Cost-minimization analysis of drugs used for empirical treatment of urinary tract infection in a tertiary care hospital

Background: Urinary tract infections (UTIs) are one of the commonly encountered infections and a large number of drugs are indicated in UTI ranging from oral conventional drugs to most advanced injectable drugs. Cost-minimization analysis (CMA) is employed to project the least costly drug when two treatments are shown to be therapeutic equivalents. Aims and Objectives: This study aims to perform a CMA at a tertiary care center to determine the least expensive drug for UTI and to project a cheapest alternative from available options based on the results of CMA. Materials and Methods: This was a cross-sectional study conducted over duration of 3 months in the clinical departments on patients diagnosed to have UTI and prescribed empirical antimicrobial treatment. The approval of Institutional Ethics Committee was sought before beginning the study. Pattern of drug prescription and average cost incurred in the treatment of patients with empirical antimicrobial therapy was calculated. CMA included the projection of the least expensive drug based on average cost incurred per patient in outpatients and inpatients respectively. Results: A total of 59 patients of UTI given empirical treatment were included in the study. Fluoroquinolones and cephalosporins were commonly used drugs for empirical treatment of UTI. Nitrofurantoin (average cost of 11–14 Rs. per patient) can be projected as the cheapest drug for empirical treatment of UTI on outpatient basis as well as a drug to supplement injectables in indoor patients. Injectable ciprofloxacin can be projected as the most inexpensive alternative for empirical treatment of UTI in patients of the inpatient department. Conclusion: Nitrofurantoin for oral treatment and ciprofloxacin in injectable form are cheapest among available alternatives for empirical treatment of UTI. To prevent treatment failures and increase in cost of treatment, correlation of results of CMA with local antimicrobial sensitivity pattern is important.

Effects of Corona Pandemic on Global Environment and Economy

The COVID-19 pandemic is draw into concern as the most reproving international fitness tragedy of the century since December 2019, the era of Second World War. A new transmissible respiratory disease comes in existence in Wuhan, Hubei province, China and the World Health Organization named it as COVID-19 (corona virus disease 2019). For the quarter of 2020 the corona virus epidemic has swamp the international locations of the sector and changed the pace, material and nature of our lives. In this evaluation accompanying, we inspect some of the various social, environmental and economic issues influenced by COVID-19. The COVID-19 epidemic has ended in over 4.3 million confirmed instances and over 290,000 deaths globally. The Indian economy as with the global economy, was faced with multiple curtailment too when the pandemic emerged. Advance estimation recommend that the Indian economy is anticipate to witness real GDP augmentation of 9.2 per cent in 2021-22 after reducing in 2020-21. This implicit that overall economic activity has retrieve past the pre-epidemic levels. Social spacing, self-isolation and travel diminution have led to a less staff throughout all capitalism or economic sectors, and because of that many jobs to be bygone. Schools have closed down, and there is requirement for artefacts and products has reduced. In contrast, there requirement for medical essentials has significantly increases. In reaction to this global epidemic, we summarize the effect of COVID-19 on socio-economic condition on individual factors of the world economy and environment.

Laboratory surveillance of chikungunya in Madhya Pradesh, India (2016-2017)

Background & objectives: Chikungunya (CHIK) is a neglected, re-emerging arboviral disease. Limited information on CHIK-confirmed cases during interepidemic period is available from India. This surveillance study was conducted in Madhya Pradesh (MP), India, during the years 2016-2017, to provide information about CHIK cases. Methods: Blood samples collected from patients suspected having CHIK were tested by immunoglobulin (Ig) IgM ELISA or real time reverse transcription-polymerase chain reaction (rRT-PCR) for the detection of CHIK virus (CHIKV)-specific IgM antibodies or viral RNA, respectively. Partial envelope-1 gene sequencing was done. Clinical and demographic data were collected and analyzed. Results: Of the 4019 samples tested, 494 (12.2%) were found positive for CHIKV infection. The positivity was detected in both rural and urban areas. The mean age of CHIK-positive cases was 33.12�.25 yr. Headache and joint pain were the most prominent symptoms, 34.6 per cent (171/494) of the CHIK cases required hospitalization and six patients with CHIKV infection died. The East/Central/South African genotype of CHIKV was found to be circulating in the study area. Interpretation & conclusions: Our study recorded a higher CHIK positivity during 2016-2017 in comparison to earlier reports from MP, India. A high proportion of CHIK cases required hospitalization and deaths were also reported, which indicated the severity of the disease in the study area. In-depth molecular analysis of the virus and other risk factors is essential to understand the trends in disease severity.

