Metformin is commonly used oral hypoglycaemic agent in the treatment of type-2 Diabetes Mellitus (DM). One of the important side effect of long term metformin therapy is malabsorption of vitamin B 12 which could lead to megaloblastic anemia and peripheral neuropathy. Therefore annual screening of serum vitamin B 12 level or serum methylmalonic acid (MMA)/serum homocysteine level should be done in cases taking metformin for more than four to five years with average dose of >1g per day, even in the absence of haematological or neurological abnormalities. However, as the incidence of type-2 DM is increasing, cost of annual measurement of vitamin B 12 level also increases. Considering cost factor for annual screening, vitamin B 12 supplementation appears to be more cost effective approach rather than annual screening for routine prophylaxis. Routine vitamin preparations available in the market may contain less amount of B 12 and hence are not of much therapeutic use in treatment of B 12 deficiency due to Metformin. Hence there is a need to look for higher doses of approximately 500-2000μg/day.

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Background: Caesarean section is commonly performed operation in women in last few decades and can be life saving for the child, the mother or both in certain cases. Primary caesarean section in the multipara means first caesarean section done in the patients who had previously delivered vaginally once or more. Aims and objectives of this study were to know the incidence and various indications of primary caesarean section in multipara.Methods: This was a prospective study of primary caesarean section in multipara women admitted at tertiary care hospital in western rural Maharashtra during the period of 6 months from January 2018 to June 2018. Multipara with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >20 weeks gestation were included. Women with previous abortions and previous section were excluded.Results: Total no. of deliveries during this period were 4648.Total 1705 sections were performed during the same period. Thus, the incidence caesarean sections are 36.68%. Out of these sections 194 sections were performed in multipara for the first time, thus giving the incidence of 0.42% of total deliveries and 11.38% of total caesarean sections. Most common indication for caesarean section in multipara was malpresentation (19.6%) followed by foetal distress (16.49%) and severe pre-eclampsia (13.4%).Conclusions: Present study concludes that proper antenatal care should always be given to multipara even though there was history of previous vaginal deliveries.

Background: The present study was designed to assess awareness regarding rational drug therapy and fixed dose combinations (FDC) amongst interns and II MBBS students in a tertiary-care teaching hospital in Maharashtra, India.Methods: This cross-sectional, questionnaire-based study containing MCQ and analytical questions on rational drug therapy, fixed dose combinations and role of Pharmacist in dispensing correct drug to the patients was carried out in both interns (n=80) and II MBBS students (n=100). The completed questionnaires were then collected and analysed statistically for responses.Results: Mean average score obtained by II MBBS students (score - 36.66marks) was significantly better than interns (score- 20marks) which probably may be due to pharmacology teaching they were undergoing. II MBBS students were found to be better informed as compared to the interns (p<0.05) on questions related to rational drug therapy. On the questions related to rationality of FDC in Yes/No type, interns and II MBBS students were found to be equally informed (p>0.05). However, on question related to justification of FDC, interns were found to be better informed as compared to the II MBBS students (p<0.05). On single question pertaining to role of pharmacist, interns were found to be better informed than II MBBS students possibly due to their better understanding of patient-pharmacist relationship.Conclusions: Our study highlights the significance regarding knowledge of rational drug therapy and fixed dose combination (both rational and irrational), both rational and irrational, amongst both interns and II MBBS students while identifying the possible areas of interventions to make them rational clinicians.

Background: Caesarean section is one of the commonly performed operation in women due to safety reason and modern techniques. Primary caesarean section in the multipara means first caesarean section done in the patients who had previously delivered vaginally once or more. Aims and objectives of this study were to know association of various parameters like Age, Parity, Haemoglobin, Blood Pressure, Baby weight, Perinatal and Maternal Mortality with primary caesarean section among multipara. Methods: This was a prospective study of primary caesarean section in multipara women admitted at tertiary care hospital in western rural Maharashtra during the period of 6 months from January 2018 to June 2018. Multipara with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >20 weeks gestation were included. Women with previous abortions and previous section were excluded. Results: Total 1705 sections were performed during the same period out of total 4648 deliveries. Out of these sections 194 sections were performed in multipara for the first time. Maximum numbers of patients (58%) were in the age group of 15-24 years and Parity 2 (68%). Almost 70% women among multipara have Hb <11 Mgm/dl. Most of the patients (84.53%) have normal Blood pressure readings. Most of the babies' i.e.70 (36.08%) have birth weight in the range of 2.5-3 kg. Out of 194 deliveries, there were only 3 neonatal deaths (1.54%) and 1 maternal death (0.51%). Conclusions: Proper antenatal and intrapartum care and early referral can reduce the maternal and perinatal morbidity and mortality in multipara.