Prescribing patterns of cardiovascular drugs in cardiology outpatient department in a tertiary care hospital in Western Odisha

Background: Cardiovascular morbidity plays a villainous role globally as well as countries like India. Additionally, irrational prescription incurs greater damage to health and wellbeing. Drug utilization studies scrutinize the appropriateness of treatment and provide favorable feedbacks to strengthen clinical practices. The objective of the study was to describe treatment practices in cardiology outpatient and drug utilization pattern using core prescribing indicators by World Health Organization (WHO).Methods: A cross-sectional, observational study of 4-month duration was undertaken for cardiology Outdoor patients at a tertiary care hospital. 615 prescriptions were screened and analyzed.Results: Males (59.84%) were more in number than females (40.16%). Average number of the prescribed drugs per patient were 4.32±2.7 and (3.73±1.1 for cardiovascular drugs). Generic prescription was 60.98%. Percentage encounters with antibiotics 4.11, injectables 2.92%, fixed-dose combinations (FDCs) (11.8%) were documented. Drugs from the National List of Essential Medicines were 75.89%. The most common diagnosis was ischemic heart disease (68.29%). Hypolipidemics (78.25%) followed by antiplatelets (71.14%) were toppers in cardiovascular drug. Antiulcer drugs (PPI/Antacids) comprised 58.54% of total prescriptions.Conclusions: Less adherence to EDL, less generic prescriptions, use of FDC are major shortcomings. Areas to further rationalization like optimal use of evidence based medication like beta-blockers, newer anticoagulants/anti-platelet agents and newer anti-anginal agents are identified

Utilization trends of drugs in patients admitted with ischemic heart disease in a tertiary care teaching hospital

Background: Coronary artery disease (CAD) takes the highest toll of lives across the world as well as India. Prompt diagnosis and effective treatment is lifesaving. Drug utilization studies scrutinize the appropriateness of treatment and provide favourable feedbacks to strengthen clinical practices. Several other studies have reported underuse of four evidence-based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD. Polypharmacy, injection overuse is some of the shortcomings. The objectives of this study was to describe treatment practices in terms of different disease spectrum and drug utilization (group-wise and individually) for inpatients with CAD using core prescription indicators by WHO.Methods: A cross-sectional study of 4-month duration was undertaken for patients with CAD admitted to cardiology indoor of a tertiary care hospital. A total no of 143 prescriptions was screened and analyzed.Results: Males (67.13%) were more in number than females (32.87%). Age group from (57-66) topped in frequency (61.05%) ahead of (67 to 76) group (38.46%). Average no of drugs per patient were 8.056±1.97 and 5.86±0.14 for cardiovascular drugs. Prescription in generics (45.49%), antibiotics (0.61%), fixed-dose combinations (FDCs) (0.52%) and injectables (28.47%) were noted. The most common categories of CAD were ST-segment elevated myocardial infarction (69.23%) followed by chronic stable angina (17.48%). Antiplatelets (100%), hypolipidemics (99.3%), antianginals (60.14%), β-blockers (37.06%) and ACE-I/ARBs (27.97%) were utilized. Drugs from the national list of essential medicines were 66.49%.Conclusions: Among four evidence-based drugs, use of β-blockers and ACE-I/ARBs were inappropriately low. Polypharmacy and overuse of Injectable drugs are noted

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

A comparative clinical and echocardiography study of acute myocardial infarction, patients above and below 40 years of age

