Aims:Envenomation with poisonous snakes is associated with considerable morbidity and mortality. The present study was undertaken with the objectives of assessing anti-snake venom (ASV) use, early adverse reactions to ASV, premedication and clinical outcomes in snake bite patients. Association of various risk factors (age, gender, dose of ASV, time gap between snake bite and ASV administration, use of mechanical ventilation and type of snake bite) with mortality was also assessed.Settings and Design:This retrospective study was conducted at two Tertiary Care Teaching Hospitals.Subjects and Methods:The medical records of 176 patients of snake bite with documented use of ASV were retrospectively analyzed to retrieve relevant data.Statistical Analysis:Descriptive statistics was used to express results about ASV use, early adverse reactions to ASV, premedication and clinical outcomes. Univariate and multivariate analysis was performed to find out significant risk factors associated with mortality.Results:The main indication for ASV was vasculotoxic snake bite (75%) followed by neurotoxic snake bite (16%). Mean dose of ASV was 18.63 ± 14.52 vials. Prophylactic premedication with corticosteroids alone or in combination with antihistaminic was used in more than 70% patients. Early adverse reactions to ASV were seen in 4% patients. Neurotoxic snake bite was a significant risk factor associated with mortality in multivariate analysis.Conclusions:Neurotoxic snake bite is an independent predictor of mortality in snake bite patients. Currently used polyvalent ASV may be less effective in treating neurotoxic snake bite.

Background: High-risk pregnancy is an important determinant of drug use during pregnancy. The aim of study was to evaluate drug use pattern according to WHO core-drug prescribing indicators and US-FDA pregnancy category in indoor patients of high-risk pregnancy. Methods: It was a prospective, observational study. All high-risk pregnant women admitted to tertiary care hospital and willing to give consent were included. The data was collected from 290 patients over 12 months. The data was analysed to evaluate drug utilization according to WHO core drug use indicators and in relation to US-FDA pregnancy risk category. Results: The study found that 74.82% of women were between 20-30 years of age and were admitted during third trimester of pregnancy. The most commonly prescribed drug class was vitamins and minerals prescribed in 82.75% patients. Average number of drugs per encounter was 6.4. Percentage of drugs prescribed by generic name and from essential drug list was 73.07% and 77.07% respectively. Percentage of encounters with an antibiotic and an injection prescribed was 29.31% and 65.17% respectively. The prescription of drugs belonging to US-FDA pregnancy drug categories A, B and C were 92.06%, 86.55% and 4.82% respectively. Conclusions: Overall, the principles of rational prescribing were followed according to the various drug use indicators mentioned by the WHO and US FDA pregnancy risk category. Further studies are required to find out specific drug or drug therapy related problems and plan targeted interventions to improve drug use.

Background: Self-medication is common in medical students but few studies address the concern regarding knowledge of adverse drug reactions (ADRs) among them. None of the study compares the practice of self-medication among the same medical students as their level of education increases. Hence the study was planned to compare the pattern, source, reason of self- medication and assess the level of awareness about potential ADRs to the consumed drugs in medical students during second year through their internship.Methods: It was a longitudinal cross sectional questionnaire-based study conducted among under graduate second year MBBS students of a medical college and repeated during their internship few years later in order to avoid variability in questionnaire. Chi-square and Fischer’s exact test were used for testing statistical significance. p value less than 0.05 was considered to be statistically significant.Results: 80 students were present on the day of study during their IInd MBBS and 73 students during their internship. Comparatively more students self-medicated during their internship than during their IInd MBBS (68% vs 55%). Analgesics (56.8% and 80%) were most commonly used. 35(70%) of interns were aware of potential ADRs and was statistically very significant in comparison to their awareness during IInd MBBS [9(20.45%)]. Interns rely more on themselves (96%) for self-medication.Conclusions: The practice of self-medication begins early in the career of medical students and is carried forward into their future. Hence it is imperative to educate students regarding responsible self- medication very early in their curriculum.

INTRODUCTIONHypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality.Globally hypertensive disorders of pregnancy complicate approximately 5-10 % of pregnancies.1 Incidence of hypertensive disorders in India is found to be 10.08. 2According to The American College of Obstetricians and Gynaecologists (ACOG) practice bulletins, hypertensive disorders of pregnancy are classified as chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed upon chronic hypertension and gestational hypertension. Methods: This prospective, observational study in a tertiary care hospital was conducted in 150 pregnant women with hypertensive disorders of pregnancy from January 2014 and December 2014 who fulfilled the inclusion criteria. Antepartum and intrapartum care and the maternal and perinatal outcome were noted. The data was analyzed to evaluate clinical outcome and drug utilization according to WHO core drug use indicators. Results: Gestational hypertension was most common among hypertensive disorders of pregnancy seen in 62/150 (41.3%) women. The most common symptom was headache (48%) while sign noted was edema (69%). A total of 66% women had preterm delivery and 42% babies weighed less than 2.5 kg. Average number of drugs per encounter was 9.7. Percentage of drugs prescribed by generic name and from essential drug list was 64% and 79% respectively. The most commonly used drugs were vitamins and minerals prescribed in 100% patients followed by antihypertensive drugs (92%). The most common antihypertensive used were calcium channel blockers and anticonvulsant was magnesium sulphate. Conclusions: There was increased maternal and perinatal morbidity and operative intervention among pregnant women with hypertensive disorders of pregnancy. Most of the drugs were used appropriately and were in accordance with standard guidelines. The important problems identified were inappropriate use of antimicrobials, use of sublingual nifedipine and use of brand names in 1/4th of prescriptions.