International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 6(9), May, 2014

Pages: 99-108

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ST-SEGMENT RESOLUTION: A CRITERION OF SUCCESSFUL THROMBOLYSIS IN ACUTE MYOCARDIAL INFARCTION

Author: Nilay Suthar, Paltial Palat, Shivkumar Masaraddi, Manish Patel, Dilip Modi

Category: Healthcare

Abstract:Background: Thrombosis of the coronary artery is the principal cause of myocardial infarction in the territory of the affected vessel. To limit the size of infract area and for the salvage of the jeopardized myocardium, restoration of patency of infarct related coronary artery is very important to reduce morbidity and mortality in these patients.1,2 The physician's ability to predict patency of the infarct related artery from clinical variables however is disappointing. The role of ST-segment resolution during an ST segment infarction has over the years, grown into not only an alternative way of approximating risk and chances of reperfusion in the absence of a coronary angiogram, but also a method challenging the traditional \"gold standard\" for predicting risk and reperfusion at the myocardial level. Thus, ST-segment resolution at 90 minutes is an excellent marker of successful myocardial reperfusion1 and a strong predictor of survival and preservation of left ventricular function.3-5 Aims and Objectives: We studied the relation between ST-segment resolution and various outcomes in cases of acute myocardial infarction at our institute.Our aim was to study ST-segment resolution as a marker and a simple bedside tool for predicting of successful myocardial reperfusion, 90 minutes after thrombolysis in STEMI (ST elevation myocardial infarction).We also studied and attempted to correlate ST-segment resolution at 90 minutes after thrombolysis as a predictor of recovery, in-hospital adverse events, morbidity and mortality in STEMI. Methods: The present study was conducted on 50 patients who had received thrombolytic therapy with streptokinase for ST Elevation AMI, in our ICCU. Detailed clinical history with specific emphasis on presenting complaint and associated coronary risk factors and management done were captured. Results: The study corroborates the evidence that the recanalization and the patency of the IRA (Infarct Related Artery) remained higher in the patients with complete resolution of ST-segment at 90 minutes group, than the patients with partial resolution and the no resolution groups. Conclusions: ST-segment resolution can be used as a simple non-invasive tool for the prediction of the patency of the IRA after thrombolysis.

Keywords: St-segment, resolution, Acute Myocardial Infarction, thrombolysis.

Full Text:

INTRODUCTION

World Health Organization (WHO) has defined anAdverse drug reaction (ADR) as any noxious, unintended, and undesired effect of a drug, which occurs at the doses which are used in humans for prophylaxis, diagnosis, or therapy. [1] The concept of Pharmacovigilance has been given to keep a watch on ADRs. The science and the activities which relate to the detection, assessment, understanding and the prevention of adverse effects or any other drug-related problems is referred to as Pharmacovigilance.[1][2] Adverse drug reactions (ADRs) have a major impact on public health as they are associated with significant morbidity and mortality. [3] Healthcare professionals are one of the important pillars of an efficient pharmacovigilance system because of their contribution in the form of spontaneous reporting. [4]Spontaneous reporting of ADRs is one method of Pharmacovigilance and which is undertaken through the Yellow Card Scheme (YCS) in UK.[5] The Uppsala Monitoring Centre (UMC, WHO), Sweden is maintaining the international database of ADR reports.[6] In India it is maintained by Central Drugs Standard Control Organization (CDSCO) with the Drug Controller General(India) [DCG(I)] as its head. Underreporting of ADRs is the major problem amongst doctors and needs serious rethinking. To improve this, the knowledge, attitude and practice of doctors towards Pharmacovigilance and the reporting system should be improved and awareness should be created. The objective of this study is to assess the awareness of Pharmacovigilance amongst the health care professionals, working in NIMS medical college and hospital, Jaipur, India.

MATERIALS AND METHODS

This study was an anonymous questionnaire based survey for health care professionals working in NIMS Hospital, Jaipur. The study was conducted after getting approval from the Institutional Ethical Committee. A structured validated questionnaire consisting of thirteen questions was distributed amongst doctors and residents of all the departments during a single visit to the NIMS Hospital , to each of them and they were asked to tick the option/s which they felt was/ were the best. All the doctors and residents in all the OPDs and wards of all the departments were contacted during this single visit. Consenting participants anonymously completed the questionnaire and were collected on the same day. Doctors were allowed to give suggestions regarding improvement of ADR Reporting. Questionnaire was based on previous study done on pharmacovigilance.[1][6] Survey was descriptive and after completion of data collection it was organized and compiled as percentages. The sum total of percentages was not always 100% because some questions contained multiple options to choose from.

STATISTICAL ANALYSIS:

The data was subjected to descriptive analysis using microsoft excel. Different parameters were given as percentile.

