P Ravi Shankar

Teaching pharmacovigilance to medical students and doctors

The World Health Organisation defines pharmacovigilance as the pharmacological science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem. Pharmacovigilance plays an important role in ensuring drug safety. Hence,every country needs a functioning pharmacovigilance programme. Pharmacovigilance is being taught, in theory, in many developed countries, but the practical approach is missing in developing countries. Pharmacovigilance should ideally be taught to small groups of medical students, interns, postgraduates and practitioners by linking it to the activities of a functioning pharmacovigilance centre in a teaching hospital. It should be activity-based, problem-based and linked to the rational use of medicines. Students should be trained during their internship and residency. The non-inclusion of pharmacovigilance in university syllabi and unfamiliarity with problem-based learning could prove to be stumbling blocks to the success of the concept. Pharmacologists should create awareness on pharmacovigilance among doctors of other specialities and enlist their support in teaching the subject.

Importance of Transferable Skills in Pharmacology

As self-directed l e arningxa0 becomes more i mporta ntxa0 inxa0 the field of pharmacology, so, too, are xa0”transferable skills. In this study, the attitudes of second medical skills.” In this study,the attitudes of second year medical undergraduatesxa0towards transferable skills in pharmacologyxa0were assessed.xa0Differences due to gender, natiionality and medium of instruction were investigated.xa0A survey was conducted with the helpxa0of a self-administeredxa0questionnairexa0asking the students to rate, firstxa0the importancexa0of thexa0particular transferable skiill,xa0second, theiir own ability in these skills and, third, thexa0effectxa0of integrated teaching. Studentsxa0werexa0of thexa0opinion that transferable skills werexa0very important in pharmacology. Female students gave a higher rating to thexa0importance of drugs and communication skills than males. The Indian students rated theirxa0problem solvingxa0skills higher than the other defined demographic groups. Finally, students hadxa0axa0level of confidencexa0in their own skills. These results suggest that students aare well equipped to succed in the revised curriculum of Kathmanduxa0University, Nepal, which will place a greater emphasis on self-directed learning inxa0the future.

Personal Drug Selection: Problem-Based Learning in Pharmacology: Experience from a Medical School in Nepal

Background At the Manipal College of Medical Sciences, Pokhara, Nepal, Pharmacology is taught during the first four semesters of the undergraduate medical course. Personal or P-drug selection is an important exercise. The present study was carried out to obtain student opinion about the P-drug learning sessions, the assessment examinations, and on the small group dynamics. Method The practical sessions on P-drug selection are carried out in small groups. Student feedback about the session was obtained using focus group discussions. The focus groups were selected to represent both genders and the three main nationalities, Nepalese, Indians, and Sri Lankans. There were four Nepalese, five Indians, and three Sri Lankans. Within each nationality and gender category the students were randomly selected. The respondents were explained the objectives of the study and were invited to participate. Written informed consent was obtained. The discussion lasted around two hours and was conducted in the afternoon in two groups of six students each. The first author (PRS) acted as a facilitator. The responses were recorded and analyzed qualitatively. Results The overall student opinion was positive. Around 25% (3 respondents) of respondents were confused about whether P-drugs were for a disease or a patient. Group consensus was commonly used to give numerical values for the different criteria. The large number of brands created problems in calculating cost. The students wanted more time for the exercise in the examination. Formative assessment during the learning sessions may be considered. The group members usually got along well. Absenteeism was a problem and not all members put in their full effort. The physical working environment should be improved. Conclusions Based on what the students say, the sessions on P-drugs should be continued and strengthened. Modifications in the sessions are required. Sessions during the clinical years and internship training can be considered.

Pretreatment with sarafotoxin 6c prior to coronary occlusion protects against infarction and arrhythmias via cardiomyocyte mitochondrial KATP channel activation in the intact rabbit heart during ischemia/reperfusion

