Clinico-Epidemiological Characteristics of Healthcare Workers with SARS-CoV-2 Infection during the First and Second Waves in a Teaching Hospital from Eastern India: A Comparative Analysis

In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82, p < 0.001)]. Although, the prevalence of SARS CoV-2 infection and risk of being symptomatic was higher during second wave, the risk of hospitalization was less when compared with the first wave.

Screening of Weight-Loss Herbal Products for Synthetic Anti-Obesity Adulterants: A Target-Oriented Analysis by Liquid Chromatography-Tandem Mass Spectrometry

BACKGROUND

The medical and social impact of being overweight, as well as the difficulty in making long-term changes in diet, physical activity, and pitfalls associated with allopathic management, lure obese individuals to over-the-counter weight-loss herbal products (WHPs). However, the safety of herbals is questionable, as reports from all over the world suggest adulteration with synthetic weight loss agents. Objective: The present study was carried out to develop a rapid and sensitive method to screen potential weight loss adulterants in WHPs. Methodology: We procured 33 licensed brands of WHPs that are available in Puducherry (India) and through web stores. Drug-free spiked herbal matrices were used for internal proficiency testing. Spiked herbal matrices and samples were extracted and centrifuged. The supernatant was collected and subjected to liquid chromatography-tandem mass spectrometry analyses. Isocratic elution was carried out by the mobile phase of methanol: 0.1% v/v formic acid (70%:30% v/v) through a C₁₈ column. Analytes were monitored in electrospray ionization positive and negative modes, and an multiple reaction monitoring (MRM) scan was used. Results: Run time was 12 min. Intra- and inter-day precision was < 15% and recoveries were in the range of 99% to 115%. Limit of quantification (LOQ) of the analytes were in the range of 0.1 to 0.3 ng/ml. Conclusion: We developed a sensitive and rapid validated method for the detection of potential adulterants in WHPs. None of the WHPs analyzed were found to contain adulterants. The proposed method will be useful for routine monitoring. WHPs analyzed in this study were not adulterated indicating that WHPs from licensed sources are reliable.

Prevalence and predictors of potential drug-drug interactions in patients of internal medicine wards of a tertiary care hospital in India

Background

Drug-drug interactions are a major source of adverse drug events (ADEs). Polypharmacy, age and the number of comorbid conditions are important predictors of adverse drug interactions. ADEs account for up to 5% of hospital admissions per year and an increase in the length of hospital stay.

Objective

To find the prevalence and predictors of potential drug-drug interactions (pDDIs) in patients admitted to the wards of an internal medicine department of a tertiary care hospital.

Method

Patients admitted to internal medicine wards with prescriptions having more than one drug were selected. Demographic details including age, gender, number of comorbid conditions, number of drugs prescribed and the disease for which the patient was admitted were recorded in a case record form. Interactions were checked using Micromedex DrugReax software.

Results

A total of 939 patients were recruited for this study based on inclusion criteria. 433 prescriptions (46%) had one or more pDDIs, with a range of 1-13 drug interactions per prescription. A total of 1395 drug interactions were found, with 866 moderate drug interactions (62%), 435 major interactions (31.1%) and 89 minor interactions (6.3%). During the study period only three contraindicated drug combinations (0.2%) were recorded. A significant association (p<0.01) was found between the number of pDDIs and predictors, age and number of drugs.

Conclusion

A total of 433 prescriptions (46%) had one or more pDDIs. Older patients and those prescribed >6 drugs are at major risk for occurrence of pDDIs. Moderate severity interactions were the highest number followed by major severity interactions.

Comparative Effect of Divided Doses of Adult Solid and Liquid Oral Formulations of Antiepileptic Drugs in the Management of Pediatric Epilepsy

Objective:

To compare the differences in the efficacy and safety of the commonly prescribed AEDs in the management of epilepsy in children when using divided doses of adult solid oral formulations (DDSF) with the liquid oral formulations (LFs).

Materials and Methods:

Patients who had one or more seizures per month and prescribed with DDSF were recruited. Initially the patients were continued on DDSF for 4 months following which they were switched over to LF for the subsequent 4 months. Seizure frequencies and adverse drug effects (ADRs) were recorded every month for 8 months and plasma AED levels were estimated at the end of 4^th and 8^th months.

