ABSTRACT
Background: Polytherapy and comorbidities are a significant component of drug prescriptions in type 2 Diabetes mellitus (T2DM) patients. Irrational prescriptions and increased cost and number of drug therapies in T2DM put a considerable burden on patients as well as health authorities. Drug utilization studies are a very important tool in the evaluation of such prescriptions for logistical planning and medical audit of a health care setup. Aims and Objectives: To determine the drug utilization patterns of Antihyperglycaemic agents in diabetic patients attending medicine outpatient department and to assess average cost per prescription and to assess the economic implication. Materials and Methods: A prospective observational drug audit was carried out between January 2017 to June 2018 to determine drug utilization patterns of antihyperglycemic and other agents in T2DM patients attending medicine outpatient department of Konaseema Institute of Medical Science General Hospital, Amalapuram. The data were assessed using the World Health Organization indicators for drug utilization and analyzed using mean percentage and Chi-square tests. Value of P < 0.05 was taken as significant. Results: Metformin had highest Defined Daily Dose of 0.77 and was the most common drug prescribed both as monotherapy (14%) and in combination therapy with glimepiride (42.5%). Amlodipine (15.5%) was the most common non-diabetic drug prescribed in our patients. Average number of drugs per prescription was 3.05, while average number of antihyperglycemic agents per prescription was 1.81. Average cost per prescription was under rupees 50 in 30% of patients and all drugs were prescribed by their brand names. Conclusion: Metformin should be available in sufficient quantities in health care system for T2DM patients and drugs should be prescribed by generic names to reduce cost of drug treatment.
ABSTRACT
Purpose: To study the trends in collection, storage and utilization of donor corneas in eye banks in India. Methods: The data was collected from 12 eye banks in India that collected more than 1000 corneas per year. The retrospective analysis of the parameters like characteristics of the donor and the host, storage media used, number of eyes collected, number of eyes utilized, causes of non-utilization of the tissue and the procedures performed was done. Results: A total of 20,564 eyes were collected by the 12 eye banks during the year 2013–2014. Voluntary eye donation (VED), and hospital cornea retrieval program (HCRP) contributed to 59.6% and 40.4% of tissue procurement respectively. Whole globe enucleation (52.3%) was more commonly performed as compared to in-situ excision of the donor corneas. The most commonly used storage media at all eye banks was McCarey-Kaufman (MK) media (83.3%). The utilization rate of the donor eyes was 50.5%. The most frequent indication for corneal transplantation was infection (active infection - 33.13%, healed infection - 10.78%) followed by Pseudophakic bullous keratopathy (PBK) (13.57%). Full thickness keratoplasty (optical penetrating keratoplasty - 47.23%, therapeutic penetrating keratoplasty - 31.74%) was performed most often followed by endothelial keratoplasty (12.41%) in the developing country. Conclusion: VED still contributes to majority of the donor tissue retrieval in India. The majority of the eye banks still utilize whole globe enucleation technique and store tissues in MK media. Trends from previous years showed a change towards HCRP, in-situ excision technique and preservation in the long-term storage media.
ABSTRACT
Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.
ABSTRACT
We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.