A comparative study to assess prescription pattern, cost, and appropriateness of antimicrobial usage in a rural government tertiary care hospital and rural private practitioners

Background: Antimicrobial resistance is defined as the ability of microorganism (bacteria, fungus, virus, or parasite) to resist the effects of a drug to inhibit microorganism growth, which is becoming a major concern worldwide particularly in developing country like India. Aim and Objectives: The aim of this study was to identify, compare, and assess the appropriateness of antimicrobials prescribed in a rural tertiary care hospital and those prescribed by rural private practitioners and to assess the average cost of antimicrobials per prescription. Materials and Methods: A cross-sectional study was conducted, in which a total of 2003 prescriptions were analyzed from outpatient department (OPD) of rural tertiary and prescriptions from nearby chemist shops for prescription pattern, cost, and appropriateness. Results: It was identified that most of the antimicrobial containing prescriptions in both private and public health sector were prescribed by MBBS doctors (56.33%). In Government Medical College (GMC) OPDs, antimicrobials were prescribed mostly for gastrointestinal infection (25.75%) and beta lactams (45.23%) followed by fluoroquinolones (27.10%) were the most commonly prescribed. While among rural private practitioners, gastrointestinal infections (33.50%) followed by fever (27.70%) were the most common clinical conditions, for which antimicrobials were prescribed and 13.40% prescriptions contained more than one antimicrobial. About 43.37% of antimicrobials prescribed in OPDs of GMC and 56.20% antimicrobials prescribed by private practitioners were found to be inappropriate which was statistically significant. Conclusion: The study concluded that around half of the prescriptions analyzed were inappropriate and so there is a strict need of supervising the antimicrobials prescribing patterns, consumption, and it’s dispensing from the pharmacy shops.

Awareness and utilization of Geriatric Welfare Schemes among urban elderly population of District Gautam Budh Nagar

Background: India has 8.6% elderly population which is going to increase to 12% by 2025. Government of India is providing for the elderly through various social security and welfare schemes as well as legislations. But various studies, mostly in rural areas have shown that the awareness regarding these schemes was poor and incomplete. Utilization of schemes by the beneficiaries was even poorer. Very few studies have assessed the same in urban areas. Aims & Objectives: To assess the awareness and utilization of geriatric welfare schemes and factors associated with them among urban elderly. Material & Methods: The study was conducted in urban field practice area of Dept of Community Medicine, SMS&R, Greater Noida. 402 elderly living in slums of Bhangel, Noida, were interviewed using semi structured questionnaire assuming 50% awareness levels in the urban area with 10% relative precision and 95% confidence interval. Results: Awareness regarding any one scheme was 31.6%, of whom only one fourth subjects knew about more than one scheme. Among those who knew about the schemes, only 40% were utilizing them. The awareness as well as utilization was found to be significantly associated with religion, caste and educational status of the subject. Conclusion: The study shows poor awareness and even poorer utilization of geriatric welfare schemes among elderly people of urban slums. Further studies are required for judging the influencing factors.

Soft tissue tumours of eyelid.

Soft tissue tumours of eyelid constituted 28.9% of all eyelid tumours. Morphologically they were either vascular 32 cases (49.23%), neural 24 cases (36.92%), fibrous 6 cases (9.23%) or adipose tissue tumours 3 cases (4.62%). The age ranged from 1-30 years, haemangiomas and neurofibromas were present since birth. Upper eyelid was involved in 81.54% cases. Neurofibroma was associated with generalized lesions in 13.6% cases.

Tumours of eyelid: a clinicopathologic study.

A retrospective study of 207 cases of eyelid tumours and tumour like lesions, diagnosed histopathologically, was carried out for the period 1957 to 1991. There was a slight preponderance of males as the male/female ratio was 1.3:1. The age of the cases ranged from one to 80 years. Benign tumours were usually seen in the first two decades whereas the malignant tumours were common in the age group of 40 to 60 years. Malignancy was noticed in 85 cases (41.1%). Of these cases of malignant tumours, basal cell carcinoma was the commonest (38.8%) followed by sebaceous carcinoma (27.1%), squamous cell carcinoma (22.4%), basisquamous cell carcinoma (8.2%) and melanoma (3.5%). The ratio of basal cell carcinoma to squamous cell carcinoma was 1.74: 1. Of the 122 benign lesions common ones were vascular tumours (21.3%), neural tumours (18.0%), dermoid cysts (16.4%), squamous cell papilloma (13.1%) and naevi (12.3%).

