A study of prescription pattern in the drug therapy of acne vulgaris at a tertiary care hospital in Mangalore, India

Background: Acne Vulgaris is the most common skin disorder of the pilosebaceous unit with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity, affecting about 80% of teenagers and has considerable psychological and social consequences and physical disability. Use of established topical and oral drugs assumes paramount importance in the treatment of acne vulgaris. Therefore, periodic auditing of prescription is necessary to increase therapeutic benefit and decrease adverse effects. Aim and objectives of the study was to evaluate the pattern of prescription and its rationale in the drug therapy of acne vulgaris. To monitor the adverse effects, if any.Methods: A prospective, hospital based, observational study. Data was collected for a period of 1 year from January 2015 to December 2015 from the outpatient records in the OPD of Dermatology at Justice K.S. Hegde Charitable Hospital, Deralakatte, Mangalore, in a specifically designed proforma.Results: The prescription data of 346 patients were analyzed of which 45.1% were males with an average age of 21.94±0.3 years. Among the four grades of Acne Vulgaris, Grade II (53.17%) was more prevalent followed by Grade I (26.58%), Grade III (13.87%) and Grade IV (6.35%). The number of drugs prescribed for topical use was 514 of which the most commonly prescribed drugs were Benzoyl Peroxide (19.46%), a combination of Tretinoin and Clindamycin (17.12%), Tretinoin alone (12.45%), Clindamycin alone (10.51%) etc. The number of drugs prescribed for systemic use was 98 consisting of Doxycycline (55.1%), Azithromycin (34.7%), Isotretinoin (6.12%) and Erythromycin (4.08%).Conclusions: There was rationality in most of the prescriptions giving no scope for polypharmacy

Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratios as Prognostic Factors after Stereotactic Radiation Therapy for Early-Stage Non–Small-Cell Lung Cancer

IntroductionThe hematologic indices of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are correlated with clinical outcomes after stereotactic radiation.MethodsWe retrospectively evaluated the pretreatment NLR and PLR in patients treated with stereotactic radiation for early stage non–small-cell lung cancer at our institution. A total of 149 patients treated for non–small-cell lung cancer were identified, and 59 had stage I disease with neutrophil, platelet, and lymphocyte levels within a 3-month period before treatment. Receiver operating characteristic (ROC) analysis was performed to examine cutoff values for survival and nonlocal failure followed by Kaplan–Meier analysis for survival.ResultsWith a median follow-up of 17 months, 28 deaths were observed, and the median overall survival for all patients was 43 months. Based on the ROC analysis, NLR and PLR cutoff values for further survival analysis were determined based on the ROC analysis to be 2.98 and 146. The median overall survival was not reached for patients with low NLR or PLR but the survival was 23 months for patients with high NLR or PLR. There was no correlation between NLR and nonlocal failure, but on multivariate analysis PLR was found to be associated with freedom from nonlocal failure. Nonlocal failure rates were 11% for patients with PLR less than 250 and 58% for PLR greater than 250 (p < 0.001).ConclusionThe pretreatment NLR and PLR represented significant prognostic indicators of survival in patients treated for early-stage non–small-cell lung carcinoma with stereotactic radiation. The PLR may be used as a prognostic indicator for nonlocal failure after stereotactic radiation for early-stage lung cancer

Defining oligometastatic disease from a radiation oncology perspective : an ESTRO-ASTRO consensus document

Background: Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence. Methods: A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature. Results: Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, single-centre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed. Conclusion: While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1–5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits

Randomized Phase II Study Comparing Prophylactic Cranial Irradiation Alone to Prophylactic Cranial Irradiation and Consolidative Extracranial Irradiation for Extensive-Disease Small Cell Lung Cancer (ED SCLC): NRG Oncology RTOG 0937

