Efficacy and safety of topical 2% rebamipide ophthalmic suspension in dry eye disease at tertiary care centre

Purpose: To evaluate the effect and side effects of topical 2% rebamipide ophthalmic suspension in dry eye disease. Method: This prospective randomized case control study included total 80 patients (40 cases and 40 controls) of dry eye. Symptoms were graded according to OSDI scoring system and specific tests for dry eye included Tear film breakup time (TBUT), Schirmer’s test, Fluorescein corneal staining (FCS), Rose Bengal staining) were performed. Case group received 2% rebamipide ophthalmic suspension four times daily and control group given carboxymethylcellulose 0.5% four times daily. The follow ups had done at two, six and twelve weeks. Results: The maximum numbers of patients were between 45-60 years. Patient with mild moderate and severe OSDI Score shows marked improvement. Mild TBUT score showed improvement but statistically not significant (P value-0.34). In moderate and severe TBUT Score statistically significant improvement (P value- 0.0001, 0.0001). In all grade FCS shows statistically significant improvement with p value-0.0001, 0.0001, and 0.028 respectively. Schirmer’s test score in all cases had shown improvement but statistically not significant and P value were 0.09, 0.07, and 0.07 respectively. In mild, moderate and severe Rose Bengal staining statistically significant improvement (P value -0.027, 0.0001, and 0.04) .The only side effect was dysgeusia (10% patients). Conclusion: Rebamipide 2% ophthalmic suspension showed significant improvement in symptoms and signs of dry eye. It able to modify epithelial cell function, improve tear stability, and suppress inflammation suggests that it may be a first drug of choice for severe dry eye disease.

Study of Prescription Pattern of Antihypertensive Drugs in Medical OPD in SGT Medical College and Hospital, Gurugram

Objectives: Present study was conducted to find out currenttrend of drug prescribing of antihypertensive drugs prescribedeither as monotherapy or in combinations. As well as variationswere seen in prescribing drugs with regards to the age, sex.Materials & Methods: An observational, prospective, crosssectional study involving 120 prescriptions for patients ofessential hypertension was conducted in the outpatientdepartment of Medicine SGT Medical Hospital, Faculty ofMedicine and Health Sciences, Gurugram. The blood pressure(BP) measurement was done at the time of enrolment andother patient information like demographics and the drugdetails were recorded in Performa sheet. Data obtained wereanalyzed and expressed in percentage.Results: 71 males and 49 female of essential hypertensionpatients were included in study. Most of patients were in theage group of 40 -49 years constituting 72.5 % of total 120patients. 52 patients were on mono therapy 64 (53%) ofpatents were put on Dual therapy and few patients 4 (3.33%)were on Triple therapy. Out of 52 patients those were on monotherapy maximum patients were put on angiotensin receptorblocker (38.46%) and 11.54% of patients were takingAngiotensin converting enzyme inhibitor. 64 patients wereprescribed with Dual therapy. Out of these 46.9% of patientswere prescribed with ARB + Diuretics and nearly 2% patientswere on ARB + β blocker combination therapy. Only fourpatients were taking Triple therapy, 50% of patients were onCCB + ARB + Diuretics and 50% were on CCB + ACEI +Diuretics.Conclusions: Hypertension is more prevalent in male patientsthan female patients. ARBs (38.46%) were the most commonsingle drugs used for most of the uncomplicated essentialhypertension followed by CCBs (36.54%) ARB prescription asmonotherapy may be increases because of few or minimal sideeffects caused by them. Most common mode of treatment ofhypertension was Dual therapy or triple therapy combinationtherapy fixed dose combinations (56%). In the FDCs ARB +Diuretics (48%) were most preferred combination for treatmentof hypertension then CCB + β blocker (30%) and only 9% ofpatients were treated on ACEI based FDCs. Only 44% ofpatients were prescribed with drugs mentioned in the nationallist of essential medicine (NLEM). Prescribing drug from NLEMshould be encouraged to reduce the burden of treatment coston the patients. ARB were the most preferred drug for thetreatment of hypertension may be because of low toxicity andfewer side effect, easily available in the market.

Inferior vena cava thrombosis in a case of amoebic liver abscess: Is hypercomplementemia responsible for this rare entity.

Among the liver abscesses, thrombosis of the inferior vena cava (IVC) has been reported mainly in amoebic liver abscess (ALA) caused by Entamoeba histolytica (E.H). It is an unusual complication especially in paediatric age group. Association of hypercomplementemia and IVC thrombosis has not been discussed previously. Published data suggest that E.H can activate the complement system and can cause hypercomplementemia. A very few studies suggest that complement activation and hypercomplementemia are associated with thrombus formation. We describe a paediatric case of ALA complicated by IVC thrombosis extending to the right atrium and discuss the possible role of hypercomplementemia in causation of IVC thrombosis in cases of ALA.

Pericardial Effusion in Children: Experience from Tertiary Care Center in Northern India.

