A Comparative Study On Pharmacoeconomic Analysis Of Rheumatoid Arthritis Patient In Two Different Hospitals In Tamil Nadu

Objective: The objective of the present study is to compare the prescribing patterns and cost of illness of Rheumatoid arthritis patients in two different hospitals. Methods: This is an observational study conducted in two different tertiary care hospitals in Salem district after obtaining approval of the Institutional Ethics Committee (IEC) (Registration Number EC/PHARM D/2019.06). A sample size of 102 (above 18 y) patients were included (52 from group 1 hospital and 50 from group 2 hospital). The study was conducted over a period of 6 mo from February 2019 to July 2019. The cost was collected by a patient face-to-face interview. Results: Out of 102 patients, females (57.84%) patients were more prevalent than men with the age group of 50-59 y in both groups. Methotrexate was most commonly prescribed drug in group 1(36.5%), whereas in group 2 are Sulfasalazine (37%). Among the DMARDs unit cost of methotrexate is high but the monthly cost was high for Sulfasalazine, because the methotrexate is prescribed on a once-weekly basis while sulfasalazine is taken twice a day. The cost of NSAIDs comes around 46.47% of the total drug cost of the month. In steroids, cost comes around 11.73% of the total drug cost. Among the direct cost of two groups, the drug cost and transportation cost is higher when compared with other costs. Indirect costs such as lost wages, due to disease is higher in group 1. Conclusion: The study concluded that the burden of RA to the patient is huge, Appropriate standard prescribing guidelines should be developed and implementation of the rational drug must be promoted. Polypharmacy was reported in group 1 hospital, the progression of symptoms was the same in both hospitals, it increases the cost of therapy and overall cost of patients. Hence it becomes vital to diagnose and control the disease at an early stage to control the economic burden on the patient.

Elevated Neutrophil to Lymphocyte Ratio in Older Adults with Cocaine Use Disorder as a Marker of Chronic Inflammation

Objective@#The neutrophil to lymphocyte ratio (NLR) is a non-specific, easy-to-obtain marker of inflammation associated with morbidity and mortality in systemic, psychiatric, and age-related inflammatory conditions. Given the growing trend of substance use disorder (SUD) in older adults, and the relationship between inflammation and SUD elevated NLR may serve as a useful inflammatory biomarker of the combined burden of aging and SUD. The present study focused on cocaine use disorder (CUD) to examine if cocaine adds further inflammatory burden among older adults, by comparing NLR values between older adults with CUD and a non-cocaine using, aged-matched, nationally representative sample. @*Methods@#The dataset included 107 (86% male) participants (aged 50−65 years) with cocaine use disorder. NLR was derived from complete blood count tests by dividing the absolute value of peripheral neutrophil concentration by lymphocyte concentration. For comparison, we extracted data from age-matched adults without CUD using the National Health and Nutrition Examination Survey. Individuals with immunocompromising conditions were excluded (e.g., rheumatoid arthritis and sexually transmitted infections such as HIV). A doubly-robust inverse probability-weighted regression adjustment (IPWRA) propensity score method was used to estimate group differences on NLR while controlling for potential confounding variables (age, gender, race, income, nicotine, marijuana and alcohol use). @*Results@#The IPWRA model revealed that the CUD sample had significantly elevated NLR in comparison to non-cocaine users, with a moderate effect size ( weight = 0.67). @*Conclusion@#Although non-specific, NLR represents a readily obtainable inflammatory marker for SUD research. CUD may add further inflammatory burden to aging cocaine users.

Disseminated zoster in an immunocompromised

@#In an immunocompromised patient such as HIV infection, disseminated herpes zoster is a common cutaneous manifestation. It is very important to have clinical suspicion of HIV, whenever a patient presents with cutaneous manifestation of HIV. This is a case of a 32 year old male who came in at for consult at our institution with a chief complaint of fluid filled bumps which started on the left abdominal area progressing to the trunk, upper and lower extremities with associated pricking pain. Patient was diagnosed with disseminated zoster and was given acyclovir with noted complete resolution of lesions. Laboratory tests were requested which revealed that the patient also had concomitant HIV and Hepatitis B. Patient was referred to the Center for Tropical and Travel Medicine for proper management.

