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Background: Preterm birth is one of the important causes of perinatal mortality and morbidity in developed countries after congenital malformations. Postponement of delivery plays essential role in preventing such incidences by allowing fetal lung maturity. Methods: This is a prospective study conducted over a period of 20 months among the patients admitted for preterm labour with gestational period between 27 to 36 weeks. After the patients obeyed all the inclusion criteria, they were administered terbutaline 250 µg subcutaneously every 8th hourly followed by 5 mg tablet orally twice daily till contractions ceased. The patients were analysed for gestational period at which they presented with preterm labour contractions, associated risk factors, response to terbutaline, and gestational period at delivery, perinatal complications, neonatal and maternal outcomes. The data obtained were analysed by descriptive analysis. Results: There were 1,678 deliveries during study period, out of which 207 (12%) presented with preterm labour and 20 (~10%) patients received terbutaline. Idiopathic (50%) and vaginal infections (25%) were common causes of preterm labour among the patients who received terbutaline. The labour was prolonged by 3 - 5 days among 8 patients, 7 - 15 days in 9 patients and 15 - 30 days in 3 patients. Common maternal side effects were nausea and tremors. Neonatal outcome was good in most of the cases except in 5 (25%) neonates who required NICU admission but they all recovered well without any morbidity. Conclusions: Administration of terbutaline prolonged labour without any serious maternal complications and better neonatal outcome as 90% of the neonates were born without any complications. Hence, terbutaline can be used as a safe and effective tocolytic agent among patients presenting with preterm labour.

Background: Pulmonary tuberculosis being the predominant manifestation of the disease Extra-Pulmonary sites can also involve as a result of dissemination from a chief focus. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with category I DOTS and to identify the incidence and pattern of ADRs caused by anti-tubercular drugs and to assess the causality and severity of the reported ADRs. Methods: Data was collected from cases of Tuberculosis patients diagnosed and treated under category I DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). These patients were monitored for ADRs during OPDs and hospital stay. Any Adverse effects observed were recorded in ‘Adverse Drug Event Reporting Form’ prepared by the CDSCO, Govt. of India. The data were evaluated for patient demography, types of TB, incidence of ADRs, onset and outcome of the ADRs. ADRs were also assessed for their causality and severity by using WHO-UMC criteria and Hartwig’s scale. Results: Extra-pulmonary cases accounted for 32.2% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 224 patients of EPTB who were started on ATT as per DOTS, we noted ADR in 52 patients and 73 ADRs. Gastritis was the most common ADR (25%) followed by anorexia (14%) and skin reactions (9.6%) and multiple drug therapy was the major predisposing factor for these ADR’s. Conclusions: Extra-pulmonary Tuberculosis accounts for 32.2% of the total cases studied. Treatment irregularities and alcohol abuse are the two most common reasons for default. On evaluation of the causality of ADRs, majority of them were found to be ‘possible’ by WHO-UMC and Naronjo’s causality assessment scale. The severity assessment of ADRs showed that 42% reactions were moderate and 58% were of the ‘mild’ nature.

AIMS: The purpose of the study is to determine the prevalence of Hypomagnesemia among patients presenting with acute exacerbation of asthma and during its standard treatment and to know its clinical significance. SETTINGS AND DESIGN: This is a prospective study done on inpatients admitted with acute exacerbation of asthma. METHODS: A total of 50 patients admitted with acute asthma were enrolled in the study with random selection. Treatment started according to GINA (Global Initiation of Asthma) protocol. Serum Magnesium levels were measured at intervals of 0 min, 90 minutes and 180 minutes and 24hrs after starting nebulization. STATISTICAL ANALYSIS: The Excel and SPSS 10.5 (SPSS Inc, Chicago) software packages were used for data entry and analysis. The student 'T' test was used to differentiate gender parameters Proportions were compared using Chi-square test. One-way analysis of variance was used to test the difference between groups. RESULTS: Hypomagnesemia at the time of admission (0 min) was found in 15(30%) subjects and it increased to 22(44%), 16(32%) and dropped to 7(14%) at 90min, 180min and 24 hours respectively after starting treatment. Maximum drop in magnesium level was noted at 90min (by 0.162 mg/dl). Severity of asthma was statistically and clinically significant with hypomagnesemia (P=0.04). CONCLUSION: As Hypomagnesemia was significantly associated with severe asthma attack, an effort should be made to check and correct serum magnesium level during admission and at least after 2 hours of nebulization.

Background: Pulmonary tuberculosis being the predominant manifestation of the disease extra-pulmonary sites can also involve as a result of dissemination from a chief focus. Extra- pulmonary tuberculosis is more common in HIV cases. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with DOTS and to assess any difference in outcome of treatment in HIV positive extra-pulmonary tuberculosis. Methods: Data was collected from cases of tuberculosis patients diagnosed and treated under DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). We evaluated extra-pulmonary cases and recorded sites of involvement in order of frequency. We also studied treatment outcome by recording as per definitions given by the WHO and also evaluated any difference in outcome of extra-pulmonary tuberculosis disease with HIV co-infection. Results: Extra-pulmonary cases accounted for 30.5% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Most common site of extra-pulmonary tuberculosis was pleura (29.9%) followed by meninges (22.5%), abdomen (19.6%) and lymph node (10.7%) tuberculosis. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 8 HIV reactive patients, 5 patients completed treatment and the remaining 3 patients died during the course of treatment. Conclusions: Extra-pulmonary Tuberculosis accounts for 30.5% of the total cases studied. Pleura is most common site of extra-pulmonary TB in our study. Treatment irregularities and alcohol abuse are the two most common reasons for default. Co-infection with HIV seems to have a poor outcome on patients with extra-pulmonary TB and needs to be studied in large number of samples.

Background: The objective of the study was to assess the awareness of P- drug selection among rural general practitioners’s (GP) for common medical conditions.Methods: Fifty general practitioners in Tumakuru district were provided with proformas for selection of P- drugs for mild to moderate hypertension, diabetes, upper respiratory tract infections and acid peptic disease based on safety, affordability, need, and efficacy (SANE criteria).Results: Forty one GP’s responded by completing the proformas. Seventeen of them were aware of the concept of P- drug selection. In hypertension, beta blockers followed by Angiotensin Converting Enzyme (ACE) inhibitors were most commonly preferred. In diabetes, biguanides followed by sulfonylureas were preferred as oral hypoglycemic agents. Ampicillin, Ciprofloxacin and Cotrimoxazole were the commonly used antibiotics for upper respiratory tract infections. Ranitidine and antacids were preferred for acid peptic disease. Affordability followed by efficacy was the deciding criteria for P- drug selection.Conclusions: There is lack of awareness of P- drug selection among many rural GP’s. Therefore, there is necessity to create awareness about P- drug selection through continued medical education for rational use of drugs.