Pleomorphic adenoma of skin (chondroid syringoma) involving the eyelid.

Lid tumours are fairly common. However, pleomorphic adenoma (chondroid syringoma) is quite rare. In a series of 207 eyelid tumours and tumour like lesions, pleomorphic adenoma was observed in a male aged 41 years; its incidence being 0.48%.

Surface epithelial tumours of the ovary.

Surface epithelial tumours (SET) constituted 65.7% of all the ovarian tumours. Benign tumours were 182 (71.9%), of low malignant potential (LMP) 11 (4.4%) and frank malignant 60 (23.7%). Maximum number of cases, 102 (40.3%) belonged to 3rd decade. Mean age for serous cystoma was 31.5% years as compared to 30.8 years for mucinous cystoma. The commonest presenting feature was the abdominal lump observed in 182 cases (71.9%) and pain in abdomen in 120 (47.4%).Serous cystomas were t he most frequent tumours and comprised of 32.21% of all the ovarian tumours or 46.01% of all the SET or 65.56% of all the cystic SET. Seventeen (11.7%) of serous tumours were bilateral. Mucinous cystomas constituted 14.55% of all the ovarian tumours or 30.8% of all the SET. These tumours were bulky (78.6%; 15 cm diameter) and multilocular (83.9%).Mucinous cystadenocarcinoma was the commonest malignant epithelial tum our (36.6%). Endometroid carcinoma comprised 3.65% of all the SET or 8.4% of all the ovarian malignancy. Squamous metaplasia was seen in one case whereas 2 cases were of mesodermal mixed tumour with heterologous element as rhabdomyosarcoma. Clear cell carcinoma, Brenner tumour and unclassified group constituted 0.79%, 1.18% and 1.58% of all SET respectively.

A histomorphologic and ultrastructural study of the malignant tumours of the renal pelvis.

The study was carried at two different centres. Only 9 cases of primary malignant tumours of the renal pelvis could be collected during the period of 7 years (1984-1990). Renal pelvis malignancies constituted 0.21% of all the malignancies and 12.16% of all the malignant growths of the kidney (9 out of 74 cases). The age of these patients ranged from 24 to 70 years; the mean being 41.7 years. Male/female ratio was 8:1. Common triad of complaints (pain, haematuria and lump) was noticed in 22.2% of patients. Individually they were noticed in 77.8%, 66.7% and 44.4% of patients respectively. Transitional cell carcinoma was the commonest, seen in 7 patients (77.8%) whereas squamous cell carcinoma and adenocarcinoma were noticed in one patient (11.1%) each. Hydronephrosis, chronic pyelonephritis and nephrolithiasis were noticed in 66.7%, 44.4% and 22.2% of patients respectively. Ultrastructural study of urothelial tumours revealed tumour cells in various stages of differentiation with loss of intercellular junctions and dense collection of rough endopasmic reticulum fibrils around the nucleus.

Solid tumours of the ovary.

One hundred seventeen solid ovarian tumours, diagnosed histologically during the period between 1971 and 1990, were studied. The overall incidence of solid ovarian tumours was 23.4% of all the ovarian tumours (500 cases) studied. Of 117 solid ovarian tumours 19 (16.2%) were benign and the rest 98 (83.8%) were malignant. Epithelial tumours were the commonest (28.2%) followed by germ cell tumours (22.2%), sex cord stromal tumours (21.4%), metastatic tumours (19.7%) and non-specific tumours (8.5%). The average age (26.8 years) was comparatively low for germ cell tumours otherwise in other groups it ranged between 42 and 45 years. Below 15 years immature teratoma was diagnosed in 4 cases and granulosa cell tumour in 2 cases. Bilateral tumours were seen in 22 cases (23.2%) out of 95 cases observed. Pain and fullness in the pelvic region were observed in 94.9% cases. Varied morphological picture was seen in 6 cases of endometrioid carcinoma. Dysgerminoma constituted 6.8% of solid ovarian tumours. Gliomatosis peritonei was noticed in one case of immature teratoma. Granulosa cell tumour accounted for 11.1% of solid ovarian tumours. Of 23 cases of metastatic tumours, Krukenberg tumour was noticed in 88.9% cases. Diagnostic problems as well as prognostic factors of solid ovarian tumours have been discussed.

