Drug utilization study in neonatal intensive care unit at tertiary care hospital

SUMMARY OBJECTIVE: Neonates are more susceptible to drug interactions and adverse effects, and special care should be taken when prescribing medication to them. This study aimed to investigate drug usage in the neonatal intensive care unit of a tertiary care hospital. METHODS: This prospective observational study was conducted on 98 patients at the Apollo tertiary care hospital (Bannerghatta, Bangalore, India) in a period of 6 months. The most common indications for neonatal intensive care unit admission, average number of drugs per patient, the most frequently used medication, distribution of patients based on the birth procedure, and possible drug interactions were collected from patient profiles. RESULTS: Among the patients, 52% were males and 48% were females. Notably, 38% of patients were preterm, 60% were term, and only 2% were post-term. Also, 80.6% were born by cesarean section and 19.4% were born by normal vaginal delivery. The highest mean of drug use was in the patient of 1,000-1,500 g (8.06 per patient). Preterm was the most frequent indication for admission in neonatal intensive care unit, followed by hyperbilirubinemia and then respiratory distress syndrome. The most frequently used medication was vitamin K (99%) and antibiotics followed by dextrose. In different types of antibiotics, amikacin (41%), cefoperazone+sulbactam (35%), cephalosporin (1%), ceftriaxone (0.7%), and amoxicillin (0.3%) were commonly administered. There were some possible interactions, such as aminoglycoside with furosemide and calcium gluconate. CONCLUSION: Premature birth and resulting low birth weight were the main reasons for drug prescription. High administration of antibiotics is probably an area of concern and should be seriously considered.

Assessment of quality of life among stroke survivors: a longitudinal study

Background: Quality of life (QoL) among stroke survivors is a concern which has not received sufficient attention in India. The objective of the study was to assess the quality of life of stroke survivors in rural population of Chikkaballapur district, Karnataka.Methods: A community based longitudinal study was done amongst the 150 incident stroke cases registered during the period from March 2013 to November 2014 and who survived beyond 28 days. The cases were enrolled and interviewed using a semi-structured questionnaire and were followed up for 6th month period. QoL was assessed at baseline (at 28 days), at 3rd month and 6th Month using Stroke Specific QoL scale (SSQoL) and Barthel index (BI).Results: The mean age of the persons with stroke was 61.3±15 years with a majority being males (69.3%). Baseline median score (IQR) of SSQoL at 28th day was poor i.e. 131 (77-183). Among the 150 cases, 136 (91%) survived until the end of 6th month. The overall QOL gradually improved to 182 (133-213) and 185 (147-213) at 3rd and 6th month respectively and similar improvement was seen individually in physical, psychological and social domains as well and on multivariate logistic regression age <60 years and few disturbed consciousness among the stroke survivors during the 6th month follow up were found to be predictors for improved quality of life.Conclusions: QoL showed significant improvements in all physical, psychological and social domains by the end of the 6th month of follow up.

Fractured retained Double-J stents presenting as urethral foreign body

Background: In few studies, Dexmedetomidine was used an adjuvant to local anesthetics in peripheral nerve blocks Aim: This study was aimed to examine the effect of adding Dexmedetomidine to Bupivacaine 05% during the femoral sciatic nerve blocks and to evaluate its effect in prolonging post-operative analgesia Materials and methods: This was a prospective, double blinded, randomized study which consisted of 80 patients, Patients were randomly allocated into two groups (40patients each): In group BD, (Bupivacaine-Dexmedetomidine hydrochloride), one mL, containing 100 μg, was added to 39 mL of Bupivacaine 05% In group B; 1 mL of normal saline was added to the same volume of Bupivacaine 05% Results: There were no statistically differences between the two groups in demographic data and surgical characteristics The onset time of sensory block, motor block and surgical anesthesia time were significantly shorter in group BD when compared to group B The durations of sensory block, motor block and analgesia were longer in BD group when compared to group B Systolic arterial pressure (SAP) and heart rate were significantly lower in group BD when compared to group B from 10 to 90minutes after initiation of block (P<005), diastolic arterial pressure was similarly lower in group BD at 45, 60, and 90 minutes following initiation of block Conclusion: This study showed that a prolonged duration of analgesia was associated with addition of Dexmedetomidine 100μg to bupivacaine 05% during US-guided combined femoral and sciatic block for below knee surgery and is also associated with significant bradycardia requiring treatment

