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.

TLC-spectrophometric separation and trace determination of monocrotophos and dichlorvos in enviromental and biological samples.

Organophosphorus insecticides, monocrotophos and dichlrovos are increasingly being used in agriculture to control insects on a wide range of crops. Their ready access has resulted in misuse in many instances of homicidal and suicidal poisoning cases. This paper describes about a chromogenic spray reagent for the detection/determination of monocrophos and dichlrovos in environmental and biological samples by TLC and spectrophotometric method. Monocrotophos and dichlorvos on alkaline hydrolysis yield N-methyl acetoacetamide and dichlroacetaldehyde respectively, which in turn react with diazotized p-amino acetophenone to give red-violet and red coloured compounds. Other organophosphorus insecticides do not give this reaction. Moreover, organochlorine and synthetic pyrethroid insecticides and constituents of viscera (amino acids, peptides, proteins etc), which are generally coextracted with the insecticides, do not interfere. However, phenolic compounds and hydrolysed product of carbamate insecticides may interfere and differentiate from monocrotophos and dichlrovos by Rf values. The lower limit of detection is 0.2 mg for monocrotophos and 0.1 mg for dichlorovos. The absorption maxima of the reddish-violet and red colour formed by monocrotophos and dichlrovos, are measured at 560 nm and 540 nm respectively. Beer's Law is obeyed over the concentration range of 1.2 to 6.8 mg and 6.2 to 35 mg in the final solution volume of 25 mL. The molar absorptivity and Sandell's sensitivity of monocrotophos and dichlrovos were found to be 7.1 x 10(5) (+100) 1 mole(-1) cm(-1) and 0.008 mg cm(-2), 1.2 x 10(5) 1 mole(-1) cm(-1) and 0.003 mg cm(-2) respectively. The standard deviation and relative standard deviation were found be +/- 0.005 and 2.05% +/- 0.007 and 2.02% respectively. The developed method has been successfully applied to the detection and determination of monocrotophos and dichlrovos in environmental and biological samples.

Bioremediation of pulp and paper mill effluent with Phanerochaete chrysosporium.

The present study reports on the treatment of pulp and paper mill effluent by Phanerochaete chlysosporium and the same has been compared at two different pH, 5.5 and 8.5. At both the pH, colour, COD, lignin content and total phenols of the effluent significantly declined after bioremediation. However, greater decolourisation and reduction in COD, lignin content and total phenols were observed at pH 5.5. Such bioremediated effluent of pulp and paper mill could gainfully be utilized for crop irrigation.

Vegetation pattern related tc grazing pressure in alpine meadows of Nanda Devi Biosphere Reserve.

The present study aims to analyze the interaction of prevailing biotic pressure on plant species diversity in Nanda Devi Biosphere Reserve (NDBR) which lies in northern part of Uttaranchal hills between 79 degrees 40'E to 80 degrees 05'E longitude and 30 degrees 17' N to 30 degrees 41'N latitude and covers an area of 2236.7 km2. A total of 75 species has been found which included the herbaceous plants viz., grasses, sedges and forbs. Generally, the plants have a short life span of 3-4 months. However, few species persist throughout the growth period i.e. May-October. Phytosociological study performed in plots of varying slope and grazing pressure intensity revealed that the dominant grasses were Danthonia cachemyriana and Poa annua and dominant forbs were Trachydium roylei and Geum elatum in all the plots. Grasses were abundant on west facing slopes while forbs preferred the even topography of east facing meadows. The grasses and sedges together had optimum density during July and August. In general, short lived species exhibited more diversity for one or two months whilst the long lived species exhibited optimum diversity althrough the snow free period. The species diversity is maximum (100%) in moderately grazed bughiyals i.e. Pacchu and minimum in intensively grazed bughiyals i.e. Martoli. The species distribution among the plots was 60-90% contagious and 11.2-38.0% randomirrespective of grazing pressure, thus highlighting the significance of grazing pressure in management of alpine meadows.

Soil microbial population and enzyme activity related to grazing pressure in alpine meadows of Nanda Devi Biosphere Reserve.

