RESUMO
Background & objectives: Flow cytometry is an important tool to diagnose acute leukaemia. Attempts are being made to find the minimal number of antibodies for correctly diagnosing acute leukaemia subtypes. The present study was designed to evaluate the analysis of side scatter (SSC) versus CD45 flow dot plot to distinguish acute myeloid leukaemia (AML) from acute lymphoblastic leukaemia (ALL), with minimal immunological markers. Methods: One hundred consecutive cases of acute leukaemia were evaluated for blast cluster on SSC versus CD45 plots. The parameters studied included visual shape, CD45 and side scatter expression, continuity with residual granulocytes/lymphocytes/monocytes and ratio of maximum width to maximum height (w/h). The final diagnosis of ALL and AML and their subtypes was made by morphology, cytochemistry and immunophenotyping. Two sample Wilcoxon rank-sum (Mann Whitney) test and Kruskal-Wallis equality-of-populations rank tests were applied to elucidate the significance of the above ratios of blast cluster for diagnosis of ALL, AML and their subtypes. Receiver operating characteristic (ROC) curves were generated and the optimal cut-offs of the w/h ratio to distinguish between ALL and AML determined. Results: Of the 100 cases, 57 of ALL and 43 cases of AML were diagnosed. The median w/h ratio of blast population was 3.8 for ALL and 1 for AML (P<0.001). ROC had area under curve of 0.9772.The optimal cut-off of the w/h ratio for distinction of ALL from AML was found to be 1.6. Interpretation & conclusions: Our findings suggest that if w/h ratio on SSC versus CD45 plot is less than 1.6, AML may be considered, and if it is more than 1.6, ALL may be diagnosed. Using morphometric analysis of the blast cluster on SSC versus CD45, it was possible to distinguish between ALL and AML, and their subtypes.
RESUMO
Background: Cough and common cold are one of the commonest morbidities in the community. Cough and cold medicines are abound in Indian market despite the fact that majority of them lack scientific evidence of their use in this common condition. Aims & Objective: To analyze the prescribing pattern of ‘cough and cold’ medicines in Central Gujarat. Material and Methods: An observational, cross-sectional, questionnaire- based study was carried out to assess the prescribing pattern of doctors with regard to cough and cold. A total of 100 prescribers with a graduate degree (n=50) or a post-graduate degree (n=50) from Central Gujarat were selected randomly. After interviewing all doctors, data were analyzed to find the percentage of patients prescribed ‘cough & cold medicines’, their types of dosage form, use of FDCs, indications, any adverse events encountered and non-pharmacological measures advocated. Results: Prescribing FDCs for cough and cold was significantly higher (92% vs 72%, P<0.05) in post graduate prescribers attached to private hospitals than in graduate prescribers attached to government/teaching hospitals. Usage of solid dosage forms was significantly higher (p<0.05) in prescribers attached to government or teaching hospitals as compared to prescribers attached to private hospitals (84% vs 60%). About 18% of graduate and 25% of post graduate prescribers gave cough and cold medicines at patients’ behest. Only 15% prescribers prescribed cough and cold medicines for dry cough while antihistamines were advocated by 96% of prescribers. About 50% of the physicians prescribed these medicines for conditions like upper and lower respiratory tract infections. Non pharmacological measures were recommended by 75% prescribers. Conclusion: Efforts are needed to create awareness amongst prescribers about the rational use of cough & cold medicines and also pay attention to ADR caused by them. Reforms in medical education and CME are recommended.