Role of inflammatory markers in predicting mortality and outcome of acute encephalitis syndrome in children of Eastern Uttar Pradesh India

Background: The present study was performed to study the role of inflammatory markers viz. C-reactive protein, procalcitonin, serum ferritin and serum lactate dehydrogenase in predicting the mortality and outcome in patients with acute encephalitis syndrome admitted to pediatrics ICU, BRD medical college, Gorakhpur.Methods: 140 patients/children of the age group ranging from 1 year to 16 years admitted in the acute encephalitis syndrome unit of BRDMC during 1 August 2021 to 31 July 2022 were analyzed with the prospective observational study.Results: Vaccination status (p<0.001) and socioeconomic status (p=0.020) were associated with mortality outcome in AES patients. Serum procalcitonin levels with cut off value >0.10 mg/dl and serum LDH levels with cut off value of 480u/L have shown a positive association with the mortality in AES patients. (p=0.041 and p=0.038, and strength of association is 0.67 and 0.65, respectively. C-reactive protein with a cut-off value 10 mg/dl and serum ferritin with a cut-off value 140 ng/ml have shown no association with mortality with p values of 0.143 and 0.267, respectively. The Area under the ROC curve is maximum for serum procalcitonin (0.937) with a cut-off value 0.10 ng/dl with 100% sensitivity and 75.8% specificity (confidence interval 95%: 0.894-0.980). The negative predictive value is 100% and PPV is 13.7%. Similarly, the area under the ROC curve for CRP with a cut-off 10mg/dl is 0.900 (confidence interval 95%: 0.841-0.959) with 100% sensitivity of and 64.8%. specificity. Consequently, the negative predictive value is 100 % and the positive predictive value of 11.1%.Conclusions: For predicting the mortality in AES patients 2 prognostic markers viz. C reactive protein and procalcitonin can prove to be promising prognostic screening tests, and therefore, both the tests are advised consecutively.

Prescription Quality Index Based Analysis of Prescriptions of Outdoor Patients in a Tertiary Care Centre in Haryana

Writing a prescription is a combination of science and art. Good quality prescriptions are a sign of prescriber’sexpertise. Analysis of quality of prescriptions can be carried out by various methods and by using certain toolsas well. Prescription Quality Index (PQI) is one such validated tool for analyzing the prescription quality. Thepresent study was undertaken on 2155 prescriptions to analyse the prescriptions of outdoor patients by usingPrescription Quality Index tool. Each prescription was evaluated by using questionnaire of PQI tool. The toolconsists of 22 questions, based on the answers of which a score was calculated for each prescription. Thena collective mean score for all the prescriptions was calculated. Depending upon individual scores, theprescriptions were graded in to poor, medium and high-quality prescriptions. The mean PQI score for all the2155 prescriptions was 28.94 ± 0.23. We found that 1015 (46.10 %) prescriptions were of poor quality, 46(2.13 %) were of medium quality and 1094 (50.77 %) were of good quality. The overall mean score of all theprescriptions falls in to the poor-quality prescription category according to PQI. It was concluded that therewere many lacunas that require the attention of prescribers in order to attain and maintain high standardprescription quality.

Assessment of prescription writing practices in a government tertiary care hospital in Haryana by using WHO prescribing indicators

Background: Writing a prescription is a combination of science and art. Good quality prescriptions are a sign of prescriber’s expertise. World Health Organization has defined certain parameters to promote rational drug use in all countries. This study was designed to assess the prescription writing practices in a government tertiary care hospital in Haryana by using WHO prescribing indicators.Methods: A total of 2155 prescriptions were evaluated. Each prescription was evaluated for average number of drugs prescribed per patient per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed and percentage of medicines from Essential drug list prescribed. These indicators help us to check polypharmacy, practice of prescribing drugs by brand names, antibiotic overuse, preference of injectables and non-adherence to Essential drug list.Results: The average number of drugs prescribed per patient per encounter was calculated to be 3.25±0.24. The percentage of medicines prescribed by generic names was 35.89%. Percentage of encounters with an antibiotic prescribed was 48.21 % and with an injection prescribed was 1.85%. The percentage of medicines form NLEM was 76.36%.Conclusions: The values of WHO prescribing indicators obtained from this study show that there are some areas where the prescribers need to improve their prescribing practices.

Materiovigilance : An Emerging Discipline

The main objective of study is to compare the adverse drug reactions (ADRs) of Zidovudine and Stavudine containing regimens. It is a prospective observational study conducted in the ART centre of a tertiary care teaching hospital in central India. The data collected were recorded on standard ADR reporting forms. Standard scales were used for assessment of ADRs. In twelve months duration total 263 patients on ART were observed for ADRs. 128 patients on Stavudine based regimen and 135 patients were on Zidovudine based regimen. Total 72 ADRs detected in 68 patients. Incidence of ADRs was more in Zidovudine based regimen. Zidovudine associated with early and mild ADRs while Stavudine associated with late and distressing ADRs. Considering the magnitude of ADR related problems, results support the discontinuation of Stavudine based regimens