Double bubble pneumo-descemetopexy for the management of Descemet membrane detachment: An innovative technique

A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet’s membrane (DM) could be visualized. We performed a novel surgical approach, “double-bubble pneumo-descemetopexy.” The surgical procedure included unrolling of DM with “small air bubble” and descemetopexy with “big bubble.” No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet’s stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.

Effect of mydriatic eye drops (combined 0.8% tropicamide and 5% phenylephrine) on the measurements of corneal parameters using Pentacam

Purpose: The purpose of the study is to investigate the effects of combined 0.8% tropicamide and 5% phenylephrine on the corneal parameters using Pentacam. Methods: The study was performed on 200 eyes of 100 adult patients visiting the ophthalmology clinic for evaluation of refractive errors or cataract screening. Mydriatic drops (Tropifirin; Java, India) containing tropicamide 0.8%, phenylephrine hydrochloride 5%, and chlorbutol 0.5% (as a preservative) were instilled into the eyes of the patients three times every 10 minutes. The Pentacam was repeated after 30 minutes. The measurement data of various corneal parameters from different Pentacam displays (keratometry, pachymetry, densitometry, and Zernike analysis) was manually compiled on an Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) 20 software. Results: Analysis of Pentacam refractive maps revealed a statistically significant increase (P < 0.05) in the values of radius peripheral (cornea front), pupil center Pachymetry, pachymetry apex, thinnest location Pachymetry, and cornea volume. However, pupil dilation did not affect the Q?value (asphericity). Analysis of the densitometry values revealed significant increase in all zones. Aberrations maps revealed statistically significant increase in the value of spherical aberration after the induction of mydriasis, but the values of Trefoil 0º, Trefoil 30º, Koma 90º, and Koma 0º were not affected significantly. We did not observe any untoward effect of the drug, except transient blurring of vision. Conclusion: The current study showed that routine mydriasis in the eye clinics leads to a significant increase in various corneal parameters including corneal pachymetry, cornea densitometry, and spherical aberration as measured by Pentacam, which can influence the decision?making in the management of various corneal diseases. The ophthalmologists should be aware of these issues and make adjustments in their surgical planning accordingly

Congenital corneal anesthesia: A case series

Congenital corneal anesthesia (CCA) is an extremely rare condition where the cornea is affected in isolation or as a part of congenital syndrome, or can be associated with systemic anomalies. This case series of 12 eyes provides an overview of various clinical presentations and their final treatment outcomes. The average age of presentation was 3.2 years with a female preponderance (75%). Fifty percent of the patients had bilateral involvement and 50% had corneal ulcers at presentation. Two eyes required therapeutic keratoplasty for corneal perforation. All patients had isolated CCA except for one who had an associated hereditary and sensory autonomic neuropathy.

Isolation of Enterococcus spp. in various clinical sample and their antimicrobial resistant pattern with MIC of vancomycin in patient attending tertiary care centre, RIMS, Ranchi, Jharkhand

Introduction- Enterococci are part of normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections.it is second most common cause of nosocomial infections in gastrointestinal tract, wound and genitourinary tract. To process all the clinicalAim- samples from various department in our hospital, for isolation of Enterococci spp. To speciate the isolates & to have resistance pattern of the isolates of vancomycin total 926 sample were collected from both outMaterial & Methods- patients and in patient in all clinical departments and transported to microbiology laboratory. specimens were processed by inoculating on to blood agar, MacConkey Agar, nutrient agar, potassium tellurite agar and incubated at 37°C for24-48 hr. Enterococci were identified by their typical arrangement in and salt tolerance test Gram stain, bile esculin test and biochemical tests. Antimicrobial susceptibility patterns were determined by performing Kirby-Bauer disc diffusion method and Minimum inhibitory concentration (MIC) values were identified by tube dilution methods. Result- a total of 926 sample, 645 (69.72%) were culture positive and 281 (30.28%) were culture negative. Among 645 culture positive cases, 81(12.55%) were Enterococcus faecalis. Antimicrobial susceptibility & MIC done as per standard protocols. The E. Faecalis showed 99% sensitive to Vancomycin. the resistance to vancomycin was 1% & further confirmed by MIC via tube dilution methods. In which MIC was ?32 ?g/ml in one isolate. About 8 of Enterococcal strains showed MIC of 0.0125?g/ml. species level identification of Enterococcus is important forConclusions- epidemiological study and also for analysis of drug resistant pattern. Effective detection of vancomycin resistance helps in reducing the morbidity and mortality of VRE in hospitalized patients

