ABSTRACT
Introduction: The geriatric population assumes great significance in terms of both preventive and curative health care services utilized. The patho-physio-psychological changes associated with ageing make their problems unique. In the geriatric population, hypertension accounts for a huge proportion of cardiovascular and all cause mortality and morbidity. We conducted a study to describe the patterns of antihypertensive drug use in the geriatric population, compare it to the current recommendations and conduct an analysis using the WHO-INRUD drug use indicators. Methods: A prospective cross sectional drug utilization study of 100 prescriptions of hypertensive patients (as per JNC 7) of either sex and ≥60 years was undertaken as per the WHO – DUS and the STROBE guidelines. Results: Statistically significant relation was found between BP control, and addictions and CIRSG score. The 100 prescriptions contained 344 drugs, out of which, 171 were antihypertensive drugs. Three percent of antihypertensive drugs were prescribed by generic names. Seventy nine percent of antihypertensive drugs were prescribed from the ‘hospital drug schedule’. Amlodipine, Hydrochlorothiazide, Losartan and Telmisartan were prescribed to 79%, 24%, 11%, 11% respectively. The combination of ARB (Angiotensin Receptor Blocker) + Diuretic was prescribed to 36% and that of ARB + CCB (Calcium Channel Blocker) was prescribed to 21%. The PDD/DDD ratios of Carvedilol, Losartan, Furosemide and Telmisartan were 0.7, 0.8,1 and1.2, respectively. Conclusion: Creating awareness regarding the role of addiction in BP control and advocating lifestyle changes is paramount in HTN management. Overall, the principles of rational prescribing were followed. The prescription pattern observed was as per current recommendations.
ABSTRACT
Introduction: Vertigo is a common and distressing complaint seen in primary care. It can be due to central or peripheral causes, which should be determined right at the outset. In some cases, the vertigo is transient and easily manageable while in others it can be more troublesome and difficult to treat. Case: A 43 year old male presented with episodes of severe vertigo and vomiting progressively increasing since six months. Despite multiple consultations, complete work up and treatment with the standard therapy for suppressing vertigo, his symptoms persisted. On history and examination, it seemed to be a case of Ménière’s Disease and we started him on specific therapy. The patient showed marked improvement within a week and continued to do so at the end of three months despite stopping all treatment. Conclusion: Identification of the cause of vertigo, multidisciplinary management and specific treatment, rather than just vestibular suppressants, are paramount in managing a case of vertigo.
ABSTRACT
Introduction: Although tuberculosis is hyper-endemic in India and is responsible for a huge proportion of respiratory morbidity, adequate workup should be conducted to rule out other differential diagnosis wherever applicable. Case Report: A 32 year old male health worker was suffering from productive cough and gradually increasing breathlessness since three months. The investigations conducted were a sputum analysis and a chest x-ray, both of which were normal and hence he was treated as a case of allergic bronchitis. Subject presented to us after three months with no relief. We further investigated him and found severe eosinophilia in the peripheral blood, a positive anti-filarial antibody and a negative triple stool test for ova and parasites. He was treated with diethylcarbamazine and albendazole+ivermectin combination. The patient responded well and had no complaints at the end of the 4 week treatment. Discussion and Conclusion: The subject should have been evaluated by conducting a basic investigation like a complete blood count. Delay in treatment of cases of tropical pulmonary eosinophilia can lead to permanent respiratory morbidity.