Tuberculosis in pregnancy

Tuberculosis (TB) is one of the oldest diseases known to affect human being. In 2012, out of the estimated global annual incidenceof 8.6 million TB cases, 2.3 million were estimated to have occurred in India. The disease is responsible for killing more women ofreproductive age than all the combined causes of maternal mortality. The exact incidence of TB in pregnancy is not readily availablein many countries due to a lot of confounding factors. It is, however, expected that the incidence of TB among pregnant womenwould be as high as in the general population, with possibly higher incidence in developing countries. Pregnancy has no positiveor negative impact on TB. The clinical presentation of TB is similar to nonpregnant woman but the diagnosis is often delayeddue to nonspecific early symptoms and has similar constitutional symptoms like malaise and fatigueness found in pregnancy. Thebacteriological diagnosis sample should be processed for tests such as ZN-stain, light-emitting diode microscopy, Gene-Xpert,and gold standard test culture. Treatment of non-multi-drug resistance (MDR) patients should be treated by the same regimen asnonpregnant patients except the use of Streptomycin. The most of the second-line anti-TB drugs are teratogenic and so expectedmother with MDR-TB should be advised to terminate the pregnancy

Knowledge, attitudes, and practices regarding drug allergy among healthcare providers in Eastern India

Background: Drug allergy (DA) or hypersensitivity is an immunologically mediated reaction producing stereotype symptoms which is challenging for health care providers (HCP). Objective of current study was to assess the knowledge, attitudes and practices of drug allergy among healthcare providers in eastern India. Methods: A 25-item self-administered DA questionnaire was developed and applied in our study. The questionnaire covered 3 domains: knowledge, attitudes, and practice patterns. From July 2020 to September 2020, HCPs participated in the cross-sectional study. Results: A total of 237 HCPs participated in the study, and all questionnaires were analysed. Among the respondents, 226 (95.4%) were nurses, 9 (3.8%) were doctors and 2 (0.8%) were pharmacists. The majority of HCPs agreed that drug-induced immediate allergic reactions were IgE mediated 225 (94.9%), occur within 6 hours of drug administration (89.9%), and epinephrine was the first choice for drug-induced anaphylaxis (76.8%). 97.9% HCPs agreed that penicillin skin test was valuable to predict the allergic reaction. More than 80% of the respondents would take patients’ allergic history before drug administration, while 75.5% agreed that they recognize and manage drug allergy timely when it occurs. Conclusions: Drug allergy was often diagnosed and managed inadequately, regardless of practice location, employment status and speciality in eastern India. The HCPs demonstrated a low level of knowledge regarding DA. Advanced education is urgently needed for better understanding and filling the gaps that exist in the knowledge and clinical practice of DA

Unusual cause of chest pain: Thoracic aorta calcification

A 40-year-old woman treated for pulmonary tuberculosis presented with chest pain which was aggravated with exertion without radiation. Chest X-ray shows widening of mediastinum, old healed, and calcified parenchymal lesion. Computed tomography scan showed annular calcification of aorta (solar eclipse sign) with significant narrowing of aorta. The patient responded well with vasodilator nifedipine, and almost 75% reduction in symptoms was seen after 1 month of the treatment

Bilateral cavitary lung adenocarcinoma in a young lady: A rare case report with review of literature

A mucinous variant of bronchioloalveolar carcinoma is described as a rare variant of invasive adenocarcinoma and is characterized radiologically by consolidation, groundglass opacity, and nodules. Here, we report the case of a young lady with multiple cavitary disease presented with respiratory failure and mimicking as tuberculosis, pneumonia, vasculitis but initial laboratory investigations and bronchoscopy couldn’t clinch the diagnosis. Later on, CT-guided biopsy confirmed the diagnosis of mucinous bronchoalveolar carcinoma.  Immunohistochemistry for TTF-1, EGFR, ALK, ROS mutation had been sent but the patient requested to discharge, have been put on EGFR inhibitor Gefitinib 250 mg once a day considering adenocarcinoma, female, Asian origin but couldn’t turn-up to review further details. The clinician should be aware of the cavitary presentation of adenocarcinoma of lung even in younger patients where the most common differential is tuberculosis

A clinico-radiological and pathological profile of lung cancer patients presented to All India Institute of Medical Sciences (Patna)