Evaluating The Changing Trends In Emergence Of Multidrug Resistance Among Gram Positive Organisms Isolated From Skin And Soft Tissue Infections From A Tertiary Care Hospital, Jharkhand

Drug resistance among gram positive aerobic cocci poses a significant problem in management of patients with skin and soft tissue infections (SSTI's). S. aureus is the most common organism that causes mild skin and soft tissue infections to serious infections such as sepsis and toxic shock syndrome. Enterococcus and Streptococcus species have also emerged as a cause of skin and soft tissue infections and health care associated infections (HAI's). SSTI's is an inflammatory microbial invasion of epidermis, dermis and subcutaneous tissue. It is classified according to the layer of infection, severity of infection and microbiologic etiology. The practice guidelines of the Infectious Disease Society of America (IDSA) for the diagnosis and management of skin and soft tissue infection classifies SSTI's into five categories comprising superficial and complicated infections which include impetigo, erysipelas, cellulitis, necrotizing fasciitis, surgical site infection. Risk factors associated with development of SSTI's include poor hygiene, overcrowding, co- morbidities like diabetes, immunocompromised state, overuse of antibiotics, prolonged hospital stay, burn patients etc. Prompt recognition, timely surgical debridement or drainage with appropriate antibiotic therapy is the mainstay treatment for SSTI's. Empirical therapy includes penicillin, cephalosporins, clindamycin and cotrimoxazole. Multi-Drug resistance is of major concern commonly caused by MRSA (Methicillin resistant staphylococcus aureus) which includes CA-MRSA (Community acquired methicillin resistant Staphylococcus aureus), HA-MRSA (hospital acquired methicillin resistant Staphylococcus aureus), VRSA (vancomycin resistant staphylococcus aureus) & VRE (vancomycin resistant Enterococci). HA-MRSA is generally susceptible to clindamycin, vancomycin, Linezolid & trimethoprim- sulfamethoxazole. In contrast, CA-MRSA is usually sensitive to these former antibiotics as well as broader range of oral antimicrobial agents like clindamycin, linezolid, quinolones, daptomycin, tigecycline etc. These empirical therapeutic agents provide coverage for both S. aureus, Streptococcus species and Enterococcus species. Therefore, demographic knowledge of antimicrobial agents and their resistance pattern plays a significant role in management of SSTI's

A comparative study to determine the role of pre and post-operative antibiotic therapy versus only pre-operative antibiotic therapy in patients of non-perforated acute appendicitis

Background: If properly used in appendicitis, antibiotics can reduce the rate of infection by 50%. The use of post-operative antibiotics for preventing infective complications in non-perforated cases is still controversial.Methods: A randomised prospective study was conducted in the Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi with patients who presented acute appendicitis. A minimum number of 30 patients each in group A (pre-operative and post-operative antibiotics) and group B (only pre-operative antibiotics) were evaluated for 18 months, from January 2018 to June 2019.Results: The mean age of group A is 29.9±15.16 years and in group B is 25.97±9.470 years (p value=0.122, insignificant). There was male preponderance. The seroma formation in both the groups was 10.00% and no patients developed intra-abdominal abscess. The incidence of local site oedema was 10% in both the groups A and B and their p value is insignificant. In both the groups A and B, 10% of the people developed pus discharge from the stitch line and the p value is insignificant. In group A, 6.67% of the patients and in group B 10.00% of the patients developed stitch line inflammatory changes and the p value insignificant. In group A, 13.3% and in group B, 10.00% of the patients developed fever and their p value is 1. The mean length of hospital in case 1.23±0.5 days (group A) and is 1.17±0.45 days (group B) (p value=0.508).Conclusions: Hence we can conclude that a well-chosen and adequately-timed pre-operative antibiotics are adequate in preventing post-operative complications and post-operative antibiotics do not affect the same.