Double malignancy in a benign cystic teratoma of the ovary (a case report).

A case of malignant change in a benign cystic tertoma of the ovary has been reported where there was double malignancy. Leiomyosarcoma was associated with squamous cell carcinoma (In situ). The patient remained well for one year after ovariotomy.

Morphological changes in diseased gall bladder: a study of 415 cholecystectomies at Aligarh.

Morphological changes of gall bladder were studied in 415 cholecystectomy specimens. There was a preponderance of females (male to female ratio--1:6.5). The mean age of the cases was 43.6 years. Most of the cases (63.4%) were in the 4th and 5th decades of life. The average duration of illness was 2.8 years. Associated cholelithiasis was present in 85.3% cases. Gall-stones were of mixed variety in 78.2% cases, cholesterol type in 15.3% cases and both types were present in 6.5% cases. Chronic cholecystitis was the main histological diagnosis (50.8%). Other lesions observed were adenomyomatosis (8.2%), adenomatous hyperplasia (10.1%), granulomatous cholecystitis (4.1%), cholesterosis (2.7%), acute cholecystitis (4.1%), acute on chronic infection (10.8%), sub-acute cholecystitis (2.4%) and carcinoma gall bladder (6.8%). The frequency of Rokitansky-Aschoff's sinuses was closely related with the degree of inflammatory response. In 13 (6.2%) cases the diagnosis of chronic follicular cholecystitis was made. All the cases of cholesterosis were multiparous females and of younger age. Of the malignant lesions, adenocarcinoma was the commonest (96.4%).

Stromal cellular response in breast tumours and allied lesions.

Histopathological study for stromal cellular response was made on 200 cases of benign and dysplastic lesions and malignancy of breast. Infiltrations with lymphocytes and plasma cells were observed in 64% cases of fibroadenoma, 66.6% cases of giant fibroadenoma, 61% cases of mammary dysplasia and 33.3% cases of gynaecomastia. While mast cell infiltration was not observed in giant fibroadenoma, its presence was observed in 92% cases of fibroadenoma, 77.8% cases of mammary dysplasia and 33.3% cases of gynaecomastia. Lymphocytes and plasma cells infiltrations were observed in 100% of cases of invasive duct carcinoma, medullary carcinoma and fibrosarcoma. Comedocarcinoma showed infiltration with these cells in 75% of cases while that for colloid carcinoma and Paget's disease of breast were observed in 50% of cases of each. Infiltrations with mast cells were observed in 92.3% cases of invasive duct carcinoma, 75% cases of comedocarcinoma and 25% cases of medullary carcinoma. Other malignant conditions of breast did not show mast cell infiltration. Degree of infiltration with lymphocytes and plasma cells was mainly of low grade in benign and dysplastic lesions compared to high degree of infiltration in malignancy. Mast cell infiltration was of low degree in both the types of lesions.

Heterotopic bone formation in renal cell carcinoma (a case report).

A case of renal cell carcinoma with heterotopic bone formation occurring in a female aged 55 years has been reported. There was no haematuria and the morphological picture showed only ossified stroma and no sarcomatoid appearance.

Mesenchymal chondrosarcoma--a case report.

A Case of extraosseous mesenchymal chondrosarcoma occurring in the occipital region in a 26 year old male is being reported. The patient remained free from recurrence on any metastasis even after 2 years of the tumor resection.

Chronic granulomatous cholecystitis: a clinicopathological study of 17 cases.

In a clinicopathological study of 376 cases of gall bladder diseases, chronic granulomatous cholecystitis was diagnosed in 17 specimens (4.52%). All these cases presented with pain in the right hypochondrium and a non-functioning gall bladder. Besides cholegranulomas and xanthogranulomas, 5 cases presented with localised yellowish brown areas in the wall of the gall bladder which revealed on histology proliferation of histiocytes containing abundant granular brown pigment (as seen in ceroid granulomas), intermingled with lymphocytes, plasma cells and occasional foreign body giant cells. The average age of the patients was 41.3 years. Cholelithiasis was present in 12 cases (70.6%). In one case the gall bladder was bilocular, having granulomatous lesion on one side of the septum and papillary adenocarcinoma on the other side.