Results:

A total of 200 patients completed the study protocol. The median seizure frequencies per month with DDSF and LF were: partial seizures (20.5, 9.0; P < 0.001), generalized tonic-clonic seizures (6.5, 2.0; P < 0.001), myoclonic seizures (58.5, 29.0; P < 0.001). Mean plasma drug levels ± SD (μg/ml) with DDSF and LF were: sodium valproate (48.2 ± 13.7, 69.1 ± 16.3; P < 0.001), phenytoin sodium (5.0 ± 2.4, 12.8 ± 3.8; P < 0.001), carbamazepine (4.5 ± 2.0, 11.5 ± 4.8; P < 0.001) and phenobarbitone (14.1 ± 5.2, 25.4 ± 12.3, P < 0.001). The incidence of treatment emergent ADRs was poor scholastic performance (25.5%), behavioral problems and dizziness/sedation (21.0%), somnolence/sleep disorders (19.5%).

Conclusion:

Patients treated with LF had better seizure control and optimal therapeutic drug levels and less adverse effects when compared to DDSF.

National list of essential medicines of India: the way forward

Essential medicines lists have been shown to improve the quality and cost-effectiveness of health care delivery when combined with proper procurement policies and good prescribing practices. The Ministry of Health, Government of India revised the National List of Essential Medicines of India (NLEMI 2011) in June 2011, eight years after the last revision. The NLEMI 2011 contains 348 medicines and was prepared over one and a half years by 87 experts. Though there are some positive aspects to the list such as the documentation of a detailed description of the revision process, inclusion of many experts from various fields in the review committee, well written description of the essential medicines concept and others, a critical review of the list reveals areas of major and minor concerns. Improper medicine selection like the inclusion of a nearly obsolete medicine such as ether, an anesthetic agent; non-inclusion of pediatric formulations; spelling errors; and errors in the strengths of formulations diminishes the significance of the NLEMI 2011. In its present form, the NLEMI 2011 did not align with the Indian Pharmacopoeia, and the National Health Programs as well as the National Formulary of India 2010. Formatting errors, non-inclusion of an index page, syntax and spelling errors may also undermine the usefulness of the NLEMI 2011 as a reference material. An urgent revision of the NLEMI 2011 is suggested so as to avert misinforming the wider international and local readers.

Is there need for a transformational change to overcome the current problems with postgraduate medical education in India?

In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diploma course under the MCI has become unpopular and is largely a temporary refuge for those who do not get admission to degree courses. The level of skills of the outgoing graduate is falling and the increase in the number of seats is taking place in a haphazard manner, without reference to the needs. In spite of increase in seats, there is a shortage of specialists at the secondary and tertiary care levels, especially in medical colleges, to share teaching responsibilities. Further, the distribution of specialists is skewed, with some states having far more than others. To remedy these ills and fulfil the requirements of the country over the next two decades, a working group appointed by the erstwhile governors of the MCI was asked to suggest suitable modifications to the existing postgraduate system. After an extensive review of the lacunae in the present system, the needs at various levels and the pattern of postgraduate education in other countries, it was felt that a competency-based model of a 2-year postgraduate course across all specialties, the use of offsite facilities for training and a criterion-based evaluation system entailing continuous monitoring would go a long way to correct some of the deficiencies of the existing system. The details of the proposal and its merits are outlined for wider discussion and to serve as a feedback to the regulatory agencies engaged in the task of improving the medical education system in India. We feel that the adoption of the proposed system would go a long way in improving career options, increasing the availability of teachers and dissemination of specialists to the secondary and primary levels, and improving the quality of outgoing postgraduates.

Availability of five essential medicines for children in public health facilities in India: A snapshot survey

Objective:

To collect information on the availability of five essential children's medicines in the public health facilities of India.

Materials and Methods:

A snap shot survey of the availability of five essential medicines for children was conducted. Five medicines which are included in the National Rural Health Mission (NRHM) list for subcentres were selected, i.e., vitamin A liquid solution, syrup cotrimoxazole, oral rehydration salt (ORS), syrup paracetamol, and zinc sulphate (oral liquid or tablets). Information about this survey was posted in two e-groups for pharmacologists and pharmacists and volunteers were requested to collect data on the availability of these five medicines and fill up a data sheet which was emailed back to the organizers. Data was collected from February 14 to 21, 2010.

Results:

Data were collected from 129 public health facilities spanning 17 states, two union territories and NCT Delhi. The overall median availability was 80% (range: 0%-100%). Punjab, Tamilnadu, and Jharkhand showed 100% median availability (range: 40%-100%). Ninety percent of the facilities have ORS, paracetamol, and cotrimoxazole whereas zinc was available in only 36% of the public health facilities. Syrup cotrimoxazole and ORS have 100% availability in all states except in four and paracetamol has nearly 100% availability in all but six states.

