Patna, India
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Pathak A.K.,IGIMS | Kumar M.,IGIMS | Mohan L.,IGIMS | Dikshit H.,IGIMS
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Skin diseases are the major contributors of disease burden in society. It affects individuals of all ages, neonates to elderly. Owing to its chronic nature, it causes serious impact on quality of life and financial status of the sufferer and his family. The problem gets compounded with the inappropriate and irrational use of medicines. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and curb the menace of irrational prescribing which has become a global phenomenon. Aim: This study aims to determine the drug utilization pattern and assess the economic burden of the patient with skin disease. Materials and Methods: It was a prospective, cross-sectional study conducted over a period of three months from January to March 2015 in newly diagnosed cases attending outpatient department of Skin and VD, IGIMS, Patna. The prescriptions were analysed with the help of descriptive statistics and results were expressed in percentage. Results: Total 752 prescriptions were analysed during the study. Male patients were lesser as compared to female as male to female ratio was 0.88. Over 50% of patients were in adolescent age group i.e. 21-40 years. Acne (17.95%) was most common disease in the study population followed by eczema and Dermatophytosis. Among the drugs, antihistaminics (24.13%) were prescribed most frequently followed by antifungals and antibiotics. Topical agents constituted almost 60% of the total prescription and average number of drugs per prescription was 5.13, irrespective of the dosage forms prescribed. Conclusion: This drug utilization study provides an insight to the prescriber regarding various issues related to polypharmacy, cost analysis and prevalent disease pattern in the region. This study also suggests periodic evaluation of prescription pattern to monitor and improve quality of prescription in other departments of the hospital. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.


Pathak A.K.,IGIMS | Kumar M.,IGIMS | Dokania S.,Monitoring Center | Mohan L.,IGIMS | Dikshit H.,IGIMS
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Pharmacovigilance (PV) is related to detection, assessment, understanding and prevention of Adverse Drug Reactions (ADRs) which are incurred when drug is made available in the market and used in different physiological conditions. In many countries, ADRs ranks among the top ten leading cause of morbidity and mortality. There is a lack of formal culture for monitoring and reporting of ADRs in India, with ADR reporting rate being only 1% as compare to 5% in world. This type of academic detailing activity helps to create awareness of ADR reporting in the institutions. Aim: This study was planned to evaluate and analyse the incidence and patterns of ADRs in various inpatient and outpatient departments of hospital. Materials and Methods: This was an observational, retrospective and record based study conducted by analysing the spontaneous ADR forms, collected over a period of 12 months (September 2014 to August 2015) at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Results: During the period of one year, 292 ADR forms were collected from 4,34,965 patients attending OPD and inpatients of the hospital. Incidence of ADR was 0.67 per thousand patients and average of around 24 ADR collected per month. Male:Female ratio was 1.30. Adolescent (16-30 yr) was the most common age group affected. Department of Skin and VD reported the maximum number of ADRs (33.22%), followed by the Departments of Oncology (18.84%). Antibiotics were the most common drug implicated followed by anticancer drugs. Conclusion: ADR reporting is an ongoing and continuous process. Studies from the institute helps to identify and rectify the problems related to ADR reporting. Pitfalls can be addressed by creating awareness among physicians and the patients to achieve finally the goal of Pharmacovigilant India. © 2016, Journal of Clinical and Diagnostic Research. All Rights Reserved.


Ranjan N.,IGIMS | Singh R.P.,IGIMS | Kumari A.,IGIMS | Upadhyay R.,IGIMS
International Journal of Urological Nursing | Year: 2016

Female urethral stricture (FUS) is a distressing disease in the field of urology both for the patient and for the health care provider. It has been treated using various techniques such as urethral dilatation (UD), urethrotomy and urethroplasty. The disease's recurrence after urethral dilation, however, is not uncommon. Female urethroplasty carries the risk of stress urinary incontinence, and long-term studies on its success are lacking. We present our study of treating FUS by repeated UD in a dedicated cystoscopy and dilation clinic managed by nurses. After the initial cystoscopy and dilation of FUS to 30 Fr, patients were followed up with in the dilation clinic at regular intervals. Over the past 5 years, 190 patients have been treated at our cystoscopy and dilation clinic and at are various stages of follow up. We find that the primary treatment of FUS by nurses at our institute leads to improved outcomes. Nurse-led cystoscopies have been in vogue in Australia and the UK for some time now. There is an urgent need to expand the conventional indications of nurse-led surgical interventions in order to allow medical care to reach the community at large. © 2016 John Wiley & Sons Ltd. and BAUN.