Outbreaks of dengue in Central India in 2016: Clinical, laboratory & epidemiological study

Background & objectives: Dengue virus (DENV) causes outbreaks and sporadic cases in tropical and subtropical countries. Documenting intricacies of DEN outbreaks is important for future interventions. The objective of this study was to report clinical, laboratory and epidemiological features of DEN outbreaks reported in different districts of Central India in 2016. Methods: In 2016, outbreaks (n=4) suspected of DEN were investigated by rapid response team. Door-to-door fever and entomological surveys were conducted. Blood samples were collected and tested using NS1 or IgM ELISA; real-time reverse transcription-polymerase chain reaction was done to identify serotypes of DEN virus (DENV). NS1-positive samples were tested for the presence of IgG by ELISA. Clinical and demographic data were collected and analyzed. Results: Outbreaks occurred in both urban and rural areas in monsoon season and Aedes aegypti was identified as the vector. Fever, chills, headache and myalgia were the major symptoms; no fatality was recorded. Of the 268 DEN suspects, 135 (50.4%) were found serologically positive. DEN positivity was higher (n=75; 55.56%) among males and in the age group of 16-45 yr (n=78; 57.8%). DENV 3 followed by DENV 2 were detected as the major responsible serotypes. High attack rates (up to 38/1000) and low cumulative IgG prevalence (14.9%) were recorded in rural areas. Interpretation & conclusions: Our study showed that DENV 3 was the major serotype responsible for outbreaks that occurred in monsoon. High attack rates and lower number of secondary infections in rural areas indicated that DENV is emerging in rural parts of Central India. Early diagnosis at local level and timely intervention by mosquito control activities are needed to avoid such outbreaks in future.

Molecular studies on dengue viruses detected in patients from Central India

Purpose: Dengue viruses (DENVs), the causative agents of dengue (DEN), are classified into four serotypes and several genotypes. Identifying circulating serotypes and genotypes has clinical and epidemiological importance; however, limited information in this regard is available from Central India. This laboratory-based study was done to fill this lacuna. Materials and Methods: The samples collected in the acute phase of illness were subjected to DEN NS1 ELISA, and NS1-positive samples (n = 80) were subjected to serotyping; representative samples from each serotype were sequenced to identify genotypes. Results: Seventy-one (88.75%) samples could be serotyped. All the four DENV serotypes with dominance of DENV-3 (n = 33; 47%) were detected. DENV-4 was detected after a gap of 3 years. Cases with multiple DENV serotype infection were identified. Genotyping showed that DENV-1 belonging to genotype III, DENV-2 cosmopolitan (IV), DENV-3 genotype III lineage C and DENV-4 genotype I were in circulation in the year 2016. Conclusion: Our study documents the molecular characteristics of DENV circulating in the area. Detection of heterologous DENV serotype with dominance of DENV-3 emphasises the need for regular molecular monitoring.

Role of environmental factors & oxidative stress with respect to in vitro fertilization outcome

Background & objectives: Oxidative stress, lifestyle factors as also exposure to certain environmental factors are known to affect the fertility status in human beings. The aim of this study was to evaluate the role of OS and lifestyle and environmental factors affecting IVF outcome. Methods: A total of 253 couples were included, and biological samples such as blood, follicular fluid (FF), cumulus cells and semen were collected. Relevant biochemical parameters and metals namely lead (Pb), cadmium (Cd), copper (Cu) and zinc (Zn) were determined in the biological samples. ?-human chorionic gonadotropin levels ?100 IU/l were considered to predict viable pregnancy on the 15th day of embryo transfer (ET). Results: The mean body mass index (BMI) was significantly lower in females with positive IVF outcome compared to those with negative outcome. Couples residing in the residential area showed more percentage of positive IVF outcomes as compared to couples residing in industrial/agricultural area. FF Zn level was significantly higher (P<0.001) among the females' participants who have undergone ET as compared to those who have not undergone ET. FF MDA and serum Cu levels were significantly higher (P<0.05) in the female participants with negative IVF outcome as compared to positive IVF outcome. Logistic regression revealed that maternal BMI (P=0.034) and FF MDA level (P=0.047) were significantly associated with the IVF outcome. Interpretation & conclusions: The success rate of IVF was about 31.8 per cent, and BMI was significantly lower in females with positive outcome. The higher levels of MDA in FF and SP might have a negative impact on IVF outcome, higher Zn level in SP, FF and serum might have a positive role in embryo transfer as well as IVF outcome. The role of stress management and nutrition supplementation during the IVF treatment may be explored.