Conclusion:

The availability of essential medicines for children in public health facilities is not satisfactory and needs to be improved.

Educational program for patients with type-1 diabetes mellitus receiving free monthly supplies of insulin improves knowledge and attitude, but not adherence

BACKGROUND:

Though patients attending a diabetic clinic in a tertiary care hospital were given free monthly supplies of insulin, it was found that their glycemic control was poor.

SETTINGS AND DESIGN:

A prospective interventional study was carried out at the outpatient clinic in a tertiary care hospital.

AIMS:

To evaluate the effectiveness of a six month educational interventional program on the knowledge, attitude and practices (KAP) of type-1 diabetic patients receiving free monthly supplies of human insulin and to assess their adherence.

METHODOLOGY:

Sixty-seven type-1 diabetics, receiving free insulin vials each month, were recruited. The patients' baseline glycemic index, plasma insulin and KAP scores were determined using a validated questionnaire. The patients were educated about the disease and use of insulin for the next six months. In the seventh month, the KAP questionnaire was readministered and blood parameters measured.

STATISTICAL ANALYSIS:

Blood glucose, glycosylated hemoglobin and plasma insulin were compared by paired t tests. Mean KAP scores by Wilcoxon matched-pairs signed-ranks test. Difference in the proportion of patients answering the items was compared using test of proportions for dependant groups.

RESULTS:

The overall mean scores (± SE) increased from 30.8 ± 0.5 to 42.2 ± 0.4 (P < 0.001). The improvement in practice scores, though significant, was marginal, that is, from 17.7 ± 0.3 to 18.8 ± 0.3. In three out of the ten items under practice domain, only the manner in which vials were being stored at home showed significant improvement (P < 0.0001). The adherence to the insulin regimen increased from 82 to 86%, but was not significant. Patients cited financial reasons for nonadherence.

CONCLUSION:

The study showed that a planned educational intervention in type-1 diabetics, receiving monthly supplies of insulin free of charge, did not improve the key aspects of the practice component, even though the knowledge and attitude improved.

Effect of temperature on the potency & pharmacological action of insulin

BACKGROUND & OBJECTIVE

Since proper storage of insulin is necessary for its action, the present study was undertaken to determine the extent to which improper temperature storage conditions could have contributed to the potency of the three insulin formulations tested.

METHODS

Two human insulin formulations (regular and biphasic) from three different manufacturers were stored at 5 different temperatures. In vitro potency of insulin was determined by high performance liquid chromatography on every seventh day for a period of 28 days. For the in vivo study, insulin tolerance test was done by injecting human regular insulin intraperitoneally to rabbits on the 25(th) day of storage. Blood glucose was determined at 0, 15, 30 and 60 min after insulin injection using glucometer.

RESULTS

Storage at 32 and 37 degrees C showed 14-18 per cent decrease in potency of insulin in both the formulations on 28(th) day for all the three brands. Also the rabbits receiving insulin stored in 32 and 37 degrees C did not show a significant decrease in blood sugar level when compared to those receiving insulin stored at 5 degrees C.

INTERPRETATION & CONCLUSION

Improper storage of insulin decreases the potency and hence the pharmacological action of insulin. Patients should be educated on the proper methods of storage, and free supplies of insulin for more than two weeks use should not be dispensed.

Study of the knowledge, beliefs, and practice of sleep among medical undergraduates of Tamilnadu, India

CONTEXT

Sleep-related problems are common in young adults who are enrolled in professional colleges due to academic and social pressures, which may subsequently have serious consequences.

OBJECTIVES

This study was conducted to find out whether final-year medical undergraduates possess basic, clinically relevant knowledge (K) regarding sleep and sleep-related problems and to discover their beliefs (B) regarding sleep and sleep hygiene. We also wanted to assess their sleep practices (P) and suggest remedial measures, if necessary.

DESIGN AND SETTING

Six hundred fifteen final-year medical undergraduates of both sexes belonging to 6 medical colleges of Tamilnadu state, India, were given a self-administered, anonymous questionnaire to test their basic knowledge (11 items), prevailing beliefs regarding sleep (including sleep hygiene [13 items]), and their sleep practices (6 items).

RESULTS

In all 3 domains tested (K, B, and P), there was no significant difference between sex. An appreciable percentage scored < or = 70% marks ("good") only in K and P (63.9% and 79.5% of all participants, respectively), whereas only a very small percentage scored "good" in B (9.1%). There was no difference in K, B, or P in terms of sex or domiciliary status except for a significant difference (P < .012) regarding beliefs between urban and rural groups. There was also no correlation between knowledge and beliefs or between knowledge and practice.

