ABSTRACT
Background: Rational use of medicines promotes good health practices and prevents inappropriate use of medicines, polypharmacy, unnecessary use of antimicrobials, injections, and also encourages use of medicines from essential medicine list and dispensing by generic names. The aim of the study was to analyze the outpatient prescriptions of a tertiary care centre by utilizing World Health Organization (WHO) core drug use prescribing indicators.Methods: A retrospective observational study was conducted in a tertiary care health setup at Puducherry, South India. Outpatient prescriptions from all the major clinical departments were analyzed using WHO prescribing indicators and they were compared with some similar studies.Results: The average number of drugs per prescription was 2.74. The percentage of prescriptions with antibiotics was 20.33% and the percentage of prescriptions with injections was 0.16%. The percentage of drugs prescribed by generic names and from essential medicine list was 83.13% and 87.9 respectively. Further antibiotic utilization was found to be higher in the department of ENT (56.67%), respiratory medicine (45%) and surgery (40%). Percentage of drugs prescribed by generic names in pediatrics and respiratory medicine were found to be 67.88% and 65.27% and percentage of drugs prescribed from essential medicine list in dermatology was 69.62%.Conclusions: Prescription pattern followed in our Institute almost adheres to the guidelines laid down by the WHO. Moreover, it is also implied that a routine audit of this type should be done in health care setups to ensure that they adhere to the WHO guidelines for better health care.
ABSTRACT
Introduction: In the intensive care unit (ICU), approximately 30% of all patients require mechanical ventilation. Reintubation isa high-risk procedure in critically ill patients. Anticipating a difficult airway and identifying high-risk patients can be life-saving.10–20% of critically ill patients who are extubated will be reintubated within 72 h which leads to long-term ventilation-relatedcomplications such as ventilator-associated pneumonia and ventilator-associated lung injury, which greatly affect the length ofstay and mortality in the ICU.Aim: The aim is to study the causes, risk factors, and outcomes associated with reintubation.Materials and Methods: In this retrospective study, clinical data of patients who were reintubated were collected and the factorsassociated with reintubation were analyzed.Results: A total of 532 patients were intubated in the ICU, of which 25 cases (9.2%) required reintubation, 19 patients haddiabetes, 17 of them had hypertension, and 14 had coronary artery disease. Majority of the patients improved after intubationand the mean ventilator stay after reintubation is 3.4 days. Among patients who were reintubated 9 patients were dischargedafter recovery, 4 patients were discharged against medical advice, 5 were discharged on request, and 7 patient died.Conclusion: Reintubation is associated with more procedural complications such as hypoxia and hypotension and prolongedICU stay, and the ICU team must be prepared for such complications. Laryngeal edema was also an observed complicationin a few patients.
ABSTRACT
BACKGROUND: The B cell lymphoma‑2 gene is a proto‑oncogene whose protein product inhibits apoptosis. Its role is associated with keeping cells alive, but not by stimulating them to proliferation, as other proto‑oncogenes do. Increased expression of protein product of Bcl‑2 gene appears in the early phase of carcinogenesis leading to apoptosis impairment and in consequence to the progression of neoplastic changes. OBJECTIVE: To evaluate and compare the expression of Bcl‑2 protein in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Sixty cases of formalin‑fixed paraffin‑embedded archival specimens comprising of 30 cases of leukoplakia with oral epithelial dysplasia and 30 cases of OSCC were taken for immunohistochemical analysis using monoclonal antibody against anti‑human Bcl‑2 oncoprotein. RESULTS: Immunostaining for Bcl‑2 protein was identified in basal and parabasal layers as granular cytoplasmic staining in oral epithelial dysplasia. In OSCC, Bcl‑2 immunoreactivity was most prominent in the peripheral cells of the infiltrating tumor islands which diminished toward the center in well‑differentiated and moderately differentiated OSCC, whereas stronger and more diffuse expression of Bcl‑2 oncoprotein was seen in poorly differentiated OSCC. Overall positivity of 26.7% (8/30) was observed in oral epithelial dysplasia and 30% (9/30) in OSCC in this study. INTERPRETATION AND CONCLUSION: Altered expression of Bcl‑2 oncoprotein may be an early molecular event which leads to prolonged cell survival, increased chances of accumulation of genetic alterations, and subsequent increase in malignant transformation potential.