ABSTRACT   BACKGROUND Myocardial infarction is one of the major health problems in both developed and developing countries and is the leading cause of premature death among adults in developed countries while its incidence is on an increase in developing countries as well, including India. Coronary Artery Disease (CAD) in young (<40 years) has aroused considerable interest in recent years. OBJECTIVES. To determine the prevalence of various risk factors in young AMI patients and to compare them with that of older patients. To compare the clinical presentation, course and complications among both the groups. METHODS: Clinical Criteria : Severe excruciating retrosternal pain with or without radiation to upper extremities, abdomen, back, neck or jaw, not relieved by rest, lasting more than 30 minutes and frequently for a number of hours suggested the diagnosis of MI. Where the pain was not a prominent feature other features like severe diaphoresis, syncope, shock, sudden dyspnoea, and sudden onset of pulmonary oedema in the absence of other known cause of acute left ventricular failure were taken into consideration. When any of these features including a prolonged retrosternal pain especially in a person with known coronary risk factors were present the possibility of acute MI was strongly suspected and further laboratory investigations were done to settle the diagnosis. RESULTS & DISCUSSION AMI was found to have male preponderance with M:F ratio of 9:1 and 2:8:1 in group I & II patients respectively. Smoking habit was found to be the commonest risk factors. Equal patients in each group had TC/HDL-C ratio in excess of 4.5. Anterior wall infarction was the commonest form of infraction in both Groups. Among the early complications, the occurrence of heart failure was found to be significantly high in Group II patients. Other complications such as arrhythmias, & conduction defects, shock, pericarditis, post infarction angina, thromboembolic episodes & mitral regurgitation did not differ significantly in incidence when both groups were compared. Heart failure occurred in significantly higher percentage in group II patients than in Group I patients.   Anterior apical, septal, anterolateral, inferior, basal & posterior, wall motion abnormalities were found in both groups. Death was more in Group II patients during early hospitalization period. CONCLUSION: In the present study it is clearly evident that the natural course, extent of ventricular dysfunction arrythmias / wall motion abnormalities/ mortality in acute myocardial infarction bears many similarity in both younger and older patient population; but not in all aspects. Family history of coronary heart disease and obesity may be more associated with younger and older patient groups respectively while incidence of heart failure in older patients are significantly higher when compared with that is seen in younger patients.   Key words: Coronary Artery Disease (CAD), Young AMI, Echocardiography in AM

A CROSS SECTIONAL STUDY TO EVALUATE ACUTE KIDNEY INJURY IN SCRUB TYPHUS PATIENTS: ACUTE KIDNEY INJURY IN SCRUB TYPHUS PATIENTS

OBJECTIVE: This study was conducted with the objective to estimate the incidence and severity of acute kidney injury [AKI] scrub typhus patients. METHODS: This was a cross-sectional study conducted 90 patients diagnosed with scrub typhus in a tertiary care centre. Basic demographic and treatment details of the patients were recorded. Routine haematological investigations and biochemical profiles were performed upon admission and follow-up.  AKI was defined and classified based on the RIFLE criteria RESULTS: Mean age of the patients was 49.0 ± 19.5 years and female preponderance was observed. The haemoglobin level was significantly lower in AKI patients as compared to non-AKI patients. Meanwhile, there was a significant increase in mean TLC count, CRP, Total bilirubin in AKI patients as compared to non-AKI patients.  was significantly higher  as compared to those without AKI . Increasing age, ICU admission, shock, urinary abnormalities and mechanical ventilation were the factors significantly associated with AKI. CONCLUSION AKI is a frequently reported complication in scrub typhus patients. In evaluating febrile illness associated with AKI, scrub typhus should be considered

Thyroid function test in sickle cell disease: Thyroid function test

Abstract OBJECTIVE: This cross-sectional study aimed to evaluate the thyroid function (T3, T4, and thyroid stimulating hormone levels) in patients with sickle cell disease (SCD).  METHODS: This cross-sectional observational study was conducted in the general medicine department of the Veer Surendra Sai Medical College and Hospital, Burla, Sambalpur, Odisha (India). The investigation was performed in the sickle cell clinic, medical ward, and outpatient department (OPD) of the institute. This study was conducted from Nov-2019 to Oct-2021. Sixty-eight patients with SCD were enrolled for assessing their thyroid function. The reference ranges for serum T4 (4.5-12 µg/dL), serum T3 (60-200 ng/dL), and thyroid stimulating hormone (0.3-5.5 uIU/mL) were defined to evaluate the thyroid function. RESULTS:  The average thyroid stimulating hormone, mean T4 level, and mean T3 level among the patients were 4.02, 4.67, and 74.15, respectively. The incidence rates of hypothyroidism and euthyroid status were 23.5% and 76.5%, respectively. While 9.59gm/dL was the mean hemoglobin level, 11-16gm/dL was observed in 42.6% of patients compared to <11gm/dL in 57.4% of patients. Patients within the age group of 14-25 years had a higher incidence of hypothyroidism (62.5%). The differences in hypothyroidism between males and females were statistically insignificant (68.8% vs. 31.2%, p=0.11).  CONCLUSION: Patients with SCD had clinically significant reductions in T3 and T4 levels. In addition, higher levels of thyroid stimulating hormone and reductions in endogenous T3/T4 levels were observed in male patients. Overall, SCD was associated with a higher incidence of hypothyroidism. &nbsp