CONCLUSION

We conclude that future doctors have insufficient knowledge with more misconceptions (indirectly reflecting inadequate knowledge) regarding sleep. Hence, there is a compelling need to develop an educational strategy to overcome misconceptions and improve knowledge regarding sleep-related problems and proper sleep practices among students.

Academic dishonesty in Indian medical colleges

Integrity is a necessary attribute expected in practitioners of medicine. Unfortunately there is evidence on hand that academic dishonesty is widely prevalent in many Indian medical colleges and that a proportion of students seem to think that there is nothing wrong in participating in such acts. This practice needs to be discouraged as those indulging in unethical acts during student days are likely to indulge in similar practices while dealing with their patients. It is, therefore, necessary that teachers in medical colleges show 'zero tolerance' to such acts. There is a need for faculty and administrators to be above board in their actions and be role models for ethical behaviour. Hence, acts of academic misconduct committed by faculty and administrators should also be dealt with quickly, fairly and firmly. A milieu of transparency, fairness and student awareness will go a long way in minimizing this pervasive malady.

Effect of occupational noise on the nocturnal sleep architecture of healthy subjects

BACKGROUND & OBJECTIVES

Noise is considered to be a non-specific stressor which generally causes physiological and psychological effects in an individual. Many occupations involve workers being subjected to loud noise levels without adequate protective measures. The study was done to document the changes, if any, in the nocturnal sleep architecture of healthy persons exposed to loud occupational noise during daytime.

METHODS

The study was a retrospective cohort design wherein three groups of eight subjects each, exposed to continuous occupational background noise levels of >75dB for 1-2 years, 5-10 years and >15 years were selected. Corresponding age and gender matched healthy controls (eight for each group) who worked in a quiet atmosphere was also recruited. All night sleep polysomnography was done on all subjects. In the morning, subjects rated their quality of sleep on a Visual Analogue Scale.

RESULTS

There is a strong association between occupational exposure to loud noise and poor sleep efficiency (Relative Risk 2.49; Confidence Interval 1.12 to 5.57; P=0.01, Fisher's exact test). The group exposed to noise for 1-2 years had a decrease in Total Rapid Eye Movement Time, Non Rapid Eye Movement Time, Slow Wave Sleep Time, Sleep Onset Latency and Total Sleep Time. The other two groups showed lesser number of changes in sleep architecture. Subjectively there was a decrease for sleep continuity in Group I and an increase for sleep onset in Group II. There is no correlation between loudness of noise in the workplace and sleep efficiency.

INTERPRETATION & CONCLUSION

It can be concluded that workers exposed to loud background occupational noise are at an increased risk of having poor quality sleep but adaptation to this effect probably takes place after a few years.

Effect of occupational noise on the nocturnal sleep architecture of healthy subjects

BACKGROUND & OBJECTIVES

Noise is considered to be a non-specific stressor which generally causes physiological and psychological effects in an individual. Many occupations involve workers being subjected to loud noise levels without adequate protective measures. The study was done to document the changes, if any, in the nocturnal sleep architecture of healthy persons exposed to loud occupational noise during daytime.

METHODS

The study was a retrospective cohort design wherein three groups of eight subjects each, exposed to continuous occupational background noise levels of > 75dB for 1-2 years, 5-10 years and > 15 years were selected. Corresponding age and gender matched healthy controls (eight for each group) who worked in a quiet atmosphere were also recruited. All night sleep polysomnography was done on all subjects. In the morning, subjects rated their quality of sleep on a Visual Analogue Scale.

RESULTS

There is a strong association between occupational exposure to loud noise and poor sleep efficiency (Relative Risk 2.49; Confidence Interval 1.12 to 5.57; P = 0.01, Fisher's exact test). The group exposed to noise for 1-2 years had a decrease in Total Rapid Eye Movement Time, Non Rapid Eye Movement Time, Slow Wave Sleep Time, Sleep Onset Latency and Total Sleep Time. The other two groups showed lesser number of changes in sleep architecture. Subjectively there was a decrease for sleep continuity in Group I and an increase for sleep onset in Group II. There is no correlation between loudness of noise in the workplace and sleep efficiency.

INTERPRETATION AND CONCLUSION

It can be concluded that workers exposed to loud background occupational noise are at an increased risk of having poor quality sleep but adaptation to this effect probably takes place after a few years.