Surgical management of varicose veins: a comparative analysis between radiofrequency ablation and open surgery with venous stripping

Background: Varicose veins are a common condition affecting the lower limbs. Apart from having cosmetic problem, if not treated in time it can have some serious complications and are difficult to treat. Multiple modes of surgical management exist for the disease.Methods: This is a prospective clinical study, done over a period of 5-years, between February 2015 to February 2020. Patients were divided into 2 groups: group I (n=103) included those who underwent open surgical to treatment with venous stripping. Group II (n=104) included those who subjected to Radiofrequency ablation (RFA). Groups were selected with comparable physical parameters. Various parameters like bleeding, hematoma, blood requirement, postoperative inflammation, pain, numbness, mobilization, date of discharge and resuming duties were compared. All patients were followed up for 1y ear.Results: Majority of our patients belongs to age group 20-40 years with mean age of 35year in both groups. Male has dominance over female with male to female ratio 4:1. We noticed significant complication in group I than group II, such as bleeding (20:1), hematoma (5:0), inflammation (60:1) and blood requirement (1:0). In group II, we noticed early mobilization of patient (1day v/s 3 days), discharge from hospital (1day v/s 5 days) and resuming duties (5 days v/s 2 weeks).Conclusion: RFA keeps an edge over open surgical treatment with venous stripping.

E-Learning Versus Traditional Teaching in Medical Education: A Comparative Study

Background: Traditional method of learning via face to face lecture has been in curriculum since timesimmemorial. E-learning via multimedia has been a recent introduction in education system. Purpose: Tocompare e-learning with the traditional method of teaching in medical education. Material and Methods: Thetwo different methods of teaching were applied on the same group of students. A total of six lectures wereconducted. Three of them were taught by traditional method of teaching and three by e-leaning. Formativeassessment in the form of written examination was carried out, followed by qualitative assessment at the endof session. Results: The mean marks obtained after Exam-1 (i.e. following traditional teaching method) was6.46 ± 1.48 and mean marks obtained after Exam-2 (i.e. following e-learning) was 8.37 ± 1.27. The meandifference score was 1.91 ± 1.55. The paired t-test was applied, and the value of t was 11.96 with p-value<0.001. The results between two teaching methods were statistically significant. For qualitative analysisLikert scale was used. 66% of students strongly agreed that e-learning is a superior method than traditionalmethod of learning. Conclusion: The e-learning proved to be more efficient and uniform method of studentlearning with revision facilities.

Dyslipidemia in Primary Open Angle Glaucoma

Glaucoma is the leading cause of irreversible blindness worldwide. Primary Open Angle Glaucoma (POAG) isusually asymptomatic till advanced stages of the disease. Intraocular pressure (IOP) is the primary risk factorfor development of POAG. But in spite of control of IOP, some cases progress which strengthens the viewthat there must be other independent risk factors in the pathogenesis of glaucoma. Serum lipids have beenfound to be associated with glaucoma in few studies. We conducted a study to assess the relation betweendyslipidemia and glaucoma on 100 cases of glaucoma and 100 age-matched controls. Detailed ophthalmicexamination was done in all subjects and fasting lipid profile was compared between cases and controls.Levels of total cholesterol, total triglycerides and LDL were significantly higher in cases than in controls witha p value < 0.0001. We conclude that dyslipidemia is an independent risk factor for POAG.