RESULTS

150 questionnaires were distributed amongst the doctors of NIMS Hospital after brief description about the study. The dully filled forms were collected on the same working day.Incompletely filled and forms which were not filled were excluded from the study. 96 forms were included for evaluation. In our study 66.66 % respondents were males and 33.34% were females as shown in figure:1.

Response rate was 64% (96/150) as 96 dully filled forms were collected back. Out of 96 responders, 40 were senior doctors and 56 were residents. We found that 96% respondents were having knowledge that Pharmacovigilance deals with ADRs. We found that 41.5% respondents had knowledge about the phases of clinical trial and knew that Pharmacovigilance is done in Phase IV of clinical trial. while 37.5% thought that pharmacovigilance is done in Phase I clinical trial. On the other hand 8.4% doctors were in favour of Phase II while 7.3% ticked on Phase III clinical trials.We found that knowledge of location of WHO Uppsala Monitoring centre( Sweden) was present amongst 68.8% doctors while rest were unaware of its location. To our surprise only 21% doctors were of the view that all the physicians, dentists, nurses, physiotherapists and even pharmacists can report ADR. Still maximum number of doctors thought that only physicians can send the ADR report. Interestingly only 36% doctors were aware of the fact that events related to allopathic drugs, herbal medicines, vaccines and blood products can be reported but maximum doctors thought that only allopathic drug ADRs should be reported.ADR reporting is generally done by most of the doctors only for allopathic drugs and vaccines. But it actually encompasses other products also like herbals, traditional medicines,and blood products, biological and medical devices .[6]Events which should be reported has been depicted in figure :2.

Interestingly 87.5% responders were aware of the National Pharmacovigilance Centre in India but only 16.7% actually reported suspected ADRs to any ADR Reporting centre. In our study attitude regarding ADR Reporting amongst respondents has been shown in the followingtable:1.

Majority of doctors were of the view that the doctors should be trained in ADR reporting (37.5%) and ADR reports should be kept confidential. 18.6% opined thatmore CMEs should be arranged on Pharmacovigilance while 8.4% felt need about tollfree number for ADR reporting. There should be an emphasis oninculcation of knowledge about Pharmacovigilance right from the second year when a medical student steps into the world of pharmacology.

DISCUSSION

Male preponderance was seen in our study which corresponds with the study done by Pankaj G et al 2011[6] . In contradiction to our study female preponderance was seen in study performed by Subish P et al 2011 in Nepal.[8] We got a response rate of 64% in our study. Our findings coincide with the findings of Khan S A et al 2013 (response rate was 62.9%). [7] while it was 67.9% in a study done in Nepal.[8] In contradiction to this very high response rate of 93.3% was present in a study done by Pimpalkhute SAetal 2012[3] Similarly in a Nigerian study response rate of 82.5% was observed.[9] We found that 96% respondents were having knowledge that Pharmacovigilance deals with ADRs. But in another Indian study 77% of the subjects knew the term ‘Pharmacovigilance.[1] In an Indian study by Chopra D et al nearly two third (66%) of the doctors knew the definition of ADR. [11] We found that 41.5% respondents had knowledge about the phases of clinical trial and knew that Pharmacovigilance is done in Phase IV of clinical trial. In a study done by Hardeep et al 2013 68.9% knew about Periodic Safety Update Report.[1] In our study, only 21% doctors were of the view that all the physicians, dentists, nurses, physiotherapists and even pharmacists can report ADR. Similarly in Nigeria 89.9% considered doctors, as the most qualified health professionals to report ADRs.[9] Interestingly in a study by Khan SA et al 2013 , major proportion (85.3%) of the doctors were aware that all ADRs should be reported.[7] Surprisingly in a study done by Chopra D et al 2011, only one tenth of the doctors (10%) knew ,what should be reported ? [11] In a study performed in China , 61.7% of the doctors, 62.7% of the nurses and 61.1% of the administrators had ever encountered an ADR during their practices, but did not report to the national monitoring center or other centers.[16] Interestingly 87.5% responders in our study were aware of the National Pharmacovigilance Centre in India but only 16.7% actually reported suspected ADRs to any ADR Reporting centre. But, only 59% subjects were aware of the existence of a National Pharmacovigilance Centre in India in a previous Indian study.[1] 73% respondents were aware of the existing programme in India in another study.[11] Santosh KCet al2013 concluded that there were 74.8% of healthcare professionals who had seen patient experiencing an ADR; however, only 20.1% had reported.[13] Similarly in a study performed in Tamil Nadu , 47.5% respondents had observed ADRs in their practice, and 37% had reported it to the national pharmacovigilance center.[14] In an Iranian study done amongst pharmacists, more than half of those responding felt that ADR reporting should be voluntary, while 26% felt it was a professional obligation. [15]

CONCLUSION

This study has given us an overall pattern of awareness of pharmacovigilance amongst doctors working in NIMS Hospital. Our study will help in promoting knowledge about Pharmacovigilanceamong clinicians. To conclude despite of shortcomings our study can offer a wealth of data on implementation of Pharmacovigilance.Poor knowledge of Pharmacovigilance and underreporting of ADRs in a developing country like India is a matter of great concern and needs prompt intervention.