Effect of Acute Exposure to Loud Occupational Noise during Daytime on the Nocturnal Sleep Architecture, Heart Rate, and Cortisol Secretion in Healthy Volunteers

OBJECTIVES

Noise is one of the commonest physical stressors to which industrial workers are exposed. Many workers complain of symptoms associated with a non-specific generalized stress response, including disturbed sleep. However, industrial workers may be exposed to more than one source of stress and it is not possible to completely attribute the disturbed nocturnal sleep and changes in heart rate to the effects of loud noise alone. This study was done to find out whether acute exposure of healthy individuals to loud occupational noise during the daytime would cause changes in their nocturnal sleep architecture, heart rate during sleep and serum cortisol levels.

METHODS

Baseline polysomnography was done on ten subjects who were exposed for eight hours either to continuous occupational background noise levels of >75dB(A), or a quiet environment. Sleep polysomnography was done on the night prior to and after exposure. Blood was collected for serum cortisol estimation at night prior to sleep and in the morning after waking up. Statistical analysis was done by repeated measures ANOVA with Tukey's post test.

RESULTS

The sleep efficiency was less than 80% and the total time spent in Rapid Eye Movement (REM) sleep, Slow Wave Sleep (SWS) and the REM onset latency were significantly decreased on the night after exposure to noise. There was a significant increase in stage shifts. The percentage fall in heart rate during sleep was decreased compared to the baseline values. The serum cortisol levels in the morning after exposure to noise was significantly increased.

CONCLUSION

Workers exposed to loud background occupational noise react to the stress and show changes in nocturnal sleep architecture and heart rate which may be contributed to the exposure to noise.

Recruitment of subjects for clinical trials after informed consent: does gender and educational status make a difference?

CONTEXT

Researchers and investigators have argued that getting fully informed written consent may not be possible in the developing countries where illiteracy is widespread.

AIMS

To determine the percentage of patients who agree to participate in a trial after receiving either complete or partial information regarding a trial and to find out whether there were gender or educational status-related differences. To assess reasons for consenting or refusing and their depth of understanding of informed consent.

SETTINGS AND DESIGN

A simulated clinical trial in two tertiary health care facilities on in-patients.

METHODS AND MATERIAL

An informed consent form for a mock clinical trial of a drug was prepared. The detailed / partial procedure was explained to a purposive sample of selected in-patients and their consent was asked for. Patients were asked to free list the reasons for giving or withholding consent. Their depth of understanding was assessed using a questionnaire. Chi-square test was used for statistical analyses.

RESULTS

The percentages of those consenting after full disclosure 29/102 (30%) and after partial disclosure 15/50 (30%) were the same. There was a significant (p=0.043) gender difference with a lesser percentage of females (30%) consenting to participation in a trial. Educational status did not alter this percentage. Most patients withheld consent because they did not want to give blood or take a new drug. Understanding of informed consent was poor in those who consented.

CONCLUSIONS

The fact that only one-third of subjects are likely to give consent to participate in a trial needs to be considered while planning clinical trials with a large sample size. Gender but not educational status influences the number of subjects consenting for a study. Poor understanding of the elements of informed consent in patients necessitates evolving better methods of implementing consent procedures in India.

Predictors of nocturnal oxygen desaturation in chronic obstructive pulmonary disease in a South Indian population

CONTEXT

Nocturnal Oxygen Desaturation (NOD) in patients with chronic obstructive pulmonary disease (COPD) is associated with a poor prognosis.

AIMS

To document the occurrence of NOD in COPD and to identify factors which might predict NOD in COPD patients with daytime arterial oxygen tension (PaO2) > or =60 mm Hg.

SETTINGS AND DESIGN

This prospective study was conducted in patients attending the special respiratory clinics or admitted in JIPMER, Pondicherry.

METHODS AND MATERIAL

Thirty consecutive patients with COPD were divided into two groups, desaturators and non-desaturators on the basis of nocturnal oxygen saturation.

STATISTICAL ANALYSIS USED

Unpaired 't' test, Karl Pearson's correlation equation and stepwise multiple regression analysis was done.

RESULTS

Fourteen patients (46.6%) experienced NOD. Desaturators had lower awake oxygen saturation, PaO2, forced vital capacity, forced expiratory volume in one second and peak expiratory flow rate. There was positive correlation between nocturnal O2 saturation and PaO2 (r=0.638 and P value =0.014) and awake SPO2 (r=0.901 and P value <0.001).

