Valproic Acid versus Lamotrigine as First-line Monotherapy in Newly Diagnosed Idiopathic Generalized Tonic -Clonic Seizures in Adults - A Randomized Controlled Trial.

INTRODUCTION: Idiopathic Generalized Tonic-Clonic Seizures (GTCS) are frequently encountered in adults. Their successful control is necessary to improve the quality of life of these patients. Valproic acid is a simple branched-chain carboxylic acid and lamotrigine is a phenyltriazine derivative. Opinions differ in regards to their effectiveness in idiopathic GTCS. AIM: To compare the effectiveness of valproic acid and lamotrigine in newly diagnosed adults with idiopathic generalized tonic-clonic seizures. MATERIALS AND METHODS: The present prospective randomized study was conducted on 60 patients suffering from idiopathic GTCS. Thirty patients received valproic acid and rest 30 patients received lamotrigine. All patients were followed regularly monthly for one year for treatment response and adverse effects. RESULTS: After 12 months follow-up, 76.67% patients taking valproic acid and 56.67% patients taking lamotrigine were seizure-free. Common adverse effects recorded were nausea, dyspepsia, headache and skin rash. CONCLUSION: Valproic acid is more effective than lamotrigine as first-line drug in the treatment of adults with newly diagnosed idiopathic generalized tonic-clonic seizures.

Risk of Acute Kidney Injury with Amikacin versus Gentamycin both in Combination with Metronidazole for Surgical Prophylaxis.

INTRODUCTION: Surgical site infection is one of the most important complication of surgery. It increases the mortality and morbidity. In order to decrease the incidence of surgical site infections perioperative antimicrobial prophylaxis has been recommended in certain types of clean and clean contaminated surgeries. Aminoglycosides are indicated as surgical prophylaxis for prevention of surgical site infection in patients with B-lactam allergy. AIM: The present study was carried out to study and compare the renal safety profile of single high dose gentamycin and amikacin as surgical prophylactic antibiotic. MATERIALS AND METHODS: Prospective and randomized study was carried out on 100 patients for over one year period in a tertiary care teaching hospital of western Uttar Pradesh, India. Patients in amikacin group received amikacin 15 mg/kg + metronidazole 500 mg intravenously single dose and those in the gentamycin group had gentamycin 5 mg/kg + metronidazole 500 mg intravenously single dose, one hour prior to incision. RESULT: A total of 16% patients of amikacin group and 24% patients of gentamycin group developed acute kidney injury within one week of drug administration. The rise in serum creatinine was temporary as all patients had normal serum creatinine level at one month follow up. CONCLUSION: Aminoglycoside intravenous single high dose is not safe as surgical prophylaxis.

Prescribing Pattern of Anti-malarial Drugs with Particular Reference to the use of Artesunate in Complicated Plasmodium Vivax Cases.

BACKGROUND: In developing countries, Malaria has been found to be one of the most common cause of fever and morbidity, particularly among infants and young children. Therefore, its drug utilization studies should be carried out to know the rationality of treatment. AIM: To evaluate the use of antimalarial agents in children with a diagnosis of Malaria and visited to OPD & IPD Paediatric department of a tertiary care teaching hospital. MATERIALS AND METHODS: This was a prospective six months study based on a Medication Utilization Form, which has been designed in consultation with the paediatrician. One hundred eighty three children <12 y of age were selected on the basis of inclusion and exclusion criteria. RESULTS: Out of 183 patients, 110 were infected with Plasmodium falciparum (60.10%) and 73 with Plasmodium vivax (39.89%). Most of the patients were male, 56.83% and 43.16% were female patients. Most of the complicated cases were found from Plasmodium falciparum (n = 110) than Plasmodium vivax (n=15). In prescriptions with monotherapy, Artesunate (n=101) was found to be the most commonly prescribed drug and in prescriptions containing more than one drug, Artesunate - lumefantrine (n=125) combinations were frequently used. Most of the drugs were prescribed by oral route (n=285), than the parenteral route (n=140). The average number of drugs per encounter was 2.32 and only 4.50% drugs were prescribed by generic name. Average drug cost per prescription in complicated cases was found to be higher (185.5 INR) than uncomplicated cases (115 INR). CONCLUSION: Artemisinin were used as first line drugs irrespective of the causative agent for malaria, which is not recommended, however has been found to be effective in complicated cases of Plasmodium vivax also. The cost of the prescription was higher. Interventions to rectify over prescription of injectables necessary to further improve rational drug use in our facility. Also, there should be an awareness program, especially in slum areas to cut down the transmission of disease.

A prospective study on the antimicrobial usage in the medicine department of a tertiary care teaching hospital.