Prevalence of Non Fermenting Gram Negative Bacilli with Their in vitro Antibiotic Sensitivity Profile in RIMS, Ranchi

Background: Non fermenting Gram Negative Bacilli arediverse and complex group of bacteria that possess very fewdefined characteristics. They are aerobic, non-fermentingGram negative bacilli which were initially considered ascontaminants but have come up with life threatening infectionsin hospitals as multidrug resistant organisms posing a threatbecause of their inherent and acquired drug resistance nature.Aims: Isolation and identification of NFGNB in clinical samplesand determination of their antibiotic sensitivity profile.Materials and Methods: The study was conducted in theDepartment of Microbiology, RIMS, Ranchi from February2017-July 2017. Various clinical samples reaching theBacteriology section of the Department of Microbiology wereprocessed and NFGNB were isolated and identified usingstandard procedure and their antibiotic susceptibility wasperformed.Results: A total of 3581 samples were received out of which2246 were culture positive and 217 were identified as NFGNB.The isolation rate of NFGNB was 9.6%. Number of malesaffected by NFGNB was 121 and that of females was 96.Analysed by specimen NFGNB were isolated from 91 urine, 74pus, 11 ear swab, 6 sputum, 8 body fluid, 21 blood culture and6 catheter tip samples. Urine was most common specimenaccounting for 42% followed by pus (34%), blood (9%), earswab (5%), body fluid (4%), sputum and catheter tip (3%each).The clinical samples from indoor patients yielded highestpercentage of NFGNB (38%) followed by ICU patients (36%)and outdoor patients (26%). Among the NFGNB isolatedPseudomonaas aeruginosa (51%) was the most commonfollowed by Acinetobacter baumanii (22%), Pseudomonas spp(19%), Acinetobacter spp, Stenotrophomonas maltophila,Burkholderia cepacia (2% each), Ralstonia spp &Sphingobacterium spp (1%). Non fermenters were highlysensitive to Imipenem accounting for 91.5% followed byPiperacillin-tazobactam (71.5%), cefoperazone sulbactam(67.7%) & Amikacin (55.6%) on an average.Conclusion: NFGNB considered being contaminants in thepast have now emerged as important health care associatedinfections. In our setting Imipenem can be used for thepreliminary treatment of infections caused by nonfermenters.As these organisms are important opportunistic andnosocomial pathogens causing infections inimmunocompromised patients, better infection control policiesin our settings and its implementation is a must.

Bacteriological Profile and Antibiogram of Bloodstream Infection in a Tertiary Care Hospital, India

Purpose: Blood stream infections (BSIs) are an importantcause of morbidity and mortality worldwide. Continuous orintermittent presence of microorganisms in the circulating bloodis a danger to every organ in the body. BSIs range from selflimiting infections to life threatening sepsis requiring rapid andaggressive antimicrobial treatment.[1] Culture of blood is a vitaltool to diagnose such infections. Antibiotic susceptibilitypatterns help in rationalizing therapy.Objective: The objective of this study was to determine thebacteriological profile and their antibiotic sensitivity patterns ofisolates from blood stream infections.Materials and Methods: This is a retrospective studyconducted from February 2018 to January 2019 at a tertiarycare hospital, RIMS, India. Blood samples were asepticallycollected and incubated in BD Bactec system, a fullyautomated blood culture system for detection of aerobic growthand incubated for 7 days at 37°C. Identification of microbialgrowth was done by standard methods (biochemical tests) andantibiotic sensitivity test was carried out by Kirby-Baur discdiffusion method as per Clinical Laboratory Standards Instituteguidelines (CLSI guidelines).Results: A total of 82 (28%) pathogens were isolated from 289bacteremia suspect patient blood specimens. Gram‑positivecocci (65.85%) were predominant organisms recoveredfollowed by Gram‑negative bacilli (34.15%). Staphylococcusaureus, Klebsiella spp and CoNS, were the primary pathogensisolated. Staphylococcus aureus (48%) was the predominantamong all. Glycopeptides, aminoglycosides, and carbapenems,were the most effective drugs for treating bacteremia.Conclusions: Early diagnosis and appropriate antimicrobialtreatment is the basis for the successful treatment of sepsis.The understanding of local bacteriological profile andantimicrobial susceptibility patterns may help the clinician inrationalizing the empirical treatment strategies.