Depressive Disorders among People with Chronic Illness in an Urban Area of South India

Over the past decades, twin demographic and epidemiological transitions have been reflected an increase in the burden of chronic diseases. Although public health practitioners have recognized the increasing burden, the socioeconomic and overall health impact is to be adequately researched. Depressive disorders are considered an important correlate, for appropriate management of chronic disease but have been given relatively less importance. Hence, this study was taken up in an urban slum of Bengaluru city to explore the associations between depressive disorders and chronic diseases.Methodology: The cross-sectional community-based study was conducted in an urban slum of Bengaluru city using a modified cluster sampling technique. All persons who were ill or on long-term medication or were hospitalized for a period more than 3 weeks in the past 1 year were interviewed. A semi-structured pre-tested questionnaire incorporating Hamilton Depression Rating Scale was used. Results: He overall prevalence of chronic illness was 10% among the study population with 10.9% having mild depression, and 1.2% having mild-moderate depression, and none severe depression. None of them were taking any treatment for their depression. The mean age of those with mild depression was 53.9 years and was greater among females (males 5.0% and females 16.7%). The latter was highly statistically significant. Of the 91 persons with symptoms of mild depression, nearly two-thirds (58.2%) belonged to Class IV of Modified B G. Prasad’s classification. Factor analysis showed that HAM-D scores to have a significant relation with chronic illness. Discussion: Depressive disorders among those with chronic disorders are hitherto unrecognized in routine clinical practice. Middle ages, females and those lower down in the socioeconomic hierarchy are at greater risk. There is a need to establish a mechanism for appropriate management of these disorders.

A comparative study of FNAC breast lesions and BI-RADS grading with a focus on grade 4 and grade 5 categories

Breast carcinoma is showing an increasing trend amongst urban women population. Breast Imaging Reporting and Data System (BI-RADS) is a widely accepted risk assessment procedure for carcinoma breast in clinical practice. Fine needle aspiration cytology (FNAC) is an established and important preoperative diagnostic modality. We have done a two year comparative study of these two procedures in the department of Pathology, at Gandhi Hospital from June 2014 to May 2016. We have done 720 FNACs for breast lesions during this period and compared the results with BI-RADS classification by mammography / ultrasound screening at the department of radiology, Gandhi Hospital. Out of total 720 patients who underwent FNAC, BI-RADS grading was available for only 540 cases. Cytological patterns were compared with BI-RADS grading for these 540 cases. The Concordance and Discordance among these findings are discussed with special emphasis on grade 4 and Grade 5 BI-RADS lesions in which carcinoma breast risk is high.

Insertion-deletions burden in copy number polymorphisms of the Tibetan population.

BACKGROUND: Many studies have been conducted to identify either insertions-deletions (inDels) or copy number variations (CNVs) in humans, but few studies have been conducted to identify both of these forms coexisting in the same region. AIMS AND OBJECTIVES: To map the functionally significant sites within human genes that are likely to influence human traits and diseases. MATERIALS AND METHODS: In this report, we describe an inDel map in the 1051 Tibetan CNV regions obtained through CNV genotyping using Affymetrix Genome-wide single nucleotide polymorphism 6.0 chip. InDel polymorphisms in these copy number polymorphism regions were identified with a computational approach using the 2500 deoxyribonucleic acid sequences obtained from the 1000 Genome Project. RESULTS: The study identified a total of 95935 inDels that range from 1 bp to several bps in length which were found scattered across regulatory regions, exons and in introns of genes underlying the CNVs. A study on the distribution of inDels revealed that the majority of inDels were found in coding regions of the genome than the noncoding, while within the genes, inDels in intron regions were more followed by exonic regions and finally the regulatory regions. CONCLUSION: Study of inDels in CNV regions contribute to the enhanced understanding of the role played by the two variations and their collective influence on the genome. Further, a collection of these inDel genetic markers will aid in genetic mapping, further understanding of the phenotypic variability, identification of disease genes and in detecting novel CNVs.

