Assessment of Prescribing Pattern and Safety Profile of Drugs Used in Intranasal Route in Paediatric Age Group of Patients in a Tertiary Care Hospital.

Background Recently there has been an increased preference for intranasal delivery of drugs due to highly vascular nasal mucosa, bypassing first pass metabolism and the blood brain barrier (BBB) lead in quick drug absorption to the systemic circulation and direct access to brain from olfactory region. For pediatric patients this route offers significant benefits over injections or oral routes, like increased compliance, easy administration, and minimal side effects. Objective Assessment of prescription pattern of drugs and safety profile of drugs used by intranasal route in paediatric age group. Method Our study was a prospective observational study paediatric age group of patients conducted in the departments of Pharmacology, Paediatrics and Otorhinolaryngology of Burdwan Medical College and Hospital, Burdwan. Data were collected in CRF and frequency distribution of collected data done. Microsoft Excel 2010 was used for analysis. Result Common age group was infants. Males were more in number. Most common indication was epistaxis. Intranasal drugs per prescription were 1.05. Most commonly prescribed intranasal drug was nasal saline. Nasal decongestant was the most common prescribed medication. Nasal drops were the most common dose formulation. Conclusion Intranasal drug prescribing in our study was mainly aimed for treating local problems, very few being for systemic action. Some prescribing indicators like prescribing by generic name and prescribing from national essential drug lists were acceptable with scope for improvement. Average number of drugs per prescription and antibiotic use was high. Adverse events after intranasal drug use were primarily local and nose related.

Land use and land cover dynamics with special emphasis on shifting cultivation in Eastern Ghats Highlands of India using remote sensing data and GIS.

Continual, historical, and accurate information about the land use/land cover (LULC) changes of the earth's surface is extremely important for sustainable management of natural resources. In this study, historical topographic sheets, IRS P6 LISS-III, and LANDSAT TM images were used to provide recent and historical LULC conditions of the Eastern Ghats Highlands of east India. The supervised classification results were further improved by employing image enhancement and visual interpretation. Ratio Vegetation Index with fuzzy-based possibilistic c-means classification approach has improved the classification accuracy of the shifting cultivated area. Post-classification comparisons of the classified images indicated that the major change consisted of barren land and forestland changing into agricultural land and scrubland. Between 1931 and 2008, forest cover was decreased from 52.7% to 29.6% of total area. There was an increase in the scrub area from 874 (10.4%) to 1269 km2 (15.2%), and agricultural land from 978 (11.7%) to 2864 km2 (34.2%) during the same period. The rate of deforestation was found to be 0.65 km2 per year for reserve forest and 24.50 km2 per year for mixed forest. The shifting cultivated area in the district was 308.7 km2 during 2004, and that has been reduced since then and now is stabilized to 186.4 km2 area. Among this 186.4 km2 area, nearly half is covered by abandoned shifting cultivation. The decadal rate of decrease of shifting cultivated area is 0.15% per year. The shifting cultivated areas were mainly distributed at elevations 580-810 and 810-907 m and slopes 20-30 and 30-40%. Southeast and south facing slopes were preferred for shifting cultivation. Based on the identified causes of the change in shifting cultivation, policy recommendations for their better management were made.

Epidemiology of gynecological cancers in Kamrup Urban District cancer registry.

BACKGROUND: Cancers of the female reproductive system - namely cancer of the cervix, corpus uteri, ovarian, vulvar, vaginal, fallopian tube cancers and choriocarcinoma are an important cause of cancer morbidity and mortality among women worldwide. It is estimated to be the third most common group of malignancies in women. The comprehensive global cancer statistics from the International Agency for Research on Cancer indicate that gynaecological cancers accounted for 20% of the 14.1 million estimated new cancer cases and 8.2 million cancer deaths among women in the world in 2012. The estimation of cancer burden is necessary to set up priorities for disease control. Gynaecological cancers have increased in India and are estimated to be around 182,602 by the year 2020 constituting about 30% of the total cancers among women in India. Among these, cancer of the uterine cervix followed by ovary and corpus uteri are the major contributors. METHODS AND MATERIALS: Cancer is not notifiable in India, so method of collecting information on cancer was active with voluntary participation of different sources including major hospitals, diagnostic centers, state referral board and birth and death registration centers within registry area. RESULTS: A total of 3767 (44%) cases were registered in women out of the total number of 8561 cancer cases during the period from 2010-2014. In case of gynaecological cancers a total of 661 cases of cervical, ovarian and corpus uterine cancers were registered out of the total 3767 female cancer cases (17.5%) for the year 2010-2014.The annual average crude rate in women for all sites of cancer was 117.4 per 100000 population. The corresponding AARs was 166.6. CONCLUSIONS: Women's health issues have attained high concern in recent decades. Utmost efforts should be made to educate women in early cancer detection by creating awareness on risk factors and symptoms.