Introduction—RTOG-0937 is a randomized phase-II trial evaluating 1-year OS with PCI or PCI plus consolidative radiation therapy (cRT) to intra-thoracic disease and extracranial metastases for ED-SCLC. Methods—Patients with 1–4 extracranial metastases were eligible after CR or PR to chemotherapy. Randomization was to PCI or PCI+cRT to the thorax and metastases. Original stratification included PR vs CR after chemotherapy and 1 vs 2–4 metastases; age \u3c 65 vs ≥ 65 was added after an observed imbalance. PCI was 25GY/10 fractions. cRT was 45GY/15 fractions. To detect an OS improvement from 30% to 45% with a 34% hazard reduction (HR=0·66) under a 0.1 type-1 error (1-sided) and 80% power, 154 patients were required. Results—Ninety-seven patients were randomized between March, 2010 and February, 2015. Eleven patients were ineligible (nine PCI, two PCI+cRT), leaving 42 randomized to PCI and 44 to PCI+cRT. At planned interim analysis the study crossed the futility boundary for OS and was closed prior to meeting accrual target. Median follow-up was 9 months. One-year OS was not different between the groups: 60.1% [95% CI: 41.2–74.7%] for PCI and 50.8% [95% CI:34.0–65.3%] for PCI+cRT (p=0.21). Three and 12-month rates of progression were 53.3% and 79.6% for PCI, and 14.5% and 75% for PCI+cRT. Time to progression favored PCI+cRT, HR=0.53 (95% CI: 0.32–0.87, p=0.01). One-patient in each arm had Grade-4 therapy related toxicity and one had Grade-5 therapy related pneumonitis with PCI+cRT. Conclusions—OS exceeded predictions for both arms. Consolidative RT delayed progression but did not improve 1-year OS

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Parasitization capacity of trichogramma chilonis ishii (hymenoptera: trichogrammatidac) on the eggs of helicoverpa armigera (lepidoptera: noctuidae) under laboratory conditions

The pod borer, Helicoverpa armigera is considered to be the most important pest of several crops such as cotton, tomato, tobacco, chick pea, pigeon pea etc. Trichogramma chilonis, the tiny wasp, which are the major parasitoids of lepidopteran eggs are used to control plant pests and are used widely in augmentative biological control. In the present laboratory study, infestation capacity of the parasitoid on the eggs of H. armigera was undertaken at Mysore, India. Also, the hatchability rate, developmental period and longevity of the biocontrol agent were studied. The results revealed that the T. chilonis exhibited 58.54% parasitization and 93% hatchability on the pod borer. It took an average of 8.28 days to develop under laboratory conditions and lived for 6.7 days. These findings will be helpful in employing T. chilonis in the control of H. armigera on the agricultural crops in the fiel

A study of prescription pattern in the drug therapy of acne vulgaris at a tertiary care hospital in Mangalore, India

Background: Acne Vulgaris is the most common skin disorder of the pilosebaceous unit with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity, affecting about 80% of teenagers and has considerable psychological and social consequences and physical disability. Use of established topical and oral drugs assumes paramount importance in the treatment of acne vulgaris. Therefore, periodic auditing of prescription is necessary to increase therapeutic benefit and decrease adverse effects. Aim and objectives of the study was to evaluate the pattern of prescription and its rationale in the drug therapy of acne vulgaris. To monitor the adverse effects, if any.Methods: A prospective, hospital based, observational study. Data was collected for a period of 1 year from January 2015 to December 2015 from the outpatient records in the OPD of Dermatology at Justice K.S. Hegde Charitable Hospital, Deralakatte, Mangalore, in a specifically designed proforma.Results: The prescription data of 346 patients were analyzed of which 45.1% were males with an average age of 21.94±0.3 years. Among the four grades of Acne Vulgaris, Grade II (53.17%) was more prevalent followed by Grade I (26.58%), Grade III (13.87%) and Grade IV (6.35%). The number of drugs prescribed for topical use was 514 of which the most commonly prescribed drugs were Benzoyl Peroxide (19.46%), a combination of Tretinoin and Clindamycin (17.12%), Tretinoin alone (12.45%), Clindamycin alone (10.51%) etc. The number of drugs prescribed for systemic use was 98 consisting of Doxycycline (55.1%), Azithromycin (34.7%), Isotretinoin (6.12%) and Erythromycin (4.08%).Conclusions: There was rationality in most of the prescriptions giving no scope for polypharmacy