Prescribing pattern of anticancer drugs in the medical oncology department of a tertiary care teaching hospital

Background: To study drug utilization of anticancer drugs in the oncology inpatient department (IPD) of Kamineni Hospitals, L.B. Nagar, Hyderabad, India.Methods: One hundred prescription records were screened and analysed as per the study parameters from the oncology IPD of Kamineni Hospitals, Hyderabad. Commonly used anticancer drugs were recorded; furthermore, different types of carcinomas were noted.Results: Age group of patients was in between 04 and 80 years, 62 were females and 38 were male patients. The most common type of carcinoma was carcinoma of the breast (28%). Cisplatin was the most commonly used anticancer drug (29%). Adjuvant drugs were used in 98% of the patients.Conclusions: Incidence of cancer is more in females than males. Adjuvant and cytoprotective drugs used may have had a bearing on the relatively lower incidence of adverse effects.

Efficacy of pregabalin premedication prior to surgery in attenuating the adverse hemodynamic response to laryngoscopy and tracheal intubation

Background: In general pregabalin is used in patients with normal blood pressure undergoing operation for controlling the response of the pressor in nature. There are few studies which have been carried out to study efficacy of pregabalin in controlling responses to instrumentation of the airway in patients with controlled hypertension. Objective was to study efficacy of pregabalin premedication 90min prior to surgery in attenuating the adverse hemodynamic response to laryngoscopy and tracheal intubation.Methods: Hospital based randomized comparative trial was conducted. 100 patients of ASA I and II physical status aged 18-60 yrs scheduled to undergo elective surgery like orthopaedic, spine, otorhinolaryngeal, gynaecological and general surgical procedures. Patients were randomly divided into 2 groups of 50 each. Randomization was done by computer generated table. Group "P" received- 150mg pregabalin. Group "C" received-200µg clonidine.Results: The patients in clonidine group documented the heart rate as more compared to the patients in the pregabalin group at various time intervals. The patients in clonidine group documented the mean systolic blood pressure as more compared to the patients in the pregabalin group at various time intervals. The patients in clonidine group documented the mean diastolic blood pressure as more compared to the patients in the pregabalin group at various time intervals.Conclusions: We concluded that use of pregabalin is more effective in comparison to use of clonidine in terms of controlling the hemodynamic parameters. But it has been found that bradycardia may not be properly attenuated with the use of pregabalin.

Consensus statement for the management of dyslipidemia and hypertension in the Indian population with diabetes

The mortality rate from cardiovascular disease (CVD) in India is higher than the global figures (272 per 100,000 persons vs. 235 per 100,000 persons, respectively). Smoking, obesity, hypertension, diabetes and dyslipidemia are the known risk factors for atherosclerotic cardiovascular disease (ASCVD). The treatment of either condition aims to reduce the risk of ASCVD. This goal is achievable only when a holistic, simultaneous treatment is initiated and is monitored to reduce the blood glucose, blood cholesterol, and BP. India heralds a huge population of nearly 73 million people with diabetes. Diabetes is one of the major contributors of ASCVD, dyslipidemia and hypertension often coexist with diabetes. Patients diagnosed with either condition need risk stratification, followed by defining the treatment target for each risk category and developing appropriate treatment strategies based on the risk category. Unfortunately, there is no clear guideline that defines the treatment targets and subsequent management. This statement has been created based on the vast experience and an extensive literature review conducted by experts from multidisciplinary teams to address several treatment dilemmas that are routinely faced by clinicians when treating their patients with diabetes. An attempt is made to provide well-defined answers to these quandaries. This statement discusses screening, diagnosis, risk stratification, treatment targets, and management of dyslipidemia and/or hypertension in patients with diabetes and provides a roadmap for the treatment of Indian patients to curtail the risk of ASCVD.

Channelizing the Existing Perceptions of Medical Students Towards Reflective Learning: ANew Insight

Introduction: Reflection is an important component of medical education promoting deeper learning. It createsresponsibility among medical students for their own learning. The aim of the present study is to gain insightsinto their existing perceptions on the concept of reflection in terms of attitudes and practices. Channelizingsuch perceptions helps in transformative learning to apply in similar situations in future. Methodology: Atotal of 76 first year MBBS students both male and female were included in study. Two questionnaires wereadministered with an interval of one week with priming, to channelize their outlook towards reflective learning.Questionnaire I was used for quick assessment of existing attitudes towards learning and need- orientedpractices. Questionnaire II was developed to assess changes in their attitudes on reflective learning and goaloriented practices after priming. Results: The responses showed a shift in the perceptions on attitudes andreflective learning practices from rather naive to a more mature type. Discussion: Priming indeed had animportant role in enabling students to express their true behavior and help channelize their reflective habits.These differences in the responses were further explained on the lines of defense mechanisms probablyoperating at different levels in the minds of the students. Conclusion: Including reflective practices routinelyin the curriculum would help students learn, remember and perform better as future health care professionalsand also inculcate the habit of lifelong learning.

