Study of price variations of anti-epileptic drugs available in different brands in Indian pharmaceutical market

Background: To analyze the cost ratio and percentage cost variations in different brands of the commonly prescribed anti-epileptic drugs available in Indian pharmaceutical market.Methods: The maximum and minimum price of each brand of the drug given in INR was noted by using CIMS January to April 2018 edition and drug today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of one bottle in case of 100ml syrup and 10 tablets/capsules was calculated in case of oral drugs and the cost of one 1 vial or ampoule was noted in case of injectable drugs. At last the cost ratio and percentage cost variation of various brands was compared.Results: After calculation of cost ratio and percentage cost variation for each brand of anti-epileptic drug tablet clonazepam (2mg) shows highest cost ratio and percentage cost variation as: 10.41 and 941.66, carbamazepine (200mg SR tablet) shows lowest cost ratio and percentage cost variation as: 1.09 and 9.32.Conclusions: Epilepsy is the most common neurological disorder and Epileptic drugs are to be prescribed for prolonged period. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. There is a wide difference in the cost of different brands of anti-epileptic drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy

A study of neonatal hyperbilirubinemia from a tertiary care hospital in Northern India

Objective: The objective of this study was to analyze the incidence of pathological jaundice, average time of presentation, mean duration of phototherapy, and need for exchange transfusion with appropriate medical management. Methods: Thus, retrospective study was conducted at neonatal intensive care unit of a tertiary care hospital from August 2017 to August 2018. All live births who were diagnosed with neonatal hyperbilirubinemia and requiring treatment were included in the study. Exclusion criteria included any baby with conjugated serum bilirubin >20% of total serum bilirubin or >2 mg/dl or neonate with any congenital malformation. Results: Nearly 5% of total babies delivered developed neonatal jaundice requiring treatment. The most common causes isolated were ABO incompatibility followed by Rh incompatibility. Almost 46% of babies were not found to have any cause. The most likely etiology concluded in this group was breastfeeding jaundice. Conclusion: Breastfeeding jaundice should be considered as one of the common causes of pathological jaundice making lactational counseling during antenatal and postnatal period an essential component of management and prevention of pathological jaundice. Early detection and timely intervention with lesser invasive treatment modalities such as intravenous immunoglobulin G, hydration, and phototherapy should be attempted aggressively to avoid need for high-risk procedures like exchange transfusion

Factors determining poor prognosis in scorpion sting in coastal Andhra Pradesh

Introduction: Scorpion stings are a major public health problem and a common emergency in India and other tropical countries. In India, red scorpions are more prevalent, and their venom is more likely to cause cardiovascular complications and mortality. Objective: There are very few studies regarding predictors of poor prognosis. Hence, this study was designed which aimed to identify these factors. Materials and Methods: In this hospital-based, prospective study, children admitted to scorpion sting between December 2009 and November 2010 were included. Relevant information was collected and analyzed. Results: Scorpion stings account for 1 in every 36 admissions. Maximum cases were in 0-3 and 7-9 years age groups with mean of 6.78 years. Red scorpion stings were more common and are associated with more severe presentations. There was considerable variation in sting-prazosin interval (SPI) ranging from 2 to 28 h. If the child’s age was below 6 years, red scorpion sting and SPI >8 h were very significantly associated with a higher incidence of complications such as peripheral circulatory failure, congestive cardiac failure, myocarditis, and acute pulmonary edema. Conclusion: Younger age, red scorpion, and delay in administration of prazosin are predictors of poor prognosis in scorpion stings in children, a common and fatal medical emergency in India

Reproductive Ecology of Male and Female Strobili and Mating System in Two Different Populations of Pinus roxburghii

We studied several flowering traits, namely, male-female cone phenology, male-female cone production per tree, mating system, sex ratio, air-borne pollen grains and pollen migration, over four successive years in two different natural populations of P. roxburghii from Garhwal Himalaya, India. Assessment of each trait mentioned except pollen dispersion was done by selecting five representative trees randomly in each population. The pollen migration was studied on naturally isolated source trees. The pollen trapping was done in all directions up to 2.5 km. The average reproductive period in P. roxburghii was 36 days with 3–5 days protandry. There were significant year and population effects for male and female cone output and pollen grains production per tree. In mass production year (1999), an average production of pollen cone per tree was estimated as 42.44 ± 8.32 × 103 at lower altitude and 28.1 ± 0.89 × 103 at higher altitude. The controlled pollination results in high level of outcrossing with 90% seed setting. We conclude that the high male-female ratio and tremendous pollen production capacity in P. roxburghii indicate high male competition among trees within populations. The isolation strip of 600 m is considered minimal for the management of seed orchard

Scrub typhus in India: Whether increased reporting or expanding geographies?

