Study of prescribing pattern of antimicrobial agents in indoor patients of a tertiary care hospital.

Background: To evaluate prescribing pattern of antimicrobial agents in indoor patients of medicine and surgery department of SBH Government Medical College, Dhule. Methods: This was a retrospective cross sectional study carried over a period of 3 months. The patients who were admitted and received antimicrobial therapy in department of Medicine and Surgery were randomly selected and included in the study. The case record sheet and drug chart were obtained from Medical Record Section of the Hospital. The data was collected using case record form specially prepared for the study. The cases were categorised according to slightly Modified Kunin’s Criteria. Results: Total numbers of patients receiving antimicrobial therapy were 130 in medicine department and 93 in surgery department. Most commonly prescribed antimicrobial agent was cefotaxime (21.7%) in medicine and metronidazole in surgery (30.6%) department. The average number of antimicrobials per patient was found to be 1.7 and 3.02 in medicine and surgery department respectively. The switch on therapy from parenteral to oral route was employed in 16.15% patients in medicine department and 11.82% patients in surgery department. As per Kunin’s modified criteria, 66.2% and 58.06% patients received antimicrobial therapy appropriately in Medicine and surgery department respectively. Conclusion: This study highlights the problem of over-prescription of antibiotics and a trend towards polypharmacy. The interventions to rectify the problem of inappropriate use of antimicrobial agents are needed to make therapy more rational and cost effective.

Development and evaluation of a hot-melt coating technique for enteric coating

Conventional enteric coating requires the use of organic based polymers which are equally hazardous to the environment and operating personnel. Hot-melt coating avoids the use of solvents and is a safer and time-saving process. The present study was designed to assess the efficacy of hot-melt coating (HMC) as an enteric coating technique. Pellets prepared by extrusion spheronization were selected as the core formulation for a model of the gastric irritant drug diclofenac sodium (DFS) because of their innate advantages over single-unit formulations. Stearic acid (SA) and palmitic acid (PA) were evaluated as enteric hot-melt coating materials. HMC was carried out in a specially modified coating pan by applying SA and PA in molten state onto preheated pellets to achieve a coating level of 5-15 %w/w. Hot-melt coated pellets were evaluated for disintegration pH and in vitro dissolution in the pH range 1.2 to 6.8, along with basic micromeritics. SEM of coated pellets showed a uniform and smooth coating. These results indicated that HMC of both SA and PA exhibited very good enteric coating ability. The coated pellets showed negligible drug release in acidic pH. As the pellets were subsequently transferred to a higher pH level, a gradual increase in release of the drug from the pellets was observed with increasing pH of the dissolution media. The release was dependent upon coating extent, providing sustained enteric release as opposed to abrupt release with mixed release kinetics.

O revestimento entérico convencional requer o uso de polímeros orgânicos os quais são igualmente danosos ao meio ambiente e ao pessoal que o executa. O revestimento por fusão a quente evita o uso de solventes e é processo mais seguro e que consome menos tempo. O presente estudo foi planejado para avaliar a eficácia do revestimento por fusão a quente (RFQ) como técnica de revestimento entérico. Os péletes preparados por esferonização por extrusão foram selecionados como formulação central para modelo de fármaco irritante gástrico, o diclofenaco sódico (DFS) em razão das vantagens inerentes sobre as formulações de única dose. O ácido esteárico (AE) e o ácido palmítico (AP) foram avaliados como materiais para o revestimento de fusão a quente. O RFQ foi realizado em recipiente especialmente modificado, aplicando AS e PA no estado fundido em péletes pré-aquecidos para atingir nível de revestimento de 5 a 15% p/P. Os péletes revestidos por fusão a quente for avaliados quanto ao pH de desintegração e à dissolução in vitro na faixa de pH de 1,2 a 6,8, juntamente com base micromerítica. O SEM dos péletes revestido mostrou revestimento uniforme e plano. Esses resultados indicaram que o RFQ tanto do AE quanto do AP apresentou capacidade de revestimento muito boa. Os péletes revestidos mostraram pouca liberação do fármaco em pH baixo. Como os péletes foram, subsequentemente, transferidos para pH mais altos, observou-se aumento gradual na liberação do fármaco dos péletes com o aumento do pH do meio de dissolução. A liberação foi dependente da extensão do revestimento, sendo a liberação entérica controlada, contrariamente à liberação abrupta com cinéticas mistas.

Bifid liver in a patient with diaphragmatic hernia.

Liver malformations including lobe and segmental abnormalities are rare. We report a 65-year-old lady with complaints of breathlessness and fullness after meals for two months. Investigations revealed a diaphragmatic hernia on the right side with a bifid liver; the right lobe of the liver was among the hernia contents. The lady is asymptomatic after surgical repair.