Arginase Activity as a Useful Cardiac Marker for Differential Diagnosis of UA and MI: A Pilot Study.

Aims: The present study was undertaken to find the levels of aspartate transaminases (AST), creatine kinase (CK-MB) and arginase in serum sample of patients under study and check effectiveness of arginase as a marker in acute coronary syndrome (ACS), and to find the correlation between AST and CK-MB with arginase in unstable angina (UA) and myocardial infarction (MI). Study Design: Case control study carried out at department of Biochemistry, B. J. Medical College Pune, Maharashtra, India, between Sept 2011-Dec 2013. Methodology: The study comprised of clinically diagnosed 60 patients: 30 of UA and 30 of MI. Age and sex matched 30 patients were studied as controls. Blood sample were collected from individual under study, serum was separated and used to estimate levels of CK-MB, AST and arginase. Results: The levels of AST, CK-MB and arginase were estimated and the results were compared with that of control. The levels of arginase were elevated significantly (P<0.001) like AST and CK-MB in patients with MI as compared to UA. In the study there was no correlation observed between CK-MB and arginase in patients of UA or controls. The same was true with the levels of AST and arginase. On the other hand a strong positive correlation was found between CK-MB and AST with arginase in MI patients. Conclusion: It can be concluded that like AST and CK-MB, arginase also increases with progression of ACS. Thus arginase can be used as sensitive marker to differentiate between UA and MI.

A Patient with Tracheal Leiomyoma and Meningioma: A Case Report.

Most of the tumors that form in the trachea and bronchi in adults are malignant but a few are benign. Common benign tumors of the trachea are squamous cell papilloma, fibroma, hemangioma and leiomyoma. Leiomyoma of trachea constitute only 1% of the common benign tumors of the trachea and hence few cases are reported in the literature. Meningiomas are a diverse set of tumors arising from the meninges, majority of these tumors are usually benign and only 8% are either atypical or malignant, which could recur after treatment or removal. Presence of both this uncommon tumors in a single patient is quite rare. We present a case of a woman with both the tumors.

Three cases of Iohexol induced seizures in paediatric patients undergoing CECT head and the role of pharmacovigilance.

In the modern era, the highly specific radiological investigation are on an increase and most of them mandates the use of contrast agents. These contrast agents are not free of adverse reactions and some of them are even potentially life threatening. Strictly implementing Knowledge, Awareness and Practice (KAP) in the institution. Contributing knowledge to the medical literature about the incidence of Iohexol induced seizure, which might be on an increase on the global level. Awareness by means of Pharmacovigilance Programme (PvP) to ensure the safety of the patient. Within the short period of three days, three cases of contrast induced seizures were reported by the Department of Paediatric and were treated accordingly. The Department of Pharmacology, expedited all the three cases to the National Co-ordinating Centre, Ghaziabad, India by entering the data into Vigiflow and also directed the chief pharmacist of the drug store to immediately stop the use of Iohexol with same batch number to prevent further risk.

Delay in seeking specialized care for oral cancers: Experience from a tertiary cancer center.

OBJECTIVE: Advanced oral cancers are a challenge for treatment, as they require complex procedures for excision and reconstruction. Despite being occurring at a visible site and can be detected easily, many patients present in advanced stages with large tumors. Timely intervention is important in improving survival and quality of life in these patients. The aim of the present study was to find out the causes of delay in seeking specialist care in advanced oral cancer patients. MATERIALS AND METHODS: A prospective questionnaire based study was done on 201 consecutive advanced oral squamous cancer patients who underwent surgery at our hospital. All patients had either cancer of gingivobuccal complex (GBC) or tongue and had tumors of size more than 4 cm (T3/T4) and were treatment naïve at presentation. RESULTS: Even though most patients observed abnormal lesions in their mouth, majority delayed the decision to visit a physician early. A significant percentage of patients (50%) also reported a delayed diagnosis by the primary care physician before being referred to a tertiary care center for definitive treatment. The average total duration from symptoms to treatment was 7 months. CONCLUSION: The main reasons of this delay in receiving treatment were due to patients themselves (primary delay) or due to time taken by the primary physician to diagnose the condition (secondary delay). Oral self-examination can be helpful in detecting oral cancers early.

Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma.

Objective: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients. Materials and Methods: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1) surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion) or (2) organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes). Results: The mean age of this population was 55 years. Most (83%) of the patients had pyriform sinus (PFS) involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33) and organ preservation protocol was planned after NACT in 73% (19/26) patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%), mucositis 5%, diarrhea 5%. The median progression free survival was 20 months. Conclusions: NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.

Assessing the Quality of life and Needs of HIV-AIDS Patients in Manipur A Preliminary Study.

This study aims to as.es. the quality of life (QoL) as perceived by HIV/AIDS patients and the needs of such people in their local context in Manipur. A cross sectional study was carried out in two selected districts of Manipur namely, Imphal west and Chandel. A total of 20 People Living with HIV/AIDS (PLHA) respondents were interviewed using WHOQoL-HIV instrument and a semi-structured interview. The overall quality of life mean score was 3.07 from the range of score between 0-5. Similarly, on a scale of 4-20, the scores in the six domains of the quality of life in descending orders were spirituality, religion, personal beliefs or SRPB (12.73); psychological (12.72); physical (12.41); level of independence (12.28); social relationship (11.83); and environment (11.54). Comparison of QoL showed female faring better with 3.12 mean score than their male counterparts (mean score: 2.83). The study also identified some of the needs of HIVIAIDS infected people in relation to clinical, financial, educational, psychological, socio-cultural, household needs, etc.

Double burden of underweight and overweight among children (10–19 years of age) of employees working in Indian industrial units.

Background. Along with the existing problem of underweight, overweight in children is increasing in the developing world. However, there is little information on its magnitude and pattern in the Indian context. We aimed to study the pattern and correlates of overweight in Indian children and adolescents. Methods. A total of 3750 children in the age group of 10–19 years, who were family members of randomly selected employees from 10 different industrial sites in India, were surveyed using an interviewer-administered questionnaire. Results. The prevalence of underweight was highest in peri-urban areas (30.2% and 53.2% according to Indian and international criteria, respectively). In urban and highly urban areas, the prevalence of underweight was 14.1% and 9.8%, respectively, according to the Indian criteria, and 27.1% and 19.2%, respectively, according to international criteria. The proportion of overweight children was highest in the highly urban category (19.1% and 13.4% according to Indian and international criteria, respectively). The level of urbanization (OR 3.1 and 4.7 for overweight in urban and highly urban areas, respectively, compared with peri-urban areas, p<0.001), physical activity (OR 0.4, p<0.001, in children with physical activity score >75th percentile compared with a score <75th percentile) and frequency of meals outside the home (OR 12, p<0.001, if >25% weekly meals taken outside the home compared with <25% of weekly meals outside home) were significant predictors of overweight. Conclusion. There is a double burden of underweight and overweight among Indian children and adolescents.

Air pollution induced changes in the photosynthetic pigments of selected plant species.

Changes in the concentration of different photosynthetic pigments (Chlorophyll and carotenoids) were determined in the leaves of six tree species exposed to air pollution due to vehicular emissions. The six tree species, which are all economically important because of their being fruit bearers, used for timber, fodder and as road side trees on the basis of their air pollution tolerance index. These included Mangifera indica L., Tectona grandis Linn.f., Shorea robusta Gaertn.f., Holoptelea integrifolia (Roxb.) Planch, Eucalyptus citridora Hook. Syn. and Mallotus philippinensis Muell-Arg. Reduction in chlorophyll ‘a’, ‘b’ and carotenoid was recorded in the leaf samples collected from polluted areas when compared with samples from control areas. The highest reduction in total chlorophyll was observed in Holoptelea integrifolia (Roxb.) (48.73%) Planch whereas, the lowest reduction (17.84 %) was recorded in Mallotus philippinensis Muell-Arg. Similarly in case of carotenoid contents, highest reduction (43.02 %) was observed in Eucalyptus citridora, and lowest in Mallotus philippinensis Muell-Arg (19.31 %). The data obtained were further analyzed using one-way ANOVA and a significant change was recorded in the studied parameters. These studies clearly indicate that the vehicular induced air pollution reduces the concentration of photosynthetic pigments in the trees exposed to road side pollution.