Kumar S.,SRMSIMS | Pathak A.K.,IGIMS | Saikia D.,AIIMS | Kumar A.,SRMSIMS
Journal of Clinical and Diagnostic Research | Year: 2015

Introduction: Metformin is a preferred drug for starting treatment in type 2 diabetes mellitus. But, eventually most of the patients need additional drug to control blood sugar level. The choice of drug depends upon several factors including patient specific criteria, economical factors and treatment satisfaction. Aim: The aim of the present study is to investigate the effects of adding sitagliptin or glimepiride on efficacy, safety and treatment satisfaction in patients with type 2 diabetes mellitus. Materials and Methods: It was a retrospective observational study on 50 patients each in sitagliptin and glimepiride group, who are receiving treatment for at least 12 weeks and are stable on respective treatment regimen. Glycated haemoglobin (HBA1c) was the primary measure of efficacy. Safety was assessed by checking weight gain/loss, hypoglycaemia episodes and other laboratory investigations. Patient satisfaction was assessed by Diabetes Treatment Satisfaction Questionnaire. Results: The HbA1c level after 12-24 weeks of treatment was not found to be significant compared to each other or from baseline. Compared to baseline fasting plasma glucose & postprandial plasma glucose were lower in glimepiride group. Sitagliptin was associated with less episodes of hypoglycaemia. Weight gain was associated with glimepiride but it was non-significant (p=0.08). Overall treatment satisfaction score were better for sitagliptin but were not statistically significant. Conclusion: The efficacy of sitagliptin was comparable. Sitagliptin had superior adverse effect profile with less chances of hypoglycaemia and weight gain. Questionnaire scores were higher for sitagliptin indicating better treatment satisfaction compared to glimepiride. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


Priyadarshi R.N.,IGIMS | Anand U.,Paras HMRI Hospital | Pandey M.K.,Paras HMRI Hospital | Chaudhary B.,AIIMS | Kumar R.,Paras HMRI Hospital
Journal of Clinical and Diagnostic Research | Year: 2015

Gartric lipomas are rare. They are mostly small in size, and usually remain asymptomatic. We report a case of giant (14×11cm) gastric lipoma in a 46-year-old male who presented with features of gastric outlet obstruction clinically mimicking gastric malignancy. Upper endoscopy showed a large smooth polypoid mass with broad base arising from posterior wall of gastric antrum with areas of superficial ulcerations. Multiple endoscopic biopsy specimens were nondiagnostic. A computed tomography (CT) scan of the abdomen revealed a huge cauliflower- like intraluminal mass with lobulated surface projecting into gastric lumen and pyloric canal. The mass demonstrated uniform fat density consistent with lipoma. The case is presented to stress the diagnostic problems related to this condition, and emphasize the role of CT in arriving at a correct diagnosis of lipomatous gastrointestinal tract tumours. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


Shraddha J.,JNMC | Priya M.,IGIMS | Sunil K.,JNMC
Indian Journal of Otolaryngology and Head and Neck Surgery | Year: 2013

We report a case of melanocarcinoma of sino-nasal region in a 42 year old female who presented with brownish-colored sino-nasal mass involving left orbit, spontaneous epistaxis, facial swelling on left side, and ulceration of overlying skin, cervical and distant metastasis in liver over a short time span of 3 months. On biopsy, the mass was diagnosed as melanocarcinoma of nose and paranasal sinuses. Primary mucosal malignant melanoma of the nasal cavity, paranasal sinuses, and nasopharynx is an aggressive disease and fortunately rare with current research data being mainly from western populations. The disease is known to be more common among elderly population in their seventies and to follow a prolonged course due to innocuous symptoms. This case is being reported for its rarity in our geographical region, early age of presentation and rapid progression of the disease over a span of 3 months. © 2012 Association of Otolaryngologists of India.


Kumar M.,IGIMS | Mohan L.,IGIMS | Dikshit H.,IGIMS
Journal of Clinical and Diagnostic Research | Year: 2014

Background: Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARBs) has been a major therapeutic advance in the management of hypertensive patients. This study was designed to compare adverse effects on renal markers in treatment with two commonly used drugs Perindopril and Telmisartan in cases of Hypertension. This was an 'observational' and 'cross-sectional' study. Methods: This study was conducted in two groups, Group A (Newly diagnosed hypertensive patients) and Group B (Old but poorly controlled hypertensive), each had 100 patients. In both groups, half the patients were given Perindopril 4 mg OD and half were given Telmisartan 40 mg OD for 24 weeks. If blood pressure was not controlled, dose was titrated to response and increased to 8 mg OD and 80 mg OD for Perindopril and Telmisartan respectively to keep mean arterial pressure between 90-115 mmHg. The adjusted dose was kept constant in both groups. Blood urea, serum creatinine and creatinine clearance was estimated initially and then at 4th, 12th and 24th week. Results: Treatment with Perindopril showed that mean baseline values for blood urea, serum creatinine and creatinine clearance in newly diagnosed and old hypertensive patients were 30.88, 1.37, 64.09 and 33.68, 1.53, 55.98, respectively. After study period these values were 32.24, 1.40, 63.97 and 29.80, 1.46, 59.23 respectively (p value > 0.05). Treatment with telmisartan showed that mean baseline values of blood urea, serum creatinine and creatinine clearance in both group of patients were 30.88, 1.52, 59.31, and 31.72, 1.40, 65.67, respectively. After treatment these values in both groups were 31.92, 1.43, 62.66; and 32.20, 1.46, 61.70, respectively (p value > 0.05). Conclusion: It concluded that both Perindopril and Telmisartan significantly reduces systolic, diastolic and mean arterial pressure without any significant effect on renal function in both newly diagnosed and old hypertensive patients.