Self-rated health as a measure of health status among people with chronic illness in an Urban area of South India.

Background: Rising burden of chronic illnesses across the globe necessitates the assessment of needs of persons suffering from these illnesses. Self-rated health has been found to be a valid and reliable tool in population health surveys. Material and methods: A cross-sectional study using modified cluster sampling technique was undertaken in the urban field practice area of M S Ramaiah Medical College, Bangalore. A semi-structured pre-tested questionnaire was used for data collection, which was done by interview method through house-house visits. Self- rated health was assessed using a 5-point scale ranging from Very Good -Good –Fair- Poor- Very poor. This rating was crosschecked by an assessment by the investigator. Descriptive statistics and factor analysis were used for the purpose of analysis of data and weighted kappa statistic was used to test agreement between self-rated health and health assessed by investigator. Results and Conclusions: Overall prevalence of chronic illness in the study population was 10.0% and significant difference was observed between males and females. In the study population, 72.0% (293) rated their health as fair. 13.0% rated their health as poor while the investigator assessed the health status of the study pop-ulation as fair in 72.0% of the study population and as poor in 4.9% of the study population. Weighted Kappa statistic showed 33% agreement between the two ratings. Factor analysis of 32 variables included in the study explained 67% of the total variance. Principal component analysis of these factors yielded 12 factors of which 3 were considered major depending on the number of variables included and percentage variance explained by that factor. Major factor 1 contained 11 variables including self-rated health and explained 14.3% of the variance, which signifies the role of self-rated health as a measure of health status.

An ascending aortic haemodynamic comparison between normotensive and hypertensive subjects.

Background: Systemic hypertension, a common disorder with potentially serious complications, exerts ill effects through structural and functional modifications of arterial wall. Haemodynamics play an important role in the development of atherosclerosis. Local hemodynamic temporal pressure and wall shear stress are important for understanding the mechanisms leading to various complications in cardiovascular function. Objectives: Since we could not find such a study in literature involving Indian population, this prompted us to investigate and establish the relationship between the blood pressure and the ascending aortic pulse wave parameters in normal individuals and compare the same with hypertensives. Material and methods: A case control study was done in a ter􀆟ary care hospital involving 25 hypertensive pa􀆟ents and further compared with 25 normotensive subjects of same age group ac􀆟ng as control. The GE ̶ P 100 Doppler echocardiography machine was used to study acceleration time, deceleration time, ejection time, ejection fraction, peak flow velocity and pressure gradient in hypertensives and compared the same with age matched normotensive. Also ascending aortic diameter was mapped at the annulus. Results: The results of our study confirmed our assumption that in hypertensive the ascending aortic haemodynamic parameters are abnormal and both systolic and diastolic blood pressure does exert a statistically significant influence on the Doppler parameters of ascending aorta. The acceleration time, deceleration time, pressure gradient and ejection time showed statistically significant increase in hypertensives when compared to normotensive. At the same time the ejection fraction and the ascending aortic diameter showed a statistically significant decrease than normotensive. Conclusion: We would conclude to say that the Doppler parameters of ascending aortic blood flow are abnormal in hypertensives. This altered haemodynamics may lead to further ill effects by way of altered peripheral haemodynamics. This Doppler evaluation of ascending aortic blood flow can be developed as a clinical tool for evaluating hypertensives and assessing the benefit of treatment of hypertension.

Dietary factors and cancer chemoprevention: an overview of obesity-related malignancies.

