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.

Therapeutic assessment as a brief and intensive intervention for avoidant restrictive food intake disorder, belching, and histrionic personality disorder: A case report

A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks

Comparison of efficacy of two topical drug therapy of acne vulgaris – 1% clindamycin versus 5% dapsone: A split face comparative study

Background: Acne vulgaris is common skin problem for adolescents and young adults. Topical clindamycin is an established treatment modality effective in mild-to-moderate acne. Dapsone has been used orally for the treatment of acne but used less due to its systemic side effects. Topical dapsone may offer new treatment option for acne vulgaris due to its dual anti-inflammatory and anti-microbial effect. Aim and Objective: The aim of the study was to compare the efficacy of 1% clindamycin gel with 5% dapsone gel in the patient of Grade II acne vulgaris. Materials and Methods: It was a prospective interventional study with split face comparative study design. Each patient was received a pair of labeled tubes of medication – Right (Rt) side containing clindamycin 1% and left (Lt) side containing dapsone gel 5%. The assessment was done by calculating the change from baseline, after 4, 8, and 12 weeks of the total lesion count and both inflammatory and non-inflammatory lesions using repeated measures analysis of variance. Results: A total of 40 patients were included in the study. Both inflammatory and non-inflammatory lesion count reduce significantly at the end of 4, 8, and 12 weeks on both side (P < 0.05). Mean reduction in total count of lesions after 12 weeks of therapy by dapsone 5% was 5.4 ± 5.05 (50.0%), while by clindamycin 1% gel was 5.0 ± 2.76 (50.5%). Conclusion: Dapsone 5% gel monotherapy and clindamycin 1% gel monotherapy have almost equal efficacy when compared after 12 weeks of therapy, but dapsone 5% gel therapy is slightly better effect on inflammatory lesions than clindamycin 1% gel.

Effect of potassium application on yield and quality of green gram (Vigna radiata L.) on coarse textured soils of southern Haryana

Crops need large quantity of potassium for enhancing their yield as well as quality. Pulses are important crops grown in India but their productivity is low. Among production inputs, recommendations for N and P fertilizers are made in most states with no K application resulting in imbalanced nutrient supply and lower crop yields.To quantify optimum dose for green gram ( Vigna radiata L.), a series of field experiments were conducted at Regional Research Station, CCS HAU, Bawal, Haryana, to assess the response of green gram to fertilizer potassium on coarse textured (Typic Haplustepts) soils of southern Haryana. After completion of research trials, crop was tested on farmer’s field through demonstrations and on farm trials (OFTs) to evaluate the response and adoptability of green gram as per the fertilizer potassium doses concluded in research experiment. Five levels of fertilizer potassium (0, 10, 20, 30 and 40 kg K2O ha-1) were evaluated for the response of green gram in randomized block design replicated thrice. The results of research trials revealed that the yield, protein content and growth parameters of green gram increased significantly with the application of fertilizer potassium @20 kg K2O ha-1. Significantly higher yield of green gram was recorded (5.87, 16.29, 19.23 and 22.36 %) due to application of 10, 20, 30 and 40 kg K2O ha-1, respectively over control. The total K uptake by green gram increased significantly with the incremental doses of potassium application which helped to prevent the depletion of available soil K and build-up its content in the soil. The mean K use efficiency varied from 38.30 to 54.15 and maximum (54.15 %) was recorded with the application of 20 kg K2O ha-1. The benefit cost ratio was also increased with the application of potassium and reflected in terms of additional returns per rupee (Rs. 10.94, 15.63, 12.17 and 10.72) invested on application of K @ 10, 20, 30 and 40 kg K2O ha-1, respectively. The farmer’s field trial results with 0 and 20 kg K2O ha-1 revealed that application of 20 kg K2O ha-1 increased the yield of green gram by 10.87% over control.

Comparison Of Maternal And Fetal Outcome Following Caesarean Section In Pre- Eclamptic Patients Under General And Spinal Anesthesia

Background:Pre-eclampsia is a multi-system disorder in pregnancy associated with significant maternal morbidity and mortality and also affects neonatal outcome. Choice of anesthesiatechnique and skillful management is equally important for maternal and fetal well-being. So, this study was designed to compare the maternal and fetal outcome following cesarean section in pre-eclamptic patients under general and spinal anesthesia. Material And Methods:This prospective, randomized observational study was carried out in 60 parturients age between 18 to 40 years divided in two groups 30 parturients in each. ASA Physical Status II and III who delivered after 34 weeks of gestation with criteria of mild pre-eclampsia by means of Elective/emergency C-section were included. After giving pre medication Group G received thiopentone, succinylcholine intravenously before intubation followed by oxygen, sevoflurane and atracurium (after delivery of baby). Group S received spinal anesthesia by using 2 ml of 0.5% heavy bupivacaine. Heart rate, blood pressure, SpO2 of mother and neonate were recorded at specific time points. Also post of ICU shifting of mother for maternal outcome and APGAR score at 1,5,7minutes, ABGA, resuscitation requirement and NICU admission data were recorded for fetal outcome.Result:After induction maternal heart rate and blood pressure were higher side (still within 30% from baseline) in group G as compared to group S. APGAR score, ABGA and NICU shifting requirements had favorable outcome in group S. Conclusion:Spinal anesthesia is first choice as it is more safe, simple and with better maternal and fetal outcome.

