Drug utilization study in intensive coronary care unit of a tertiary care teaching hospital.

Background: Critically ill patients are admitted in Intensive coronary care unit. The intensive coronary care unit (ICCU) is a setting where a large number of drugs are administered to patients. Information on drug utilization in intensive coronary care units (ICUs) are lacking in India. Objectives: To identify pattern of drug use and suggest measures. Methods: Prospective drug utilization study was conducted in patients admitted in ICCU for six months. Data was collected in previously prepared case record form. Data was recorded from the admission of patient in ICCU to discharge from ICCU. Analysis was done by using drug use indicators, age and sex wise distribution, morbidity pattern of disease, frequency of drug use, cost of drug therapy and length of stay. Data analysed using Microsoft Excel. Total 605 cases were analysed. Results and Interpretation: Mean ± SD6 of age of all patients being admitted in ICCU is 57.05 ± 11.92 years. Most frequent morbidity found is myocardial infarction. Average number of drugs per encounter is 14.85. Percentage of encounters with an antibiotic and injection prescribed is 27.44% and 98.68% respectively. 34.46% drugs are prescribed by generic name and 43.75% drugs were prescribed from WHO essential drug list. Most commonly prescribed drug is Tablet Aspirin. Frequent injections used are promethazine, heparin, hydrocortisone, buprenorphine, streptokinase, metoprolol, Pentazocin and frusemide. Average drug cost per encounter is 867.84 Rs. 65.38% cost is spent on fibrinolytics. Conclusion: Average number of drugs per encounter is high it should be kept low whenever possible. From all drugs prescribed 42.66% drugs were parenteral. Percentage of drug prescribed by generic name is less. Drugs should be prescribed by generic name. Cost of drugs spend by patient is high. Antibiotics are less frequently prescribed. The mortality rate is low. Essential drug list for ICCU should be prepared. Seminar or group discussion can be done with health professionals working in ICCU to discuss drug utilization pattern for further improving prescribing pattern.

Optimizing multimodality treatment for head and neck cancer in rural India.

Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infrastructure availability, factors impacting treatment decisions, cost estimations, completion of treatment, and major treatment-related complications for the patient population treated in our clinic for a 2-year period. Results: A total of 230 head and neck cancer patients were treated with curative intent. Infrastructure support included basic operating room facility (cautery machine, suction, drill system, microscope, and anesthesia machine without ventilator support), blood bank, histopathology laboratory, and computerized tomography machine. Radiation therapy (RT) facility was available in a nearby city, about 75 km away. One hundred and fifty-four (67%) patients presented at an advanced stage, with 138 (60%) receiving multimodality treatment. One hundred and eighty-four (80%) patients underwent primary surgery and 167 (73%) received radiotherapy. Two hundred and twelve (92%) patients completed the treatment, 60 (26%) were lost to follow-up at 18-month median follow-up (range 12-26 months), with 112 patients (66%) being alive, disease free. Totally 142 were major head neck surgeries with 25 free flap reconstructions and 41 regional flaps. There were 15 (6%) major post-op complications and two perioperative mortalities. Average cost of treatment for single modality treatment was approximately 40,000 INR and for multimodality treatment was 80,000 INR. Conclusions: This study demonstrates that it is feasible to provide basic multimodality treatment to head and neck cancer patients in the community.

Immunoglobulin M nephropathy nephropathy in adults and adolescents in India: A single-center study of natural history.

Background: Immunoglobulin M nephropathy (IgMN) is an idiopathic glomerulonephritis (GN) usually presenting clinically as steroid resistant/dependent nephrotic syndrome (NS) with pathology of mesangial proliferative GN or focal and segmental glomerulosclerosis with diffuse predominant mesangial IgM deposits. Not much information is available about its natural history. This is the first Indian study to our knowledge on IgMN in adults and adolescents. Materials and Methods: We evaluated renal biopsies performed at our center between January,'04 to September,'09. Biopsies of all adolescents and adults were evaluated for IgMN and we studied their age, gender distribution, blood pressure (BP), disease duration, steroid/immunosuppressive management and serial serum creatinine (SCr), urinary proteins, and BP values. Patients with other systemic diseases/infections and children were excluded. Results: IgMN constituted 4.3% of 2702 adult renal biopsies. No significant gender predilection was noted. Males presented at average age of 23.1 years, females at 30 years. Steroid-dependent NS was the commonest presentation noted in 75% followed by steroid-resistant NS. Hypertension was noted in 10% patients. Mesangial proliferative GN (MePGN) was commonest histopathological finding noted in 74.4%, followed by focal segmental glomerulosclerosis (FSGS) in 16.2%, and minimal change disease (MCD) in 9.4% biopsies. Sole IgM deposits were noted in 88.5%. All MCD, 35.6% MePGN reached remission, FSGS progressed to renal failure by 1 year. Hypertension, proteinuria, interstitial fibrosis, and FSGS were bad prognosticators. Conclusions: This is the first Indian study of IgMN in adults and adolescents carried out over a period of 5.8 years, which has shown that hypertension, proteinuria, and interstitial fibrosis at presentation have bad prognosis.

Steroidogenic inhibition in testicular tissue of formaldehyde exposed rats.

Three groups of rats (n = 10) were subjected to intraperitoneal treatment of formaldehyde daily at doses of 5, 10 and 15 mg/kg body weight over a period of 30 days. Gradual diminution in body and testicular weight was observed in all treated groups. Leyding cell impairement was conspicuous in those given doses of 10 and 15 mg/kg. Inhibition of 3 beta-delta 5-hydroxy steroid dehydrogenase and accumulation of sudanophillic materials in testicular tissue of formaldehyde treated rats was recorded histochemically. Significant decline of serum testosterone was also observed in the same groups. Structural and functional impairement of Leydig cells after formaldehyde treatment caused steroidogenic inhibition.

Spontaneous left ventricle cavity thrombus in a patient of systemic lupus erythematosus.

A 32 year old female with systemic lupus erythematosus having circulating lupus anticoagulant developed a thrombus in the left ventricle cavity, an unusual site. She responded to standard anticoagulant regime.

Echocardiography and pulmonary artery pressure: correlation in chronic obstructive pulmonary disease.

The aim of this study was to assess whether 2 dimensional echocardiography can provide reliable parameters to quantitatively estimate pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease. Twenty subjects, 16 males and 4 females, mean age 54.5 year +/- 4.92 were evaluated. Right ventricular dimensions were measured using subcostal 2- dimensional (2D) approach viz. right ventricular maximum short axis (Rv) and tricuspid annulus (TA). Free right ventricular anterior wall (AW) was measured by M-Mode. A 2D Index was calculated RV x TA + Aw and the same correlated with mean pulmonary artery pressure (r = 0.97). This appears to be a useful non-invasive method foe estimating PH in cases of COPD.

Value of DOPEG estimation in CSF in depression.

3,4-Dihydroxyphenyl ethylene glycol (DOPEG), a metabolite of noradrenaline (NA), was estimated in CSF of 30 patients of depression diagnosed by the criteria of American Psychiatric Association in DSM-III; and compared with levels in 10 non-depressed individuals who served as controls. Mean DOPEG levels in CSF in the patient group (801.37 +/- 28.09 micrograms/l) were significantly higher (P less than 0.01) than those in the control group (724.3 +/- 34.62 micrograms/l). Formation of excessive amount of this particular metabolite suggests an excessive intraneuronal deamination of NA, partially accounting for the overall decline in the availability of NA in the noradrenergic neurons in patients of depression.

Some photoresponses of isolated tissue preparations to ultraviolet light in the presence of photosensitizers.

Responses of isolated tissue preparations to ultraviolet (UV) light were studied with and without the presence of photosensitizers like eosin, fluorescein and sodium nitrite. Exposure to UV light in the presence of sodium nitrite induced consistent relaxation of rat duodenum. The photorelaxation was found to be related to the concentration of sodium nitrite. Adrenergic or cholinergic mechanisms do not seem to be involved. The isolated rat duodenum preparation exhibited quantitatively consistent photoresponse for 3 to 4 hr at its normal tone obviating the need for additional spasmogens as needed with other preparations. The preparation is a suitable test model for the study of photobiologic response evoked by UV light.

A simple method for continuous recording of perfusion rate of blood vessels of frog.

A method for continuous registration of perfusion rate of frog blood vessels has been developed utilizing a modified Marey's tambour with lever system, connected to the perfusion bottle. The responses of frong blood vessels to some autonomic drugs have been studied using this method.