Drug Utilization Pattern and Cost Analysis in Rheumatoid Arthritis Patients – A Cross–Sectional Study in Tertiary Care Hospital, Mumbai.

Aims: To study the current prescription pattern and to analyze the cost of the treatment Prescribed to RA patients referred to rheumatology OPD in KEM hospital. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine and Department of Pharmacology, Seth GSMC & KEM Hospital, between July 2011 and December 2011. Methodology: The study protocol was approved by the institutional ethics committee. Patients attending Rheumatology OPD for existing RA disease were recruited as per inclusion criteria. Written informed consent was sought. It was a cross-sectional study. Total 100 consecutive rheumatoid arthritis patients (fulfilling the American College of Rheumatology Criteria 1987) were recruited from 1st July to 1st September 2011. Results: Majority of patients (67%) in the study population were on combination of two DMARDs. Most frequently prescribed two DMARDs combination was methotrexate and hydroxychloroquine (64%). Average total cost per prescription was found to be 763.39 (US$ 14), while average hospital and out of pocket expense were 281.12 (US$ 5) and 482.88 (US$ 9) respectively. Conclusion: The drug use pattern in RA was found to be DMARDs based and majority of the cost was borne by the patient. The total cost increased was due to administration of drugs to treat the adverse drug reaction. Prospective studies in a larger number of patients are needed to assess the utility of prescription audit and cost analysis of drugs used in RA.

Analysis of Pyrethroids in Mosquito Mats, Coils and Spray Canisters.

Use of mosquito mats, coils and spray are popular methods of avoiding mosquito bites. There are many commercially available mosquito mats, coils and spray canisters which contain pyrethroids, that can cause nervous system toxicity on substantial exposure. Prolonged use of these mosquito repellents can affect human health. When cases of pyrethroid poisoning are reported to a forensic toxicologist, it is very important to be able to extract, isolate, separate and detect the pyrethroid compound. Thin Layer Chromatography (TLC) is widely used today for the detection of pyrethroids. More sophisticated techniques such as Gas Chromatography-Mass Spectrometry (GC-MS) or High Pressure Liquid Chro-matography (HPLC) can be used for the confirmation of the compound. It is therefore important to create a laboratory database, which can be helpful in forensic examinations in future.

Virtual cystoscopy: reality in imaging of bladder tuberculosis.

We present a case of urinary tuberculosis investigated initially by ultrasound and multidetector computed tomography (MDCT). The MDCT-derived volumetric data were used to generate virtual cystoscopy (VC) images, which revealed a bladder ulcer. The presence of this ulcer was confirmed by conventional cystoscopy-guided biopsy and there was good agreement regarding various features of the ulcer, such as the site, size and shape, as detected by virtual and conventional cystoscopies. VC, a result of simple postprocessing of preacquired MDCT data, proved valuable in the characterization of the bladder lesion in conjunction with CT and ultrasound images. Although a larger study is warranted, in our case these en face VC representations of the ulcer served as useful precursors to conventional cystoscopic biopsy.

Magnetic resonance urography (MRU) versus intravenous urography (IVU) in obstructive uropathy: a prospective study of 30 cases.

AIM: Intravenous Urography (IVU) as a diagnostic modality has limitations in patients of obstructive uropathy with impaired renal function. Our aim was to study the technique and diagnostic accuracy of Magnetic Resonance Urography (MRU) in obstructive uropathy and to correlate the findings with IVU. METHODOLOGY: Forty-eight patients, selected over a six-month period, based on mild to severe pelvicalyceal dilatation on screening ultrasonography, underwent an IVU; those having non-obstructive dilatation were excluded (18 patients). Thirty patients (age range 10 to 75 years) with definite obstructive dilatation underwent MRU. These were obtained using an open MRI unit (Siemens Magnetom Open Viva) with low-dose gadolinium-DTPA (0.01 mmol/kg body weight) using various MRI sequences. MRU studies were classified as 'excellent' or 'diagnostic' and data generated was compared with that of IVU. RESULTS: MRU studies were 'excellent' in twelve and 'diagnostic' in eighteen patients. Of the sixty pelvicalyceal systems (PCS) evaluated in thirty patients, there were thirty-seven calculi, nine pelvi-ureteric junction (PUJ) obstructions, six with impaired renal function, four malrotated kidneys and one each of horseshoe kidney, pancake kidney, pelvic mass (endometriomas), duplex moieties, ureterocele and vesico-ureteric reflux. MRU better depicted moderate-severe PCS dilatation, staghorn and urethral calculi, impaired renal function, extrinsic ureteric and PUJ obstruction. IVU better depicted small calculi and mild PCS dilatation. CONCLUSIONS: In these thirty patients of obstructive uropathy, low magnetic field, open MRI units and low-dose Gd-DTPA provided cost-effective MRU studies with excellent diagnostic utility. MRU scored over IVU in patients with moderate-severe dilatation, staghorn and urethral calculi, impaired renal function, extrinsic ureteric and PUJ obstruction.

