Τετάρτη, 9 Νοεμβρίου 2016

Brainstem auditory evoked potentials in the older population

Source: National Journal of Physiology, Pharmacy and Pharmacology
Sangeeta Gupta, Gaurav Gupta.
Background: The central nervous system is no exception to the effects of aging. Physiologic changes due to aging have been suggested to impair the neurotransmission in the auditory pathways. Brainstem auditory evoked potential (BAEP) allows for the evaluation of such age-related transmission delays within the auditory system. Aims and Objectives: The present study, hence, intended to study healthy older subjects to attain a BAEP data normalized for age and gender for this less routinely studied age group. Materials and Methods: BAEP was recorded in 80 healthy normoacusic subjects (40 males and 40 females) in the age group of 41-80 years. BAEP latencies were compared in different age groups by oneway ANOVA. Correlations of latencies with age were performed using Pearson correlation coefficient. Gender differences in the older subjects were studied by unpaired t-test. P


An evaluation of knowledge, attitude and practice of pharmacovigilance among interns in a tertiary care teaching hospital of North Maharashtra

Source: International Journal of Basic & Clinical Pharmacology
Kiran Prabhakar Vakade, Vijayaprasad M. Sangisetti, Mitali V. Binayke, Vijaykumar N. Abhavathi, Bana Bihari Nayak.
Background: Adverse Drug Reactions (ADRs) are considered as one of the leading cause throughout the world resulting in significant increase in mortality and morbidity, therefore its monitoring is very essential in today's practice of medicine. Spontaneous reporting of ADRs have played a major role in the detection of unsuspected, serious and unusual ADRs previously undetected during the phases of clinical trials. Under-reporting of ADRs is considered as one of the major hurdle for the success of pharmacovigilance. Aims and objectives were to assess the knowledge, attitude and practice of pharmacovigilance among interns in a tertiary care teaching hospital. Methods: A cross sectional, observational, questionnaire based study was carried out using a predesigned Knowledge Attitude Practice (KAP) questionnaire. Study was conducted after the permission of Institutional Ethical Committee (IEC). The study included 100 interns who had completed at least ten months of their internship. The KAP questionnaire was assessed and analyzed and data was presented as percentages. Results: On an average only 31.17% interns answered correctly related with knowledge about pharmacovigilance. 88.63% interns agreed that ADRs reporting is necessary. According to 85.22% interns, pharmacovigilance must be taught in details to healthcare professionals. Only 34.09% had ever seen the ADR reporting form. Only 17.04% interns had knowledge about how to report ADR? Conclusions: Our study revealed that there was lack of awareness related with knowledge, attitude and practice of pharmacovigilance among the interns. There is need of implementation of pharmacovigilance awareness programs for undergraduates.


Vomiting, Rifampicin And Collapse

Source: The Southeast Asian Journal of Case Report and Review
Jatinder Mokta, Kiran Mokta, Asha Ranjan.
Adrenal insufficiency is an important life threatening manifestation of tuberculosis. Patient can have insidious onset of symptoms, or acute adrenal crisis depending upon the acute of adrenal deficit. Here we report a patient of tuberculosis who developed acute adrenal insufficiency after initiation of anti tubercular therapy.


Hydatid Cyst Presenting With Inferior Vena Cava Obstruction

Source: The Southeast Asian Journal of Case Report and Review
Jatinder Kumar Mokta, Kiran Mokta, Asha Ranjan.
Hydatid cyst disease is caused by echinnococcus species in humans. Humans are accidental hosts. Here, we present a case report of male with disseminated hydatid cyst disease secondary to spillage of peritoneum with cysts during the previous surgery. He presented with features of inferior vena cava obstruction. We report this case as inferior vena cava (IVC) obstruction is a rare presentation of this common disease of Himalayan area like ours where animals stay at close proximity to humans.


Respiratory Bronchiolitis With Christ-Siemens-Taurine Syndrome

Source: The Southeast Asian Journal of Case Report and Review
Harsha Vardhana Varma, Jayasree Helen, Aruna Kumari Badam, Somnath Dash.
We the present the case of Respiratory Bronchiolitis in whom Christ Siemens Taurine syndrome was also diagnosed after stepwise approach, such kind of rare entity found in this part of the world should be an eye opener for every one.