Scrub typhus is a potentially fatal disease with serious complications in untreated cases or where there is delay in starting treatment. It has been considered to be limited to certain geographic areas with vegetations and cattle grazing fields like Jammu. Scrub typhus cases/outbreaks have been reported in the recent past from South India, Mumbai, Goa, Himachal Pradesh, and Haryana. Recently, we had a case of scrub typhus in a child residing in Delhi with no history of travel outside. A 10-year-old girl admitted with high-grade fever, abdominal pain, myalgia, and erythematous rash with hepatomegaly but without lymphadenopathy and developed splenomegaly in the 2nd week of illness. She was confirmed to be a case of scrub typhus after immunoglobulin M enzyme-linked immunosorbent assay for the disease. Scrub typhus is a matter of great public health importance that all medical practitioners should be sensitized about this disease and its varying presentations and complications

Hydatid disease of proximal femur: a case report

Hydatid disease is the most common infection in Central Asia, Middle East, East Africa caused by Echinococcus which is a cestode. However infection to bone alone is very rare. We report a case of Hydatid cyst in bone parse. A 55 years old lady came with a complaint of pain over right hip since 1 year.  Radiologically found to be having osteolytic lesion over proximal femur for which surgery was done and biopsy report showed hydatid cyst. The case is reported for its rarity

Comparative study between Blair’s procedure of ankle fusion and arthroscopic ankle arthrodesis

Background: Our objective was to perform a comparative study in terms of functional outcome of Blair’s procedure of ankle fusion versus arthroscopic methods of ankle fusion.Methods: 25 patients that underwent arthroscopic ankle arthrodesis versus Blair’s procedure of ankle fusion were taken for study at government medical college, Srinagar (VCSGGIMS and R) from the duration 2015-2021. Clinical assessment was done foot and ankle disability index and visual analog scale score for pain. Radiological assessment was done by serial X-rays. Regular follow-ups were taken till one year.Results: Both modalities proved to be equally effective in terms of patient’s functional outcome. Our analysis showed that Blair’s procedure ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, p=0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, p<0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, p<0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, p=0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, p=0.20), and operation time (MD 4.09, 95% CI 2.4910.66, p=0.22).Conclusions: We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. Further high quality randomized controlled trials that are adequately powered are required

Students’ attitudes on personal drug selection exercise in writing prescription

Background: This study was developed to know the students’ views regarding personal drug (P-drug) concept in rational prescription of drugs and also giving them training of creating and using personal drug concept.Methods: 40 medical students (5th semester) divided in four groups were involved voluntarily in a three phase, questionnaire based and prospective study. In first and second phase students were taught and asked to derive P-drug using different standard text books and Current Index of Medical Specialties (CIMS) by analyzing efficacy, safety, cost and convenience of drugs used for type II diabetes mellitus. Third phase was designed to know the students’ perception regarding the exercise and difficulties faced in the process of P-drug selection. It contained demographic and 12 questions with answer using Likert scale.Results: Students selected biguanide (metformin) as a P-drug in terms of efficacy, safety, cost and convenience. 95% (36 out of 40) responded in the questionnaire, out of which 92% (33 out of 36) had given answer with mean score ≥4. Overall median score was 4 and Interquartile Range was 4-5. 89% (32) strongly agreed that P-dug selection teaching helped them to understand pharmacology better. Majority (83% or 30) were in favour of introducing P-drug selection exercises in undergraduate pharmacology curriculum.Conclusions: P-drug selection exercise helped students to understand the differences among various drugs used for the treatment of type II diabetes mellitus and given them a strong foundation for developing rational use of the medicine in their future career as a doctor

Nietypowe objawy po masażu zatoki szyjnej u chorej z blokiem przedniej wiązki lewej odnogi — opis przypadku

A 65-year-old diabetic and hypertensive woman was admitted for evaluation of syncope. Her baseline electrocardiogram revealed normal sinus rhythm with left anterior hemiblock. Her treadmill test, holter monitoring and external loop recorder examinations were normal. Right sided carotid sinus massage (CSM) revealed 2:1 atrioventricular block (AV) (Mobitz II type) while left sided CSM had no effect. Permanent pacemaker implantation was performed (DDIR, St Jude Medical, USA). Mobitz II type AV block due to CSM reflects enhanced vagal efferent tone on AV node and his bundle fibre.Kobieta w wieku 65 lat z cukrzycą i nadciśnieniem tętniczym została przyjęta na obserwację z powodu omdlenia. W wyjściowym elektrokardiogramie stwierdzono prawidłowy rytm zatokowy z blokiem przedniej wiązki lewej odnogi pęczka Hisa. Wyniki testu wysiłkowego na bieżni oraz zapisy z monitora holterowskiego i zewnętrznego rejestratora pętlowego były prawidłowe. Prawostronny masaż zatoki szyjnej (CSM) ujawnił blok przedsionkowo-komorowy (typu Mobitz II) 2:1, natomiast lewostronny CSM nie spowodował żadnego efektu. Chorej wszczepiono stały stymulator serca (DDIR, St Jude Medical, Stany Zjednoczone). Blok przedsionkowo-komorowy typu Mobitz II spowodowany CSM odzwierciedla wzmożone napięcie części eferentnej nerwu błędnego w węźle przedsionkowo-komorowymi i włóknach odnogi