Bilateral thalamic infarcts due to occlusion of artery of percheron - a rare vascular variant

The artery of percheron is a rare vascular variant, occlusion of which is uncommon and associated with bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 50 year-old male patient with acute bilateral thalamic infarcts. Patient presented with history of sudden onset of altered sensorium with episodes of restlessness, agitation and loss of consciousness. Non-contrast CT scan of head was suggestive of bilateral paramedian thalamic infarcts

Cost-analysis study of second generation antihistamines used in the treatment of allergic rhinitis in India

Background: Second-generation antihistamines (SGAs) are the most commonly used drugs for AR nowadays. The cost of medicines is very important determinant in drug compliance; selection of low cost quality drugs would thus be helpful in improving compliance. Literature search revealed no such study done in India and the current study was thus planned to compare the variation in the cost of different SGAs used for the treatment of allergic rhinitis in India. The study results would help doctors, pharmacists in selecting the least costly options among the available SGAs.Methods: The costs in Indian rupee (INR) of different generic and branded SGAs available in Indian market were referred from CIMS, drug today and the website www.medindiaguide.com. The dose for each drug was taken as per WHO defined daily dose (DDD) for allergic rhinitis. The highest and lowest price for ten tablets/capsules of each SGA manufactured by different pharmaceutical companies was noted. The percentage cost variation and cost ratio were then calculated for each drug.Results: Eight oral SGAs with a total of 1050 oral tablets or capsules manufactured by different companies are available for use in AR in India. The highest number of manufacturers were for levocetirizine (483), and lowest for mizolastine (2). Fexofenadine (INR 123.56) was the costliest and levocetirizine the cheapest (INR 2.3) SGA. Maximum variation in price was seen with cetirizine (4300%). The cost ratio was highest for cetirizine (44), and lowest for mizolastine (1.1). Cetirizine is the only SGA from the National List of Essential Medicines (NLEM) 2015 of India; also the only SGA in the DPCO 2013 list of controlled drugs and formulations.Conclusions: There is huge variation in the price of same SGA being manufactured by different companies. Between the least expensive and the most expensive cetirizine, there is a huge cost variation of 4300%

Przezskórna komisurotomia mitralna u nastolatka ze stenozą mitralną i tętniakiem lewego przedsionka — zabieg trudny technicznie

Percutaneous trans-mitral commissurotomy (PTMC) using an Accura balloon is an effective procedure for the mana- gement of patients with rheumatic mitral stenosis. It is not infrequent to encounter an aneurysmal left atrium (LA), especially in the developing world where patients often present very late. This is a technically challenging procedure as the septum often bulges into the right atrial side, making the puncture often difficult. Furthermore, it bulges anteriorly and inferiorly so it becomes even more challenging. Because of the vertical lie of the septum, the needle often dissects the septum rather than puncturing it.  Here, we describe the case of a 17 year-old boy with severe mitral stenosis with a giant, aneurysmal left atrium (LA — 13.5 × 16 cm) where an inter-atrial septal puncture was achieved by probing the fossa ovalis to enter the left atrium instead of a conventional transseptal puncture. PTMC was successfully done, increasing the mitral valve area from 0.8 cm2 to 1.9 cm2. Przezskórna komisurotomia mitralna (PTMC) przy użyciu balonu Accurato to skuteczny zabieg stosowany w leczeniu chorych ze stenozą mitralną (MS) spowodowaną chorobą reumatyczną. Nierzadko spotyka się u tych chorych tętniak lewego przedsionka (LA), zwłaszcza w krajach rozwijających się, gdzie pacjenci często bardzo późno zgłaszają się do lekarza. Zabieg ten jest trudny technicznie, ponieważ przegroda często wpukla się do prawego przedsionka, utrudniając wykonanie nakłucia. Co więcej, przegroda wybrzusza się w kierunku przednio-dolnym, co dodatkowo zwiększa trudność zabiegu. Ze względu na pionowe położenie przegrody igła często rozdziela przegrodę, zamiast ją przebić.  W niniejszej pracy opisano przypadek 17-letniego chłopca z ciężką MS i olbrzymim tętniakiem LA (LA — 13.5 × 16 cm). Aby dostać się do LA, sondowano otwór owalny zamiast konwencjonalnego nakłucia przegrody. Przeprowadzono z po- wodzeniem zabieg PTMC, zwiększając powierzchnię zastawki mitralnej z 0,8 cm2 do 1,9 cm2.

To study the preferred antihypertensive drugs in patients suffering from diabetes mellitus at a tertiary care hospital of Uttarakhand with an emphasis on compelling indications

Background: People with diabetes are more likely to also have high blood pressure. Hypertension can increase the risk of diabetes complications and is a powerful risk factor for development of a wide variety of cardiovascular, cerebrovascular and renal diseases. The treatment of hypertension in patients with diabetes thus becomes all the more important and may effectively prevent cardiovascular events. This study was thus planned with the aim to study the preferred antihypertensive drugs in patients suffering from diabetes mellitus and to teach UG students about the clinical importance of compelling indications in the treatment of hypertension.Methods: A total of 100 prescriptions of patients suffering from hypertension and diabetes mellitus were collected from diabetic hypertensive visiting the department of Medicine. Data was analysed in terms of percentage to find out the most and least preferred antihypertensive drugs in diabetes mellitus.Results: ACE inhibitors (30.95%) and ARBs (30.16%) were the most preferred, diuretics (19.84%), and CCBs (11.9%), and beta blockers (7.14%) were the least preferred antihypertensive drugs in diabetes patients. Three patients were on non-pharmacological treatment and among the remaining 97 prescriptions, monotherapy was the most common mode (70.1%) of therapy for hypertension, and drugs in combination were prescribed to 29.89% patients.Conclusions: ACE-I and ARBs were the preferred antihypertensive drugs prescribed in diabetic hypertensive. Treatment of hypertension should be individualized depending upon the compelling indications. This should be taught to undergraduate students in a practical way in collaboration with Medicine department

