NSAIDs Preferred Over Opioid as Post-Operative Analgesic: A Prospective, Observational Prescribing Pattern Study in a Tertiary Care Hospital of Eastern India

Pain is an unpleasant sensation as a consequence of injury, disease along with emotional disorder occurring in varying degrees of severity. Poor control of pain is complete unethical, clinically unsound and economically disastrous. Effective pain control in postoperative period is one of the essential components of post-operative care for those patients who have undergone surgery. Inadequate and inappropriate pain control results in significant increase in post-operative morbidity or mortality. Methods: An prospective, observational analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the post- operative ward of department of general surgery from the bed side tickets of the patients. Results: In our current study we observed out of 515 postoperative patients 49.5% (255) were male and 50.5 % (260) were female, on the other hand more Hindu(85.4%) than Muslim(14.6%). On the day of surgery Monotherapy was prescribed for 440(67%) patients and 33% received both combination analgesic therapies. A total of 33% patients who received dual analgesic therapy immediate post-operative period most commonly used combination was Tramadol+Diclofenac (130/170), followed by Tramadol+ Paracetamol (40/170). In the following post-operative days increase in use of Diclofenac+Paracetamol was noted. No Triple drug therapy observed in this study. Conclusion: The results of current study shows that diclofenac was the most commonly prescribed analgesic. It is due to high efficacy of diclofenac in post operative pain control with better safty profile; i.e. lesser side effects compared to other analgesic.

Study of Antibiotic Utilization Pattern and Cost of Antibiotic Therapy in Patients Undergoing Cholecystectomy in a Tertiary Care Hospital of Eastern India

Cholecystectomy, one of the most common operative procedures done in our institution. In a developing country like India, choice of antibiotics should be rational to reduce the burden of cost. There are no standard treatment guidelines to follow regarding antibiotic usage causing indiscriminate use of this antibiotic. Methods: An observational, prospective analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the department of general surgery from the bed side tickets of the patients after taking a short history and informed consent from the patient. Cost of the therapy was calculated from CIMS (Current Index of Medical Specialities) and institutional pharmacy. Results: More commonly single antibiotic (190/320) prescribe followed by two antibiotic (80/320) and three antibiotic (50/320). Piperacillin + Tazobactum most commonly prescribe antibiotic as a single agent and overall. Ceftriaxone / Tazobactum + Metronidazole preferred combination when two antibiotic use at a time. Mean hospital stay 3.78 days. Average duration for prescribing of antibiotic 3.25 days. Mean cost for antibiotic in 984 INR, with a range 115-2700 INR. The average duration of stay in open Cholecystectomy was 7 days whereas the mean duration of stay in cases of laparoscopic Cholecystectomy was reduced to 3.07 days. Average antibiotic prescribing duration was 4.75 days significantly higher than Lap. Cholecystectomy (1.4 days). Conclusion: As there is no standard treatment protocol and antibiotic policy to follow antibiotics are used as pick and choose method due to lack of standard treatment protocol.

Antiepileptic Drugs In Pediatric Indoor: Widely Prescribed; Wisely Consumed?

Seizure is a very common manifestation of a variety of disorders in pediatric age groups. The choice of antiepileptic drugs varies in different age groups in various doses, routes and frequencies. The perception of the care giver regarding proper use of medications is also equally important for success of pharmacotherapy. This study aimed to explore the prescribing pattern of seizure medications in pediatrics inpatients of a tertiary care hospital and assess the parent’s knowledge on drug intake simultaneously. Methods: A prospective observational study carried out with the prescription data of 107 children aged less than 18 years admitted in the pediatric department with the diagnosis of seizure and analyzed with descriptive statistics to obtain drug utilization indices. A questionnaire survey was employed on the parents of the children to assess their knowledge. Results: Neonatal presentation with seizure was more common than older pediatric age group. Commonest causes of convulsions were birth asphyxia with its sequel (84.78 %), CNS infection (39.34%) and epilepsy (32.79%). Monotherapy was highly prevalent (73.80%) with phenobarbitone and phenytoin being commonest drugs in neonatal and post-neonatal populations respectively. No newer generation antiepileptics were used. Generic prescribing was 28.03% with all the drugs being enlisted in essential medicine list. Average no. of anticonvulsants per prescription was 1.28. Parent’s knowledge about frequency of drug administration and food interaction was largely deficient. Conclusion: Monotherapy with older antiepileptics are preferred in pediatric indoor patients presenting with seizures. Parent education on appropriate use of medication is needed to rationalize the therapy.

Antimicrobial prescribing patterns in surgical inpatient of tertiary care hospital in Eastern India

Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.