CONCLUSIONS

The rate of occurrence of NOD in COPD was 46.6%. Awake SPO2 is the only single predictor of nocturnal oxygen desaturation in these patients.

Effect of hyoscine butylbromide and atropine on heart rate during nocturnal sleep

This is a single blind crossover study designed to test the effects of hyoscine butylbromide (HBB), an anticholinergic which does not cross the blood brain barrier (BBB), on the temporal changes in heart rate during nocturnal sleep. The effects were compared with atropine sulphate which is known to cross the BBB. Ten healthy male volunteers slept in the JIPMER sleep disorders laboratory for three nights and received either saline, atropine sulphate (0.4 mg, i.v.) or HBB (10 mg, i.v.) just prior to sleep onset. All night polysomnography recording was done to monitor heart rate during the specific stages of sleep. The normal physiological fall in heart rate is blunted by both drugs during slow wave sleep whereas only HBB prevented the fall in rapid eye movement sleep. Therefore, HBB may be a better choice as pre-anaesthetic medication for patients with cardiac abnormalities since it does not alter heart rate during both slow wave sleep and rapid eye movement sleep.

Comparative effects of hyoscine butylbromide and atropine sulphate on sleep architecture in healthy human volunteers

The changes in sleep architecture, heart rate and respiratory rate to hyoscine butylbromide (HBB), a peripherally acting anticholinergic was studied. These effects were compared with that of atropine sulphate, a drug known to cross the blood brain barrier. The study followed a single blind cross over design with a one week washout period. Atropine sulphate (0.4 mg) and HBB (10 mg) were given intravenously to ten adult healthy male volunteers before sleep onset. Normal saline was used as control. All night sleep polysomnography was done with the standard montage for sleep staging. Respiration and airflow were also monitored. Rapid eye movement (REM) latency was significantly increased with both the drugs whereas the duration of REM sleep was decreased only with atropine. Slow wave sleep (SWS) was also increased significantly by atropine. There was no change in heart rate, or respiratory rate during any of the sleep stages. HBB affects the initiation of REM sleep whereas atropine affects both its initiation and maintenance.

Effect of the Karnatic music raga "Neelambari" on sleep architecture

The raga Nelambari in the classical Indian Karnatic system of music is said to be able to induce sleep and also have some sleep promoting qualities. This hypothesis was scientifically tested using sleep polysomnography with eight healthy subjects who listened to either Neelambari (test) raga or Kalyani (control) raga. There was no difference in sleep architecture or in subjective feeling of quality of sleep. The anecdotal references to the quality of sleep promoting effects of Neelambari probably reflect a conditioned response since most lullabies in South India are sung in Neelambari raga.

Ascorbic acid delays the development of tolerance to amphetamine induced anorexia but does not affect the reverse tolerance which develops to the locomotor activity

Ascorbic acid (1 g/kg) accentuated anorectic and locomotor effects of amphetamine (5 mg/kg) and delayed development of tolerance to anorectic effect. On the contrary, it did not alter the pattern of reverse tolerance to increased locomotor activity. The results suggest that modulation of dopamine receptor sensitivity by ascorbic acid may be the reason for the delay in development of tolerance to amphetamine induced anorexia.

Drug utilization at primary health care level in southern India

Primary health centres provide health care to the majority of the population in developing countries. A drug utilization study was conducted for 1 y at two primary health centres in Pondicherry, India. Information on complaints, diagnosis and drugs prescribed was collected. From the 2953 prescriptions studied, it was found that on an average each patient received 2.71 drugs. Vitamins, antibiotics, analgesics and antihistamines were the most commonly used, accounting for more than 80% of the drugs prescribed. The antimicrobials which constituted one fourth of the drug consumption, comprised sulphonamides, tetracycline and cotrimoxazole. About half of the patients received injections, particularly of the vitamin B Complex and antibiotics. The results will be used to plan intervention strategies for the promotion of rational drug use.

Pharmacokinetics of single dose oral digoxin in patients with uncomplicated type II diabetes mellitus

Digoxin pharmacokinetics was studied in eight patients with uncomplicated type II diabetes mellitus and seven healthy volunteers. After a single oral dose of digoxin (1 mg), the drug concentration was measured in the serum collected at different time intervals, using a radioimmunoassay method. The diabetics had a higher serum concentration of drug when compared to control. The clearance rate of digoxin was significantly reduced in diabetics when compared to healthy volunteers. The elimination half-life of about 22 hours in both groups is much less than that reported in Western data. Possible reasons for this discrepancy are discussed.