Financial audit of wastage of anticancer drugs: Pilot study from a tertiary care center in India

"PURPOSE: Drug wastage is a major concern in oncology where costs of antineoplastic drugs are exorbitant, and the disposal of toxic drugs increases the chances of occupational hazards to healthcare and sanitary workers and environmental pollution at the site of disposal. The principal objective of this study was to ascertain the extent of drug wastage and calculate its financial costs. MATERIALS AND METHODS: This was a prospective pilot study conducted to ascertain the quantity of drug wastage in a tertiary care hospital.This pilot study was conducted in day care and inpatient facilities in February 2016. The prescription of cytotoxic drugs, recommended dose, the quantity used, and remainder (waste) left were recorded from the nurses and pharmacy files of the hospital. Cost evaluation of the actual use and the waste was undertaken and an audit was conducted to understand in which anticancer drug the maximum wastage was generated. RESULTS: The results of this study indicated that 6.1% of the total amount of reconstituted drugs was wasted. The highest drug wastage was observed in trastuzumab (29.55%), followed by etoposide (20.4%), dacarbazine (17.14%), daunorubicin (16.67%), and carboplatin (11.29%). Cost analysis showed that the total cost of the drug issued during the study period was Rs. 1,294,975 and the cost of drug wastage amounted to Rs. 143,820 (11.1%). CONCLUSION: To the best of authors’ knowledge, this is the first study from India and the results indicate that the financial impact of anticancer drug wastage was substantial. Attempts should be directed at minimizing the wastage and cost savings without risking patients’ treatment regimen and administering effective dose schedule."

NIRF Heptamethine Cyanine Dye Nanocomplexes for Multi Modal Theranosis of Tumors / 전남의대학술지

Heptamethine cyanine dyes are categorized as a class of near infrared fluorescent (NIRF) dyes which have been discovered to have tumor targeting and accumulation capability. This unique feature of NIRF dye makes it a promising candidate for imaging, targeted therapy and also as a drug delivery vehicle for various types of cancers. The favored uptake of dyes only in cancer cells is facilitated by several factors which include organic anion-transporting polypeptides, high mitochondrial membrane potential and tumor hypoxia in cancer cells. Currently nanotechnology has opened possibilities for multimodal or multifunctional strategies for cancer treatment. Including heptamethine cyanine dyes in nanoparticle based delivery systems have generally improved its theranostic ability by several fold owing to the multiple functionalities and structural features of heptamethine dyes. For this reason, nanocomplexes with NIRF heptamethine cyanine dye probe are preferred over non-targeting dyes such as indo cyanine green (ICG). This review sums up current trends and progress in NIRF heptamethine cyanine dye, including dye properties, multifunctional imaging and therapeutic applications in cancer.

NIRF Heptamethine Cyanine Dye Nanocomplexes for Multi Modal Theranosis of Tumors / 전남의대학술지

Heptamethine cyanine dyes are categorized as a class of near infrared fluorescent (NIRF) dyes which have been discovered to have tumor targeting and accumulation capability. This unique feature of NIRF dye makes it a promising candidate for imaging, targeted therapy and also as a drug delivery vehicle for various types of cancers. The favored uptake of dyes only in cancer cells is facilitated by several factors which include organic anion-transporting polypeptides, high mitochondrial membrane potential and tumor hypoxia in cancer cells. Currently nanotechnology has opened possibilities for multimodal or multifunctional strategies for cancer treatment. Including heptamethine cyanine dyes in nanoparticle based delivery systems have generally improved its theranostic ability by several fold owing to the multiple functionalities and structural features of heptamethine dyes. For this reason, nanocomplexes with NIRF heptamethine cyanine dye probe are preferred over non-targeting dyes such as indo cyanine green (ICG). This review sums up current trends and progress in NIRF heptamethine cyanine dye, including dye properties, multifunctional imaging and therapeutic applications in cancer.

Monitoring and decontamination of pesticide residues in okra (Abelmoschus esculentus Moench).

A monitoring study was carried out in okra for a period of six months to assess the level of pesticide residues of three different chemical groups ie organochlorines, organophosphates and synthetic pyrethroids. Okra samples showed residues of malathion and profenophos. To evaluate the effect of different decontaminating solutions in the removal of pesticide residues, okra var. Varsha Upahar was sprayed with a mixture of pesticides which were frequently detected in okra. Estimation of residues was done using Gas Chromatograph equipped with Electron Capture Detector. The results indicated that dipping in tamarind (2 %) solution for 15 minutes followed by washing in tap water was found to be more effective in reducing all pesticides tested when compared with other treatment solutions. This study helped to standardize simple cost effective strategies to eliminate harmful pesticides from okra which could be practiced by home makers.

