Changing chronobiology of cardiovascular outcome following prophylaxis.

Cardiovascular events like angina, myocardial infarction and stroke have shown an increasing occurrence in the morning hours. We did this pilot nested case control study to see for any change in the time pattern of occurrence of cardiovascular events among patients on prophylaxis. A pilot study was done and the demographic characters, history of cardiovascular diseases, time of occurrence of cardiovascular event, history of drug intake and compliance were noted. Eighty four patients on prophylaxis and 135 patients presenting for the first time reported during the study period. Age did not show any significant difference. More males were getting prophylaxis for stroke and for the combined cardiovascular events. Time distribution of events showed peak occurrence between 8 to 12 hr followed by 20 to 24 hr among those who were not on prophylaxis and reverse in those on secondary prophylaxis. Odds of developing cardiovascular events though was not significantly different, was higher between 16-20 hr (1.26), 20-24 hr (1.48) and 0-4 hr (1.22) among those on prophylaxis. Seventy eight patients were taking antihypertensives. This observation demands further studies to determine the cause of evening increase in cardiovascular event especially since very little is known regarding evening exaggeration of risk factors which is becoming relevant especially in those getting prophylaxis.

Antiepileptic TDM pattern at a tertiary care hospital in India.

Therapeutic drug monitoring, a comparatively new investigational procedure in clinical pharmacology, is considered very beneficial to epilepsy patients though it increase the health care cost. Aim of this study was to determine the pattern of use of antiepileptic drug level monitoring over the last 7 years in our tertiary care centre and to critically comment on its utility. Retrospective data audit of archived data from 1998 to 2004 and age, sex, estimated levels of phenytoin, carbamazepine and phenobarbitone by HPLC were noted down, tabulated and compared. Chi square test was used for analysis. Three thousand five jundred thirty four blood samples of patients requesting for 4213 estimations of phenytoin, phenobarbitone or carbamazepine were received. Among the obtained samples, 44.0% (1058) were of children, 68.0% (2402) were of males, 0.6% (22) patients were getting 3 and 18.0% (635) getting 2, antiepileptic medications. 13.0% (546) samples showed level in the toxic range and 39.0% (1653) in lower range. There was increasing demand observed for estimation of antiepileptic drugs, over the 7 years. The number of abnormal values of phenytoin, phenobarbitone and carbamazepine did not show any significant difference over the years. The pattern was similar to that observed in other countries.