Pattern of antiepileptic drug utilization in epilepsy patients in outpatient departments of a tertiary care hospital

Background: Epilepsy is one of the common neurological disorders diagnosed early in life. Availability of many antiepileptic drugs (AEDs) makes it difficult to choose the appropriate pharmacotherapy. Aim and Objective: Understanding the pattern of AED prescription to evaluate the rationality of AED prescriptions in epileptic patients. Materials and Methods: This was a retrospective, observational study carried out at new civil hospital, Surat for a duration of 6 months. The study involved collecting data from the case files of all the patients irrespective of age or gender diagnosed with epilepsy and undergoing treatment from any of the outpatient departments of the hospital. Demographic details, clinical diagnosis, and detailed data about the prescribed pharmacotherapy were recorded in a pre-approved data sheet. The WHO prescribing indicators were evaluated for each prescription. Descriptive statistics was used. Results: The average age of the patients was 21.64 ± 10.46 years. A total of 1565 drugs were prescribed in the 331 epilepsy patients’ prescriptions. Out of this, 551 drugs (35.21%) were antiepileptics. Most of the patients received monotherapy (75.53%). The most commonly prescribed drug was sodium valproate (46.10%) followed by phenytoin (30.13%) and carbamazepine (10%). The average AED per prescription was 1.70. Majority of the prescriptions (94.63%) used generic names. There were no injectable used and no fixed dose combinations were prescribed in any of the patients. Conclusion: The prescriptions followed the rational prescribing pattern. Treatment of epilepsy is usually by monotherapy with valproate being the most commonly used AED. Prospective studies to evaluate adverse effects and patient compliance will help in efficient policy-making decisions.

Endocannabinoid Signaling in Spermatozoa: A Mini-Review

Spermatozoa undergoes array of signaling and intracellular pathways and ultimately become competent enough to accomplish fertilization. Hormones, ion channels and signaling molecules in both male and female reproductive tract show bidirectional cross play. The recent discovery of endocannabinoids and their receptors in male and female reproductive system opened new vistas for their research in regulating sperm function. Interestingly, endocannabinoids regulate sperm motility, capacitation, hyperactivity and eventually acrosome reaction. However, their complex intracellular pathways are still to be understood in regulating spermatozoa function. The present review highlights the major breakthrough research in the area of endocannabinoids in male reproduction and in more specific in sperm cells, and their association with regulation of sperm fertilizing competence

Effect of smoking on treatment outcomes among newly diagnosed Tuberculosis patients in Shimla.

Introduction: World Health Organization in 2015 had adopted “End TB Strategy” aimed at ending the global TB epidemic by 2035. Tobacco smoking has been reported to be associated with many aspects of TB disease, including increased vulnerability to being infected, recurrence with TB and related mortality. Aims & Objectives: To determine effect of smoking on treatment outcomes of tuberculosis patients at the end of six months of standardized tuberculosis treatment. Material & Methods: A prospective cohort study was carried out among newly diagnosed tuberculosis patients of Shimla city of India. Data related to smoking status was collected using the standard questionnaire which was used for collection of data regarding tobacco use in Global Adult Tobacco Survey (GATS). Details of the participant’s final treatment outcomes after end of standardized treatment of 6 months was collected from the treatment records of the patients available in the office of district TB center. Results: 72 TB patients were included as study subjects. The prevalence of smoking came out to be 37.5% (95% CI: 26.4-49.7). In our analyses, the risk of unfavorable treatment outcomes was higher among smokers (p value 0.049), Smokeless tobacco users (p value 0.031) and those with history of harmful alcohol use (p value 0.002). Conclusions: Smoking and smokeless tobacco cessation programs need to be targeted at Tuberculosis patients.