Seroprevalence of Human Immunodeficiency Virus among Antenatal Women in a Tertiary Care Hospital, India

Introduction: Human immunodeficiency virus (HIV) infection israpidly increasing in world as well as in India since thedetection of first acquired immune deficiency syndrome (AIDS)case in Chennai in 1986. Having seroprevalence rate of lessthan 1%, India is considered as low prevalence country but dueto large population this low prevalence convert in a hugesubset of HIV positive people. Unfortunately India shares onethird of total HIV positive cases of the world. Estimating the HIVseroprevalence in a low risk population of pregnant womenprovides vital information for the successful implementation ofAIDS control program and also for monitoring trend of HIV ingeneral population. Therefore, screening of pregnant women inearly pregnancy may help in prompt counselling and therapy,thereby bringing down the mother to child transmission of HIVinfection.Objective: To determine the rate and trends of seroprevalenceof HIV among antenatal women.Materials and Methods: It is a retrospective study conductedat PPTCT centre, Rajendra Institute of Medical Sciences(RIMS), Ranchi, a tertiary care referral hospital in Jharkhandstate of India from January 2014 to December 2016.The testswere done as per NACO guidelines using COMBAIDS-RSAdvantage-ST, HIV-1/2 TRISPOT and MERISCREEN HIV 1-2WB tests.Results: 19266 antenatal women were included in this study.Out of this 57 women were detected to be positive for HIV,accounting for 0.32% prevalence rate. HIV seroprevalenceamongst antenatal women is 0.32% which is in agreement withthe national projection (0.29% as per NACO annual report2014-2015). HIV seroprevalence rates showed a decreasingtrend from 0.32% in 2014 to 0.16% in 2016.Conclusion: Every antenatal woman should be screened forHIV. Appropriate antenatal screening, interventions andpreventive strategies might bring down the mother to childtransmission of HIV.

Ertugliflozin: a novel anti-diabetic drug

Diabetes Mellitus is a disorder of global proportion. Despite various treatment modalities presently being available, yet the desired glycaemic control and patient outcomes have not been achieved completely. Sodium glucose co-transporter type 2 inhibitors (SGLT2 inhibitors) are one such promising group of emerging drugs in diabetes treatment. Ertugliflozin prevents the reabsorption of glucose by inhibiting sodium-glucose cotransporter-2 (SGLT2) at proximal convoluted tubules. Ertugliflozin is available as 5mg and 15mg tablets. Ertugliflozin has been related to genital mycotic infections and urinary tract infections. Benefits of Ertugliflozin include better control on blood glucose, body weight and blood pressure.

Netarsudil: a novel intra-ocular pressure lowering agent

Optic disc health is an important indicator of visual functions. The first line of management to prevent/halt the damage to optic disc is to control responsible pathological condition, if identified. In absence of identifiable cause, the most validated approach is lowering of intra-ocular pressure (IOP). Individually, as well as combinations of currently available drugs are not fully effective in all patients of glaucoma in achieving desired IOP control. Hence, there is a need of newer alternatives which address this unmet need. Recently, a newer IOP lowering agent with a novel mechanism of action, netarsudil, has been approved by United States Food and Drug Administration (US-FDA) in December 2017. Netarsudil acts by inhibiting Rho-associated protein kinase resulting in lowering of overall tone of the contractible cells in trabecular meshwork thereby improving drainage of aqueous humor outflow and lowering of IOP. Though in its early days, this drug gives an armamentarium to ophthalmologists and physicians to control IOP in patients of open-angle glaucoma and ocular hypertension.

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

Comparison of drug advertisements published in Indian and foreign journals.

Background: Drug advertisements form one of the major sources for updating drug information by the medical professionals. It has been observed that Indian drug advertisements provide incomplete and poor quality of essential information. However, existing information on comparison of drug advertisements in Indian and foreign journals is limited. Hence, this study was planned to compare the drug advertisements published in Indian and foreign journals. Methods: A total of 200 drug advertisements, 100 each from Indian and foreign journals, were randomly selected excluding those of medical devices, surgical appliances, nutritional supplements and ayurvedic drugs. The drug advertisements from two sources were compared for drug groups, compliance to „Ethical criteria for medicinal drug promotion‟ of World Health Organization (WHO), retrievability of cited reference(s) and mention of any additional information. Results: Drug groups advertised frequently in the Indian journals were those used for chronic diseases whereas chemotherapeutic agents topped the list in foreign journals. Brand names were mentioned in 100% advertisements in both categories of journals whereas information on other ingredients known to cause problems was not mentioned in any of the studied advertisements. Overall, compliance to WHO guidelines by advertisements was 54.6% in Indian journals and 68.2% in foreign journals. The two categories of journals didn‟t differ significantly in retrievability of cited reference(s) and additional information except for information on drug storage which was significantly more mentioned in Indian journals. Conclusions: Drug advertisements in both Indian and foreign journals were incomplete for updating drug information by medical professionals

Suture Less and Glue Free Limbal Conjunctival Autografting following Pterygium Excision.