Objective:To describe profile and outcome in children with significant pericardial effusion. Methods: Hospital records of 25 children admitted with significant pericardial effusion during January 2010 to March 2013 were analyzed. Results: Thirteen (52%) children had tubercular, 6 (24%) had bacterial, 3 viral, 2 recurrent idiopathic and one had malignant pericardial effusion. Only 3 children in our series required surgical drainage. Conclusions: Echocardiography guided percutaneous pericardiocentesis and pigtail catheter placement was found to be safe and effective.

Pantoea dispersa: an unusual cause of neonatal sepsis

Neonatal septicemia is the most important cause of neonatal mortality. A wide variety of bacteria both aerobic and anaerobic can cause neonatal sepsis. Genus Pantoea is a member of Enterobacteriaceae family that inhabits plants, soil and water and rarely causes human infections, however, Pantoea dispersa has not been reported as a causative organism for neonatal sepsis. We hereby report two neonates with early onset sepsis caused by Pantoea dispersa. Early detection and appropriate antibiotic therapy can improve overall outcome of this rare infection in neonates.

Failure of Secondary Prophylaxis with Erythromycin in Rheumatic Heart Disease.

Background: Erythromycin is recommended for secondary prophylaxis in children with rheumatic heart disease, who are allergic to penicillin. Case Characteristics: A 9-year-old girl, with rheumatic heart disease, on secondary prophylaxis with erythromycin 250 mg BD, presented with acute rheumatic fever. Outcome: Responded to steroids and started on a higher dose (250 mg TDS) of erythromycin for secondary prophylaxis. Message: There is need to document the resistance of group A streptococci to erythromycin.

Bardet-Biedl Syndrome – A Rare Cause of Cardiomyopathy.

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive condition characterized by retinitis pigmentosa, polydactyly, obesity, learning disabilities, hypogonadism and renal anomalies. Cardiomyopathy in association with BBS has previously being reported only twice in literature. We report a case of a patient presenting with features of cardiomyopathy, who was subsequently diagnosed to have BBS.

Ruptured Sinus of Valsalva Masquerading as Rheumatic Heart Disease.

Ruptured sinus of Valsalva is a rare lesion in pediatric age group. We are reporting a twelve year old child with hyperdynamic circulation being diagnosed and treated as Rheumatic heart disease.

Physicochemical and Phytochemical evaluation of different black tea brands.

Standardization of herbal drugs raw material is essential to assess the quality, based on the consistency (concentration) of their active principles. Tea plant (Camellia sinensis) contains Caffeine that is responsible for the stimulating effect of the beverage. The objectives of this study are extraction, qualitative estimation of caffeine by TLC method, physicochemical standardization, phytochemical evaluation(qualitative tests) and chemical tests for detection of inorganic elements from different black tea brands. The different black tea brands (Brooke Bond Taj Mahal, Tata Premium and Duncan Double Diamond) are suddenly collected from local market. Standardization including – organoleptic properties, foreign matter, pH of aqueous solution ash values, extractive values, successive extractive values, moisture content, volatile oil content, Preliminary phytochemical screening and chemical tests for inorganic elements. The results obtained from this study can be used to standardize different black tea brands in the market.

Clinicohematological study of thrombocytosis.

Objective. To find out etiology and clinical course of thrombocytosis in Indian pediatric population. Methods. A total of 250 patients having thrombocytosis (defined as platelet count >500 x 109/L) on haematological investigations were studied over one yr period. All patients were evaluated clinically and were subjected to investigations, including complete blood counts (CBC) with peripheral smear examination. To elucidate the possible role of inflammatory cytokines in pathogenesis of RT, levels of Interleukin-6 (IL-6) and C - reactive protein (CRP) were estimated. Results. Infants and young children (<2 yr age) were most common group, contributing 60% of total cases. Out of total 250 cases, only 3 (1.2%) cases were found to have primary thrombocytosis and remaining 98.8% cases were having RT. Among RT patients, infections (alone or in association with iron deficiency anemia) were most common cause, accounting for 65% cases, while iron deficiency anemia (IDA) was second most common cause accounting for 41.3% cases (12.6% IDA alone and 28.7 % in association with infections). Other causes included nutritional dimorphic anemia and patients on treatment for megaloblastic anemia, acute lymphoblastic leukemia (during treatment) and lymphoma. Among various groups of RT, IL-6 and CRP levels were higher in patients with infection with or without IDA than IDA alone. One child with essential thrombocytosis and one child with RT had thrombotic complications. On follow up, platelet counts normalized in most of the patients with treatment of underlying conditions. Conclusions. Results of this study suggest that essential thrombocytosis is extremely rare in children. Infections and IDA (alone or in association with infections) are common causes of RT. IL-6 and CRP levels are increased in patients with RT, to a higher level in patients with infections than in patients with IDA. Most patients with RT have uneventful recovery of platelet counts to normal range with treatment for underlying condition.