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Background : Measuring antimicrobial consumption is necessary to understand the volume and patterns of use, to design appropriate interventions to reduce and rationalize its use. Materials and Methods : The antimicrobial consumption in Neurology ICU and IPD were measured over a 5-year period using WHO Defined Daily Dose (DDD) methodology. Results : There was an increasing trend in Antimicrobial Consumption (AMC) from 125.7 to 155.5 DDDs/100 days over 5 years with highest consumption in 2017-2018 (190.7 DDDs). The consumption of Watch group of antibiotics was higher than access group antibiotics both in ICU and IPD and constituted more than 75% of total antibiotic consumption. Conclusions : The initiation of empiric therapy though may be necessary depending on the patients condition, however, duration of antibiotic therapy and reducing usage of prophylactic antibiotics for aspiration pneumonia and reducing consumption of Watch group of antibiotics were identified as stewardship opportunities. Feedback on AMC data and persuasive educational interventions to rationalize and reduce antimicrobial use are required.
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Antimicrobial resistance (AMR) is a burgeoning challenge of global priority, warranting immediate action to prevent the explosion of multidrug-resistant (MDR) pathogens. Indiscriminate antimicrobial use is the most important driver for AMR. AMR has led to depletion of the antibiotic pipeline and developing new antibiotics is extremely challenging due to technical and financial issues and also resistance emerges as soon any new antibiotic is introduced. At present, preserving the power of existing antibiotics by prudent use and curtailing spread of pathogens by infection prevention and control (biosecurity) in both humans and animals are the best available options to defer AMR crisis. Meanwhile, to reduce dependence on antibiotics, other alternatives such as vaccines, antibodies, pattern recognition receptors, probiotics, bacteriophages, peptides, phytochemicals, metals, and antimicrobial enzymes are being explored. This review provides an overview of various promising, potential and under investigative strategies as alternatives to antibiotics.
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Objectives: To determine the optimum range of phenytoin (PHT) and valproate (VAP) levels and find out the critical drug levels below which chances of breakthrough seizures increase in North Indian population. Methodology: A cross-sectional, case-controlled, record-based study was conducted in a quaternary care hospital from September 2018–2019. The case group comprised epilepsy patients on monotherapy with PHT/VAP presenting with breakthrough seizures after at least 6 months of seizure control. Noncompliant, overdose, toxicity, no or partial response, any other psychiatric or neurological disorder, adverse effects, and patients taking two or more antiepileptic drugs were excluded. Results: Data of 100 patients in each group were analyzed. Significantly lower mean levels in cases were observed in PHT (5.74 ± 3.68 mg/L vs. 13.75 ± 4.27 mg/L control) and VAP (24.13 ± 27.39 mg/L vs. 76.37 ± 17.71 mg/L control). A negative correlation of drug levels was observed with age and weight in both the groups. The level/dose ratio in controls (0.05 ± 0.03; 0.09 ± 0.06) was significantly (P < 0.0001) higher than cases (0.02 ± 0.01; 0.02 ± 0.03) in PHT and VAP, respectively. Conclusions: This study identifies the critical levels and level/dose ratio at which the risk of breakthrough seizures increases. A wide level/dose ratio was found in controls, more so in the VAP group. A prospective study with larger group size along with genetic studies should be done to evaluate further.
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Myocysticercosis is not a common disorder and in particular quadriceps muscle is rarer. We are reporting this rare case of myocysticercosis involving quadriceps muscle of right thigh with ultrasonographic demonstration of nodular scolex and associated edema with no neurological involvement.
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Background: Extra pulmonary tuberculosis arises as a result of lymphatic spread from a primary focus. Fine needle aspiration cytology has assumed an important role in the evaluation of peripheral lymphadenopathy as a possible minimally invasive alternative to excisional biopsy. In most low-income countries; the only practically available bacteriologic method for diagnosing EPTB is direct smear microscopy for acid fast bacilli from the sample of the lesion. There are various methods of staining and concentration for improving sensitivity of direct microscopy for detection of tubercle bacilli in specimen.Methods: This prospective study was carried out in the Department of Pathology, Subharti Medical College and associated Chattrapati Shivaji Subharti Hospital, Meerut for a period of 2 years from July 2016 - August 2018 in 151 patients with clinical suspicion of TB and significant lymphadenopathy.Results: AFB positivity increased from 40.39% on conventional ZN stain to 48.34% on modified bleach method ZN stain and to 56.29% on Auramine-O fluorescent stain. Taking fluorescent microscopy (Auramine-O) as reference method the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of conventional ZN stain and modified bleach method ZN stain were calculated as 71.8%, 100%, 100%, 73.33%, 84.10% and 85.33%,100%,100% ,84.61% ,92.05%, respectively.Conclusions: The addition of fluorescent microscopy (Auramine-O) and modified bleach method ZN microscopy along with conventional ZN staining method would be an important adjunct to improve the microscopic detection of Mycobacterium tuberculosis in fine-needle aspirates of lymph nodes.