Obesity is a growing health problem in developed nations and in countries that are in the process of westernization like India. Obesity is linked with several health disorders such as hypertension and cardiovascular diseases, Type 2 diabetes, dyslipidemia and certain cancers. Currently, obesity-related malignancies, e.g., cancers of the breast, prostate and colon are the leading cancers in the industrialized societies. An increased amount of fat or adipose tissue in an overweight or obese person probably influences the development of cancer by releasing several hormone-like factors or adipokines. The majority of adipokines are pro-inflammatory, which promote pathological conditions like insulin resistance and cancer. On the other hand, many recent studies have shown that adiponectin, an anti-inflammatory adipokine, has anti-cancer and insulin-sensitizing effects. Adiponectin exerts its physiological functions chiefly by activation of AMP kinase via adiponectin receptors. Interestingly, several fruits and vegetables may contain adiponectin-like molecules or may increase the biosynthesis of adiponectin in our body. Studies on adiponectin analogues or adiponectin receptor agonists are a promising area of cancer chemoprevention research. In general, fruits and vegetables contain various dietary substances such as vitamins, minerals (like calcium and selenium), fiber and phytochemicals or phenolic compounds (like flavonoids and vanilloids), which may act as anti-cancer agents. Similarly, several dietary constituents including phytochemicals may have anti-obesity effects. Consumption of such dietary compounds along with caloric restriction and physical activity may be helpful in preventing obesity-related cancers. For this review article, we searched PubMed primarily to get the relevant literature.

Study of social loss or gain from a particular cause: scope for the developing countries - a review with reference to cancer.

Incidence rates have long been used to assess the burden of different diseases in a population, whereas loss due to occurrence of diseases is studied using the death rates. Death rates however, are based on and therefore describe, only number of lives lost. There have been two approaches to arrive at the actual loss or gain from a particular cause viz. Person years of life lost (PYLL) approach and cause elimination life table (CELT) approach. This review covers these approaches and the competing risk theory and models focusing on the methodological developments. A summary of the conceptual and methodological developments on these concepts has also been presented. There are eight possible approaches in dealing with the loss in the presence or gain in the absence of a particular cause of death depending upon the preferences related to PYLL/CELT approach, modeling/descriptive approach, considering or without considering competing causes. A close look at the two basic approaches reveals that PYLL and cause elimination are just different terminologies used to address the same quantity, loss in the presence or gain in the absence. As far as descriptive vs. modeling approaches are concerned, all the descriptive procedures can be put in the form of models and all the models can be presented in a descriptive way. Regarding results using different models, no practical difference exists in the results based on different models for competing risks. However, exclusion of the competing risks may result in a considerable bias in the developing countries where general mortality is relatively higher. This review study suggests freedom in the selection of a modeling or a descriptive approach without any considerable loss of accuracy but at the same time emphasizes the consideration of the competing risks. An empirical study may be recommended to confirm the conclusions of this study.

Burden of cancer and projections for 2016, Indian scenario: gaps in the availability of radiotherapy treatment facilities.

Plausible projections of future burden of cancer in terms of incident cases and requirement of radiotherapy treatment facilities at the national and state level are useful aids in planning of cancer control activities. The present communication attempts to provide a scenario for cancer in India during the year 2001 and its likely change by 2016 for all sites of cancer as well for selected leading sites. Further, a study was made of: (i) the state-wise distribution of radiotherapy treatment facilities and short falls; and (ii) pattern of investment of finances through central assistance by Government of India for cancer control activities during the various plan periods. The age, sex and site-wise cancer incidence data along with populations covered by 12 Indian population based cancer registries were obtained from the eighth volume of Cancer Incidence in Five Continents (CIV-VIII) and other published reports. Pooled age sex, site specific cancer incidence rates for twelve registries were estimated by taking weighted average of these registries with respective registry population as weight. Population of the country and states according to age and sex for different calendar years viz. 2001, 2006, 2011 and 2016 were obtained from the report of Registrar General of India. Population forecasts were combined with the pooled incidence rates of cancer to estimate the number of cancer cases by age, sex and site of cancer for the above 5-yearly periods. The existing radiotherapy facilities available in the country for cancer treatment during the year 2006 was based on the published reports and updated through personal communication from the Ministry of Health of India. During the year 2001, nearly 0.80 million new cancer cases were estimated in the country and this can be expected to increase to 1.22 million by 2016 as a result of change in size and composition of population. The estimated numbers were greater for females (0.406 millions, 2001) than males (0.392 millions, 2001). Lung, esophagus, stomach, oral and pharyngeal cancers are much higher in men while in women, cancers of cervix and breast are predominant forms followed by those of oral cavity, stomach and esophagus. Considering all the sources, it was noted that during the year 2006, there were 347 teletherapy units in the country as against a requirement of 1059. The state-wise analysis of the distribution of RCCs, and radio-therapy units shows wide gaps in the availability of facilities. The existing treatment facilities for cancer control in-terms of radiotherapy and financial allocation are woefully inadequate to take care of even the present load. The only way to fight this scourge under such circumstances is to have pragmatic programmes and policies based on currently available scientific information and sound public health principles.

