Drug utilization study in patients affected with COVID-19 in a dedicated COVID hospital

Background: There exists a treatment dilemma regarding the optimal and effective use of therapeutic drugs (hydroxychloroquine/chloroquine/azithromycin) for COVID-19. Furthermore, with changing guidelines, the data on drug utilization patterns across India are limited. Hence, this study was conducted to assess the prescription pattern and drug utilization trends in COVID-19 patients with the aim to study the drug utilization pattern in patients affected with COVID-19 in a dedicated COVID-19 hospital. Aims and Objectives: The objectives of the study are as follows: (1) To study drug utilization patterns according to the severity of the disease. (2) To study the prevalence of adverse drug reactions (ADRs). Materials and Methods: Data were collected retrospectively from 100 medical records of patients ?18 years irrespective of sex admitted in the COVID ward and ICU of a dedicated COVID hospital from May to August 2020. Pregnant and lactating women were excluded from the study. ADRs reported were also analyzed. Results: About 71% were mild in this study, 18% were moderate, and 11% were severe COVID-19 patients. Overall, the most common drugs prescribed were multivitamins, followed by pantoprazole, paracetamol, and azithromycin. Hydroxychloroquine was prescribed in 22%, favipiravir in 7%, and remdesivir in 3% of cases. The majority of moderate COVID patients received injectables piperacillin-tazobactam, methylprednisolone, and enoxaparin. The mean number of medications, duration of admission, and number of days on oxygen were higher and significant in moderate compared to mild and severe COVID patients. Overall, ADRs were encountered in 9% of cases. Conclusion: The prescribed pattern of drugs was by the national standard guidelines. Multivitamins, followed by pantoprazole, paracetamol, and azithromycin dominated the prescription pattern. Polypharmacy was encountered, which needs to be addressed for the rational use of drugs.

Revised IAP Growth Charts for Height, Weight and Body Mass Index for 5- to 18-year-old Indian Children.

Justification: The need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old. Process: The Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children’s growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole’s LMS method. Objectives: To construct revised IAP growth charts for 5-18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years. Recommendations: The IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5-18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.

Wide complex tachycardia: recognition and management in the emergency room.

Cardiac arrhythmias often present as urgent medical conditions requiring immediate care. Patient presenting with a tachyarrhythmia is a common finding in the emergency room. They also occur commonly in patients undergoing non-cardiovascular procedures including surgeries. It is thus pertinent that the physician handling such cases must be appropriately trained to diagnose and provide emergency management till the case is referred to a specialist. Most cases present as a narrow or a wide complex tachycardia. The differential diagnosis is arrived at by deciding on the ECG morphology alongwith relevant history and physical examination where feasible. This article describes the bedside approach to diagnose and treat an arrhythmia presenting as a wide complex. Wide complex tachycardia can result from rhythms originating both from the atrium and the ventricle. Appropriate deduction of the source of the arrhythmia is essential to decide on drug therapy as wrong diagnosis with inappropriate therapy can result in fatalities.

Narrow complex tachycardia: recognition and management in the emergency room.

Cardiac arrhythmias often present as urgent medical conditions requiring immediate care. Patient presenting with a tachyarrhythmia is a common finding in the emergency room. They also occur commonly in patients undergoing non-cardiovascular procedures including surgeries. It is thus pertinent that the physician handling such cases must be appropriately trained to diagnose and provide emergency management till the case is referred to a specialist. Most cases present as narrow or a wide complex tachycardia. The differential diagnosis is arrived at by deciding on the ECG morphology alongwith relevant history and physical examination where feasible. This article describes the bedside approach to diagnose and treat an arrhythmia presenting as a narrow complex.

New cardiac markers: selecting the best tools for reaching an accurate diagnosis and determining the patient's prognosis.

Many new cardiac markers have evolved over the past one decade. The role of existing cardiac markers is being redefined. Cardiac markers of late have become not only an important diagnostic tool, but also their prognostic significance is slowly being recognised. They have also become a deciding factor on the need of instituting aggressive management protocols like percutaneous coronary interventions. This article takes a latest updated look on these aspects of serum cardiac markers.

Dietary supplies of iodine and thiocyanate in the etiology of endemic goiter in Tripura.

In the post-salt iodization phase, a study on iodine nutriture status was conducted in Tripura of North East India. The clinical variable of the study was goiter and the biochemical variables were urinary iodine and thiocyanate. Random sampling methodology was followed for selecting the study areas in the State. In each study area, the studied population consisted of school children of both sexes in the age group 6-15 years. The total study areas were 22 and the total number of the population was 10,801. The total number of urine samples were analysed for iodine and thiocyanate were 1,032 (about 10%). The total goiter rate was 21.63%. Population of most of the studied areas had no biochemical iodine deficiency as evidenced by median urinary iodine excretion levels. However, the per capita consumption of iodine of about 40% population was inadequate. A large number of cyanogenic plants (SCN precursors) are used as common vegetables. This study ensures that the existing goiter prevalence in the region could possibly due to non-uniform adequate iodine supply along with the thiocyanate load.

Iodine nutritional status of the school-age children in South Tripura, North East India.

To evaluate the iodine nutritional status, the thyroids of 3,577 school-age children of both sexes are examined clinically by palpation for goiter prevalence, 345 urine samples are analysed by dry ashing to determine the urinary iodine excretion pattern and 121 edible salt samples collected from house hold are analysed by iodometric titration to monitor the iodinatien achieved through salt from 6 representative areas of South Tripura in goiter endemic North East India. Endemic goiter is found prevalent in all the study areas though its occurrence varies from 13.95% to 30.96%, indicating that clinically mild to severe degree of iodine deficiency prevails in the region. But the pattern of median urinary iodine level of the studied population shows that there is no biochemical iodine deficiency. In 66.94% salt samples had iodine content less than the recommended level of 15 ppm. As per the classification recommended by WHO/UNICEF/ICCIDD, South Tripura falls into goiter endemic by clinical criteria and no endemicity by biochemical criteria. However, iodine deficiency disorders (IDD) continue to be prevalent in the region.

Fine needle aspiration cytology in the evaluation of lymphoreticular tumours of mediastinum.

The role of needle aspiration cytology in the diagnosis of 52 cases of lymphoreticular tumours of mediastinum was evaluated from January 1985 till May 1992. Cytological analysis showed 41 cases of non-Hodgkin lymphoma, 9 cases of Hodgkin's disease and 2 cases of benign lymphoid hyperplasia. The cytological interpretations were compared to histopathological diagnosis. In the present series, a definite diagnosis of lymphoma was possible in all the cases but exact subclassification was correctly possible in 89.6% cases. There was no false positive report or any complication.