A drug utilization study of antiepileptic drugs uses in a tertiary care teaching hospital of India

Background: Epilepsy is a disorder characterized by repeated seizures due to the disorder of the neurons. Epilepsy needs life-long medical therapy. It is managed by polytherapy. Drug utilization studies help to determine rational combinations of drug use in epilepsy. Aims and objectives of the study were to analyses the drug utilization pattern of anti-epileptics and common types of epileptic seizures and to determine the safety of antiepileptic drugs (AEDs).Methods: It was a prospective, cross-sectional, observational study. Patients attending neurology epilepsy OPD with h/o seizures and taking at least one antiepileptic were recruited. Data was collected by taking demographic details including brief history of disease, clinical examination and reviewing OPD prescription. Details were recorded in case record form.Results: We recruited 102 participants (57 male and 45 females) of mean age 29.68±10.52. Mean age of onset of epilepsy was 18.9±10.5 years. Among them 77 (75.4%) were diagnosed as generalized tonic clonic seizures and 18 (17.6%) were diagnosed as focal seizures. Monotherapy was given in 31 (30.3%) patients while polytherapy was given in 71 (69.7%) patients. Valproic acid was most commonly used monotherapy (12 patients). No fixed drug combinations were used. Clobazam in 55 (53.9%) patients and valproic acid in 53 (51.9%) patients were prescribed. The other AEDs prescribed were lamotrigine, oxcarbazepine, carbamazepine, lacosamide, zincosamide, perampanel, and phenytoin. All antiepileptics were prescribed in brand name. The prescribed daily dose (PDD) was less than defined daily dose (DDD) as per anatomical therapeutic chemical (ATC) classification. Two adverse effects were reported during study period. They were mood change and blurring of vision in two different patients.Conclusions: The PDD was less than DDD as per ATC classification. Awareness should be created among neurologists to prescribe more generic drugs because of their cost effectiveness. Studies are needed with larger sample size to analyze the drug utilization patterns which helps in the planning of reduction of expenditure for the patient without compromising efficacy

Acute posterior circulation infarct due to bicuspid aortic valve vegetation: An uncommon stroke mechanism

Acute ischemic stroke may be the first clinical manifestation of the underlying cardioembolic source. We are reporting a 28-year-old man presenting with acute posterior circulation infarct due to underlying bicuspid aortic valve disease with vegetation detected by transesophageal echocardiography in the absence of clinical features of heart disease and infective endocarditis. The case report highlights the importance of routine evaluation of cardioembolic sources in all cases of ischemic stroke

Factors associated with poor outcome in tuberculous meningitis; study from a tertiary care referral Centre from South India

Introduction: Tuberculosis (TB) remains a worldwide burden with a large majority of new active cases occurring in underdeveloped and developing countries. This study is an attempt to look into various aspects of the disease that can be associated with the outcome, to promote a timely referral to an appropriate centre. Purpose: To identify various clinical, lab, CSF and radiological variables associated with poor outcome of TBM at the time of discharge. Material & Methods: Demographic data, duration of symptoms before diagnosis, clinical presentation, staging of the disease at the time of admission of all the TBM patients who presented to our centre between December, 2015 and May 2018 were noted. Results of biochemical investigations and brain and spine imaging were retrieved. Outcome at the time of discharge as measured by MRC and mRS grades was correlated to clinical profile, lab, CSF and radiological findings. Results: A total of 100 patients were included. 15 patients died. Subjects with MRC and mRS grades of 2 or more at admission constituted 65% and 93% respectively. At discharge, MRC and mRS grades of 2 or more were found in 29.63% and 39% respectively. Multivariable analysis showed a significant positive association of MRC stage at discharge with MRC stage (p = 0.001) and mRS score (p = 0.001) at admission and Vellore hydrocephalus grade (p < 0.001) when hydrocephalus first identified. Similarly, mRS score at discharge had an independent positive association with the MRC stage (p < 0.001) and the mRS score (p=0.002) at admission. Conclusion: Stage of the disease (MRC) and functional status of the patient (mRS) at admission are the two most important independent factors determining the outcome of TBM patients at the time of discharge

Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India

Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2). Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions