ABSTRACT
Background: Chronic wounds are responsible for increase in burden to healthcare systems. The evidence concerning effectiveness of antibiotic therapy or optimal regimens is insufficient. Patients with chronic wounds receive significantly more systemic and topical antibiotics. Current guidelines for antibiotic prescribing for such wounds are often based on expert opinion rather than scientific fact. As there is increasing prevalence of antibiotic resistance, the relationships between antibiotic resistance and rationales for antibiotic therapy have to be determined. Current practice of antibiotic usage for chronic wounds and postoperative wounds in a tertiary care setting should be studied.Methods: Retrospective study was conducted from February 2017 to February 2018 using medical records of patients with wound admitted in surgical departments in HIMS, Hassan, Karnataka. The inpatient records were analysed, which includes duration of stay in the hospital, number of drugs/products per person, percentage of antibiotics prescribed, percentage of antibiotic injection prescribed, and other modalities used to treat wounds.Results: In present study, amongst 100 antimicrobial prescriptions, 26 females and 74 males. The most commonly prescribed parenteral antibiotic was ceftriaxone (58%), followed by metronidazole (56%). The average number of antibiotics per prescription was 2.8. The mean duration parenteral antibiotics given was 4.26 days during their hospital stay oral antibiotics were 5.18 days after the discharge from the hospital.Conclusions: The information generated shall be used to decide the policies to govern the prescription of antibiotics in the management of chronic wounds and post-operative wounds.
ABSTRACT
Background: The midline sacrococcygeal pilonidal sinus is the common surgical condition among younger population. They present to surgical outpatient department with pain and history of pus discharge from natal cleft. These patients approach for permanent cure following repeated attacks of pain and abscess drainage. We present a new surgical technique of primary closure by applying deep tension sutures (DTS) to close the defect following excision of midline sacrococcygeal pilonidal sinus. The rationale behind this technique is to avoid prolonged hospital stay and early return to work.Materials and Methods: In this study, a group of five patients (one female and four male patients) with the age group between 18 and 35 years was studied for the effectiveness, duration of hospital stay post-operative complications, and recurrence following the new surgical technique of DTS. Following excision of midline sacral pilonidal sinus, the resulting elliptical wound varying from 6 cm to 10 cm was approximated using two or three DTS with No-1 Prolene. In this suturing technique, the sutures were held in place using small pieces of plastic tubing from intravenous drip set to avoid suture cutting through the skin. This technique was similar to abdominal wound closure in cases of complete wound dehiscence. The superficial part of the wound was approximated using No-3 zero Ethilon. In this procedure, author has not used any type of drain in the wound. No suture materials were used inside the wound to approximate the raw area (e.g., Vicryl suture). Patients were covered with IV antibiotics and analgesics for a period of 5 days. All sutures were removed on the 10th day.Results: There were no post-operative complications noted during the hospital stay and during follow-up period ranging from 2 months to 6 months. The scar was healthy with functionally, cosmetically acceptable results. There was no recurrence noted in our study group during the follow-up
ABSTRACT
Cancer persists to be a major cause of hospitalization and death every year. With the passage of time, new formulations of anticancer drugs are being introduced to the market and are drawing the concern of healthcare professionals in terms of the superiority, toxicology, and cost-effectiveness of the new formulations in comparison to the conventional formulation of the same drugs. Doxorubicin, a highly potent chemotherapeutic agent, it comes with three formulations (pegylated liposomal, nonpegylated liposomal and non-liposomal conventional formulations). English-language literature of the three formulations of Doxorubicin has been reviewed to inform the healthcare professionals regarding the differences between these formulations. Liposomal Doxorubicin promotes better toxicology profile than non-liposomal conventional Doxorubicin with an increased cost. Due to very limited studies, the cost-effectiveness of liposomal Doxorubicin is not well defined. Apart from that, this review highlights the inter patient variability in regard to the clearance and volume of distribution following the administration of liposomal Doxorubicin. In conclusion, further studies regarding the superiority of liposomal formulation of Doxorubicin , efficacy and dose standardization of liposomal Doxorubicin should be sought in the near future in a more better way.
ABSTRACT
Background: Drug utilization research is a part of Pharmacoepidemiology defined by the WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. Conducting periodic studies of pattern of drug use in our hospital setting is essential to critically analyse the current hospital drug policies and to make recommendations based on various guidelines to improve upon the current drug usage pattern. Aims and objectives of the study was to generate data on the drug utilization pattern in Medical ICU and to monitor antimicrobial usage in MICU.Methods: Patients who were admitted in medical ICU of Hassan institute of Medical Sciences were recruited based on inclusion-exclusion criteria. The study was conducted over a period of 3 months from April 2018 to June 2018. The demographic and clinical treatment data of patients were collected. The prescriptions were assessed as per the WHO indicators.Results: Common causes of admission were suicidal poisoning, snake bite, viral thrombocytopenia, myocardial infarction and stroke. The average duration of stay was 5.74 days and average number of drugs/patient was 5.26. Pantoprazole, Ranitidine, Ceftriaxone, Atropine, Pralidoxime, ASV, Ondansetron, and N-acetylcysteine were commonly prescribed drugs. 42.4% of drugs were prescribed by generic names and 84.2% of the drugs were prescribed from Essential Medicine List.Conclusions: This study will provide database to address prescription protocols and guide appropriate use of drugs in the ICU setting.
ABSTRACT
Background: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. The beginning of dialysis treatment causes subtle changes in the life of CKD patients, mainly in the physical and social spheres. It affects the self-care of these patients which lead to poor adherence to dialysis. Hence, the present study was conducted to screen for depression.Methods: This was an observational study among 100 patients undergoing haemodialysis at HIMS, HASSAN. After taking informed consent, subjects were requested to complete Beck, depression Inventory, a 21-question multiple-choice self-report inventory for measuring the severity of depression. Descriptive statistics was applied to infer the findings.Results: The study population showed depression of mild (31%), borderline (10%), moderate (17%), severe (7%) and extreme (3%) grade and the remaining subjects did not show depressive symptoms (32%).Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status of the patients, low literacy rate, gender and those started on dialysis recently.
ABSTRACT
Background: There is much debate regarding the importance of promoting the use of cheaper generic alternatives over brand-name drugs. While generic drugs have been noted to be comparable to brand-name drugs in their ability to treat conditions, significant debate surrounding their bioavailability or the concentration of the drug that reaches its site of action has arisen. Many experts continue to believe that generic and brand-name drugs are bioequivalent and equally viable options for effective drug treatment, as assumed in this review.Methods: Prices of commonly used branded and generic medicines in same concentration, dosage form and combination were compared with the help of Indian Drug Review, brochures of pharmaceuticals and pharmacies and Jan Aushadhi price list 2017. Mean of all the prices available of branded and generic medicine were calculated and the percentage difference in the mean costs of generic and branded medicines were calculated.Results: The mean cost of 47 branded medicines out of the selected 50 medicines was higher than their generic versions. Mean cost of 3 generic medicines was higher than branded ones. Percentage difference in the mean costs of branded and generic medicines varied from <10% to >70%.Conclusions: This study has shown a very noteworthy difference of prices between branded and generic drugs. Efforts should be taken to promote the generic medication. Misconception about low efficacy with generic drugs should be erased.
ABSTRACT
Background: Chronic Kidney Disease (CKD) is a silent disease that is frequently diagnosed in advanced stages. The prevalence and incidence of chronic kidney disease (end-stage renal disease) are continuously increasing, particularly in elderly patients. Poor adherence to complex multimodal therapies is a widely recognized problem in the daily care of dialysis patients, contributing to excess morbidity and mortality of this population. Aims and objectives was to assess the adherence to medications among patients undergoing haemodialysis and to explore the factors affecting non adherence.Methods: After obtaining approval from Institutional Ethics Committee, a prospective observational study was carried out among 150 patients, who were on dialysis in a tertiary care hospital, Hassan. An eight item Morisky Medication adherence questionnaire was used to assess medication adherence. Chi-square test applied to assess statistics.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non-adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to Dialysis. Other reasons contributing to non-adherence to treatment were forget fullness (86.66%), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11%) and lack of assistance (48.88%).Conclusions: In this study patient showed moderate adherence. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence.