BackgroundEndothelial ETB receptor activation by exogenously administered sarafotoxin 6c(a snake venom peptide with a sequence homology to ET-1 prior to ischemia activates release of nitric oxide(NO) and previous studies have shown that NO facilitates mitochondrial KATP activation in cardiac cells and cardioprotection.Objectives and methodsThe aim of this investigation was to test whether the administration of sarafotoxin 6c(a selective ETB receptor agonist) has cardioprotective and antiarrhythmic effects against ischemia and reperfusion injury in a well-standardized model of reperfusion arrhythmias in anesthetized adult male rabbits (nu2009=u200953) subjected to 30xa0min occlusion of the left coronary artery followed by 120xa0min of reperfusion.ResultsPretreatment with sarafotoxin 6c (0.24xa0nmol/kg, i.v.) prior to the period of coronary occlusion offers significant infarct size reduction (19.1u2009±u20092.0% versus 39.7u2009±u20093.7% in the saline control group; Pu2009<u20090.01) and antiarrhythmic effects. Sarafotoxin 6c treatment significantly attenuated the incidence of life-threatening arrhythmias like sustained VT (13 versus 100% in the saline control group; Pu2009<u20090.005) and other arrhythmias (25 versus 100% in the saline control group; Pu2009<u20090.005), and increased the number of surviving animals without arrhythmias. Pretreatment with 5-HD but not HMR 1883 abolished the beneficial effects of sarafotoxin 6c on reperfusion induced arrhythmias and cardioprotection suggesting that benefits have been achieved via the selective activation of cardiomyocyte mitochondrial KATP channels. Sarafotoxin 6c evoked NO release and selective activation of mitoKATP channels in cardiomyocytes contributes to cardioprotection and antiarrhythmic activity during ischemia-reperfusion in the anesthetized rabbit.ConclusionsWe conclude that the selective activation of ETB receptors by sarafotoxin 6c prior to coronary occlusion contributes to cardioprotective and antiarrhythmic properties.

Reading habits and attitude toward medical humanities of basic science students in a medical college in Western Nepal.

Background: The Manipal College of Medical Sciences, Pokhara, Nepal, admits students from Nepal, India, Sri Lanka, and other countries to the undergraduate medical course. Purposes: The present study sought to describe and explore reading habits of medical students during the first three semesters and obtain their views regarding inclusion of medical humanities in the course. Methods: The authors introduced a voluntary module in medical humanities to the fifth- and sixth-semester students. Gender, semester, and nationality of respondents were noted. Commonly read noncourse books (fiction and nonfiction) were noted. Student attitudes toward medical humanities were studied using a set of nine statements. A total of 165 of the 220 students (75%) participated. Indians followed by Nepalese were the most common nationalities. Results: Romantic fiction and biography were most commonly read. The Alchemist and The Da Vinci Code were commonly read books. Students were in favor of inclusion of medical humanities in the curriculum. The median total score was 30 (maximum possible score = 45). Conclusions: Students read widely beyond their course. The possibility of introducing medical humanities in the curriculum should be explored.

Publishing a Drug Information Bulletin: Experiences from a Developing Country

The Drug Information Bulletin is published by the Drug Information Center (DIC) of Manipal Teaching Hospital, Pokhara, Nepal every quarter. The DICs in Nepal are linked together under the Drug Information Network of Nepal. The first issue of the bulletin was published in November 2003. The bulletin has various sections under which the articles are categorized. The bulletin is distributed internally within the hospital and in the college. The hard copies of the bulletin are also distributed to various organizations in Nepal and around 20 countries. Recently, Vigil, a pharmacovigilance bulletin, has been started as a two-page pullout. The bulletin is financially supported by the institution. The contributors of the bulletin are mainly from the departments of Pharmacology and Hospital Pharmacy. There are occasional contributions from outside as well. The resources of the DIC are used for publishing the bulletin. Though there are limitations, the editorial team has shown that it is possible to publish a quarterly bulletin in a resource-limited setting in a developing country.

Cessation of hostilities – opportunities for medical schools in Nepal

N epal is a small and mountainous developing country in South Asia, famous for having the highest mountain on Earth – Mount Everest – and known as the land of the Lord Buddha, the apostle of peace. Tragically, Nepal has recently experienced more than a decade of violent insurgency that has affected all aspects of life there. The ‘people’s war’ was launched by the Communist Party of NepalMaoist (CPN-Maoist) on 12 February 1996, seeking the overthrow of the constitutional monarchy and the establishment of a Maoist people’s democracy. The insurgency began in three mid-western mountain districts, and by 2001 had spread to involve 68 of Nepal’s 75 districts. The insurgency has affected the lives of roughly two-thirds of the 24 million people in Nepal, and the cost in terms of human life and human suffering has been enormous.