Detection of multidrug-resistant tuberculosis using MGIT™(TM) and MAS-PCR in Tripura, India.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) poses a global threat that is further compounded by the human immunodeficiency virus (HIV) epidemic. OBJECTIVE: To detect MDR-TB among pulmonary TB (PTB) patients with or without HIV coinfection by isolating and identifying Mycobacterium tuberculosis from clinical samples and performing drug susceptibility testing (DST). METHODS: Sputum was collected from presumed PTB cases. Microscopic examination was performed following Ziehl-Neelsen (ZN) staining and cultured in Löwenstein-Jensen (LJ) medium. First-line anti-tuberculosis DST of the isolates was performed using MGIT™ (Mycobacterial Growth Indicator Tube) and multiplex allele-specific polymerase chain reaction (MAS-PCR). RESULTS: Of 172 study subjects, 59.3% (102/172) were smear-positive and 40.7% (70/172) were smear-negative. In the smear-positive and -negative groups, respectively 62.7% (64/102) and 8.6% (6/70) were culture-positive. DST on MGIT showed a cumulative resistance of 7.1% (5/70) to isoniazid (INH) and rifampicin. More ethambutol (EMB) and combined INH+EMB resistance was detected using MAS-PCR. CONCLUSION: MDR-TB is a problem in Tripura, and culture and phenotypic DST are required for diagnosis. MAS-PCR may provide an alternative rapid screening tool.

Traumatic gut injury: a study of 100 cases in Mymensingh Medical College Hospital.

This study was done to find out the mode of presentations, management options and the factors which dictate the out-come of the patients with traumatic gut injury. It has been carried out in the department of Surgery, Mymensingh Medical College Hospital in 100 patients with traumatic gut injury from January 2009 to December 2010. Most of the patients were within 21-30 years (47%) and male patients were the predominant group (90%). In this study penetrating injury was more common (57%) than non-penetrating (43%) injury as a cause of gut injury. Stab (64.91%) was the main mechanism of penetrating abdominal trauma; while road traffic (58.14%) was the main mechanism of non-penetrating abdominal trauma. Diagnosis was made on clinical presentation, physical examination and some investigations. Abdominal pain (98%) was the chief complain and chief sign was abdominal tenderness (98%) and absent bowel sound (91%). Small gut injury was present in 71% patients, 20% patients had large gut injury and 9% had both gut injury. In small gut, jejunum (49.29%) was the most vulnerable portion and right sided colon (55%) was the most affected portion in large gut trauma. Spectrum of injury in small gut included single perforation (63%), multiple perforations (23%), laceration (11%) and devascularization (3%) injury. Primary repair in 60.87%, resection & anastomosis in 27.54% and resection anastomosis with proximal diversion in 11.59% patients were done in small gut injury. Injuries in the large gut were classified into three categories according to Flint Colon Injury Severity Scoring. Highest incidence was in Grade I (60%) category, second in Grade II (35%) and Grade III (5%) was the third one. Simple primary repair in 40%, primary repair or resection anastomosis with proximal diversion in 30%, loop ileostomy in 20% and Hartman's procedure in 10% were done in patients of large gut injury. Resection anastomosis with proximal diversion was performed in patients of both small and large gut injury. Outcome of management was quiet acceptable with 47% of patients having uneventful recovery. Delayed presentation, delayed definitive management, haemodynamically unstable patient, site and number of injuries in the gut were the crucial factor for the overall 44% morbidities of this series. Morbidity rate was 9%. More than half of the patients (56.04%) discharged from the hospital within 10 days. Only a few patients could be followed up for a few months after surgery, who reported to have a satisfactory outcome with no morbidity.

Tuberculosis of the thyroid gland.

We are reporting a case of thyroid gland tuberculosis presenting as a painless hard nodular swelling of the thyroid with concomitant pulmonarytuberculosis in a 53-year-old adult diabetic male. Fine needle aspiration cytology showed epitheloid cell granuloma without any acid fast bacillus. He made an uneventful recovery with anti tuberculous drugs. Though rare, tuberculosis should be considered as a differential diagnosis of nodular or diffuse enlargement of thyroid gland.