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Background: The present study was planned to assess the knowledge, attitude and practice of healthcare providers regarding adverse drug reaction reporting and pharmacovigilance in a tertiary care hospital.Methods: The study was conducted in a tertiary care teaching hospital, it’s a observational, KAP cross-sectional questionnaire-based study. The KAP questionnaires was developed toward pharmacovigilance and ADRs and were used to assess the medical professionals.Results: Only 64% of doctors, 52% PG’s and 40% of nurses knew the correct knowledge regarding Pharmacovigilance (PhV). Regarding the attitude, all the respondents think reporting of ADR is a very necessary. 98% of doctors,80% of postgraduates and 96% of nurses have experienced ADR in the patient in their professional practice but reporting of same is very less. The factors discouraging them from reporting ADR’s was also assessed. 34% said difficult to decide whether ADR has occurred or not, 34% said lack of time, 17%- no remuneration and 15% said a single unreported case may not affect ADR database.Conclusions: This study demonstrated that knowledge and attitude towards pharmacovigilance is gradually improving among medical professionals, but unfortunately the actual practice of ADR reporting is still deficient among them.
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Background: Pharmacology is one of the most clinically applied subjects which are highly volatile. Hence new methodologies have to be introduced in medical curriculum which must be in line with the students’ preferences. The study aimed to determine the opinion of students regarding the teaching of pharmacology, the best way of knowing and retaining the subject and application of the subject in future practice.Methods: The study will be conducted at private Medical college in Mangalore. It is an observational, KAP cross-sectional questionnaire-based study. Convenient sampling method is used in which 140 Second year MBBS students were enrolled. SPSS version 21 was used to generate tables and graphs. Results of the study are based on descriptive statistics.Results: Questions which were not answered were taken as invalid response. Results show that majority preferred newer learning methodology, case-based learning, integrated teaching were more appealing, and peer associated teaching like group discussion was better for applied topics. Attitude of students in learning has shifted from traditional text book to the recent concept of knowledge sharing.Conclusions: In general students’ perceptions regarding learning pharmacology was observed to be positive. The study highlights the need for interactive teaching. Practical sessions can be used to teach basic concepts and rational use of drugs. Knowledge seeking behaviour needs improvisation by teacher.
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Background: A wide and gradual variation exists periodically in the patterns of pharmacotherapy among patients admitted with CVDs in CCU. Periodic evaluation of drug utilization in the CCU is necessary for optimization of health care system, proper use of resources and making prescription policy.Methods: It was retrospective and prospective study. Study was carried out at Tertiary care hospital in Mangalore. Retrospective study period was from 1/07/2010 till 31/12/2010 and Prospective study duration was from 1/01/2016 till 30/06/2016. Patients from CCU were participants of this study.Results: Data of total 278 patients were taken, out of which 138 patients from 2010 and 140 patients in 2016 were analyzed respectively and were compared among drug therapy for IHD - Nitrates, dual antiplatelet therapy (aspirin and clopidogrel), dyslipidemic drugs and beta blockers remain drug of choice in both retrospective and prospective study. But, anticoagulant (heparin/ LMWH) use increased in prospective studies. In Heart failure - nitrates, antiplatelet, dyslipidemic drugs followed by inotropes and diuretics was used in both study. Cardiomyopathy was managed with diuretics, ACEIs, and nitrates in both retrospective and prospective study.Conclusions: In conclusion, predominance of male gender and poly-pharmacy were observed. However, it has identified areas to further rationalize and optimize patterns of polypharmacy and evidence based use of medications like beta blockers, anticoagulants/antiplatelet agents and antiarrythmisc. The results on the major determinants of cardiovascular drug use in CCU matched with the existing indications and cautions for use with each drug class.
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Background: Oral cancers form nearly 30% of the cancers. The most effective way of combating oral cancer is by early diagnosis followed by concurrent chemo-radiotherapy which is the most popular approach in current practice. The adverse effects seen in oral cancer patient’s due to their treatment are nausea & vomiting, mucositis, constipation, diarrhoea, fatigue & radiation dermatitis. Polypharmacy is due to variety of treatment options in oral cancer patients, which needs to be addressed.Methods: Over a period of 18 months, the in-patient records of 79 patients with oral cancers, admitted to oncology ward of Justice K. S. Hegde Charitable Hospital, Mangalore, were scrutinized and the data collected in a specially designed proforma. Descriptive analysis of the data was done.Results: Required data was collected from 79 patients, out of which 55.7% of the patients underwent surgery and later received chemotherapy and radiotherapy. Most commonly seen adverse effects due to treatment were weight loss (75.9%), reduced appetite (67.1%), fatigue (75.9%), pain (79.7%) and skin discoloration (50.6%), etc. Various classes of adjuvant drugs were used for complications caused due to the treatment of oral cancers. Drugs like topical applicant /mouth washes constituted the bulk of the prescriptions (22%) followed by nutritional supplements (15.34%), NSAID/opioids (12.76%) hematinic (12.59 %) and other groups of drugs were also used.Conclusions: Present study helped us to plan evidence based strategies to reduce or prevent post treatment complications. Most of the adverse effects were treated accordingly to keep the patient comfortable.