ABSTRACT
Background: Different medications are used to reduce pain and inflammation after cataract surgery. Hence this study was taken up to compare the efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% in reducing anterior chamber inflammation and pain after cataract surgery.Methods: Total of 100 patients who underwent uneventful cataract surgery with posterior chamber intra ocular lens (IOL) implantation were randomly allocated to receive bromfenac 0.09% and flurbiprofen 0.03% topically from first post-operative day onwards for 6 weeks. Assessment of anterior chamber inflammation and pain was done by slit lamp and visual analogue scale respectively on each follow up days. Analysis was done by unpaired t test and Fischer’s exact test.Results: The response to treatment was earlier in bromfenac group for all the inflammatory changes (significant difference was found on day 7, p<0.05) except for corneal edema where both the groups showed similar response. On 7th day after surgery, 72% patients in flurbiprofen group and 12% in bromfenac group had pain (score1), while on the 14th day none in the bromfenac group complained of pain whereas 4% in flurbiprofen group still had pain. Both the drugs were safe and no clinically serious adverse effects were observed in either of the groups.Conclusions: This study showed both the medications, topical bromfenac 0.09% and topical flurbiprofen 0.03% effective and safe in reducing pain and anterior chamber inflammation after cataract surgery but the response was earlier with bromfenac 0.09%.
ABSTRACT
Background: Prescription audit is a tool as well as a technique by its application,all professionals will improve the quality of prescribing drugs. Standards of medical treatment can be assessed by prescription audit. It is based on documented evidences to support diagnosis, treatment and justified utilization of hospital facilities. Prescription audit is a quality improvement process that seeks to improve patient care. In this background the present study was conducted. The objectives of the study were to know the frequently prescribed drugs in OPD, number of the drugs used per prescription and to find out the rationality.Methods: Study was conducted at Sri Chamarajendra Hospital, HIMS, Hassan in OPD of General Medicine.1000 prescriptions were collected and noted down the frequently used medication, number of drugs prescribed and their type of formulations for the particular diagnosis.Results: From the study it is noted that 1910 drugs out of 1000 prescriptions were prescribed which is approximately 1.91 drugs per prescription about 55% of the prescriptions contained single drug. Very few received 4-5 drugs (7%). Almost all the drugs in prescriptions were in Generic names. Around 95% of prescriptions doses were mentioned in mg, ml etc. The most commonly prescribed drugs in order are Antibiotics, antidiabetics antihypertensives, bronchodilators, steroids antiemetics and ORS were prescribed.Conclusions: Polypharmacy was not found in our prescriptions which indicates our prescriptions improved the patient conditions. This type of study will ensure to know the 慞� drug development and select the essential medicine list for various levels of health care.
ABSTRACT
Background: Plasmodium falciparum malaria is one of the major health problems in many tropical countries including India and due to increase in the drug resistance in India the incidence of complicated malaria has increased. Objectives: To study the renal complications of malaria. Materials and methods: 50 malaria positive cases with clinical renal disease were prospectively observed clinically and by laboratory investigations till the discharge. Results: Among the 50 malaria positive cases 41 (82 %) patients had p. falciparum infection, 4 (8%) had p. vivax and 5 (10%) had mixed infections. P. falciparum and mixed infection found to be responsible for ARF in 25 (89.28%), 3 (10.70%) respectively. Volume depletion was found to be the prominent cause (75%) of ARF, hyperbilirubinemia was noted in 64.28% of patients. Urinary abnormalities were noted in 24 (48%) cases, proteinuria in 20(40%), microscopic haematuria in 20 (40%), granular casts in 7 (14%). In the present study electrolyte abnormalities were noted in 46 (92%) of the patients. The overall mortality in the present study was 5 (10%). The cause of death was multi-factorial. MODS were the commonest cause of death. Conclusion: Renal complications were seen as the commonest complication of malaria. Early diagnosis, treatment specially the fluid management reduces the overall mortality