Role of multidetector CT virtual bronchoscopy in the evaluation of post-tracheostomy tracheal stenosis--a preliminary study.

AIM: To study the technique and utility of virtual bronchoscopy (virtual reality endobronchial simulation, VRES) as a tool to evaluate post-tracheostomy tracheal stenoses and to correlate the findings of virtual and invasive bronchoscopy and to follow-up treated lesions or those currently under treatment that were initially diagnosed with VRES. METHODOLOGY: This prospective study comprised nine patients in the age group 13 to 65 years presenting with breathlessness and stridor following one or multiple tracheostomies. They underwent plain CT using a multidetector CT (MDCT) scanner (Siemens Volume Zoom) using narrow (1 mm) collimation. These thin slice images were post-processed using an Irix-based workstation with a 'Fly-Through' endoscopy application. These patients also underwent a rigid (three patients) or fiberoptic (six patients) bronchoscopy. RESULTS: Of the nine patients that underwent VRES, five were found to have stenoses, three had obstructing granulation tissue, one had an obstructing membrane and one had synechiae. The invasive bronchoscopic findings supported the VRES diagnosis in all but one case of stenosis, one of granulation tissue and the case with synechiae. Membranes and synechiae were relatively difficult to diagnose without the corresponding axial and multiplanar images. VRES achieved a higher sensitivity, while invasive bronchoscopy a higher specificity. CONCLUSIONS: VRES proved to be comparable to invasive bronchoscopy in the depiction of post-tracheostomy tracheal stenoses, with a notable advantage in critical stenoses in that the airway distal to the stenosis could be assessed with VRES but not with invasive bronchoscopy. A preliminary VRES was found to be of assistance in the selection of patients for the more invasive therapeutic procedures such as laser ablation of granulation tissue and its follow-up.

Strategy for preventing vertical transmisssion of HIV : Bombay experience.

OBJECTIVE: To evaluate the efficacy of an interventional regime to reduce the perinatal mode of transmission of human immunodeficiency virus (HIV). DESIGN: Prospective. SETTING: Perinatal HIV clinic at a university affiliated maternity hospital. SUBJECT & METHODS: After adequate counseling, consenting HIV positive women were offered perinatal intervention: (i) administration of 400 mg of zidovudine (AZT) per day for the last 6 weeks of the antenatal period; (ii) delivery by elective Caesarian section before rupture of membrances; (iii) oral AZT powder in the dose of 8 mg per kilogram daily to the infant for the first 6 weeks of life; and (iv) avoidance of breast milk. The infants were scheduled for regular follow-up for at least 18 months. A definitive diagnosis of infectivity in the infant was ascertained by two positive enzyme-linked immunosorbent assays (ELISA) at the age of 9 months and between 15 to 18 months. RESULTS: Of the 107 mother-infant pairs enrolled, 22 infants were lost to follow-up, 15 were under 18 months of age at the time of this analysis and 2 infants died without a diagnosis. Of the remaining 68 infants followed up, 4 tested HIV positive at 18 months. Of the 229 women-infant pairs who did not receive perinatal intervention, 55 infants followed up to 15-18 months were found to be infected. CONCLUSION: This interventional strategy significantly reduced the mother to child transmission of HIV. However, the results need to be substantiated by larger studies.

Haemangiopericytoma of kidney: a report of 2 cases.

Haemangiopericytoma is a rare neoplasm of the kidney. There are no unique radiological or clinical identifiers that can aid in preoperative diagnosis. Surgery is the only reliable therapy, as both chemotherapy and radiotherapy have proven ineffective in several series. The outcome is difficult to predict, the only reliable predictor is presence or absence of metastasis. The rarity of this lesion prompts the report of these two cases.

Meckel-Gruber syndrome associated with short limbed dwarfism.

Antenatal detection of Meckel-Gruber Syndrome associated with short-limbed devarfism is described here. This association has not been previously reported.

Elevated polymorphonuclear phagocytic function in thalassemia patients by chemiluminescence.