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This paper describes 15 years’ experience of the development process of the first set of comprehensive standard treatment guidelines (STGs) for India and their adoption or adaptation by various state governments. The aim is to shorten the learning curve for those embarking on a similar exercise, given the key role of high-quality STGs that are accepted by the clinical community in furthering universal health coverage. The main overall obstacles to STG development are: (i) weak understanding of the concept; (ii) lack of time, enthusiasm and availability of local expertise; and (iii) managing consensus between specialists and generalists. Major concerns to prescribers are: encroachment on professional autonomy, loss of treating the patient as an individual and applying the same standards at all levels of health care. Processes to address these challenges are described. At the policy level, major threats to successful completion and focused implementation are: frequent changes in governance, shifts in priorities and discontinuity. In the authors’ experience, compared with each state developing their own STGs afresh, adaptation of pre-existing valid guidelines after an active adaptation process involving local clinical leaders is not only simpler and quicker but also establishes local ownership and facilitates acceptance of a quality document. Executive orders and in-service sensitization programmes to introduce STGs further enhance their adoption in clinical practice.
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Two females aged 70 years and 45 years presented in OPD of Dept. of Gynecology with large abdominal lump and ascites. In both cases, clinical and radiological diagnosis of malignant ovarian tumor was made. Ascitic fluid cytology revealed absence of malignant cells. Panhysterectomy was performed. On histopathological examination, both cases were diagnosed as benign fibrothecoma with extensive cystic change. Postoperative follow-up for about six months was uneventful and both patients recovered completely.
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Objectives: To compare the levels of homocysteine, vitamin B12 and folic acid before and after 6 months of carbamazepine therapy and to correlate them with carbamazepine level at 6 months. Design: Prospective comparative study. Setting: Tertiary care centre in North India. Participants: 51 children (2-12 years of age) presenting with motor partial seizures. Intervention: Carbamazepine (10-20 mg/μ/day) for 6 months. Main outcome measure: Change in serum homocysteine, B12, folic acid level. Methods: Fasting venous samples were collected before carbamazepine therapy and after six months. Homocysteine was analyzed using homocysteine enzyme immunoassay. Vitamin B12 and folic acid were estimated using electrochemiluminesence technique. Carbamazepine levels were measured at 6 months. Results: Of the 51 children, 36 (males-21), were followed up and their data analyzed. Mean homocysteine level was 11.51±3.95 μmol/L at recruitment and 11.77±6.65 μmol/L at six months (P=0.785). At recruitment 6(16%) children had homocysteine level above 15 μmol/L which increased to 10(27%) at 6 months. Mean vitamin B12 at recruitment was 292.1±111.2 pg/mL and 297.8±82.9 pg/mL at 6 months (P=0.764). Mean folic acid at recruitment was 9.98±3.45 ng/mL and 10.66±3.97 ng/mL at 6 months (P=0.358). There was no correlation between carbamazepine levels with homocysteine, vitamin B12 and folic acid (P>0.05). There was no effect of age, sex or dietary pattern on homocysteine levels. Conclusion: Hence 6 months of carbamazepine therapy did not cause significant change in serum levels of homocysteine, vitamin B12 and folic acid.
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Background: Passive smoking and biomass fuel use most probably are more harmful to children than adults for two reasons. The first one is children’s respiratory and immune systems are not fully developed. Secondly, they spend more time at home and are, therefore, likely to experience more intense and prolonged smoke exposure. Aims: This study was planned to find out if there is any association between childhood tuberculosis and exposure to passive smoking and biomass fuel. Methods: A hospital-based case control study was done. All registered consecutive newly diagnosed pediatric tuberculosis cases (0-14 years) from the outpatient department of a tertiary care hospital were recruited as cases. Age and sex matched controls were recruited from a public general hospital of the same locality. A semi-structured, pre-coded interview schedule was administered to parents or legal caregivers of all subjects after obtaining informed written consent. Results: A total of 200 cases and 200 controls were recruited in the study period. The factors which were significantly associated with development of tuberculosis were education of the mother, (OR 1.411, 95% CI 0.888-2.243, p-0.001), a family member having tuberculosis in the last two years and residing in the same house (OR 2.797, 95% CI 1.353-5.789; p-0.004), being a passive smoker (OR 1.725, 95% CI 1.142-2.605; p-0.009). No association between biomass cooking fuel use and development of tuberculosis was found. Conclusion: Passive smoking is associated with development of childhood tuberculosis. This requires health education programmes and medical antitobacco advice and services.
