PRESCRIPTION PATTERN ANALYSIS OF ANTIDEPRESSANTS IN PSYCHIATRIC OUTPATIENT DEPARTMENT OF TERTIARY CARE HOSPITAL IN INDIA

ABSTRACTObjectives: (1) To study the prescription pattern of antidepressants in treatment of depression in psychiatry outpatient department of tertiary carehospital in India, (2) to find the change in drug therapy during last 1 year of the treatment (old patients), (3) to study reason for a change in drugtherapy, and (4) to calculate prescribed daily dose (PDD) of the individual drugs.Methods: It was cross-sectional single centered observational study with a sample size of 284 cases. Case record forms were filled from case paper.Results were analyzed.Results: Monotherapy was practiced in 259 patients, i.e., 91.19% of the study population. A maximum number of patients (n=159, 55.98%) receivedescitalopram monotherapy. Polytherapy was practiced in 25 (8.8%) patients. Out of 160 old cases, 9 patients required a change in drug therapyeither in the form of drug or dose. PDD values were escitalopram: 12.30, fluoxetine: 18.43, paroxetine: 25, sertraline: 96.35, amitriptyline: 57.79,imipramine: 5.75, and mirtazapine: 17.67.Conclusion: From our study, it is concluded that the incidence of depression is more in females. Selective serotonin receptor inhibitors were themost common class of drugs used followed by tricyclic antidepressants. Escitalopram was most frequently prescribed antidepressant followed byamitriptyline. The prescription trend was toward monotherapy. Most patients continued treatment on the same medication. The poor therapeuticresponse was the most common reason for drug change.Keywords: Depression, Prescribed daily dose, Defined daily dose

Pleural Tuberculosis in Patients with Early HIV Infection Is Associated with Increased TNF-Alpha Expression and Necrosis in Granulomas

Although granulomas may be an essential host response against persistent antigens, they are also associated with immunopathology. We investigated whether HIV co-infection affects histopathological appearance and cytokine profiles of pleural granulomas in patients with active pleural tuberculosis (TB). Granulomas were investigated in pleural biopsies from HIV positive and negative TB pleuritis patients. Granulomas were characterised as necrotic or non-necrotic, graded histologically and investigated for the mRNA expression of IL-12, IFN-γ, TNF-α and IL-4 by in situ hybridisation. In all TB patients a mixed Th1/Th2 profile was noted. Necrotic granulomas were more evident in HIV positive patients with a clear association between TNF-α and necrosis. This study demonstrates immune dysregulation which may include TNF-α-mediated immunopathology at the site of disease in HIV infected pleural TB patients

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Not AvailableBluetongue is an insect borne (Culicoides) viral disease of small ruminants. The virus blankets the globe with a wide serotypic variation, numbered from 1 to 28. In India 21 different serotypes have been reported to be circulating across the various agro-climatic zones of the country. Non-structural proteins (NSPs) of bluetongue virus have always remained ideal target for differentiation of infected from vaccinated animals. The current study is an extrapolation of our previous work where a novel fusion construct comprising of bluetongue viral segment NS1 and NS3 was successfully cloned, expressed, purified with an efficient strategy for its suitable implementation as a diagnostic antigen. In this study, the applicability of the fusion construct has been further evaluated and optimised for field applicability. The fusion construct used in an ELISA platform projected a relative diagnostic sensitivity and specificity of 98.1% and 95.5% respectively against a pre-established test panel. The rNS1-NS3 ELISA showed substantially good agreement with the commercial BTV antibody detection kit. Finally, the study brings together the diagnostic capability of two NSPs, which can be a handy tool for sero-surveillance of bluetongue.Not Availabl

Recall rate and positive predictive value of MSUD screening is not influenced by hydroxyproline

Maple syrup urine disease (MSUD) is an autosomal recessive inherited disorder caused by the deficiency of the branched-chain 2-oxo acid dehydrogenase (BCOA-DH) complex. The worldwide incidence is approximately 1 in 185,000. MSUD is integrated in many "expanded" newborn screening (NBS) programs that use electrospray ionization tandem mass spectrometry (ESI-MS/MS). Elevated leucine, isoleucine, and alloisoleucine in the dried blood samples (DBS) of newborns are diagnostic parameters. However, with the applied method, it is not possible to distinguish the amino acids from each other, and also not from the other isobaric amino acid, hydroxyproline. While the branched chain amino acids (BCAA) leucine, isoleucine, and alloisoleucine are no diagnostic problem, because they are all elevated in MSUD patients, and, rather, increase the diagnostic sensitivity and specificity, hydroxyproline may cause false-positive screening results. Hydroxyproline is elevated in the benign familial condition hyperhydroxyprolinemia, which needs no medical intervention. The detection of cases with hyperhydroxyprolinemia have formerly been reported from screening programs that used thin-layer chromatography for phenylketonuria (PKU) screening, and, recently, two more cases have been reported, detected by ESI-MS/MS-based NBS. However, the detection of non-diseases is a heavy burden for screening programs and should be avoided if possible. With optimal settings for the quantitation of BCAAs and interpretation rules, elevated hydroxyproline should not cause false-positive screening results