A prospective interventional self-control study to analyse the profile and outcome of suture less and glue free limbal conjunctival autograft for the management of primary pterygium was carried out in 80 eyes with primary nasal pterygium requiring surgical excision. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the eyes followed by bandaging for 24 hours. The patients were followed up post operatively after 24 hrs., on 3rd day, after 1, 3, 6 weeks and at 3 months. They were examined for visual acuity, hemorrhage, wound gape, graft retraction, graft edema, recurrence or any other complication among the study population. The mean age of the patients was 40.78 years (range 19-80), 56.25% of which were females. Graft retraction occurred in 3 eyes (3.75%) and recurrence was seen in 1 eye (1.25%). Hemorrhage was seen in 26 (32.5%) eyes at 24 hours, which persisted in only 06(7.5%) eyes at 3 weeks and resolved completely in 100% of eyes at 6 weeks. Edema was also noted in 4 (5%) eyes, persisted only in 1(1.25%) eye at 3rd day and resolved completely by 1 week. At 6 weeks postoperatively, three (3.75%) eyes showed gain in best corrected visual acuity by one line and one (1.25%) eye by three lines on snellen's drum. No other complication was noted. Suture less and glue free limbal conjunctival autografting following pterygium excision is an effective and safe option for the management of primary pterygium.

Effects of calcium channel blocker, nifedipine, on antidepressant activity of fl uvoxamine, venlafaxine and tianeptine in mice.

Background: Cardiovascular diseases are commonly associated with depression. Calcium channel blockers (CCBs) form commonly used group of drugs for the treatment of a number of cardiovascular diseases. Nifedipine, a CCB, has been shown to possess antidepressant activity and potentiate antidepressant activity of imipramine and sertraline, however, literature on its interaction with newer antidepressant drugs such as fl uvoxamine, venlafaxine and tianeptine is limited. Hence, the present study was undertaken. Methods: The study was carried out in albino mice in two phases. In Phase I, antidepressant activity of nifedipine, fl uvoxamine, venlafaxine and tianeptine were confi rmed after their single dose administration using forced swim test (FST) and tail suspension test (TST) and their minimum antidepressant doses were determined. In Phase II, the effect of nifedipine on antidepressant activity of fl uvoxamine, venlafaxine and tianeptine was studied by orally administering sub-antidepressant doses of these drugs for 28 days. FST and TST were carried out on 1st, 14th and 28th day of the study and change in immobility period was observed. Results: In Phase I, all the studied drugs exhibited dose dependent antidepressant activity in both FST and TST. Minimal antidepressant dose of nifedipine, fl uvoxamine, venlafaxine and tianeptine was observed as 10, 25, 25 and 10 mg/kg respectively. In Phase II, combinations of sub-antidepressant dose of nifedipine (5 mg/kg) with sub-antidepressant doses of fl uvoxamine (12.5 mg/kg), venlafaxine (12.5 mg/kg) and tianeptine (5 mg/kg) exhibited enhanced antidepressant activity when compared to the control group and individual drug groups after same duration of treatment. Conclusions: Nifedipine, fluvoxamine, venlafaxine and tianeptine possess antidepressant activity and nifedipine exhibits synergistic antidepressant activity with fl uvoxamine, venlafaxine and tianeptine.

Prescription patterns of antihypertensive drugs in a tertiary care hospital in India.

Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India. Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with comorbidities were excluded from study. The data were analyzed to fi nd out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency. Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensinconverting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed. Conclusions: This study represents the current prescribing patterns for antihypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.