Awareness of over the counter antibiotics to combat antimicrobial resistance

Background: In India there is wide use of over the counter (OTC) antibiotics and unawareness of its harmful effects. In India dispensing antibiotics without prescription is a major contribution factor in development of antimicrobial resistance (AMR). The objectives of the present study were to evaluate awareness and proper use of OTC antibiotics in the community.Methods: Responses to a questionnaire covering various aspects on awareness and usage of OTC antibiotics were obtained from 100 families and 100 pharmacy shops in the community by second year MBBS students after permission from institutional ethical committee. The study period was from January 2019 to June 2019.Results: Among 100 responders 78% used OTC antibiotics for frequently reported illness like common cold (58%), body- ache (19%), fever (13%) and cough (10%). Most common reason for using OTC antibiotic is to avoid high consultation fees (64%).76% pharmacy dispense antibiotics without prescription. 60% pharmacy unaware of increase chance of developing resistance due to OTC antibiotics. 80% pharmacy maintain register book and were aware of laws and regulations of OTC prescription but still 70% dispense drugs due to fear of losing sales and profit. 50% pharmacy said they encourage patients to consult the physician and get the prescription. Most common antibiotic sold without prescription is amoxicillin (51%) and azithromycin (38%).Conclusions: We have identified unawareness among people about use and harmful effects of using OTC antibiotics. Also pharmacies are not following rules and regulations for OTC drugs. So our aim is to increase public knowledge of proper use and harmful effects of OTC antibiotics and help our global program to reduce AMR.

Glycemic control in cardiac surgery: Rationale and current evidence.

Studies in cardiac surgical patients have shown an association of hyperglycemia with increased incidences of sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias and longer intensive care and hospital stay. There is considerable controversy regarding appropriate glycemic management in these patients and in the defi nition of hyperglycemia and hypoglycemia or the blood sugar levels at which therapy should be initiated. There is also dilemma regarding the usage of “tight glycemic control” with studies showing confl icting evidences. Part of the controversy can be explained by the differing designs of these studies and the variable defi nitions of hyperglycemia and hypoglycemia.

Anesthetic management of a child with nephrotic syndrome undergoing open heart surgery: Report of a rare case.

The congenital nephrotic syndrome (NS) in infancy and childhood is an important entity but combination with acyanotic congenital heart disease is uncommon. Anesthesia in such cases is challenging because of associated problems like hypo-protienemia, anti-thrombin III deficiency, edema, hyperlipidemia, coagulopathy, cardiomyopathy, immunodeficiency, increased lung water etc. We describe anesthetic management of a patient with childhood NS and sinus venosus atrial septal defect (ASD) undergoing open heart surgery. We also suggest guidelines for safe conduct of anesthesia and CPB in such patients.

Calcified ductal aneurysm with severe aortic regurgitation.

A rare case of calcified aneurysm of the ductus arteriosus with severe aortic regurgitation is presented. We believe this is the first report of such a case in the English literature.

Minimally invasive pulmonary artery banding: a new approach.

BACKGROUND: A variety of approaches have been described for banding of the pulmonary artery. The indications for this procedure are limited; however in developing countries, many patients still need pulmonary artery banding for a variety of reasons. We describe a new approach, minimally invasive, using only a split in the manubrium sterni to conduct the procedure. METHODS AND RESULTS: Between January 2000 and May 2002, 19 patients who had undergone pulmonary artery banding using a minimally invasive technique were compared with 20 cases of pulmonary artery banding performed by the conventional technique. The mortality was similar in the two groups (p=0.45). The period of intubation and duration of intensive care unit stay were significantly shorter in the minimally invasive group (p=0.015 and 0.002, respectively). The duration of hospital stay was not significantly different between the 2 groups (p=0.139). In the minimally invasive group, three patients underwent subsequent reoperation. CONCLUSIONS: Minimally invasive pulmonary artery banding is useful in babies with high-flow cardiac lesions and cardiac cachexia.

Giant pulmonary artery aneurysm with right ventricular outflow tract obstruction.

Aneurysm of the main pulmonary artery is rare. Its natural history is not well understood and there are no clear guidelines regarding its optimal treatment. We present a case of a huge saccular aneurysm of the main pulmonary artery which was associated with infundibular and valvular pulmonary stenosis. It was repaired using a pericardial patch with concomitant pulmonary valvotomy and infundibular resection. Postoperative recovery was uneventful and the patient is doing well. Follow-up echocardiogram revealed good repair.

Ventricular septal defect with congenital mitral valve disease: long-term results of corrective surgery.

BACKGROUND: A retrospective analysis of the mortality, morbidity and long-term follow-up of patients undergoing corrective surgery for ventricular septal defect and congenital mitral valve disease is presented. METHODS AND RESULTS: Between January 1991 and December 2000, 69 consecutive patients aged 2 months to 45 years (median 18 months) underwent repair of ventricular septal defect and associated mitral valve disease. In 52 patients (75%), the ventricular septal defects were located in the perimembranous and subarterial area. Forty-six patients had congenital mitral incompetence and 23 had congenital mitral stenosis. The ventricular septal defect was repaired through the right atrium in all. Sixty-five patients underwent reconstruction of the mitral valve and 4 underwent primary mitral valve replacement. Another 4 patients underwent mitral valve replacement after a failed repair. Associated procedures included: patent ductus arteriosus ligation (n=12), aortic valve replacement (n=6), coarctation repair (n=13), interrupted aortic arch repair (n=1), atrial septal defect closure (n=17) and Takeuchi repair (n=1). There were 6 early deaths (8.6%). Three deaths were due to pulmonary arterial hypertensive crisis and one due to residual mitral stenosis. One death was due to intractable congestive heart failure. Another patient died due to persistent low cardiac output. Follow-up ranged from 6 months to 120 months (mean 64.4+/-33.6 months). Reoperation was required in 22 patients, mainly for recurrent/residual mitral valve dysfunction or hemodynamically significant left ventricular outflow tract obstruction. There were 4 late deaths, 2 due to residual mitral stenosis and the other 2 as a result of a thrombosed prosthetic valve. At 10 years, the actuarial survival rate was 850+/-5.0%, and freedom from reoperation was 45%+/-10.0%. CONCLUSIONS: Reconstruction of the mitral valve along with closure of VSD is possible in most cases. However, careful follow-up is recommended to detect changes in the mitral valve status over a course of time.