Medication use pattern and quality assessment of psychiatry outpatient department prescriptions of a tertiary care hospital

Background: Psychiatric illness is a major but often underreported health burden. The field of psychopharmacotherapy is continuously evolving therefore needs monitoring to prevent irrationality. In this setting, authors analyzed the prescribing pattern of psychotropic drugs while simultaneously monitoring prescription quality in a tertiary care teaching private hospital.Methods: A 6 month-prospective observational study was conducted in psychiatry out-patient department. Prescription pattern was analyzed using World Health Organization (WHO) drug use indicators. The quality of the prescriptions was assessed as per prescription writing guidelines issued by The Department of Health and Family Welfare, Government of West Bengal.Results: Of the 745 prescriptions analyzed, depression and psychosis constituted the bulk of diagnosed cases irrespective of any gender predominance. The average number of psychotropic drugs per prescription was 2.85±1.48. Antidepressants, sedative-hypnotic and anxiolytics are most commonly prescribed drugs. 37.58% of psychotropic drugs were given as fixed dose combination, most common being risperidone with trihexyphenidyl. Only 2.91% of the drugs were prescribed in generic name whereas 53.99% were enlisted in national essential medicine list 2015. Polypharmacy and therapeutic duplication were noted in 41% and 26.84 % of prescriptions and dose, duration and frequency were not mentioned in 2.68%, 53.02% and 19.00% of the prescription respectively.Conclusions: Use of psychotropic drugs follows closely with different treatment guideline, though routine uses of central anticholinergics with atypical antipsychotics are not recommended. Despite high utilization of NLEM, more generic prescribing, correct prescription dosing schedule, avoidance of polypharmacy and non-Judicious use of multivitamin FDCs may significantly improve treatment outcome.

Psammomatous melanotic schwannoma as a component of Carney complex.

Melanotic schwannoma is a rare form of pigmented neural tumor commonly arising from the posterior spinal nerves and ganglia. Two variants have been described, psammomatous and nonpsammomatous. 50% of psammomatous tumors are associated with Carney complex. The biologic behavior of the tumor is diffi cult to predict and slightly over 10% of the tumors follow malignant course. We present a case of psammomatous melanotic schwannoma as part of Carney complex in a 67-year-old male. Clinical examination revealed oral mucosal and abdominal skin pigmentation. Magnetic resonance imaging showed an intradural extramedullary lesion at D8-D12 level. Intraoperative squash smear study showed sheets of spindle cells with abundant intracytoplasmic melanin pigmentation and few psammoma bodies. Based on clinical, radiologic, and histopathological fi ndings with immunohistochemistry correlation a fi nal diagnosis of psammomatous melanotic schwannoma was rendered.

Pleomorphic xanthoastrocytoma with anaplastic features: A case report.

Pleomorphic xanthoastrocytoma has been considered as an astrocytic tumor with relatively favorable prognosis. It corresponds to WHO Grade-II neoplasm. Recently, several patterns with relatively poor prognosis have been recorded and a new concept of “PXA with anaplastic features” has been proposed. The present case is about a 9-year–old girl who presented with symptoms of recurrent headache, seizures and poor academic performance. MRI revealed left frontoparietal irregular enhancing mass lesion with callosal involvement and right mid-brain arteriovenous malformation. Clinical and radiological examination was suggestive of a high grade glial neoplasm/PNET. A diagnosis of high grade glial neoplasm was rendered on the squash smears submitted for frozen sections based on the presence of spindle cells, admixed with pleomorphic bizarre, giant cells with multilobated nuclei showing few atypical mitosis and abundant eosinophilic cytoplasm. Frontal craniotomy with debulking of the tumor was performed and permanent sections revealed a biphasic glial neoplasm with spindle cells arranged in fascicles admixed with bizarre multinucleated giant cells showing abundant vacuolated and lipidized cytoplasm, nuclear hyperchromasia with intranuclear inclusions. Eosinophilic granular bodies, mitosis of 7/10 HPF, micro vascular proliferation, necrosis and invasion into the underlying brain parenchyma were noted. With these histomorphological fi ndings a diagnosis of pleomorphic xanthoastrocytoma with anaplastic features was rendered.

Chromosome profile of Leishmania donovani: Interstrain and interspecific variations.

The genome of Leishmania donovani AG83, a virulent strain causing kala-azar, was resolved into 29 chromosomal bands by pulsed field gel electrophoresis (pFGE) under standardized conditions. Comparison of the karyotype with those of other strains and species revealed variations. By Southern hybridization, specific genes were localized to individual chromosomes. Twenty-two copies of P-tubulin genes are located on band 27 (1.63 Mb); minor copies are present in band 16 (850 kb) and band 9 (650 kb). A P-tubulin related nontranscribed locus was isolated from a genomic library and shown to contain repetitive sequences hybridizing throughout the genome. Single chromosomes contain multicopy clusters of gp63 and rniniexon- derived RNA genes, but interspecific variations were observed in each case. The results emphasize the importance of using a standard reference strain of Leishmania donovani for coordinated genome mapping of this clinically important organism.