PubMed | IGIMS
Type: Journal Article | Journal: Indian journal of clinical biochemistry : IJCB | Year: 2012

Usually CPK, CK-MB and lactate dehydrogenase (LDH) enzymes are measured in blood during the period of myocardial infarction. The changes in LDH assay indicates duration of the infarction.The level of lactate dehydrogenase is 500 times greater in tissue than those found in serum. A small mass of damaged tissue causes leakage of enzyme and increases its level in serum.Any cause of tissue break down/hemolysis which is sufficiently severe can produce LDH pattern similar to that in myocardial infarction.We report this case of small bowel volvulus showing significant increase in LDH.It may be due to tissue necrosis which increases the level of LDH in serum.


Opioids are widely used in conjunction with local anesthetics as they permit the use of lower dose of local anesthetics while providing adequate anesthesia and analgesia. It both provides adequate anesthesia as well as lower drug toxicity neuraxial administration of opioids in conjunction with local anesthetics improves the quality of intraoperative analgesia and prolongs the duration of postoperative analgesia. Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects. The present study was conducted to decrease the overall dose of local anesthetics with opioid combination for urological procedure with respect to quality of anesthesia and recovery with patients satisfaction.The study population was randomly allocated by computer generated table into two groups; Group A: 5 mg 0.5% bupivacaine + 25 mcg and Group B: 5 mg 0.5% bupivacaine + 25 mg butorphanol.Highest level of sensory block was T9 and T8 with the fentanyl group and butorphanol group, respectively. The onset of sensory block was early in fentanyl group than butorphanol group. Duration of both sensory and motor block was significantly higher in butorphanol group. There was no incidence of itching in both groups. There were two patients in fentanyl group and one in butorphanol with hypotension for which injection mephentermine was given. Two patients in fentanyl group complained of nausea and vomiting, for which injection ondansetron was given. One patient complained of pain in fentanyl group for which injection propofol with injection fentanyl was supplemented.Low-dose bupivacaine with butorphanol group was devoid of any side effects in the present study but low dose bupivacaine in addition with fentanyl is superior in terms of early postoperative recovery resulting in early discharge and better outcome in comparison to bupivacaine and butorphanol group, which is beneficial in elderly patients with comorbidity.


PubMed | IGIMS and Senior Resident
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2014

Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARBs) has been a major therapeutic advance in the management of hypertensive patients. This study was designed to compare adverse effects on renal markers in treatment with two commonly used drugs Perindopril and Telmisartan in cases of Hypertension. This was an observational and cross-sectional study.This study was conducted in two groups, Group A (Newly diagnosed hypertensive patients) and Group B (Old but poorly controlled hypertensive), each had 100 patients. In both groups, half the patients were given Perindopril 4 mg OD and half were given Telmisartan 40 mg OD for 24 weeks. If blood pressure was not controlled, dose was titrated to response and increased to 8 mg OD and 80 mg OD for Perindopril and Telmisartan respectively to keep mean arterial pressure between 90-115 mmHg. The adjusted dose was kept constant in both groups. Blood urea, serum creatinine and creatinine clearance was estimated initially and then at 4(th), 12(th) and 24(th) week.Treatment with Perindopril showed that mean baseline values for blood urea, serum creatinine and creatinine clearance in newly diagnosed and old hypertensive patients were 30.88, 1.37, 64.09 and 33.68, 1.53, 55.98, respectively. After study period these values were 32.24, 1.40, 63.97 and 29.80, 1.46, 59.23 respectively (p value > 0.05). Treatment with telmisartan showed that mean baseline values of blood urea, serum creatinine and creatinine clearance in both group of patients were 30.88, 1.52, 59.31, and 31.72, 1.40, 65.67, respectively. After treatment these values in both groups were 31.92, 1.43, 62.66; and 32.20, 1.46, 61.70, respectively (p value > 0.05).It concluded that both Perindopril and Telmisartan significantly reduces systolic, diastolic and mean arterial pressure without any significant effect on renal function in both newly diagnosed and old hypertensive patients.

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