Cost effectiveness analysis in the management of stroke in a tertiary care hospital

Background: Stroke has a high economic impact on the society especially in a developing country like India. In India health insurance doesn抰 cover all people leading to out of pocket expenditure. The objective of the present study was to study the cost of illness and outcome of stroke in a tertiary care hospital.Methods: Direct medical and nonmedical costs were obtained after 28 days of follow-up. The outcome of the stroke was measured by modified Rankin scale (mRS).Results: The mean age of the patients was 65.38�.98 years. Majority of the patients suffered from ischemic stroke and belonged to lower middle socioeconomic group. The mean cost of stroke was INR 39819. There was improvement in the mRS score after 28 days following treatment of acute stroke.Conclusions:Direct medical costs forms major component of cost of stroke. Early management and hospital discharge can reduce the economic burden of stroke.

Assessment of knowledge, attitudes and practice among interns about over the counter drugs in a tertiary care hospital in India

Background: Drugs that are dispensed against a valid prescription issued to a patient by a registered medical practitioner are known as 損rescription-only drugs�. In India, they have been regulated under schedule H, H1, G, and X of the Drugs and Rules (1945). The drugs which are not included in the list of 損rescription-only drugs� are considered to be over-the-counter drugs (OTC). There is no provision for an OTC drug schedule in the Drugs and Cosmetics Rules 1945, and these drugs have higher chances of misuse or abuse. This study was undertaken to assess the knowledge, attitudes and practice among medical interns about OTC drugs in a tertiary care hospital in India.Methods: This was a cross-sectional study, which was conducted at Kempegowda Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India, from March 2018 to September 2018. A pre-validated questionnaire consisting of 24 questions to assess the knowledge, attitude, and practice was administered to 80 medical interns chosen by simple randomization, out of which 14 questions were related to knowledge, 6 related to attitude and 4 related to the practice. The participants were provided 30 minutes to complete the questionnaire. The data recorded were analyzed using Microsoft Excel.Results: There were some gaps in the knowledge, attitude and practice among the medical interns about OTC medications.Conclusions: There is a need for special emphasis on the MBBS curriculum about the use of OTC drugs.

Phenytoin induced toxic epidermal necrolysis: a case report

Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), are severe idiosyncratic reactions characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. The usage of anticonvulsants like carbamazepine, phenytoin, lamotrigine, phenobarbital are associated with high risk for occurrence of TEN. We present a case of toxic epidermal necrolysis in a 30 year old female probably induced by phenytoin. A 30 year old female was admitted to the emergency medicine department of KIMS hospital, Bengaluru. Lesions over the lips and oral cavity, multiple fluid filled blisters were present diffusely all over the body. Patient had a past history of oral cavity lesions with injection phenytoin. Patient is a known epileptic of over 12 years and was on treatment. Patient had a seizure attack 3 days back and visited nearby hospital and did not inform the doctor of her allergy to phenytoin. Patient was given inj phenytoin after which she developed oral lesions and also presented with fluid filled bullae all over the body. A diagnosis of toxic epidermal necrolysis was made based on clinical history and Scoreten score and was treated with betadine wash, fluconazole and antibiotics .The lesions improved significantly with the above management and patient recovered enough to be discharged from the hospital after 5 days. Severe and serious reactions such as toxic epidermal necrolysis can be caused by commonly used drugs like phenytoin.

A possible case of etoricoxib induced fixed drug eruption

Fixed drug eruption (FDE) is a most commonly with adverse drug reaction seen with use of Non-steroidalanti-inflammatory drugs (NSAIDs) in particular nimesulide followed by antibiotics and anticonvulsants. Etoricoxib is a selective cyclo-oxygenase isoenzyme-2 inhibitor which is superior to conventional NSAIDs and causes less side effects. Authors present a case of fixed drug eruption due to etoricoxib in a male patient. A 50-year-old patient presented to Outpatient Department (OPD) of Dermatology of a Tertiary Care Hospital with complains of skin rashes over lips, oral cavity, trunk, both the upper and lower limbs, palm, soles, scrotum and glans penis since a week. The detailed history of the patient revealed the use of etoricoxib a week back, prescribed for low back pain. It was suspected that the cutaneous drug reaction was due to the use of etoricoxib. The suspected drug etoricoxib was stopped, patient was admitted and managed symptomatically. The above reaction was assessed to be “possible” as per WHO-UMC and Naranjo causality scale, “moderate” on Hartwig’s scale and “Probably preventable” according to Schumock and Thornton criteria. This case reporting was done to sensitize the prescribers regarding rare side effects of the above drug and the need to confirm past history of drug reaction before prescription.

