ABSTRACT
Tuberculosis of the thyroid gland is very rare disease and isolated involvement of thyroid is even more rare. There are about 200 cases of thyroid gland tuberculosis had been reported worldwide .In India das et al repotred 21 cases thyroid tuberculosis . Almost all cases were secondary to some primary foci elsewhere in the body.The diagnosis is usually very difficult as the clinical presentation has no distinct characterstics. Clinically it may resemble thyroditis or goiter or some malignant etiology. On histo pathological evaluation, presence of necrotizing epitheloid cell granuloma along with langhan giant cells are diagnostic of thyroid tuberculosis. Further demonstration of acid fast bacilli in Z N staining confirms diagnosis.
ABSTRACT
Background: Critically ill patients are admitted in Intensive coronary care unit. The intensive coronary care unit (ICCU) is a setting where a large number of drugs are administered to patients. Information on drug utilization in intensive coronary care units (ICUs) are lacking in India. Objectives: To identify pattern of drug use and suggest measures. Methods: Prospective drug utilization study was conducted in patients admitted in ICCU for six months. Data was collected in previously prepared case record form. Data was recorded from the admission of patient in ICCU to discharge from ICCU. Analysis was done by using drug use indicators, age and sex wise distribution, morbidity pattern of disease, frequency of drug use, cost of drug therapy and length of stay. Data analysed using Microsoft Excel. Total 605 cases were analysed. Results and Interpretation: Mean ± SD6 of age of all patients being admitted in ICCU is 57.05 ± 11.92 years. Most frequent morbidity found is myocardial infarction. Average number of drugs per encounter is 14.85. Percentage of encounters with an antibiotic and injection prescribed is 27.44% and 98.68% respectively. 34.46% drugs are prescribed by generic name and 43.75% drugs were prescribed from WHO essential drug list. Most commonly prescribed drug is Tablet Aspirin. Frequent injections used are promethazine, heparin, hydrocortisone, buprenorphine, streptokinase, metoprolol, Pentazocin and frusemide. Average drug cost per encounter is 867.84 Rs. 65.38% cost is spent on fibrinolytics. Conclusion: Average number of drugs per encounter is high it should be kept low whenever possible. From all drugs prescribed 42.66% drugs were parenteral. Percentage of drug prescribed by generic name is less. Drugs should be prescribed by generic name. Cost of drugs spend by patient is high. Antibiotics are less frequently prescribed. The mortality rate is low. Essential drug list for ICCU should be prepared. Seminar or group discussion can be done with health professionals working in ICCU to discuss drug utilization pattern for further improving prescribing pattern.