CONFLICTS OF INTEREST

The authors declare that they have no competing interests.

FUNDING:

Not applicable.

ACKNOWLEDGEMENT

I would like to thank Dr. Manjula Bhargavaand all the doctors of NIMS Hospital who participated in this study. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

REFERENCES

1. Hardeep, JagminderKaur Bajaj, Kumar Rakesh. A survey on the knowledge , attitude and practice of pharmacovigilance among health care professionals in a teaching hospital in North India.JClinDiagn Res. Jan 2013; 7(1): 97–99.

2. The World Health Organization. Safety of medicines: A guide to detecting and reporting adverse drug reactions. Geneva: 2002. WHO/EDM/QSM/2002 2.

3. Pimpalkhute SA, Jaiswal KM, SontakkeSD.Evaluation of awareness about pharmacovigilance and adverse drug reaction monitoring in resident doctors of a tertiary care teaching hospital. Indian J Med Sci. 2012 Mar-Apr;66(3-4):55-61.

4. Sanghavi DR, Dhande PP, Pandit VA. Perception of pharmacovigilance among doctors in a tertiary care hospital: influence of an interventional lecture. Int J Risk Saf Med. 2013;25(4):197-204.

5. Avery AJ, Anderson C, Bond CM. Evaluation of patient reporting of adverse drug reactions to the UK 'Yellow Card Scheme': literature review, descriptive and qualitative analyses, and questionnaire surveys.Health Technol Assess. 2011 May;15(20):1-234

6. Dr. PankajGupta,Dr. AadityaUdupa. Adverse Drug Reaction Reporting and Pharmacovigilance:Knowledge, Attitudes and Perceptions amongst Resident Doctors.J. Pharm. Sci. and Res. Vol.3(2), 2011,1064-1069

7. Khan SA, Goyal C, Chandel N. Knowledge, attitudes, and practice of doctors to adverse drug reaction reporting in a teaching hospital in India: An observational study. J Nat ScBiol Med 2013;4:191-6

8. SubishPalaian, Mohamed I. Ibrahim, Pranaya Mishra. Health professionals' knowledge, attitude and practices towards pharmacovigilance in Nepal. Pharm Pract (Granada). 2011 Oct-Dec; 9(4): 228–235.

9. Oshikoya KA, AwobusuyiJO.Perceptions of doctors to adverse drug reaction reporting in a teaching hospital in Lagos, Nigeria. BMC ClinPharmacol. 2009 Aug 11;9:14.

10. Oreagba IA, Ogunleye OJ, OlayemiSOThe knowledge, perceptions and practice of pharmacovigilance amongst community pharmacists in Lagos state, south west Nigeria. Pharmacoepidemiol Drug Saf. 2011 Jan;20(1):30-5.

11. Chopra D, Wardhan N, Rehan HS. Knowledge, attitude and practices associated with adverse drug reaction reporting amongst doctors in a teaching hospital. Int J Risk Saf Med. 2011;23(4):227-32.

12. Desai CK, Iyer G, Panchal J. An evaluation of knowledge, attitude, and practice of adverse drug reaction reporting among prescribers at a tertiary care hospital. PerspectClin Res. 2011 Oct;2(4):129-36.

13. Santosh KC, Tragulpiankit P, Gorsanan S. Attitudes among healthcare professionals to the reporting of adverse drug reactions in Nepal. BMC PharmacolToxicol. 2013 Mar 8;14:16.

14. Ahmad A, Patel I, Balkrishnan R. An evaluation of knowledge, attitude and practice of Indian pharmacists towards adverse drug reaction reporting: A pilot study. PerspectClin Res. 2013 Oct;4(4):204-10.

15. Vessal G, Mardani Z, Mollai M. Knowledge, attitudes, and perceptions of pharmacists to adverse drug reaction reporting in Iran. Pharm World Sci. 2009 Apr;31(2):183-7.

16. Li Q, Zhang SM, Chen HT. Study on the knowledge and attitude to adverse drug reactions reporting among healthcare professionals in Wuhan city. Zhonghua Liu Xing Bing XueZaZhi. 2004 Oct;25(10):894-7.

17. Sweis D, Wong IC. A survey on factors that could affect adverse drug reaction reporting according to hospital pharmacists in Great Britain. Drug Saf. 2000 Aug;23(2):165-72.

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Awards, Research and Publication incentive Schemes by IJCRR

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
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A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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