Pharmacoepidemiology of drugs utilized in ophthalmic outpatient and inpatient department of a tertiary care hospital.

Periodical auditing of drug utilization is vital for promotion of rational use of drugs. So for pharmacoepidemiological analysis of the drugs, utilized in eye OPD and IPD, a study was conducted prospectively for six months, in the Department of ophthalmology and pharmacology. Data were collected, from the prescription form of patients in OPD and from the bed head tickets of patients in IPD. Various parameters of utilization pattern were evaluated. The maximum number of patients belongs to age group of 46-60 years and lower middle class of socioeconomic status but there was no sex preponderance. Dosage, frequency and duration of therapy were recorded in more than 89% of prescriptions. An average number of drugs per prescription were 2.69 and 3.2; drugs prescribed by their generic names were 26.04% and 35.33%; fixed dose combinations prescribed were 36.98% and 67.29% and polypharmacy found were 23.3% and 11.47% of prescription in OPD and IPD respectively. The commonest dosage forms were eye drops in OPD and injections in IPD. More than 80% of the drugs were prescribed from hospital pharmacy. Average total cost per prescription was 87.40 INR in OPD and 135.80 INR in IPD but it was free of cost from hospital pharmacy.

Discrete subvalvular aortic stenosis in adults.

Discrete subvalvular aortic stenosis is a relatively rare condition in adults. It is often diagnosed during first decade of life especially in association with other congenital malformations. Isolated form of discrete subvalvular aortic stenosis may however silently progress from innocent murmurs of childhood and adolescence to symptomatic left ventricular outflow tract obstruction in adults. Certain overt and subtle morphological abnormalities may underlie the initial expression as well as high recurrence rates after surgical resection of sub aortic membrane. Though surgical resection is the only treatment available, debate on the surgical technique and appropriate timing of surgery continues. Close followup with serial echocardiographic examinations in patients detected to have functional murmurs during childhood may be helpful in early detection of subvalvular aortic stertosis.

Discrete subvalvular aortic stenosis.

Discrete Subaortic Stenosis is one of the many lesions responsible for left ventricular outflow tract (LVOT) obstruction. It may present as in an isolated from as membranous or fibromuscular ring below the aortic valve or in association with other congenital anamolies such as VSD, PDA, coarctation of aorta, hypoplastic aortic annulus, double chamber right ventricle among others. The condition is rarely diagnosed antenataly or in infancy but often manifests in the first decade of life with features of progressive LVOT obstruction, LV hypertrophy and dysfunction aortic regurgitation due to damage to the aortic cusps because of the jet from the subaortic narrowing which may also render the aortic valve prone to infective endocarditis. Interaction of genetic predisposition and morphologically deformed long and narrow LVOT cause rheological abnormalities and increased shear stress in the region of subaortic stenosis and seem to be the main etiological factor alongwith poorly defined role of more extensive but subtle changes in the LV endocardium. Condition can be easily diagnosed by cross-sectional and Doppler echocardiography and confirmed by demonstrating a pressure gradient below aortic valve on cardiac catheterisation and LV angiography. Surgical membranectomy alongwith myotomy or myomectomy remain the mainstay of treatment but long term results are not satisfactory as there is a high rate of recurrences requiring reoperations. A close follow up with serial echocardiographic examinations is very helpful in early detection of subaortic obstruction in patients who have so called functional murmurs in the childhood.