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Background: Extra pulmonary TB (EPTB) including tuberculous lymphadenitis is becoming more common probably due to human immuno deficiency virus (HIV) co-infection. While children do experience a high TB related morbidity and mortality, management of TB in children is challenging. The present study was designed to study the treatment outcome of DOTS strategy for pediatric tuberculous lymphadenitis. Objective: To study the efficacy of DOTS strategy for pediatric lymphhnode tuberculosis. Methods: Retrospective analysis of 669 children of lymphnode tuberculosis treated with DOTS strategy over 9½ years. Results: Mean age was 9.8 years with significantly more girls (61.3%) than boys (38.7%) {c2=34.08, P< 0.001 (S)}. Most of the patients were in the age group of 11-14 years (48.0%) followed by 6-10 years(34.5%) and 0-5 years(17.5%) respectively. Cervical tuberculous lymphadenitis (88.2%) was the commonest form for all ages followed by axillary lymphadenitis in 3.3%. TB of other sites was seen in only 57 (8.5%) cases. Out of total 622 (93%) cases of lymphnode TB where fine needle aspiration and/ or excisional biopsy was done, it was positive (84.2%) and negative (15.6%) respectively for AFB/ cytology, while it could not be done in 47 patients due to inaccessible sites. Category I, II and III was started on 15.4%, 7.5% and 77.1% patients respectively. Overall, treatment completion rate was 94.9% and the default rate was 2.2% with a failure rate of 2.5%. Death rate was 0.3%. Conclusion: The study confirms the efficacy of DOTS strategy for pediatric TB lymphadenitis
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A significant proportion of global tuberculosis (TB) caseload is contributed by children. Management of pediatric TB especially EPTB is challenging. The present study was designed to study demographic, clinical profile and treatment outcome of DOTS strategy for pediatric tubercular pleurisy. Aim: To study the efficacy of DOTS strategy. Methods: Retrospective analysis of 106 TB pleurisy children treated with DOTS Results: Mean age was 10.8 years (median age 12.2 years) with more females (51.9%) than males (48.1%)c1 2=0.15; P= 0.698 (NS). In the age group of 0-5, 6-10 and 11-14 years, there were 15.1%, 30.2% and 54.7% patients respectively. Fever was the commonest symptom (98.1%) followed by cough (77.4%) and chest pain (55.7%). History of contact could be elicited only in 2/3rd of cases unilateral effusion (61.3%) was commonest, followed by empyema (22.6%), massive effusion and broncho-pleural fistula each in 13.2% cases respectively. Bilateral effusion was seen in 3.8% cases only. Conventional methods (mantoux, radiograph, ultrasound, pleural aspiration) and minimal invasive surgical techniques, percutaneous pleural biopsy were done to arrive at the diagnosis. Diagnosis was made by X-ray Chest in 92.5%, exudative pleural fluid (100%) predominantly lymphocytic in 85.8%, positive AFB smear and culture in 4.7 and 5.7% cases respectively. Category I, II and III was started on 35.9%, 2.8% and 61.3% patients respectively. Overall treatment completion rate was 94.3%, 4.7% default rate, 0.9% failure rate and no deaths. Conclusion: The study confirms early detection by simple tests and ensuring complete treatment using DOTS strategy.
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Dedifferentiated chondrosarcoma is a rare and most malignant form of chondrosarcoma, accounting for approximately 11 % of all chondrosarcomas. It generally occurs in older patients having slight male predilection. However, patient in the present case was comparatively younger female with tumour mass in Humerus . The prognosis of dedifferentiated chondrosarcoma is poor. Distant metastasis especially in lungs is often seen. This case is reported here because of its rarity, its association with worse prognosis and absence of pulmonary metastasis, however, subcutaneous nodules were seen at local site.
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Liposarcoma , ChondrosarcomaABSTRACT
Two cases of isolated pulmonary agenesis with no other associated congenital abnormality are reported. First case was 13-year-old girl who presented for the first time with chest infection and was found to have isolated unilateral pulmonary agenesis and responded well to antibiotics, Second case was a 10-year-old girl who had presented with total duration of illness of one year with clinical features suggestive of chronic chest infection with family history of pulmonary tuberculosis and later found to have agenesis of upper lobe of left lung in addition to having gastric aspirate positive for Mycobacterium tuberculosis. She responded to anti tubercular therapy.