Does tumor stroma ratio of breast cancer trucut biopsy determine response to neoadjuvant therapy?

Aims and Objectives: We examined the prognostic value of Tumor stroma ratio (TSR) in breast tumor core biopsy (TCB) specimen to determine response to neoadjuvant therapy (NAT) prior to modified radical mastectomy (MRM). Methods: This was a retrospective analysis of patients with breast cancer who underwent TCB before NAT between August 2016 and July 2018. TSR in TCB was studied independently by 2 pathologists ( VM, VS) defined as stroma rich (TSR?50%) or stroma poor (TSR>50%). MRM specimen of these patients were subsequently studied .Residual cancer burden (RCB) was calculated using the MD Anderson RCB calculator, categorized as complete (0), good (1) Partial (2) and no response (3). Statistical analysis was done to assess correlation of TSR to RCB. Results: A total of 62 patients were analyzed. Mean(SD) age was 48(11) years.Twenty eight (45%) and 34 (55%) patients were stroma rich and stroma poor respectively. Twenty six (42%) patients were responders and 36 (58%) non-responders to NAT. Among stroma rich patients, only 3 (10%) were responders (Class 0 &1)and 25 (90%) non-responders(Class2&3)to NAT, among stroma poor patients 23 (68%) responded well and 11 (32%) did not.TSR had a moderate negative correlation with RCB (-0.6). On univariate analysis, only TSR had a significant effect on RCB class (<0.001). Conclusions: TSR on TCB is a useful prognostic factor to determine response of breast carcinoma patients to neoadjuvant therapy.It is cost effective, simple and quick. Larger multi-centric studies would be useful to study its clinical implications.

Laboratory surveillance of chikungunya in Madhya Pradesh, India (2016-2017)

Background & objectives: Chikungunya (CHIK) is a neglected, re-emerging arboviral disease. Limited information on CHIK-confirmed cases during interepidemic period is available from India. This surveillance study was conducted in Madhya Pradesh (MP), India, during the years 2016-2017, to provide information about CHIK cases. Methods: Blood samples collected from patients suspected having CHIK were tested by immunoglobulin (Ig) IgM ELISA or real time reverse transcription-polymerase chain reaction (rRT-PCR) for the detection of CHIK virus (CHIKV)-specific IgM antibodies or viral RNA, respectively. Partial envelope-1 gene sequencing was done. Clinical and demographic data were collected and analyzed. Results: Of the 4019 samples tested, 494 (12.2%) were found positive for CHIKV infection. The positivity was detected in both rural and urban areas. The mean age of CHIK-positive cases was 33.12�.25 yr. Headache and joint pain were the most prominent symptoms, 34.6 per cent (171/494) of the CHIK cases required hospitalization and six patients with CHIKV infection died. The East/Central/South African genotype of CHIKV was found to be circulating in the study area. Interpretation & conclusions: Our study recorded a higher CHIK positivity during 2016-2017 in comparison to earlier reports from MP, India. A high proportion of CHIK cases required hospitalization and deaths were also reported, which indicated the severity of the disease in the study area. In-depth molecular analysis of the virus and other risk factors is essential to understand the trends in disease severity.

Simple multiplex RT-PCR for identifying common fusion BCR-ABL transcript types and evaluation of molecular response of the a2b2 and a2b3 transcripts to Imatinib resistance in North Indian chronic myeloid leukemia patients.

INTRODUCTION: Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome, an abnormally shortened chromosome 22. It is the result of a reciprocal translocation of chromosomes 9 and 22, creating BCR‑ABL fusion transcripts, b3a2, b2a2, and e1a2. The aim of our study was to determine the type of BCR‑ABL fusion transcripts for molecular diagnosis and investigate the frequency of BCR‑ABL fusion transcripts in CML patients by multiplex RT‑PCR in CML. MATERIALS AND METHODS: A single reaction with multiple primers multiplex PCR was used to detect and investigate the type and frequency in 200 CML patients among which 116, 33, and 51 were in CP, AP, and BC phase, respectively. RESULTS: The study included 200 CML patients, among whom breakpoints in b3a2, b2a2 transcripts were detected in 68% and 24%, respectively, while 8% of the patients showed both b3a2/b2a2. A statistically significant difference was seen between frequency of BCR‑ABL fusion transcripts and gender (P = 0.03), molecular response (P = 0.04), and hematological response (P = 0.05). However, there was no correlation found between frequencies of BCR‑/ABL fusion transcripts and other clinicopathological parameters like age, type of therapy, thrombocytopenia, and white blood cell count. CONCLUSION: Multiplex reverse transcriptase‑polymerase chain reaction is useful and saves time in the detection of BCR‑ABL variants; the occurrence of these transcripts associated with CML can assist in prognosis and treatment of disease.

Molecular characterization of clinical isolates of Cyclospora cayetanensis from patients with diarrhea in India.

Purpose: Cyclospora cayetanensis is an intestinal coccidian protozoan that has emerged as an important cause of both epidemic and endemic protracted diarrhea worldwide. Though humans appear to be the only natural hosts; the role of animals as natural reservoir is uncertain but of increasing concern. The present study aimed to study the prevalence of coccidian in different groups such as immunocompromised, clinically apparent immunocompetent and healthy individuals. Also, the study isolates were assessed for heterogeneity among the sequences. Materials and Methods: Stool samples from different groups of patients were collected. The parasite was detected in stool by different diagnostic tools such as light microscopy and nested PCR‑restriction fragment length polymorphism using 18S ribosomal RNA as the target gene. Results: The prevalence of C. cayetanensis was 2.4% (19/800) in the present study. The PCR assay amplified Cyclospora cayetanensis DNA in only 89% (17/19) isolates. Further, sequencing revealed no significant difference among the study isolates and the non‑primates. Phylogenetic analysis of the study isolates however, formed two clusters. While one cluster showed close evolutionary association with the C. cayetanensis strains, the other cluster showed evolutionary association with the two non‑primate species. Conclusion: The methods described here for detection of C. cayetanensis oocysts are simple, efficient, specific, and sensitive and therefore can be effectively applied for laboratory diagnosis and environmental assessment of fresh produce and water sources. Clinicians should include Cyclospora infection in the differential diagnosis of prolonged or relapsing diarrheal illness even in clinically apparent immunocompetent individuals.

Clonal Diversity and Drug Resistance in Mycobacterium tuberculosis Isolated from Extra-pulmonary Samples in Central India - a Pilot Study.

In India, extrapulmonary tuberculosis (EPTB) accounts for 10 - 15% of all types of tuberculosis. To identify and compare predominant spoligotypes and drug‑resistance patterns in strains of Mycobacterium tuberculosis isolated from extrapulmonary and pulmonary specimens in central India, drug susceptibility testing and spoligotyping were carried out. Spoligotyping data was analyzed using SITVIT2 database. ST11/EAI3_Ind with 33% isolates among extrapulmonary specimens and ST26/ CAS1_DEL with 28% isolates among pulmonary specimens were the most predominant lineages. Multidrug resistance was found in 5.5% of the strains isolated from extrapulmonary specimens in contrast to 17% isolated from pulmonary specimens.

Refractory giardiasis: A molecular appraisal from a tertiary care centre in India.

Purpose: The intestinal flagellate Giardia lamblia includes many genetically distinct assemblages, of which assemblage A and B, predominantly infect humans. Nitroimidazoles derivatives (metronidazole and tinidazole) and nitazoxanide are some of the therapeutic agents for treatment of giardiasis. Nevertheless, some individuals with giardiasis are non‑responsive to standard therapy. The present study highlights cases of refractory giardiasis and attempts to elucidate if genetic heterogeneity in the parasite is associated with treatment failure. Materials and Methods: Three stool samples were obtained on three consecutive days from 4000 patients with diarrhoea and were microscopically examined for the detection of trophozoites, and/or cysts, using both normal saline and Lugol’s iodine. A hemi‑nested polymerase chain reaction (PCR) assay using triose phosphate isomerase (tpi) as the target gene was performed to determine the assemblages. Sequencing of the PCR products of the patients showing failure to treatment of giardiasis was also performed. Results: Two per cent (82/4000) of the total patients were microscopically positive for Giardia lamblia in the stool samples. All these patients were treated with metronidazole/tinidazole as per the standard regimens. However, eight patients showed treatment failure to giardiasis as stool examinations were repeatedly positive even after treatment with multiple courses of anti‑giardial therapy. Genetic characterisation of all eight Giardia isolates showed that they belonged to Assemblage B and had homogeneous sequences. These patients were either treated with extended regimens or with combination therapy of anti‑giardials. Conclusion: In our experience, combination of two or more drugs for a longer duration is the treatment modality to treat refractory giardiasis.

Molecular characterisation of Giardia intestinalis assemblages from human isolates at a tertiary care centre of India.

Purpose: The aim of the study was to determine the genetic heterogeneity of Giardia intestinalis isolates detected in stool samples of the study population using polymerase chain reaction assay and restriction fragment length polymorphism. We also tried to correlate the association/differences between the clinical symptomatology and infection by different assemblages (genotypes) of G. intestinalis. Materials and Methods: This cross-sectional study was conducted from April 2008 to June 2010. A total of 40 adults (n = 40) and 42 children (n = 42) below the age of 12 years with the clinical suspicion of giardiasis and with the onset of one or more of the following fi ve symptoms, i.e., loose stool, nausea, weight loss, fatigue and foul smelling faeces and confi rmed laboratory diagnosis of giardiasis at least once during the current episode of diarrhoea were included in this study. Results: Of the 82 patients (males 66) enrolled in the study, 70 (85%) presented with diarrhoea (56 males) and 12 (15%) without diarrhoea (10 males). Out of 70 diarrheic patients, 61 (87%) had chronic diarrhoea, 8 (11.5%) had acute diarrhoea and 1 (1.5%) had persistent diarrhoea. Of the total patients, 63 (77%) were clinically assessed and were apparently immunocompetent, whereas, 19 (23%) immunocompromised patients had different underlying conditions besides giardiasis. Genotyping identifi ed all 82 (100%) isolates as assemblage B. Conclusion: We found that assemblage B of G. intestinalis presents with all kinds of clinical features ranging from asymptomatic carriage to acute, persistent or chronic diarrhoea.

Molecular characterization of Chittoor (Batai) virus isolates from India.

Background & objectives: Chittoor virus (CHITV) belongs to genus Orthobunyavirus, family Bunyaviridae. It has been isolated from various species of mosquitoes and pig from different parts of India. Five isolates of CHITV were characterized at the molecular level and compared with other Batai viruses (BATV) to find out any kind of reassortment in their genome. Methods: Complete nucelocapsid (S), glycoprotein (M) and partial RNA polymerase (L) segments of CHITV were amplified and sequenced. These sequences were compared with those of Batai viruses, isolated from different geographical locations in Asia, Africa and Europe. Results: Phylogenetic analysis revealed CHITV as a variant of BATV. High level of conservation was seen among the CHITV isolates studied. The CHITV sequences showed clustering in one lineage with the sequences from Japan and Malaysia, however, BATV sequences from Europe and Africa formed a separate phylogenetic lineage. Interpretation & conclusions: The study indicates the presence of a single genotype of CHITV circulating in India, despite the involvement of different hosts in the natural cycle by this virus. Analysis of the sequences of the S, M and L segments of genome indicated that the virus has not undergone any reassortment. This virus has not caused any epidemic involving humans, however, replication of the virus in different mosquito and vertebrate hosts species suggests that it is a cause of concern.

A novel method of plasmid isolation using laundry detergent.

Since the discovery of plasmid, various methods have been developed to isolate plasmid DNA. All the methods have one common and important target of isolating plasmid DNA of high quality and quantity in less time. These methods are not completely safe because of use of toxic chemicals compounds. The developed protocol for plasmid extraction is based on the alkaline lysis method of plasmid preparation (extraction at pH 8.0) with slight modifications. Cell lysis reagent sodium dodecyl sulfate is replaced by lipase enzyme present in laundry detergent. A good plasmid preparation can be made, which is well suited for subsequent molecular biology applications. By taking safety measures on count, contaminants like, RNA and protein can be completely avoided with maximized plasmid yield. The resultant plasmid quality and quantity can be well comparable to other prevalent methods.

Effect of temperature and insecticide stresses on Aedes aegypti larvae and their influence on the susceptibility of mosquitoes to dengue-2 virus.

Two major factors, higher temperatures and the application of insecticides, can drastically alter the genetic structure of a vector mosquito population. Due to these two stresses, the majority of the population gets wiped out, but the ones that withstand the stress and survive are likely to pass on survivability, and have an altered physiology. Our study shows that exposures to higher temperatures and DDT during the larval stage affects their susceptibility as adult mosquitoes to the DEN-2 virus. The overall transcription and translation status of heat shock protein (Hsp70) in virus high- and low-susceptible was the same as that in other batches. In the case of a DDT-resistant (R-7) strain two bands were obtained during RT-PCRs after heat shock. These two alleles were obtained only with HY-1 in which R-7 males were used for the crosses, suggesting that the second allele is probably male sex linked. The higher expression of Hsp70 may provide DDT-resistant strains a better chance of survival high temperature environments, particularly in homozygotes and hybrids. It was also interesting to note that these strains have a significantly lower susceptibility to the virus. Wide-spread DDT-resistance and a rise in temperature above the average temperature during summer may result in a population with a low susceptibility to the virus. Several families of heat shock proteins are known to be expressed in mosquitoes, and may have a cumulative role in determining susceptibility to the virus, which itself is governed by several genes.