Background: Lung cancer is one of the most common cancers and cause of cancer-related deaths worldwide. The clinicopathologicalprofile of lung cancer has shown marked regional and geographical variation. Majority of the patients have locallyadvanced or disseminated disease at presentation and are not candidates for surgery. Objective: The aim of this study was toevaluate the clinico-radiological and pathological profile of lung cancer patients and difference in histopathology betweensmoker and non-smoker. We also assessed yield of the various diagnostic procedures used for confirmation of lung cancer.Materials and Methods: A total of 30 patients diagnosed between May 1, 2016, and December 31, 2016. The completedemographic profile, smoking status, clinical, radiological, and diagnostic details were recorded in the study. Data were enteredand analyzed using SPSS software. Results: A total of 30 patients (19 male and 11 female) included in our study with mean age of55.26 years. Cough (80%) and dyspnea (80%) were the most common symptom and mass (86%), pleural effusion (53.3%) was themost common radiological presentation of patients. Clubbing and hemoptysis both was found only in 8 out of 30 (26%) patients.Adenocarcinoma (46.6%) was the most common histopathological type followed by squamous cell carcinoma (16.6%) and smallcell carcinoma (13.3%). The majority of patients (60%) presented in Stage 4. Computed tomography guided biopsy had better yieldin compare to ultrasonography guided (80% vs. 70.8%). Bronchoscopic procedure had lowest yield (38.8%). Conclusion: Theclinicopathological profile of lung cancer has changed in last few years, especially in the increase in adenocarcinoma incidence,and now it is the most common cause in both smokers and non-smoker

KNOWLEDGE, ATTITUDE AND PRACTICES ON ANTIBIOTIC USE AND RESISTANCE AMONG DOCTORS IN B.P. KOIRALA INSTITUTE OF HEALTH SCIENCES

Background: Assessment of knowledge, attitudes and practices (KAP) of antibiotic prescription among doctors may help in developing guidelines to improve antibiotics use and decrease resistance. Aims and objectives: Our aim was to evaluate KAP regarding antibiotic use and its resistance among doctors. Materials and Methods: A cross sectional, questionnaire based study was conducted among the doctors of B.P. Koirala Institute of Health Sciences, Dharan, Nepal between January-March 2016 and their KAP regarding antibiotic use and resistance was assessed by using a five point Likert scale. The data were analyzed by calculating percentage and frequency. Results: Almost half of the doctors (50.2%) used to prescribe antibiotics more than once daily. Nearly two thirds of the doctors (65.3%) received antibiotic education at a formal lecture on ward rounds. Most of the doctors (87.4%) agreed that antimicrobials are overused. One hundred thirty four doctors (42.3%) agreed that patients’ demands for antibiotics contribute to its overuse. Nearly two third doctors (70.7%) believed that locally developed antimicrobial guidelines would be more useful. Most of the respondents (89.9%) wanted more ongoing education on antibiotic use and its resistance. Conclusions: Our study reveals that antibiotics are overused and patients’ demand contribute to this. Locally developed antimicrobial guidelines would be more useful. More CME on antibiotic use and its resistance should be conducted to enhance the awareness among doctors. Keywords: Antibiotics; Attitude; Antimicrobial drug resistance; Knowledge

Prescription pattern in ischemic heart disease inpatients at B. P. Koirala Institute of Health Sciences: a cross sectional study

Background: Drug utilization pattern studies seek to screen, evaluate and suggest appropriate modifications in prescription practices. It would help to make patient care rational and cost effective. Objective was to analyze the drug prescribing pattern for treatment of ischemic heart disease (IHD). Methods: A prospective cross-sectional observational study was conducted in patients of IHD admitted in intensive coronary care unit and medicine ward for the period of six months. Data were collected in preformed case record form. The data were analyzed for drug use indicators, demographic parameters, morbidities, pattern of drug use using Microsoft excel 2010. Results: A total of 145 patients were enrolled out of that 89 (61.38%) were males. The mean age was 60.01±12.71 years and majority (26.89%) belonged to age group of 61-70 years. A total of 1208 drugs were prescribed in 145 patients. Most frequently prescribed drugs were antiplatelet group of drugs 100% encounters, followed by hypo-lipidemics (98.62%). Average number of drugs per encounter was 8.33 and percentage of drugs prescribed by generic name was 5.04%.  Conclusions: IHD was more common in males than females. The most commonly prescribed drug classes were anti-platelet drugs followed by hypolipidemic agents