The Effect of Supplementation of Standard Antibiotic Therapy with Oral Probiotics for Bacterial Vaginosis

Background: Bacterial vaginosis is a common cause of vaginal infection worldwide in women of child bearing age. It can be asymptomatic or mild infection but can lead to many complications especially during pregnancy. Recurrence is also frequently seen in women suffering from bacterial vaginosis. This infection usually occurs when normal lactobacillus flora in vagina is disrupted and replaced by pathogens. Administration of probiotics will restore normal vaginal flora and maintain normal pH and it could prove to be a reliable alternative to antibiotics in future. Objective: To assess the effect of supplementation of standard antibiotic therapy with oral probiotics (Lactobacillus) for treatment of bacterial vaginosis. Material Methods: It was an open labeled prospective study in which 100 women diagnosed with bacterial vaginosis were randomly divided into two groups. Diagnosis was made using Amsel’s criteria and Nugent scoring was done. Group A was given Oral Metronidazole, 400 mg BD for 7 days along with oral probiotic tablet containing Lactobacillus rhamnosus BD for 6 weeks whereas Group B was administered Oral Metronidazole, 400 mg BD for 7 days. Patients were assessed at 7 days for symptomatic improvement and again at the end of 6 weeks using Nugent scores. Results obtained were then compared. Results: Out of all patients 2 patients in Group A and 5 patients in Group B could not complete the study. At the end of 7 days, there was improvement in symptoms ie decrease in itching, odour and discharge. There was a significant difference in mean Nugent score before and after treatment between group A and group B at the end of 6 weeks. Conclusion: This study concluded that improvement in patients taking probiotics along with standard antibiotic therapy was significantly more as compared to antibiotics alone.

The Effect of Supplementation of Standard Antibiotic Therapy with Oral Probiotics for Bacterial Vaginosis

Background: Bacterial vaginosis is a common cause of vaginal infection worldwide in women of child bearing age. It can be asymptomatic or mild infection but can lead to many complications especially during pregnancy. Recurrence is also frequently seen in women suffering from bacterial vaginosis. This infection usually occurs when normal lactobacillus flora in vagina is disrupted and replaced by pathogens. Administration of probiotics will restore normal vaginal flora and maintain normal pH and it could prove to be a reliable alternative to antibiotics in future. Objective: To assess the effect of supplementation of standard antibiotic therapy with oral probiotics (Lactobacillus) for treatment of bacterial vaginosis. Material Methods: It was an open labeled prospective study in which 100 women diagnosed with bacterial vaginosis were randomly divided into two groups. Diagnosis was made using Amsel’s criteria and Nugent scoring was done. Group A was given Oral Metronidazole, 400 mg BD for 7 days along with oral probiotic tablet containing Lactobacillus rhamnosus BD for 6 weeks whereas Group B was administered Oral Metronidazole, 400 mg BD for 7 days. Patients were assessed at 7 days for symptomatic improvement and again at the end of 6 weeks using Nugent scores. Results obtained were then compared. Results: Out of all patients 2 patients in Group A and 5 patients in Group B could not complete the study. At the end of 7 days, there was improvement in symptoms ie decrease in itching, odour and discharge. There was a significant difference in mean Nugent score before and after treatment between group A and group B at the end of 6 weeks. Conclusion: This study concluded that improvement in patients taking probiotics along with standard antibiotic therapy was significantly more as compared to antibiotics alone.

Study of Risk Factors for Preterm Births in a Teaching Hospital: A Prospective Study

Preterm birth is a leading cause of perinatal mortality and long term morbidity as well as the long term health consequences and neurodevelopmental outcome

Magnesium sulphate as a tocolytic agent in preterm labour.

Background: Prematurity and its prevention continue to be a major challenge for both the obstetrician and neonatologist. Preterm labour is the most common obstetrical complication associated with perinatal deaths. Despite all advances in neonatology, the delivery of a preterm neonate is a clinical crisis that threatens the life and health of an infant. The obstetrician thus faces the challenge of affecting the delivery in such a way as to optimize the status of fetus-infant at birth. It is far more preferable to prevent the intiation of preterm labour than once the cascade of events has already been established. Objective: To assess the efficacy of magnesium sulphate as a tocolytic agent in preterm labour. Material and Methods: 50 pregnant patients with gestational age 28- 37 weeks with cervical dilatation not more than 3cm and cervical effacement not more than 50 % with intact membranes with regular uterine contractions with a frequency of 2 or more per 10 minutes lasting for at least 30 seconds were put on magnesium sulphate. Results: Magnesium sulphate was successful in attaining tocolysis in majority of patients and had no adverse effects on immediate neonatal out come. Conclusion: Magnesium sulphate is effective, safe and well tolerated tocolytic agent with no adverse effects on the fetus-infant.