The present study aims to analyze the interaction of prevailing biotic pressure on soil environment with emphasis on its physicochemical and microbiological characteristics determining soil fertility status and thus supporting plant and animal biodiversity in Nanda Devi Biosphere Reserve (NDBR) which is located in northern part of Uttaranchal hills between 79 degrees 40'E to 80 degrees 05'E longitude and 30 degrees 17'N to 30 degrees 41'E latitude. The experimental results revealed that the physico-chemical characteristics (viz., moisture, pH, EC, C, N, P, K, CEC) of soil were maximum in moderately grazed meadow and minimum in intensively grazed meadow. Soil microbial analysis measured in terms of total viable count (TVC) exhibited grazing sensitivity trend being maximum population of bacteria > fungi > actinomycetes. The soil microbial population was positively correlated with soil respiration, dehydrogenase activity, acid phosphatase and microbial biomass, which exhibited uneven trend with grazing pressure. Soil from moderately grazed meadow showed highest microbial count and enzyme activities, whilst intensively grazed meadow showed lowest microbial count and enzyme activities. This depicts the beneficial role of prescribed grazing up to limited extent in management of soil fertility, which might have supported luxuriant growth of a variety of grasses.

Assessment of the pulp and paper mill effluent on growth, yield and nutrient quality of wheat (Triticum aestivum L.).

Assessment of agropotentiality of the effluent coming out from century pulp and paper mill, Ghanshyamdham, Lalkua (Uttaranchal) has been made on wheat (Triticum aestivum var. UP-2329) crop grown in two soils differing in texture with different effluent concentrations. Diluted effluent increased the chlorophyll content, plant height, shoot and root biomass, grain yield, protein, carbohydrate and lipid contents in wheat grains, while undiluted effluent caused inhibition in plant growth resulting in a sharp decline of yield. Pure soil provided better growth and yield results than those soil mixed with sand.

Study of microflora in well-nourished and mal-nourished children in relation to dental caries.

Forty-five children in the age group of 2-12 years comprising 20 well-nourished (W.N.), 20 malnourished (M.N.) (both groups having DMFS of > or = 5) and 5 caries free well nourished children (control group) were studied to find out the oral microflora in these groups S. mutans was present in 55%, 20% and 0% in W.N., M.N., and control groups while S. Salivarius was isolated in 45%, 80% and 40% in the three groups respectively. There was no significant difference in the prevalence of Lactobacillus and C. albicans in the three groups. The correlation between means DMFS and the prevalence of S. mutans in W.N. and M.N. groups was highly significant (P < 0.001). Nutritional status including different grades of malnutrition had no significant bearing on the prevalence of micro-organisms isolated. The caries prevalence was higher in the W.N. group (P) while the gingival index was higher in M.N. group.

Serological and virological studies of Japanese encephalitis in the Terai region of Nepal.

In 1987 and 1990, serum samples were collected from people living in the two districts (Itahari and Chitwan) of the Terai region of Nepal. Antibodies against Japanese encephalitis (JE) virus in these sera were detected by the hemagglutination inhibition (HI) and neutralization (N) tests. By the HI test, 26 out of 172 (15.1%) sera from Chitwan and 15 out of 137 (10.9%) sera from Itahari showed positive titers. Higher positive rates were shown by the N test, where 46 out of 172 (26.7%) sera from Chitwan and 22 out of 137 (16.1%) sera from Itahari had antibodies against JE virus. A JE strain was isolated from a blood specimen of a pig raised in Kathmandu. When the nucleotide sequence of the pre-M region of the strain was compared to the same region of the other JE virus strains reported, the highest similarity was observed to the strains isolated in Nepal in 1985. These results suggest that the Terai region has been an epidemic area of JE.

Aetiology of bacterial diarrhoea in north Indian children with special reference to Campylobacter jejuni.

A total of 184 cases of acute diarrhoea, in patients aged 1-36 months, were studied clinicobacteriologically. Enteropathogens were isolated in 22.28% cases. Campylobacter jejuni was isolated from 2.17% cases only. Salmonellae were isolated from 7.6% cases and 64.28% of them were S typhimurium. More than 75% of all isolates of salmonellae, shigellae, Esch coli and Campylobacter jejuni were sensitive to gentamicin and cephaloridine. Secondary lactose intolerance was noted in 6.52% cases only.