Comparative evaluation of various analgesic drugs in Wistar rats used as a teaching tool to teach animal experiments to post graduate MD Pharmacology students

 Background: Postgraduates when join Pharmacology department, they don’t have much idea about guidelines and methods to do animal experiments. This study was designed to sensitize postgraduate students to animal experiments by evaluating the anti-inflammatory effects and the efficacy of diclofenac, tramadol and etoricoxib in reducing paw edema in wistar rats.Methods: The wistar rats of 225-250gram were divided into four groups (n=10 each). In all the groups the paw edema on right paw was created using 0.1ml of 1% formalin subcutaneously. Group 1 rats (control), group 2 were given diclofenac, group 3 were given tramadol and group 4 were given etoricoxib orally. The parameters assessed were water displacement in plethysmography after 2, 4, 24, 48 hours of giving the drug. The circumference of edematous paws after 4 hours, licking of paw was observed over 30minutes of giving the drug and was compared. Pre and post study feedback were obtained from the students by using a preformed questionnaire to assess the knowledge gained by the students.Results: The test showed that all the drugs were effective in reducing inflammation, circumference of edema and the licking duration significantly (p<0.05). The post study answering of questions by postgraduate was 100% in comparison to pre-study answering which was 33%.Conclusions: A short animal study conducted as a teaching tool to postgraduate students was able to teach the guidelines of animal experiments and handling of animals effectively

A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Background: Type 2 diabetes mellitus (T2DM) patients require anti-diabetic drugs on chronic basis, frequent monitoring of blood glucose levels and a number of laboratory investigations, all of which result in significant economic burden on the diabetes patients and the world economies. The purpose of this study was to analyse the prescribing pattern to highlight the current approaches to the rational use of anti-diabetic drugs in T2DM patients visiting the medicine out-patient department, and to calculate the economic burden of different anti-diabetic therapies prescribed to patients with T2DM in a tertiary care hospital of north India.Methods: This prospective study included T2DM patients visiting the out-patient department of medicine of a tertiary care hospital of Uttarakhand, India. Prescriptions of patients diagnosed as cases of T2DM were analysed as per the WHO drug use indicators. For pharmacoeconomic evaluation, the cost variation of different anti-diabetic therapies was compared using the cost-effectiveness analysis method.Results: 273 prescriptions from 148 men and 125 women were analysed. 805 drugs were prescribed to the patients with an average of 2.95 per encounter: 494 anti-diabetic drugs with an average of 1.81 drugs per patient, and 311 for co-morbid conditions. Of the 494 anti-diabetic drugs, 75.1% were oral anti-diabetic (OAD) agents and 24.9% were insulin’s. Metformin (209) and insulin aspart (42) were the most prescribed OAD and insulin, respectively. The pharmacoeconomic analysis included 138 patients. The cost per unit (1 mg/dl) reduction in fasting blood glucose was lowest with glipizide and metformin combination (INR 10.46) and highest with insulin degludec and insulin aspart combination (INR 217.38). The average total direct cost of therapy for two months was INR 2244.39 ± 2745.05 (INR 362.88 to INR 10806). 86.63% of the average total direct cost of therapy was attributed to anti-diabetic agents.Conclusions: Metformin was the most common OAD agent and insulin aspart was the most common injectable anti-diabetic drug prescribed in patients with T2DM. The newer anti-diabetic drugs sitagliptin and newer insulin analogues were also prescribed to a great extent. Overall, the prescribing trend was rational to a great extent and had improved since the earlier study in the same institute. The most cost-effective anti-diabetic therapy was combination therapy of glipizide and metformin. The cost of diabetes management is high, especially for insulin therapy

A case of bilateral empyema with pericardial effusion caused by streptococcus intermedius in an immunocompetent patient

Streptococcus intermedius, a member of the Streptococcus anginosus group and a part of the human oropharyngeal microbiome, is a&nbsp;recognised pathogen, mostly in immunocompromised patients or post gastrointestinal surgery, known to cause suppurative metastatic&nbsp;abscesses. We present an unusual case of bilateral empyema with pericardial effusion caused by Streptococcus intermedius in a&nbsp;healthy 30-year-old adult male patient with no known predisposing factors.This case report illustrates the ability of S. intermedius to&nbsp;produce life-threatening empyema in a healthy adult without any predisposing factors

Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup

Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup.Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant.Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p0.05), respectively.Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension

Bilateral thalamic infarcts due to occlusion of artery of percheron - a rare vascular variant

The artery of percheron is a rare vascular variant, occlusion of which is uncommon and associated with bilateral paramedian thalamic infarcts with or without mesencephalic infarctions. We report a case of a 50 year-old male patient with acute bilateral thalamic infarcts. Patient presented with history of sudden onset of altered sensorium with episodes of restlessness, agitation and loss of consciousness. Non-contrast CT scan of head was suggestive of bilateral paramedian thalamic infarcts