Usage Pattern of Fixed-dose Combinations at ICMR Network of Rational Use of Medicine Centres across India: Recommendations for Policymakers and Prescribers

Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.

Study of Clinico-mycological profile of onychomycosis at a tertiary carehospital

Introduction: Onychomycosis (OM) is a common nail disorder caused by dermatophytes, non-dermatophyte moulds and yeasts. The increased prevalence of OM along with the wide range of associated fungi necessitates the accurate laboratory isola?on and iden?fica?on of the causa?ve fungus for op?mal management strategies. The aim of the study was to evaluate clinical, epidemiological and mycological characteris?cs of OM at a ter?ary care hospital in Karimnagar. Materials and Methods: The study was conducted at Department of Microbiology for a period of one year. 109 pa?ents clinically diagnosed as OM were subjected to detailed history, clinical examina?on and inves?ga?ons. Nail clippings and subungual debris of OM pa?ents were subjected to KOH prepara?on and culture. Isolates were iden?fied by colony characters, pigment produc?on, microscopic morphology. Results: The maximum number of OM cases belonged to the age group 21-30 years with a male preponderance. Higher incidence was noted in males (71.5%) than females (28.4%). Direct microscopy of the nail clippings in 40% KOH solu?on was posi?ve in 56.8% and culture was posi?ve in 75.2% cases. The common e?ological agent was dermatophytes (45.12% cases) followed by yeasts (34.14% and non dermatophyte molds (20.7% cases). T.rubrum was the commonest among dermatophytes and Candida albicans among the yeasts. Conclusions: Although onychomycosis is not life threatening, it can cause a significant nega?ve impact on the quality of life of infected pa?ents. Early diagnosis and treatment is important to prevent distor?on of the nails which can prevent loss of working efficiency of the commonly affected popula?on.

Study of asymptomatic bacteriuria in pregnant women: prevalence, isolates and their antibiotic sensitivity pattern

Background: Asymptomatic bacteriuria (ASB) is common in pregnant women due to morphological and physiological changes in the genitor-urinary tract, which untreated may lead to complications like pyelonephritis and may also effect the fetus. The objective of our study was to determine the prevalence of ASB in pregnant women, to identify the organisms responsible and their antibiotic sensitivity pattern.Methods: A clean catch midstream urine was collected from 250 pregnant women in different trimesters attending antenatal OPD in a tertiary care hospital. Isolates and their antibiogram were obtained by conventional methods.Results: Among 250 pregnant women, 23(9.2%) had shown significant bacteriuria, and majority (52.1%) were in 3rd trimester. Escherichia coli (56.5%) was the commonest isolate followed by Klebsiella pneumoniae (17.4%). Most of the isolates showed sensitivity to imipenam, nitrofurantoin and cefepime.Conclusions: Asymptomatic bacteriuria is common during pregnancy which requires a routine examination of urine for culture and sensitivity and the positive cases should be treated with appropriate antibiotics to prevent any further complication.

Large drusen following long-standing retinal detachment.

We report an interesting finding of multiple large drusen in an eviscerated eye with a longstanding retinal detachment. The origin and composition of the drusen is also speculated on the basis of special stains.

Regulation of cellular signals by G-proteins.

Extracellular signals are transduced across the cell by the cell surface receptors, with the aid of G-proteins, which act at a critical point of signal transduction and cellular regulation. Structurally, G-proteins are heterotrimeric consisting α, β and γ subunits but in functionally active state they dissociate into α subunit coupled to GTP and as βγ dimer. G-proteins can be broadly divided into two classes based on their sensitivity to pertussis toxin and cholera toxin. Existence of various forms of each of the subunit allows molecular diversity in the subunit species of G-proteins. These subunits interact with a wide range of receptors and effectors, facilitated by post translational modification of their subunits. Different types of G-proteins mediate several signalling events in different parts of the body. This review summarizes the features of (i) structural and functional heterogenity among different subunits of G-proteins, (ii) interaction of G-proteins and their subunits with effectors with specific cases of G-protein mediated signalling in olfaction, phototransduction in the retina, ras and ras related transduction and (iii) disease conditions associated with malfunctioning of G-proteins.

A preliminary study of filariasis related acute adenolymphangitis with special reference to precipitating factors and treatment modalities.

Episodic adenolymphangitis (ADL) is one of the important clinical manifestations of lymphatic filariasis. Recurrent ADLs contribute to the progress of the disease and also have important socioeconomic implications since they cause significant loss of man days. The present study was conducted in order to identify the precipitating factors responsible for ADL attacks and also to examine the different modalities of treatment. Sixty-five individuals with filariasis related ADL attacks, who are residents of Alleppey district (endemic for Brugia malayi) were studied. All efforts were taken to identify the precipitating factors for ADLs in these individuals. They were hospitalized for a period of five days or more. All of them received symptomatic antipyretic/antiinflammatory therapy and topical antibiotic/antifungal treatment of the affected limbs. They were then randomly allocated to one of the following four regimens: group I - symptomatic alone; group II - symptomatic plus antibiotics; group III - symptomatic followed by diethylcarbamazine citrate (DEC) and group IV - symptomatic plus antibiotic followed by DEC. Patients in groups III and IV received DEC every three months up to one year. There was a significant relationship between the number of ADL attacks and the grade of edema. Presence of focus of infection in the affected limb could be identified in 28 of the 65 patients. In the majority of patients (48) response to treatment was rapid (resolution in less than five days). Neither antibiotics nor DEC (given at intervals of three months) appeared to alter the frequency of ADL attacks. On the otherhand simple hygienic measures combined with good foot care and local antibiotic/antifungal cream application (where required), were effective in reducing the number of ADL attacks.