An indirect study of cancer survival in the context of developing countries.

With classical approaches, survival refers to the life of a person after diagnosis of disease, and survival studies deal with measurement of the same to evaluate overall performance of a group of patients in terms of quality and quantity of life after diagnosis/treatment. There are numerous difficulties in the conduct of a population-based survival study in the context of developing countries, including India. Loss to follow-up is a typical problem encountered, causing biased estimates. In view of this difficulty with the classical approach, the objective of this study was to propose an indirect methodology for the study of survival. The proposed methodology is based on life table techniques and uses current data on incidence and mortality from the disease. It involves the estimation of person years free of disease (PYFD), person years with disease (PYWD), person years of life lost (PYLL) and average duration of disease (ADD) and their comparison over a time period. Empirical application was carried out for mouth and lung cancers in males and cancers of breast and cervix in females as well as for all sites combined together in each sex. Cancer incidence and mortality data by age and sex for the years 1989, 1993, 1997 and 2001 were obtained from published reports of Mumbai Cancer Registry, India. All causes of deaths for these years were obtained from Mumbai Municipal Corporation. Three life tables were constructed by applying various attrition factors: (a) risk of death from all causes; (b) risk of incidence and that of death from other causes; and (c) risk of death from other causes only. The expectation of life from the second life table gave PYFD. PYWD and PYLL were calculated by suitable subtractions among three expectations of life. ADD was calculated by dividing person years lived with disease by number developing the disease. It was noted that during 1993-2001, PYFD for all sites increased from 59.4 to 62.1 and from 63.8 to 66 years in males and females respectively. PYLL was about 0.8 year in males and 1 year in females. Similarly, PYWD was 0.6 and 1 year in males and females. ADD for all sites varied from 4 to 4.7 years in both sexes. It was about 6 years for mouth cancers and 2 years for lung cancers in males and 4-5 years for breast and cervical cancers in females. Validation of the ADD was carried out by comparison with published data for calculating median duration of disease. Given the difficulties in conduct of classical survival studies, the proposed method may provide a useful tool for having a regular audit of prognostic factors in the community.

Maternal thyroid hormonal status in preeclampsia.

BACKGROUND: The physiological changes in the thyroid gland during pregnancy are well understood but only a few reports provide information about thyroid function in complicated pregnancies. AIMS: The present study evaluates thyroid hormonal levels in cases of preeclampsia in the third trimester of pregnancy. SETTINGS & DESIGN: A case-control study was conducted in the antenatal clinic of a public hospital of Delhi. METHOD & MATERIALS: Thyroid hormones, namely triiodothyronine (Free T3), thyroxine (Free T4) and thyroid stimulating hormone (TSH) were evaluated at the time of diagnosis of preeclampsia in 82 pregnant women and equal number of matched controls. STATISTICAL ANALYSIS: The demographic data and hormone levels were analyzed using students' t test, Mann-Whitney test and chi-square test. Pearson two-tailed analysis was used for correlation. RESULTS: Mean TSH levels were significantly higher in preeclamptic group as compared to controls (p< 0.001). However, mean values of thyroid hormones were in the normal range. Approximately 40% preeclamptic women had TSH titres > 5 mIU/ml in the study group as compared to 12.2% in the controls. Approximately 76.7% of 43 pregnant women with abnormal TSH titres and 40% of 121 pregnant women with normal TSH titres belonged to the study group (p< 0.001). The odd ratio corresponding to TSH titres > 5 mIU/ml in preeclamptic women was 4.85 (95% CI 2.19-10.74). CONCLUSIONS: Mean serum TSH levels were significantly increased without concomitant changes in free T3 and T4, in preeclampsia compared to normal pregnancy. Abnormal TSH titres might be associated with a risk for occurrence of preeclampsia.