Gestational Trophoblastic Disease And Its Complications:Review Of Patient Profiles And Management At A Tertiary Care Centre

Source: The Southeast Asian Journal of Case Report and Review
Rajshree Dayanand Katke .
Gestational trophoblastic Disease refers to a spectrum of pregnancy related placental tumors, which is Classified into Hydatidiform Mole and Gestational Trophoblastic Neoplasia. This disease is characterized by abnormalities of chorionic villi in the form of excessive trophoblastic proliferation, oedema of villous stroma, invasion and metastasis. The incidence of Hydatiform mole is 1-2 per 1000 pregnancies. The risk factors are Adolescent and elderly women, Prior molar pregnancy, OC pill use, Smoking, various vitamin deficiency and increase paternal age. Clinical presentation is usually of varing duration of amenorrhea followed by irregular bleeding. Ultrasound appearance is characteristic snow storm pattern i.e a complex echogenic mass with numerous cystic Spaces with no fetus or amniotic sac in complete mole. The two basic tenets for management is Suction Evacuation and regular follow up to detect trophoblastic disease. Most clinicians obtain pre operative x-ray chest hemogram , baseline beta HCG, blood grouping, liver enzymes routinely before suction Evacuation. Prophylactic chemotherapy is routinely not recommended. If no further pregnancy is required, hysterectomy preferred over suction curettage ion women aged more than 40 years. It is also an important adjunct to treatment of chemo resistant tumors. Post evacuation Surveillance is done for a minimum of 6 months using hormonal contraception with beta HCG follow up 48 hours after evacuation and every 1-2 weeks, while still elevated and every month for another 6 months after it falls to normal levels. Gestationla trophoblastic neoplasia almost always develops with or follow some form of recognized pregnancy. Most follow a hydatidiform mole. Invasive mole are localy invasive but generally lack the pronounced tendency to wide spread metastasis. Choriocarcinoma is extremely malignant tumor. Metastasis often develop early in choriocarcinoma and are generally blood borne and most common sites are lungs and vagina. Placental site trophoblastic tumors are rare variant characterized by prolactin producing intermediate trophoblast with relatively low beta HCG, a high proportion of free beta HCG, chemo resistant and hysterectomy being the best treatment. Epitheliod tumors are rare characterized by non conformation of preceding pregnancy, nodular growth and microscopically resembles placental site tumors but the cells are smaller and display less pleomorphism. Risk assessment is done by using modified WHO prognostic scoring system. Score 0-6 generally include low risk neoplasia. In general methotrexate is given for non meta static or low risk metastatitic neoplasia. High risk GTN{score more then 7}usually requires EMA-CO regimen, surgery, radiotherapy. Survillence is one year for GTN and upto 2 years if there is metastasis. The purpose of this study was to study the incidence, epidemiological correlates of GTN, the clinical behavior, the complications and management of this disease in our hospital, and to review the literature on this uncommon disease.


An assessment of antihypertensive drug prescription patterns and adherence to joint national committee-8 hypertension treatment guidelines among hypertensive patients attending a tertiary care teaching hospital

Source: International Journal of Research in Medical Sciences
Rakesh Romday, Ajay Kumar Gupta, Pawan Bhambani.
Background: The new guidelines issued by the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-8) emphasize that aggressive blood pressure (BP) control is essential to reducing morbidity and mortality. Patient non-adherence is a serious obstacle to the effective treatment of many acute and chronic disorders. Successful treatment and outcome of a chronic disease such as hypertension depend on many factors, including resources (e.g., funds, space, and people), avoidance of serious adverse events, patient adherence with treatment plans, and the availability of effective therapies. The aim of this study is to assess the antihypertensive drug prescription patterns and adherence to joint national committee (JNC-8) hypertension (HT) treatment recommendations among hypertensive patients attending a tertiary care teaching hospital. Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year in ambulatory patients attending medicine OPD. A total of 500 prescriptions prescribed to diagnose HT were analyzed. Drug prescription patterns, and their adherence to JNC-8 report was assessed. Results: Out of 500 patients, 299 (59.8%) were male and 201 (40.2%) were female. Mean age of male and female patients were found to be 57.68±15.32 and 61.29±12.65 years respectively. As per present study, most of the physicians prescribed single drug (monotherapy, 34.6%) to control BP followed by two-drug combination (18.4%), three-drug combination (11.8%) and four-drug combination (3%). Two drugs regimen was prescribed in 18.4% of the hypertensive patients. Angiotensin receptor blocker + diuretic combination (4.4%) was mostly used in two drug combination therapy followed by Angiotensin receptor blockers + Diuretics (3.6%) and Calcium channel blocker + ACEIs combination (2.6%). No combination of ACEIs + ARBs was prescribed in any prescription. The overall rate of adherence was 16.5 % (Pre-hypertension); 87.90% (Stage 1 hypertension); and 68.20% (Stage 2 hypertension). Conclusions: In conclusion, present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with comorbid conditions.


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