Prevalence of antimicrobial chemotherapy in hospitalized patients in the department of internal medicine in a tertiary care center.

Use of antimicrobial agents (AMAs) is associated with significant reduction in morbidity and mortality. However, indiscriminate and injudicious use of AMAs leads to the ineffective treatment, increased adverse effects, exacerbation or prolongation of illness, emergence of bacterial resistance and an additional burden of an expensive medical cost to the patients. So controlled use of AMAs at right dose, right interval and right duration is of utmost importance. In this retrospective study, prevalence and prescription patterns, and cost of the prescribed AMAs in the hospitalized patients in the department of internal medicine in a tertiary care center were analyzed. A total of 428 hospitalized patients were included in the study. Out of 428 patients, 274 (64.0%, P < 0.01) patients received AMAs for therapeutic (66.4%) and prophylactic (24.1%) purposes. In 9.5% patients AMA prescription was inappropriate. Use of intravenous route was significantly higher (55.48, P < 0.01) than the oral route. COPD with acute exacerbation was most frequent condition for AMA prescription. Majority (90.42%) of AMA prescriptions were based on empirical basis. Mean number of AMA per patient was 2.12 (minimum 1 and maximum 8). Most frequently prescribed AMA was Ceftriaxone (30.2%) from cephalosporin group (33.9%, P < 0.05). Patients received AMAs for the duration of 1-31 days and total cost of single AMA dosage regimen was as high as $ 482.3. As most of the hospitalized patients were prescribed AMA empirically, strategic AMA prescription guidelines and AMA prescription monitoring systems are extremely necessary in the hospitals to prevent emergence of microbial resistance and to expedite the cost effectiveness of medical treatment.

Recent advancement in drug delivery system.

Ease of drug administration, safety, affordability and efficacy are the major concerns in pharmacotherapy leading to exploration of better drug delivery systems. Liposomes are lyotropic liquid crystals composed mainly of amphiphilic bilayers and these are more frequently used as drug carriers. Liposomes help reduce the toxicity and deliver the drug to the target tissue. So far, liposomes have been the most intensively studied lipid-based delivery system. In liposomes, a hydrophilic drug can be trapped in aqueous interior or channels between successive phospholipids bilayers whereas a hydrophobic drug can reside with the bilayer itself. The non-toxic and nonimmunogenic bilayers dissipate allowing the diffusion of the drug into the tissues. Attachment of polyethyl glycol to the surface of liposome (known as stealth liposome) aids in the better targeting of the drug to the tissues. Pegylated proteins and polymers of lactic and glycolic acids have been well studied as drug carriers and found to be resistant to phagocytosis and complement activation. Newer DNA based strategies including DNA vaccination and antisense oligonucleotides and immunomodulation show good results for new therapeutic systems. Though the DNA based therapeutic systems have high selectivity and specificity with few adverse effects, these systems are so far restricted to animal models and clinical trials.

Relationship between plasma leptin and plasma insulin levels in type-2 diabetic patients before and after treatment with glibenclamide and glimepiride.

Type 2 diabetes affects 100 million people throughout the world. Among the various factors implicated in the causation of this disease, the role of leptin, an obesity gene product, is increasingly being investigated. This especially assumes importance in the light of knowledge that obesity confers a minimum of 3-10 fold higher risk of diabetes. This study was planned to investigate the relationship between leptin and insulin levels in type 2 diabetic patients before and after treatment with glibenclamide or glimepiride. 60 type 2 diabetic patients were recruited for the study and were divided into 2 groups-one receiving glimepiride and the other group receiving glibenclamide for duration of 10 weeks. This study demonstrated a highly positive correlation of plasma leptin levels with BMI, plasma insulin and insulin resistance. No gender specific differences were observed in leptin concentrations. The study, however, failed to demonstrate any possible relationship between glycemic control as assessed by blood sugars/ glycosylated hemoglobin (HbAlc) and plasma leptin. The administration of glibenclamide or glimepiride significantly lowered blood glucose levels coupled with a decrease in (HbAlc). Both the drugs increased insulin concentrations. Glibenclamide increased leptin levels but they remained unaltered with glimepiride. Glibenclamide and glimepiride were found to be equally effective in their glucose lowering action. However, the patients receiving glibenclamide experienced higher episode of hypoglycaemic spells than those receiving glimepiride.

Prevalence of complications of simple tooth extractions and its comparison between a tertiary center and peripheral centers: a study conducted over 8,455 tooth extractions.

This study was conducted to investigate and compare the prevalence of complications of simple tooth extractions in a tertiary centre (BP Koirala Institute of Health Sciences, Dharan) and the peripheral centers (Mechi and Koshi zonal hospitals). This is a prospective descriptive study. Tooth extractions were carried out under local anesthesia in the tertiary and the peripheral centers during one year period (March 15"th 2004 to March H"111 2005). Intraoperative and postoperative complications were recorded and analyzed. Out of 8,455 tooth extractions in 6,639 [male-2,465 (37.12%) and females - 4,174 (62.88%)] patients aged between 5yrs- 65 yrs, 7,152 extractions were done in tertiary center and 1,393 extractions were done in peripheral centers.90 complications (1.06%) were observed. 53(58.89%) complications were intraoperative and 37(41.12%) complications were postoperative. 60(0.84%) complications were observed in the tertiary center and 30 (2.3%) complications were observed in the peripheral centers and the difference was highly significant (P<0.000001). The most frequent complication in the tertiary centre was fracture of tuberosity (0.15%) and in the peripheral centers it was 'roots left' (0.77%). Prevalence of 'roots left', injury to adjacent tooth and postoperative hemorrhage was significantly high (P<0.05) in peripheral centers. The higher prevalence rate of complications of tooth extractions in the peripheral centers should not be overlooked and well equipped and organized extraction procedure with qualified dental practitioner is strongly suggested to minimize the complications.