An unusual case of non-syndromic occurrence of multiple dental anomalies.

Dental anomalies have been known to occur in humans due to a variety of genetic and environmental factors. Combinations of dental anomalies are known to be associated with specific syndromes. A few cases of multiple dental anomalies have been reported in patients with no generalized abnormalities. This case report describes an unusual occurrence of a combination of dental anomalies in an apparently normal healthy 12-year-old female patient. The dental anomalies in this patient were multiple dens invaginatus, generalized enamel hypoplasia, generalized microdontia, root resorption and multiple periapical lesions, shovel shaped incisors, cup shaped premolars, taurodontism, hypodontia and supernumerary teeth.

Quantitative role of mast cells in odontogenic cystic enlargement

Aim: Mast cells have been hypothesized to play a significant role in pathogenesis of odontogenic cysts. The aim of this study was to evaluate mast cell distribution in cystic lining and the capsule to formulate a mechanism of cystic expansion. Methods: Ten formalin-fixed paraffin embedded tissue blocks each of OKC, dentigerous and radicular cysts were selected. Toluidine blue staining (1% in 1% NaCl solution) was done in 5µm thick sections and counting performed in 10 areas using an ocular grid. Areas counted were divided into 4 zones: intraepithelial, subepithelial, intermediate and deep zones (Group I, II, III and IV respectively). Statistical analysis: Mean ±S.D. was calculated in each group followed by paired ‘T’ test. Results: Mast cells had greatest concentration in subepithelial zone. ‘T’ test showed no significant differences between group I and II zones in OKC but a highly significant difference between groups I and II in dentigerous cyst. Radicular cysts showed a significant difference between groups II and III. Conclusion: Mast cell degranulation releases numerous hydrolytic enzymes that facilitate breakdown of capsular matrix increasing the hydrostatic pressure due to raised osmolality. Influx of tissue fluids results in their enlargement coupled with resorption at the bone-cyst interface.

Left subclavian artery aneurysm presenting as pseudocoarctation on CT angiogram.

A 36-year-old, hypertensive gentleman with aneurysm of left subclavian artery revealed CT picture suggestive of left subclavian aneurysm with psuedocoarctation of aorta. Cardiac catheterization showed no gradient across the psuedocoarct segment.

Prevention of no flow/slow reflow phenomenon in primary PCI by Nicorandil.

AIM: To investigate the efficacy of Nicorandil in preventing no-flow/slow reflow phenomenon in patients with acute myocardial infarction undergoing primary PCI. MATERIALS AND METHODS: From September 2004 to October 2005, 29 patients underwent a primary percutaneous coronary intervention and stenting with nicor-andil as a protocol drug at a dose of 1 mg/hour - this drug was titrated upwards to maximum tolerated dose, with a 2 mg intracoronary bolus given after balloon inflation during PCI. LAD was the infarct related artery in 62% of cases. 72.4% of them had a TIMI thrombus grade of 5. The corrected TIMI frame count following primary percutaneous intervention in the Nicorandil arm was 19.54 + 8.7. None of the patients had a no flow or slow reflow phenomenon with this protocol. One patient developed a subacute stent thrombosis necessitating a revascularization. At a mean follow up of 251 +/- 96.7% days, MACE was not reported in the other patients. Thirty four patients underwent a primary percutaneous coronary intervention and stenting without nicorandil as an adjuvant drug. Some of these patients were retrospectively assessed. They have been followed up for 285.4 +/- 264.6 days. LAD was the infarct related artery in 61.8% of cases while 79.5% of them had a TIMI thrombus grade of 5. The corrected TIMI frame count in this group was 23.9 +/- 17.5 (p <0.56). MACE was reported in 5 of these patients. The mean TIMI frame count for these 5 patients was 40.5 +/- 29.2. Glycoprotein IIb/IIIa receptor inhibitors were given to all patients in both groups. The choice of the agent used was left to the discretion of the operator. CONCLUSION: Nicorandil prevents no-flow/slow reflow phenomenon in patients undergoing primary PCI for acute myocardial infarction. This is shown by a lower corrected TIMI frame count in the nicorandil arm (p < 0.56). Reduction in the incidence of no-flow/slow reflow phenomenon translates into a lower MACE. The drug is safe and does not require intensive monitoring. It must be started early and electively in patients undergoing a primary PCI as a strategy to prevent no-flow rather than to treat this phenomenon.

Morphohistometric analysis of advancing tumor fronts in malignancies associated with oral submucous fibrosis.