Nebulized N-Acetylcysteine for Management of Plastic Bronchitis

Background: Plastic bronchitis is characterized by formation of extensive obstructiveendobronchial casts and high recurrence rates. Case characteristics: Two children (1-year-old girl, 7-year-old boy) who had recurrent episodes of respiratory distress with acuteworsening. Bronchoscopy revealed membrane-like casts. Both children were managed withnebulized N-acetylcysteine in addition to management for asthma. Outcome: Symptom-free without recurrence for more than 9 months of follow-up. Message: Nebulized N-acetylcysteine may be helpful in prevention of recurrence of plastic bronchitis due to asthma.

Analysis of calpain-3 protein in muscle biopsies of different muscular dystrophies from India.

Background & objectives: Calpain-3, a Ca2+-dependent protease has been implicated in the pathology of neuromuscular disorders (NMDs). The current study aimed to analyze calpain-3 expression in cases diagnosed as muscular dystrophy from the Indian population. Methods: Calpain-3 Western blot analysis in muscle biopsies of immunohistochemically confirmed cases of Duchenne muscular dystrophy (DMD) (n=10), dysferlinopathy (n=30) and sarcoglycanopathy (n=8) was carried out. Calpain-3 Western blotting was also used in a blinded study to identify cases of calpain-3 deficiency in 28 NMD patients with potential muscular dystrophy. Results: Calpain-3 appeared as a full length 94 kDa band with an autolytic product (~60 kDa) on Western blots with antibody NCL-CALP-12A2 (Ab-2). Eight of the 10 DMD samples showed absence of 94 kDa band but presence of 60 kDa band while one case of sarcoglycanopathy showed absence of both. Twenty one of the 30 dysferlinopathy samples showed both bands while six showed only the 60 kDa band and three showed absence of both. In the blinded study, five NMD cases with potential muscular dystrophy that showed complete absence of both bands in retrospect exhibited clinical features of limb girdle muscular dystrophy 2A (LGMD2A). Interpretation & conclusions: While the study revealed a consistent pattern of calpain-3 in DMD, one sarcoglycanopathy and three dysferlinopathy samples exhibited secondary reduction in calpain-3. It was recognized that both calpain-3 bands should be considered to confirm calpain deficiency. Further, western blot offers an economical and fast preliminary screening method for LGMD2A especially in cases of complete absence of calpain-3 prior to conclusive diagnosis by genetic testing.

Qualitative high performance thin layer chromatography (HPTLC) analysis of cannabinoids in urine samples of Cannabis abusers.

Background & objectives: Cannabis is one of the most commonly abused drugs worldwide. There is a distinct clinical correlation between cannabis abuse and mental disorders. However, it is essential to establish cannabis intake in the abusers in order to establish causality between cannabis and psychiatric illness. The limitations of current detection methods using commercial cassettes prompted us to standardize the method of extraction and detection of cannabinoids in the urine samples of cannabis abusers attending a de-addiction centre in south India. Methods: In this study, diagnostic tests on 102 male patients suspected with cannabis abuse were done. Liquid-liquid extraction of cannabinoids from urine was done and screened by Duquenois-Levine, fast blue B salt and p-dimethylaminobenzaldehyde (p-DMAB) tests. All the results were confirmed by high performance thin layer chromatography (HPTLC). Samples were considered positive for cannabis based on the positive indication in colour test and by detection of 11-nor-Δ9 tetrahydrocannabinol-9-carboxylic acid (THC-COOH) on HPTLC. Results: Based on the colour tests and HPTLC, cannabis abuse was detected in 64 of 102 patients tested. HPTLC method was found to be sensitive for detection and possible quantitation of THC-COOH. Interpretation & conclusion: We report the standardization and utility of cannabinoid extraction, screening and detection by HPTLC in the urine samples of cannabis abusers. The HPTLC method was found to be high throughput, sensitive, reproducible and cost-effective compared to commercial kits.

Non-surgical transpericardial catheter ablation of post-infarction ventricular tachycardia.

Non-surgical transpericardial approach for catheter-based epicardial radiofrequency ablation of post-infarction left ventricular tachycardia has been described as an alternative and additive procedure to standard endocardial technique for delivery of radiofrequency energy in difficult situations. We report our initial experience with this approach in three patients of post-infarction recurrent ventricular tachycardia, refactory to multiple antiarrhythmic drugs. Ablation was successful in terminating the tachycardia in two and in modifying the circuit to be amenable for control with single antiarrhythmic drug in one patient. There were no serious acute or long-term complications related to the procedure. Epicardial approach is an effective and safe adjunct to standard endocardial ablative technique for patients of post-infarction ventricular tachycardia.