An anatomical study of variations of sacral hiatus in sacra of north Indian origin and its clinical significance / Estudio anatómico de las variaciones del hiato sacro en sacros del norte de la India y su significancia clínica

Sacrum is formed by the fusion of five sacral vertebrae and forms the lower part of vertebral column. The opening present at the lower end of sacral canal is known as sacral hiatus. Anatomical variations in morphology and morphometry of sacral hiatus are important clinically as well as surgically. 159 dry clean human Sacra were taken from Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research Vallah (Amritsar). Various shapes of sacral hiatus were observed which included inverted U (42.95%), inverted V (27.51%), irregular (16.10%), dumbbell (11.40%) and bifid (2.01%). The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 56.36%. The mean length of sacral hiatus was 22.69 mm. The mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 6.49 mm. Narrowing of sacral canal at the apex of sacral hiatus (diameter less than 3 mm) was observed to be high (5.36%). The knowledge of anatomical variations of dimensions of sacral hiatus is important while doing caudal epidural block and it may help to improve its success rate.

El sacro está conformado por la fusión de las cinco vértebras sacras, y forma la parte inferior de la columna vertebral. La abertura presente en el extremo inferior del canal sacro se conoce como hiato sacro. Las variaciones anatómicas en la morfología y la morfometría del hiato sacro son importantes clínica y quirúrgicamente. Fueron utilizados 159 sacros humanos, limpios y secos, del Departamento de Anatomía, Sri Guru Ram Das Instituto de Ciencias Médicas e Investigación Vallah (Amritsar). Fueron observadas varias formas de hiato sacro: U invertida (42,95%), V invertida (27,51%), irregular (16,10%), de pesa (11,40%) y bífida (2,01%). El ápice del hiato sacro se encuentra comúnmente a nivel de la cuarta vértebra sacra en el 56,36%. La longitud media de hiato sacro fue 22,69 mm. El diámetro medio anteroposterior del canal sacro en el ápice del hiato sacro fue 6,49 mm. El estrechamiento del canal sacro en el ápice del hiato sacro (diámetro inferior a 3 mm) fue alto (5,36%). El conocimiento de las variaciones anatómicas de las dimensiones del hiato sacro es importante para el bloqueo epidural caudal y puede ayudar a mejorar su tasa de éxito.

Synostosis of atlas with occipital bone-occurrence and clinical application.

Synostosis also known as occipitalization of the atlas is a rare congenital malformation at craniovertebral junction. Atlas, the first cervical vertebra forms the ellipsoidal synovial joints with the condyles of the occipital bone. Rarely it gets occipitalized where the condyles fuse with the lateral masses of the atlas. During the morphometric study of hundred skulls in Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, two skulls showed the incomplete occipitalization of the atlas vertebrae. The partial or complete assimilation of atlas may have resulted due to the disruption in the separation of caudal part of the first sclerotome from the cranial part of the first sclerotome.

Sexing of ulna by multivariate analysis

All bones show sexual dimorphism but hip bone, sacrum and skull are valuable in accurate diagnosis. Different workers studied different bones and determined the sex with some accuracy [ranging from 70 - 100%]. They used the following methods:-Traditional-non material method [Morphological], and Metrical method [Anthropological]. 193 ulnae of known sex available in bone bank of the department of anatomy, government medical college, Aurangabad, India are studied and various dimensions are measured in this study. The methods used for analysis of sexing of ulnae are: univariate, multivariate and morphological methods. It was found that: 88.1% accuracy of sexing can be done even if one ulna is studied, and changing combinations of 4 groups doesn't influence the percentage of accuracy of sexing. From the above results, we conclude that the multivariate analysis is the best possible method for sexing of ulnae

Osteoarthritis.

Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology characterized by loss of articular cartilage and periarticular bone remodelling. OA causes joint pain, typically worse with weight-bearing and activity as well as can manifest with stiffness after inactivity. It can present as localized, generalized or as erosive osteoarthritis. Primary osteoarthritis is mostly related to aging, whereas, secondary osteoarthritis is caused by another disease or condition. X-rays, arthrocentesis and arthroscopy remain the main diagnostic tools. Blood tests are performed to exclude diseases that can cause secondary osteoarthritis. The treatment of osteoarthritis includes non-pharmacological management, pharmacological treatment in the form of drugs which can modify symptoms, symptomatic slow acting drugs for OA or structure modifying OA drugs depending upon the clinical requirement of the patient. Patients with persistent pain and progressive limitation of daily activities despite medical management may be the candidates for surgery.

COX-2 selective nonsteroidal anti-inflammatory drugs: current status.

Since, their introduction, COX (cyclooxygenase enzyme)-2 specific inhibitors have become a rapidly growing segment of the prescription drug market. Researchers have recently focused on the potentially lethal side effects associated with their. FDA has banned the use of nimesulide (hepatotoxic) in pediatric patients and rofecoxib (cardiovascular complications) in both adults and children. COX-2 inhibitors may decrease vascular prostacyclin production and may tip the balance in favour of prothrombotic eicosanoids (thromboxane A2) and lead to increased cardiovascular thrombotic events. COX-2 inhibitors can also result into increase blood pressure, macular eruptions, urticaria, pseudoporphyria, erythema multiforme, oedema, worsening of heart failure, fatal allergic vasculitis and aggravation of doxorubicin-mediated cardiac injury. The COX-2 enzyme is also involved in the development of many organ systems, and its inhibition may lead to various congenital defects in neonates. It has been reported that COX-2 inhibitors also interfere with implantation, hence their use should be avoided in sexually active women at risk of pregnancy. However, presently the choice of COX-2 selective inhibitors for a particular patient should be based upon their relative efficacy, toxicity, concomitant drug use, concurrent disease states, hepatic and renal function and relative cost.

Microbial flora in orodental infections.

The present study was carried out to compare the normal aerobic and anaerobic bacterial oral flora with flora from deep seated dental caries, gingivitis and adult periodontitis. All the samples belonging to both the control and study groups yielded microbes. Aerobe / Anaerobe ratio was high in normal flora (1.48) as compared to dental caries (0.9), gingivitis (0.72) and periodontitis (0.56). Ninety seven percent of orodental infections were polymicrobial and three or more microbes were found in 84% cases of study group as compared to 28% in controls. Streptococcus mutans and anaerobic lactobacilli were common in dental caries, Actinomyces and Peptostreptococcus spp. in gingivitis, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in periodontitis.

Averaged evoked potentials: event related potentials (ERPs) and their applications.

Endogenous potentials are evoked responses that occur independent of the stimulus evoking them. They are related to different aspects of information processing. Two types of event related potentials (ERPs) are recorded, the P300 wave and contingent negative variation (CNV). The P300 wave is the most frequently studied factor in various clinical diseases and also for neurological research. Different tasks, paradigms can be used of which the oddball paradigm, consisting of target and non-target stimuli and their variations is most popular. The effect on P300 of physiological factors like age, IQ, pregnancy, exercise and others along with the clinical application in various neurophysiological and psychiatric disorders are discussed. This review deals with various aspects of (ERPs), their methodology with a broad view of the scope and clinical horizon as regard their application in neurophysiological research.

Lipid profile of coronary risk subjects following yogic lifestyle intervention.

The effect of yogic lifestyle on the lipid status was studied in angina patients and normal subjects with risk factors of coronary artery disease. The parameters included the body weight, estimation of serum cholesterol, triglycerides, HDL, LDL and the cholesterol - HDL ratio. A baseline evaluation was done and then the angina patients and risk factors subjects were randomly assigned as control (n = 41) and intervention (yoga) group (n = 52). Lifestyle advice was given to both the groups. An integrated course of yoga training was given for four days followed by practice at home. Serial evaluation of both the groups was done at four, 10 and 14 weeks. Dyslipidemia was a constant feature in all cases. An inconsistent pattern of change was observed in the control group of angina (n = 18) and risk factor subjects (n = 23). The subjects practising yoga showed a regular decrease in all lipid parameters except HDL. The effect started from four weeks and lasted for 14 weeks. Thus, the effect of yogic lifestyle on some of the modifiable risk factors could probably explain the preventive and therapeutic beneficial effect observed in coronary artery disease.