Antimicrobial and barrier repair properties of virgin coconut oil and mineral oil in pediatric atopic dermatitis patients, a randomized, double-blind, control trial

BACKGROUND@#Atopic dermatitis (AD) is a chronic relapsing skin disease in childhood, managed by topical therapies. In the Philippines, use of affordable, widely available and effective alternative therapies such as mineral oil (MO) and virgin coconut oil (VCO), are practical especially in the far-flung areas.@*OBJECTIVES@#This study compares the antimicrobial and barrier repair properties of MO and VCO in mild to moderate atopic dermatitis, using SCORAD (SCORing for Atopic Dermatitis), bacterial culture, tewameter, mexameter and corneometer.@*METHODS@#This is a randomized controlled doubleblind trial conducted in two tertiary hospitals. Bacterial colonies, transepidermal water loss (TEWL), level of hydration and erythema were determined at baseline and after 4 weeks using bacterial culture, tewameter, corneometer and mexameter, respectively. SCORAD and adverse effects were also determined at baseline, 2nd and 4th week of treatment.@*RESULTS@#Baseline patient demographics were similar for both treatment groups. The SCORAD, TEWL and level of erythema were significantly decreased throughout the 4-week duration for both treatment groups, but much lower in the VCO group. The hydration level was significantly increased throughout the 4-week duration but much higher for the VCO group. Lastly, there is more proportion of cultures with "no growth" after the 4-week treatment duration in VCO group.@*CONCLUSION@#The antimicrobial and barrier repair properties of VCO are very important alternative which is affordable, readily available, safe and effective for children with mild to moderate AD.

Correlation of ultrasound measurement of inferior vena cava to aorta diameter ratio with hematocrit levels and severity of shock among children with Dengue fever seen at the Emergency Room of a tertiary government hospital

@#<p><strong>BACKGROUND:</strong> Severe dengue is a leading cause of serious illness and death, and intensive supportive care is the most important aspect of management. Before fluid resuscitation, a baseline hematocrit is obtained, and frequent monitoring of the complete blood count is needed.</p><p><strong>OBJECTIVE:</strong> To determine the correlation of ultrasound measurement of inferior vena cava (IVC) to aorta (Ao) diameter ratio with hematocrit levels and severity of shock among children with dengue fever.</p><p><strong>METHODOLOGY:</strong> This is a prospective study design conducted at the Emergency Room of Philippine Children's Medical Center. Clinical data and hematocrit of the children with dengue fever aged 1 month to 17 years and 364 days old were documented. The Inferior vena cava diameter (IVC)and the Aorta (Ao) diameter ratio was determined using bedside ultrasound.</p><p> <strong>RESULTS:</strong> The IVC/Ao diameter ratio correlates with high hematocrit and dengue shock in children. There is a significantly higher proportion of subjects with a hematocrit of normal range of age among those with a ratio 1.0.  A ratio of severity of Dengue illness. Sensitivity of IVC/Ao diameter ratio of Measurement of IVC/Ao diameter ratio has high interrater and intrarater reliability.</p><p><strong>CONCLUSION AND RECOMMENDATION:</strong> IVC/Ao diameter ratio was significantly associated with severity of dengue illness. It should be used to aid decision?making and monitor response to treatments in dengue fever.</p>

Biology of tooth replacement in amniotes / 国际口腔科学杂志·英文版

Tooth replacement is a common trait to most vertebrates, including mammals. Mammals, however, have lost the capacity for continuous tooth renewal seen in most other vertebrates, and typically have only 1-2 generations of teeth. Here, we review the mechanisms of tooth replacement in reptiles and mammals, and discuss in detail the current and historical theories on control of timing and pattern of tooth replacement and development.

Congenital Long QT Syndrome presenting as epilepsy.

Epilepsy can sometimes be mimicked in children by other organic conditions. We present a 11 year old boy with the congenital long QT syndrome who had recurrent "seizures" for five years which had been treated as epilepsy.

Rapid staining using toluidine blue: a reliable method for quick diagnosis in ultrasound-guided aspiration cytology.

Rapid staining of ultrasound guided aspirates is an accepted procedure for evaluation of adequacy and rapid diagnosis (RD). We have assessed the reliability of Toluidine blue stain in this regard, which has not been previously reported. 295 ultrasound guided aspirates performed over a 13 month period were studied. 59 aspirates were inadequate for RD. 103 cases were called malignant on RD of which 101 were confirmed, and 2 cases were considered highly suspicious on final diagnosis. Of 34 cases considered suspicious on RD, 32 were either signed out as malignant or considered highly suspicious while 2 cases were benign. Of 56 cases considered benign on RD, 49 were confirmed, 2 were suspicious for malignancy and 5 cases had inadequate material on final diagnosis. All 43 inflammatory lesions on RD were confirmed. The overall sensitivity for a malignant/suspicious for malignancy diagnosis was 98.54% on RD while specificity was 97.99%. Sensitivity and specificity for an inflammatory condition was 100%. Toluidine blue staining is not only a reliable method for rapid staining and diagnosis, it also permits preservation of cytological material by destaining and restaining with permanent stains.