Twenty five patients with beta thalassemia major, with no evidence of infection were evaluated for their polymorphonuclear cell (PMN) metabolic function and serum opsonic activity by chemiluminescence assay. These were divided into Group I of normal adults (n = 21), Group II thalassemia major < 5 years (n = 9) and Group III thalassemia major > 5 years (n = 16). The ability of the chemiluminescence assay (CL) to reflect opsonic and phagocytic dysfunction suggested its potential application in the evaluation of phagocytic function. The peak count of Group I was (1.07 +/- 0.24 x 10(-5)), Group II (1.60 +/- 0.83 x 10(-5)) and Group III was (2.71 +/- 0.98 x 10(-5)) respectively in the presence of autologous sera. The peak count compared between Group I and III was found to be statistically significant (p < 0.05). The peak count of Group I and II when compared showed a trend in the increase activity not statistically significant. The polymorph function of all the groups were compared with autologous serum as well as normal serum. There was no increase in polymorph function of Group III in the presence of thalassemia serum, nor any decrease in the polymorph function of thalassemia patients of Group II and III. This concluded that polymorphs of thalassemia patients are active in the presence of autologous as well as normal serum. The increased activity of thalassemia polymorphs may be due to antigenic stimulation which may be due to multiple transfusion and not due to circulating iron load.

Developmental anomalies associated with hypospadias.

Hundred and thirty patients with hypospadias were studied between 1983 and 1990, with an aim of analysing the associated anomalies in these patients. Urogenital anomalies were observed in 30% and extra-urogenital anomalies were noted in 16%. Undescended testis was the most frequently seen anomaly, having been noted in 6.9% of 130 cases. Vesico-ureteral reflux was present in 5.4% and inguinal hernia in 3.8%. The incidence of these anomalies increased in proportion to the severity of penile deformity. The present article emphasizes the need for systemic urological and endocrinal examination, especially in severe cases of hypospadias.

Ultrasound guided aspiration cytology--a valuable diagnostic aid.

Ultrasonography (US) remains underutilized as a guidance tool for performing fine needle aspiration cytology (FNAC) mainly because of a lack of understanding and experience in this technique. We describe here our experience in performing 346 FNACs. In our opinion, US guided FNACs are highly accurate and safe procedures which can be done on an out-patient basis, with routinely available equipment.

Study of anti tetanus IgG and IgM levels in maternal and cord sera by enzyme linked immunosorbent assay (ELISA).

The study was done to determine IgG and IgM antitetanus antibodies in mothers after antenatal immunization, and extent of transfer to the baby as measured by cord levels of tetanus specific IgG and IgM by ELISA using enzyme penicillinase and to study the effect of nutritional status of mothers on antibody response to tetanus toxoid and corresponding cord levels also to determine the number of doses required for protective antibody levels in cord blood. The results obtained in sera of 100 mothers at the time of delivery and their respective cord sera and results of 43 different control sera are discussed using ELISA technique.

Detection of tubercule antigen in cerebrospinal fluids by ELISA for diagnosis of tuberculous meningitis.

An Enzyme Linked Immunosorbent Assay (ELISA) was standardised to detect the presence of tubercule antigen in cerebrospinal fluids from patients with meningitis. CSF samples from clinically suspected cases of tuberculous meningitis, culture proven pyogenic meningitis and non-bacterial aseptic central nervous system (CNS) disorders were tested by ELISA to demonstrate its potential utility for routine diagnostic purpose. Tubercule antigen was detected in 73% cases of tuberculous meningitis and was absent in pyogenic and other non-bacterial CNS disorder cases. The test appears to be a promising approach for a definitive diagnosis of tuberculous meningitis.

Tenolol in angina pectoris.

Selective Beta Blocker Tenolol (IPCA) 50 mg. (A50) and 100 mg. (A100) single dose drug therapy was tried in 25 cases of angina pectoris. Hypertensives were excluded from trial. There were 4 diabetics. Drug trial over a period of 4 weeks revealed subjective and objective improvement with A50 and A100 assessed at the end of 2 and 4 weeks. The average angina attacks/2 wks. was 13.12 +/- 11.26 in basal state whereas the reduction in angina attacks was 6.285 +/- 8.80 with Tenolol 50 mg. and 3.72 +/- 2.86 with 100 mg which was statistically significant. Objective assessment of each patient done by Computerised Stress Test (CST) at the end of 2 and 4 weeks of Tenolol 50 mg and 100 mg revealed statistically significant improvement in their ST depression i.e. 3.645 +/- 1.463 mm basal ST depression, 1.692 +/- 1.680 after Tenolol 50 mg and 2.318 +/- 1.270 after Tenolol 100 mg. There was statistically significant fall in systolic BP (SBP) and double product (DP) both with A50 and 100 mg. Only one patient had slow ventricular tachycardia and mild hypotension during CST.

Triphenyl tetrazolium chloride (TTC) dye test for quick diagnosis of urinary tract infection.

We evaluate the triphenyl tetrazolium chloride (TTC) dye reduction test for quicker diagnosis of urinary tract infections for its sensitivity and reliability to detect significant bacteriuria. Of the 1400 urine samples tested 780 (55.7%) had significant bacteriuria. TTC dye test was positive in 678 (86.9%) of those with significant bacteriuria thereby showing its usefulness. The test is simple and cheap and can be carried out in field situations.