org/10.3126/kumj.v11i1.11030 Kathmandu University Medical Journal Vol.11(1) 2013: 66-70

An assessment of candidal colonization and species differentiation in head and neck cancer patients receiving radiation

BACKGROUND

Oral colonization with Candida species has been observed in upto 93% of patients receiving radiation for head and neck cancer. With immunosuppression there is a trend of emergence of rare species. The present study aimed to assess species and colonization of candida at different stages of radiation therapy for head and neck cancer.

METHODS

Oral rinses of thirty cancer patients receiving a six weeks course of radiation therapy for head and neck cancer were taken at two intervals; first at the start of radiation (0 Grays), and second at completion of radiation (60 Grays). The oral rinse was streaked onto a differential media (CHROMagar®) plates and incubated at 37ºC for 48 hours. Colony forming units (CFU) were counted and species were differentiated. Fifteen healthy controls were compared.

RESULTS

The candida albicans colony count (CFU/ml) at baseline, 0 Grays radiation ranged from 50 to 1820 CFU/ml in cases and from 0 to 300 CFU/ml in controls. C. albicans was seen in all cases (100%) and most of the controls (86.66%). Other species such as C. Krusei, C. parapsilosis, C .tropicalis, and C. glabrata were observed with a frequency of 10%, 6.66%, 3.33%, and 3.33% respectively in the cases. However, no species other than C. albicans was observed in controls.

CONCLUSIONS

Immunosupression of radiation therapy patients led to the development of species other than Candida albicans, which is the most prevalent species. Thus it can be inferred that there is emergence of the opportunistic fungal pathogens in patients with immunosupression.

Oral Health Related Knowledge And Attitude Of Anganwadi of Mangalore City, India

Dental caries is a common childhood disease. Its prevalence can be reduced by integrating dental strategies into primary health care approach. Knowledge, attitude and practice of anganwadi workers in the subject of oral health is imperative in achieving this goal. This study was therefore conducted to assess the knowledge and attitude towards oral health among anganwadi workers of Mangalore city. A questionnaire study, using convenience samples was conducted among 159 angan­wadi workers of Mangalore city. A close ended questionnaire consisting of 20 questions was used. Details of age and quali­fication were recorded. The data was analyzed using SPSS 11.5. Only 45.9% of the anganwadi workers knew that dental caries was a disease, 57.2% knew that the best time to eat sweets was during meal time, 58.5% workers stated dentists as their source of oral health information. Almost all of the Anganwadi workers were positive towards the importance of oral health education and expressed their willingness to teach children how to brush properly and obliged to advise a child need­ing dental care to go to dentist. An anganwadi worker can be a vital link in the health care delivery system. There is a need to educate them on oral health in order to reach children at an early and receptive age. It is very important on the part of the health department to carry out effective programmes on oral health for anganwadi workers. Journal of Chitwan Medical College 2013; 3(4); 6-8 DOI: http://dx.doi.org/10.3126/jcmc.v3i4.9545