Neurovascular rescue for embolic stroke following atrial septal defect closure.

Strokes following cardiac surgery occur in about 5% of patients. Intra-arterial thrombolysis is a good option in such a setting where intravenous thrombolysis is contraindicated, and when in-hospital strokes are detected well within the window for treatment and the chances of complete reperfusion are maximum. On postoperative day 4 after atrial septal defect correction, a 34-year-old woman with paroxysmal atrial fibrillation developed left middle cerebral artery stroke causing severe neurological deficits. Intra-arterial thrombolysis with urokinase led to remarkable recovery.

Isolated hypoplasia of right ventricle with atrial septal defect: a rare form of cyanotic heart disease.

Isolated hypoplasia of right ventricle is a rare kind of congenital heart disease that can present with cyanosis in childhood. We evaluated the clinical profile, diagnosis and management strategy of isolated hypoplasia of right ventricle in children. During 1993-1997, six children were diagnosed to have isolated right ventricular hypoplasia in our institution. Two patients were referred because of cyanosis, while cardiac murmur was the reason for referral in the remaining four. Besides clinical evaluation, all these patients had chest radiography, electrocardiography and echo-doppler studies. At echocardiography the valve diameters were measured and the degree of hypoplasia was quantified as standard deviation units. Cardiac catheter studies and angiography, and surgical intervention were carried out where indicated. Both operated and unoperated patients were followed up for 3-5 years. Cyanosis (severe--2, mild--4) and a soft ejection systolic murmur at the left sternal border were present in all patients. The second sound was normal. On two-dimensional echocardiography, all had hypoplasia of right ventricular (trabecular portion) and bi-directional shunt across atrial septal defect. Cardiac catheterisation was performed in four patients, which confirmed the echo findings and revealed normal right heart pressures. These four patients underwent surgical procedures. Simple closure of atrial septal defect was sufficient in two patients. Two others required bi-directional cavopulmonary anastomoses, and atrial septal defect closure was tolerated only by one of these two patients. Complete correction is not always feasible and adequacy of right ventricle to receive the entire venous return should be accurately assessed prior to, as well as during surgery.

Two dimensional and Doppler echocardiographic evaluation of double chambered right ventricle.

Two-dimensional and Doppler echocardiographic findings in 20 patients with double chambered right ventricle are described. All patients had the diagnosis established by cardiac catheterisation and confirmed at operation. Echocardiographic evaluation was done prior to surgical correction. Anomalous muscle bands in right ventricular cavity were detected in 16 patients. Doppler flow velocities in the right ventricular cavity suggested infundibular obstruction to blood flow at a low level in all 17 patients studied by Doppler echocardiography. Ventricular septal defects (11 patients), pulmonary stenosis (3 patients), and aortic regurgitation (3 patients) were detected accurately before operation by echocardiographic examination. Failure to detect the anomalous muscles in right ventricular cavity may occur in adult patients with poor anterior resolution and in those with severe right ventricular outflow obstruction and myocardial hypertrophy. Two dimensional echocardiography with Doppler flow analysis is useful in the evaluation and differential diagnosis of right ventricular outflow obstructions prior to invasive studies and surgical intervention.

Two-dimensional and Doppler echocardiographic study of coronary arteriovenous fistulas.

Sixteen patients with coronary arteriovenous fistula (CAVF) were studied by two-dimensional echocardiography (2DE). Of these 12 had Doppler studies. In all, the diagnosis of CAVF was confirmed by aortic root or selective coronary angiography. In 8 patients, the 2DE findings suggested CAVF. Five patients had dilated main coronary arteries and in 4 patients abnormal fistulous channels were identified. Two had diastolic flutter of the tricuspid valve and one had spontaneous contrast in the right atrium. In 11 out of 12 patients, Doppler analysis picked up a continuous flow (to the right atrium in 5, right ventricle in 4 and to both ventricles in 2 patients) prior to the cardiac catheterisation. We conclude that noninvasive diagnosis of CAVF can be made with the combined use of two-dimensional and Doppler echocardiography in most of the patients.