The objective of this study was to address retrospectively the invasive tumor fronts of epithelial neoplasms associated with OSF and non-associated tumors. Review of a data base of 25 OSF patients who have had concurrent oral squamous cell carcinoma served as the test sample. The controls constituted an equal number of age standardized (roughly) squamous cell carcinomas, non-associated with OSF. The diagnsis and grading were performed based on established criteria. Altogether a total of 8 histopathological variables were evaluated related to the advancing tumor fronts. After selection of cut-off levels, single parameter analysis by means of univariate test revealed significant result in none. A Total Malignancy Score (TMS) of 14.98 and 15.13(mean) were recorded for test and control respectively. Multivariate analysis showed that degree of nuclear plemorphism (p=0.015) and the pattern of invasion (p=0.003) were the only two variables which significantly affected the TMS. OSF associated tumors did not show features unique to it and therefore its response to therapy need not vary significantly from conventional cases.

Sudden hearing loss in Waardenburg syndrome

Sudden profound hearing loss in a young man with Waardenburg syndrome type I is reported. The classical features of white forelock and dystopia canthorum were present. Audiometry and auditory brainstem responses confirmed the nature of the deafness. This is the first case of this rare syndrome with the unusual presentation of sudden hearing loss reported from this part of the Kingdom of Saudi Arabia. The medical literature about this syndrome with different patterns of hearing loss is reviewed

Doença instestinal inflamatória e gravidez: uma associaçäo mórbida? / Inflammatory bowel disease and pregnancy: a morbid association?

Apresentamos uma revisäo da literatura sobre a interaçäo da gravidez com a doença intestinal inflamatória, que foi elaborada para tentar esclarecer alguns aspectos controversos dessa associaçäo, que sempre foi temida devido às intercorrências que a doença intestinal inflamatória poderá causar sobre a gestaçäo e vice-versa. Observamos que os riscos materno e fetal, apesar de pequenos, existem e podem ser alterados pela gravidade da doença na concepçäo. O tratamento cirúrgico näo impede a concepçäo nem a evoluçäo da gravidez

Effect of retinol on the hemolysis and lipid peroxidation in vitamin Ε deficiency.

A study on the effect of retinol in vitro on the hemolysis of vitamin Ε deficient rat red blood cells showed that retinol enhanced the lysis of the Ε deficient cells as compared to the lysis of normal cells. The lipid peroxidation present during hydrogen peroxide induced lysis of Ε deficient cells was however markedly inhibited in the presence of retinol without affecting the rate of lysis. In an actively peroxidising system of non-enzymatic lipid peroxidation of rat liver or brain homogenates and of brain lysosomes incubated with human erythrocytes, no lysis was obtained; incorporation of retinol in such systems resulted in lysis but no peroxidation. Hydrogen peroxide generating substances almost completely inhibited the lysis of normal human erythrocytes by retinol, but linoleic acid hydroperoxide and auto-oxidised liver or brain homogenates and ox-brain liposomes increased the lysis. It is concluded that vitamin Ε deficient erythrocyte hemolysis may be augmented by retinol, an anti-oxidant, having a lytic function without the peroxidation of stromal lipids.

Studies on hemolysis of human erythrocytes by linoleic acid.

The results presented in this paper show that lysis of human erythrocytes by linoleic acid is not caused by peroxidation of the fatty acid. Peroxidase, superoxide dismutase and scavengers of Ο · and OH had no effect on the lysis while catalase showed only marginal inhibition suggesting that Ο , OH , O and H2O2 do not play any direct role in hemolysis by linoleic acid. Generators of H2O2 inhibited the lysis completely and methemoglobin cells were more resistant to hemolysis by linoleic acid. The fatty acid did neither bind to nor fomed complex with red cell ghosts. Membrane oxidation of sulphydryl groups was also not involved in the lysis. β-Carotene, retinol and bile salts enhanced the lysis, while, cholesterol but not cholesterol acetate, inhibited it. Taurocholate-pretreated cells were more susceptible to linoleic acid lysis. These observations suggested-that lysis by linoleic acid may be due to its detergent property.

Alpha-tocopheryl acetate hydrolase in chicken liver. Characterisation and properties.

An enzyme catalysing the hydrolysis of a-tocopheryl acetate was characterised in chicken liver. The enzyme was localised in the microsomes, had an optimum pH 8·6 and a Km value of 0·5 mM. The enzyme did not hydrolyse retinyl acetate, cholesteryl acetate and ethyl acetate, thus indicating a high degree of specificity. a-Tocopheryl acetate hydrolase required bile salts as a specific cofactor. The results suggested a role for this enzyme in the absorption of vitamin E.