INTRODUCTION: As we know, some of the species of animals are endangered, as there is an increase in their declining rate and a decrease in their survival rate. The same is true for the antibiotics also, as there is a rise in the antimicrobial resistance and a decline in the development of new antibiotics. Antimicrobial Resistance (AMR) has become a major obstacle in the way of the treatment of infectious diseases worldwide. Therefore, to fight against AMR, antibiotic utilisation studies are being carried out. Therefore, with the same perspective, this prospective study was done to evaluate the current usage of the anti-microbial agents in medicine department of a teaching hospital in northern India. METHODS: This was a prospective study which was done for a period of three months from Nov 2012 - Jan 2013. The prescriptions and the patient records are reviewed and analysed. The rationality of the drug usage was also evaluated by analysing the drug prescriptions. RESULTS: Out of the 494 drugs which were prescribed to 180 patients, 291 were antibiotics. The most commonly used AMAs were the ß-lactams (penicillins and cephalosporins) -n = 102, followed by the quinolones -n = 93, Nitroimidazoles -n = 43, aminoglycosides -n = 35 and the macrolides -n = 18. The most common indication for the antimicrobial therapy was infection. According to the evaluation, the use of the antimicrobial therapy was found to be rational in 77.77 per cent patients. The average number of antibacterial agents which were prescribed per patient per course was found to be 1.61 and the average numbers of drugs which were prescribed per patient were 2.74.The average cost per prescription per day was Rs.115 and the average antibiotic cost per encounter was Rs. 85. CONCLUSION: Antibiotic resistance is increasing at an alarming rate due to the irrational prescribing habits of physicians, leading to increasing morbidity, mortality and treatment costs. Therefore, the medical professionals as well as government personnel who are related to the health sector, need to understand that antibiotics are precious and finite resources. The remedy of this situation requires that regular educational awareness programmes should be conducted in hospitals at a regular basis.

The serum C Peptide levels among the offsprings of the people with type 2 diabetes.

BACKGROUND: Insulin Resistance (IR) is a condition in which the cells of the body become resistant to the effect of insulin , that is, the normal response to a given amount of insulin is reduced. As a result, levels of insulin are needed in order for insulin to produce its effect. The incidence of diabetes in the offsprings of diabetic couples was more than the incidence of diabetes in the offsprings, of whom only a single parent was diabetic. AIMS AND OBJECTIVES: This study was done to assess the prevalence of insulin resistance in the offsprings of diabetic patients. MATERIAL AND METHODS: The present, cross sectional study conducted in the Teerthanker Mahaveer Medical College and Research Centre, Moradabad, U.P., india. The offsprings of diabetic subjects attended the General Medicine OPD and the Diabetic Clinic and they were also admitted in the indoor wards of the Department of Medicine. The study material consisted of 53 (35 males and 18 females) live offsprings of diabetics from 28 families. RESULTS: The mean c-peptide level in the offsprings of biparental diabetics was significantly higher than that in the offsprings of monoparental diabetics (p<0.01) and in the offsprings of non-diabetics (p<0.01). The frequency of the high c-peptide level was 38.1% in the offsprings of biparental diabetics, it was 21.1% in the offsprings of monoparental diabetics and it was 7.7% in the offsprings of non-diabetics. CONCLUSION: This study revealed that during the young ages of the offsprings of biparental diabetics, insulin resistance was common and that insulin resistance was more common in the obese, female offsprings of biparental diabetics.

A double-blind, placebo-controlled randomized comparison of pre and postoperative administration of ketorolac and tramadol for dental extraction pain.

OBJECTIVE: To compare the analgesic efficacy and safety of single-dose oral ketorolac and tramadol administered pre and postoperatively for dental extraction pain. MATERIALS AND METHODS: 74 patients undergoing third molar extraction (impacted or other causes) were recruited into the study, over a period of 1 year. The patients were divided into six groups and they were given ketorolac (20 mg), tramadol (100 mg), or placebo either preoperatively or postoperatively (half an hour before or half an hour after the procedure). Placebo was glucose powder filled in empty capsule. Pain assessment was done using a modified Verbal Rating Scale (VRS) at 30 min, 2, 4, and 6 h after the procedure. A record of whether rescue analgesic (ibuprofen 400 mg) was taken during the 6 h study period, along with the time it was taken, was made. Record of any adverse effects experienced by the patient was also kept. Maximum pain scores for each of the six study groups, over the 6 h study period, were noted. RESULTS: Ketorolac and tramadol were significantly better than placebo in relieving molar tooth extraction pain. Postoperative administration of tramadol was found to be more efficacious than preoperative administration in relieving the pain, whereas the preoperative administration of ketorolac was better than its postoperative administration. CONCLUSION: This study demonstrated that tramadol is equally effective to ketorolac in relieving pain in the first 6 h after molar extraction and therefore can be tried in patients who are intolerant to nonsteroidal anti-inflammatory drugs.