Pulmonary arterial hypertension in children with sickle cell anaemia

Background:Pulmonary hypertension(PHT) is a life threatening complication which occurs in adults with sickle cell disease(SCD). But there is paucity of knowledge about prevalence of pulmonary hypertension in Paediatric SCD population.Objective:To find out the prevalence of pulmonary hypertension in children with SCD.Methods:552 children age between 5 to 14 years were enrolled after written informed consent was obtained from parents/guardian. Children with Congenital heart disease, pulmonary stenosis, Rheumatic heart disease were excluded from the study. PHT in all cases of with SCD children was screened by using 2D Echocardiography in the department of cardiology. PHT is defined as mean pulmonary artery pressure (mPAP) ≥ 25 mmHg at rest. All the data were validated and analyzed with SPSS version 25.Results:Overall prevalence of pulmonary hypertension in our study is 20.4%. Of these, 6.5% subjects have mild and 13.9% subjects have moderate pulmonary hypertension. Low haemoglobin (p=0.021), high number of crisis (p=0.000), high number of blood transfusion (p=0.000), presence of loud second heart sound (p=0.000) and presence of Parasternal heave (p=0.000) were significantly associated with pulmonary hypertension. The prevalence of pulmonary hypertension in children with SCD demonstrated an increase in trend with age.Conclusion:High pulmonary artery pressures do occur in children with SCD. Screening by echocardiography can lead to early detection and intervention

Serum calcium and magnesium levels in acute gastroenteritis

Background: Acute diarrhea endemic in India has a prevalence of 7% which is commonly seen in children and also is a major problem in adults. Acute diarrhea with dehydration culminates in the loss of electrolytes. Not only Na+ K+ but also Ca2+and Mg2+ are also substantially lost and lead to symptoms and adds to morbidity and prolong hospitalization. Methods: In this observational study, a total of 100 cases of acute gastroenteritis admitted to the department of general medicine and infectious disease ward of VIMSAR, Burla, between November 2018 to December 2019 were investigated clinically and biochemically and data were interpreted statistically. Results: Males (56%) were more in number than females (44%), were mostly in the age group of 26-35 years (24%). Hypocalcemia, hypokalemia, hypomagnesemia, and hyponatremia were found in 97%, 59%, 49%, 48% of cases respectively. Correlation of Serum Ca2+with (r-value) total episodes of vomiting (-0.536), total episode of stools (-0.880), S. Na+ level (-0.374), S. K+ level (-0.729), with the duration of hospital stay (-0.770) respectively. Correlation of S. Mg2+ levels with (r-value) total episodes of vomiting (-0.475), total episode of stools (-0.498), S. Na+ level (-0.301), S. K+ level (-0.801), duration of hospital stay (-0.699) respectively. The correlations were found to be statistically highly significant (with a p-value is <0.01). Conclusion: Early detection and prompt correction of electrolytes will be beneficial, as it will decrease the duration of hospital stay, morbidity, mortality, thereby, decrease the burden on the health system of the country

Vaginal progesterone in prevention of preterm labour

Introduction: Preterm birth, defined as childbirth occurring at less than 37 completed weeks or 259 days of gestation since the first day of a woman’s last menstrual period, is one of the leading causes of neonatal morbidity and mortality. Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born. Out of 27 million babies born every year (2018 data ) in India, 3.5 million babies born are premature. Recent literature review has shown that the use of Progesterone reduces risk of preterm birth. But there is little information available regarding the role of Progesterone in preventing preterm labour. Objectives: Primary objective of the study is to find out the incidence of preterm labour among pregnant women taking vaginal progesterone. Secondary objective is toassess the safety and efficacy of progesterone in feto-maternal outcome. Methods: This is a cross sectional study where100 prescriptions from IPD of Dept of O&G, VIMSAR, Burla of women who had recently undergone labour with singleton gestation and with previous history of preterm labour were analysed. Incidence of preterm labour among those taking and not taking vaginal progesterone were compared. Results: There was decreased incidence of preterm labour as there is prolongation mean Gestational age by 9.383 weeks among pregnant women taking vaginal progesterone. Conclusions: In the present study, women taking vaginal progesterone had significantly lowered incidence preterm birth rate