Risk factors for orbital implant exposure after evisceration: A case control study of 93 patients

Purpose: The study aims to analyze risk factors for exposure of orbital implants after evisceration by comparison of patients with and without exposure of implants. Methods: This is a case control study in retrospective interventional case series; Group A- implant exposures after evisceration, Group B - Patients on follow up after evisceration with implant, without exposure, with matched duration of follow up. The sample size is calculated for a power of 80. Results: Group A comprised 32 sockets with implant exposure, presenting at median 18 months after surgery; Group B included 61 eviscerated sockets, without implant exposure, with follow up median 36 months. Odds Ratio (OR) was calculated; infected eyes -OR 1.3, P = 0.6; phthisical eye - OR 1.4, P = 0.43; multiple prior surgeries- OR 1.55, P = 0.33. Group A had 59.3% porous implants, Group B 55.7%, - OR 1.3, P = 0.5. Mean implant size in Group A 19.06 mm, Group B 18.78 mm- showed no statistical difference. Multiple logistic regression analysis showed no significant risk factor for exposure. Surgeon factor was not analyzed since there were multiple surgeons. Conclusion: This is the first study with calculated sample size, comparing implant exposure patients to a control group. Porous implant material, presence of infection, phthisical scleral shell, and prior surgery showed higher trend of exposure (Odds ratio >1), but none was conclusive. Larger size of implant was not a risk factor for exposure. Eliminating the role of several factors in implant exposure allows the surgeon to make better surgical choices: such as place an implant of appropriate size, of a material of surgeon's choice, and do primary placement of implant in a patient with evisceration post-corneal ulcer or endophthalmitis. A hypothesis and a recommendation is that meticulous attention be paid to surgical technique.

A prospective study on causality, severity and preventability assessment of adverse drug reactions in a tertiary care hospital in India

Background: The present study was undertaken to evaluate the incidence and pattern of adverse drug reaction (ADRs), causality, severity and preventability of ADRs.Methods: Data was collected and analyzed with the information such as patients’ demographic details, associated co-morbid conditions and detailed drug related information gathered from ADR reporting forms. World Health Organization (WHO) scale was used for assessing causality, modified Hartwig scale was used for assessing severity and modified Schumock and Thorntons scale were used for assessing preventability of ADRs. Data was analyzed using descriptive statistics.Results: Total 154 ADRs were reported in a period of one year (August 2016- July 2017). Out of 154 ADRs analyzed, 120 (77.9%) were in adults, 33 (21.4%) pediatric and 01 (0.7%) in geriatric patients. The most common ADR recorded was cutaneous reactions (43.5%) and the most common causative class of drugs for the same was found to be antimicrobials (46.7%) followed by non-steroidal anti-inflammatory drugs (15.6%). Causality assessment scale indicated 68.8% ADRs possible and 24% ADRs as probable. Severity assessment revealed that 45.5 % were mild, 50.6% moderate and 3.9% ADRs severe. Preventability assessment showed 84.4% of the cases were probably non-preventable.Conclusions: In this study it was found that, most of the ADRs were of possible category with mild to moderate severity and majority being non-preventable. Antimicrobial drugs being the most common offending drug class causing ADRs. Strategies targeting appropriate and cautious use of this class of drugs may benefit in reducing the number of ADRs and therefore the cost involved in the treatment.

Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

Crossmatching considerations in renal transplantation.

During the year 1993-1994, 73 renal transplant cases have been screened for the presence of anti-HLA antibodies using the standard lymphocytotoxicity assay. Amongst the 9 related transplantations with 100% negative crossmatch 6 were successful. About 8.2% of the patients had a shift from positive to negative crossmatch. It was observed that an increased number of transfusions (ranging from 3 to 21) in males and females yielded negative crossmatches. In females, however, owing to various factors such as pregnancies, parity and infections, varied percentages were observed with different donors. The crossmatches in diabetics and hypertensive patients suggest no particular correlation and probably have no role in the outcome of the assay.

Comparison of the immune responses in children vaccinated with three strains of BCG vaccine.

The present study was conducted to evaluate and compare the specific cellular responses of children vaccinated with three different strains of BCG. The study comprised of normal children with normal weight and normal general responses (PHA) to in vitro leukocyte migration inhibition test (LMIT). The three strains of BCG under study were Japan-BCG, Glaxo-BCG and Madras-BCG. One hundred children were selected at random from each group. The mean ages of these infants were 9.9 +/- 9.5, 9.8 +/- 7.6 and 9.8 +/- 8.3 weeks, respectively. Six weeks after vaccination, the diameter (in mm) of induration at the vaccination site was measured. Three months after vaccination, in vitro LMIT was performed against PPD tuberculin antigen. This test was done again after 3 months in all the children who tested negative. The mean value of the diameter of the Glaxo-BCG group (10.0 +/- 13.5 mm) was significantly higher (p < 0.05) than the mean values of Japan-BCG (9.10 +/- 3.9 mm) and Madras-BCG (8.38 +/- 4.1 mm). The mean LMI values were similar in all the three groups. There was no correlation between the in vitro and in vivo parameters. The number of children positive to LMI (PPD) were 59, 58 and 63, for the Madras, Japan and Glaxo-BCG groups, respectively. A total number of 91, 91 and 95 were positive to LMIT at the end of 6 months after BCG in the Madras, Japan and Glaxo-BCG groups, respectively. The observations suggested that there were no major differences between the three strains of BCG in their capacity to induce cellular responses.

Optimum age of a child for BCG vaccination.

The objectives of this study were to evaluate whether a newborn or a neonate is capable of responding immunologically after BCG vaccination and to find out if this immunity persists for one year. Normal infants aged between 0 days-3 months brought to immunization centre were included in the study. In vitro leukocyte migration inhibition test was performed in these children using Phytohemagglutinin and purified protein derivative (PPD). They were grouped based on their age at vaccination, their LMI values and on the time interval after vaccination. The mean values of % LMI (PPD) in all the age groups were positive and there were no significant differences between the newborns, the neonates and other groups. The values were positive and comparable even after 12 months in all the groups. The percentage of infants with positive or negative values to LMI (PHA) and negative values to LMI (PPD) were also comparable at different time intervals in different age groups. The results suggest that newborns or neonates are as capable of eliciting a positive immune response after BCG vaccination, as older infants and the practise of vaccinating a child at birth could be continued.