Adrenocorticotropic hormone and growth factor receptors in breast cancer.

Tissues from 100 cases of breast cancer were analysed immunohistochemically for the presence of adrenocorticotropic hormone (ACTH) or ACTH-like peptides and expression of c-erbB-2 oncoprotein, epidermal growth factor receptor (EGF-R) as well as oestrogen receptor (ER). Immunopositivity for ACTH was found in 15% cases of infiltrating duct carcinoma of the breast, whereas 38% and 36% breast tumours were positive for c-erbB-2 and EGF-R respectively. While 27% cases were positive for ER. The immunoexpressions of all parameters were higher in breast cancer cases with upper age group (45 years or above) than the patients below 45 years of age. A significant correlation was observed between the tumour grade and the expression of c-erbB-2 oncoprotein. Further, a positive association between the immunoexpression of c-erbB-2 and EGF-R was noticed. Interestingly, a statistically significant relationship was found between the immunopositivity of ACTH and ER. The study reflects a probable association of ACTH or ACTH-like peptides in pathological process of breast cancer.

Induction of stable benomyl-tolerant phenotypic mutants of Trichoderma pseudokoningii MTCC 3011, and their evaluation for antagonistic and biocontrol potential.

Trichoderma pseudokoningii MTCC 3011 is a very useful strain for biological control of the plant pathogen Sclerotium rolfsii under post-harvest conditions. In the present investigation, several benomyl-tolerant phenotypic mutants of this strain have been generated using a two step mutagenesis-chemical followed by gamma irradiation. The mutants differed from the wild type strain in antibiotic and disease control potential. Some of the mutants are superior to the wild type in biocontrol potential on S. rolfsii.

Screening for cancer of uterine cervix and approaches adopted in India.

Cervical cancer is the leading malignancy among Indian women. It has been estimated that in the absence of any control programme, the incident number of cervical cancer cases in the country would rise to 140 thousand by the turn of this century. Cytology screening remains the main stay for the control of cervix cancer. In the present communication the evidence available for screening for cancer of cervix has been presented. Difficulties in organising cervical cancer screening programmes in India and the alternative approach have been discussed.

A step towards quality medical research.

Only well planned and conducted research can answer questions that arise in day-to-day clinical practice. Unfortunately, most studies in India are deficient in design or execution. The results thus obtained are biased and cannot be extrapolated to the population studied. Some important questions which arise during the statistical design of investigations are selection of subjects on which observations are to be made, number of observations falling into different groups, allocation of subjects among different groups, etc. Besides planning and execution, appropriate methods need to be chosen for data analysis beforehand. If the study has been well designed and correctly analysed, the interpretation of results can be fairly simple. The present communication focuses on some issues relating to the planning of investigations in medical research with emphasis on statistical design.

Efficacy of triple therapy with PPI or H2 antagonist versus the elimination of helicobacter pylori

O Helicobacter pylori tem sido considerado importante fator nas doencas gastroduodenais e o esquema chamado triplice e o que mais se aceita no momento para a sua terapeutica. Neste estudo incluiram-se 14 pacientes portadores de gastrite cronica, 30 com ulcera gastrica e 16 com ulcera duodenal. Foram divididos em 2 grupos homogeneos para tratamento clinico, cada um com esquema bem definido: grupo A - claritromicina 250mg/2, tinidazol 250mg/2 e omeprazole 20mg em caso de gastrite e 40mg em caso de ulcera; grupo B - mesmos antibioticos e ranitidina respectivamente nas doses de 150 e 300mg. O periodo de tratamento foi de 7 dias para gastrites e 4 semanas para ulceras. Atraves de endoscopia e biopsia realizadas 30 dias depois do termino do tratamento, os 30 casos do grupo A tiveram erradicacao completa do Helicobacter pylori e cicatrizacao das ulceras. No grupo B, apenas 3 casos nao tiveram eliminacao do Helicobacter pylori. Concluiu-se que o uso de bloqueadores H2 no lugar de inibidores da bomba protonica tambem permite a obtencao de sucesso terapeutico