Knowledge, attitude and perception of suspected adverse drug reactions in consumers: a prospective observational study in a tertiary care hospital

Background: Adverse drug reactions (ADRs) are the main leading causes of hospitalization which leads to morbidity and mortality worldwide. Reporting of ADRs to national databases is necessary. To strengthen this system, consumers apart from health-care professionals have also been empowered to report any ADRs directly to the regulatory agencies. Direct and spontaneous patient or consumer reporting offers various benefits beyond pharmacovigilance (PV). Consumer reporting of ADRs has existed in several countries for decades, but in India, with the inclusion of consumer reporting of ADR, the data on the same is valuable and limited. Hence the present study is taken up. The aim of this study was to explore the knowledge, perceptions and practice of ADR reporting among consumers in KIMS hospital and research center, Bangalore.Methods: The data was collected from Patients attending OPD’s, admitted in wards and at pharmacy in KIMS Hospital and Research Center, Bangalore. It is a cross sectional descriptive study. Study period is for six months from 1st April to 31st September 2018 and sample size is 200. A structured questionnaire in English and Kannada was used as a tool.Results: Of the 200 patients from the surveyed, in males the knowledge scores were better when compared to females and attitude, perception scores were same (statistically not significant). Most of the patients opined for the establishment of consumer pharmacovigilance system at hospitals and local pharmacies.Conclusions: Knowledge about ADR reporting and pharmacovigilance is less in consumers. So that there is a need to increase awareness in consumers.

Biochemical markers assisted screening of Fusarium wilt resistant Musa paradisiaca (L.) cv. Puttabale micropropagated clones.

An efficient protocol was standardized for screening of panama wilt resistant Musa paradisiaca cv. Puttabale clones, an endemic cultivar of Karnataka, India. The synergistic effect of 6-benzyleaminopurine (2 to 6 mg/L) and thidiazuron (0.1 to 0.5 mg/L) on MS medium provoked multiple shoot induction from the excised meristem. An average of 30.10 ± 5.95 shoots was produced per propagule at 4 mg/L 6-benzyleaminopurine and 0.3 mg/L thidiazuron concentrations. Elongation of shoots observed on 5 mg/L BAP augmented medium with a mean length of 8.38 ± 0.30 shoots per propagule. For screening of disease resistant clones, multiple shoot buds were mutated with 0.4% ethyl-methane-sulfonate and cultured on MS medium supplemented with Fusarium oxysporum f. sp. cubense (FOC) culture filtrate (5–15%). Two month old co-cultivated secondary hardened plants were used for screening of disease resistance against FOC by the determination of biochemical markers such as total phenol, phenylalanine ammonia lyase, oxidative enzymes like peroxidase, polyphenol oxidase, catalase and PR-proteins like chitinase, β-1-3 glucanase activities. The mutated clones of M. paradisiaca cv. Puttabale cultured on FOC culture filtrate showed significant increase in the levels of biochemical markers as an indicative of acquiring disease resistant characteristics to FOC wilt.

Direct and indirect method of plant regeneration from root explants of Caesalpinia bonduc (L.) Roxb.— A threatened medicinal plant of Western Ghats.

An in vitro regeneration protocol has been standardized via direct and indirect methods from excised root explants of C. bonduc, a threatened woody legume used for the treatment of contagious diseases, inflammation, leprosy, antiperiodic, febrifuge, anthelmenthic, urinary disorders, leucorrhoea, piles and to heal wounds. MS medium supplemented with 17.75 µmol BAP and 2.46 µmol IBA, induced a mean of 3.40 ± 1.07 shoots directly from the surface of excised root explant. Subsequently, the shoots rooted readily on MS half strength medium with out growth regulators. In indirect organogenesis, callogenic frequency was optimized (96.66%) at the concentration of 9.04 µmol 2, 4-D and 0.88 µmol BAP. An average, 15.30 ± 5.25 shoots were differentiated from the root callus at the concentration of 17.57 µmol BAP and 2.85 µmol IAA. Shoots regenerated through callus were rooted well on MS half strength medium with growth regulators at 2.95 µmol IBA. Rooted plantlets were transferred to the pots containing sterilized soil and were successfully hardened at greenhouse condition for three weeks then exposed to the natural environment. Survival rate was more (95%) in plantlets derived through direct organogenesis than (60%) the plantlets regenerated through root calli.