Biophysical and socioeconomic characterization of a water-stressed area and simulating agri-production estimates and land use planning under normal and extreme climatic events: a case study.

This study aims in linking the biophysical and socioeconomic data base layers with the technical coefficients or simulation models for agri-production estimates and land use planning under normal and extreme climatic events, and exploring the resource and inputs management options in village Shikohpur, Gurgaon district located in the northwest part of India. The socioeconomic profile of Shikohpur is highly skewed with mostly small and marginal farmers. Though the areas under wheat in Shikohpur are increasing, the productivity is declining or remaining stagnant over the years. Most of the area during kharif season (June-September) remains fallow. Pearl millet based cropping systems (pearl millet-mustard and pearl millet-wheat) are predominant. Soils are mostly loamy sand to sandy loam with average of 70-80% sand content. Organic C content in soil is less than 0.3%, due to high prevailing temperature with little rainfall and also intensive agriculture followed in this region. Though the annual average seasonal rainfall in Gurgaon did not have much variation over the years, occurrence of extreme climate events has increased in the last two decades. The crop intensity is low and the water table is declining. Water and nitrogen production functions were developed for the important crops of the region, for their subsequent use in scheduling of the inputs. InfoCrop, WTGROWS and technical coefficients were used for crop planning and resource management under climate change and its variability, extreme events, limited resource availability and crop intensification. These will help in disseminating necessary agro-advisories to the farmers so that they will be able to manipulate the inputs and agronomic management practices for sustained agricultural production under normal as well as extreme climatic conditions.

Laryngocoele: our experince.

Laryngocoele is an extremely rare condition. Three cases of Laryngocoeles are presented. Two cases had infected laryngocoeles. The diagnosis was done clinically and confirmed radiologically. No predisposing factor was found except in one case who was a singer by profession and initially presented with stridor which was an unusual presentation. Surgical excision were done in two cases (case 1 and 3)and both the case were symptom free.

Evaluation of quantitative buffy coat (QBC) assay and polymerase chain reaction (PCR) for diagnosis of malaria.

A prospective study was undertaken to compare the Polymerase Chain Reaction (PCR) and Quantitative Buffy Coat (QBC) assay with conventional Giemsa technique for diagnosis of malaria. A total of 104 samples were taken for the purpose. They comprised of fever cases suggestive of malaria (n=74) and control group, fever cases other than malaria (n=30). Peripheral blood smears were prepared by Giemsa staining and QBC assay was performed as per standard protocol. From the stored blood samples, parasite DNA was extracted and PCR was performed using P. falciparum and P. vivax specific sets of primers. The QBC assay was 100% in agreement with the Giemsa stain. Specificity of the PCR detection of P. falciparum parasites was 100%. However, sensitivity for detection of P. falciparum and P. vivax by PCR was 64.28% and 82.35% respectively. In mixed cases of malaria (n=2), PCR results were in 100% agreement with that of Giemsa. The lower sensitivity of PCR for P. falciparum could probably be due to inaccessibility of target DNA, presence of PCR inhibitors in samples and parasite strain variations.

Paraganglioma of external auditory canal.

In the ear, paragangliomas are commonly found in the tympanic cavity or in juglar bulb. We, here, present a case of paraganglioma originating from the external auditory canal as it has not been reported in the world literature. The clinico-pathologic features of such a case has been described.

Latissimus dorsi muscle blood flow during synchronized contraction: implications for cardiomyoplasty.

BACKGROUND: Damage in latissimus dorsi muscle flaps has been reported after clinical and experimental cardiomyoplasty, and an ischemic origin has been suggested. METHOD: In situ, preconditioned latissimus dorsi muscles in 5 sheep were stimulated in either 1:1 (muscle: heart) or 1:2 synchrony with the systolic phase of the cardiac cycle, using a burst duration of either 21% or 35% of the cycle. Thoracodorsal artery blood flow and thoracodorsal venous lactate concentrations were measured before and immediately after a 3-minute period of stimulation. RESULTS: The exercise-induced augmentation of thoracodorsal artery blood flow was significantly (p < 0.05) less with a 1:2 regimen than a 1:1 regimen, for both a 21% (88%; 95% confidence interval [CI], 55.6% to 127.3% versus 138.9%; CI, 97.6% to 188.8%) and 35% burst duration (123.2%; CI, 84.7% to 169.9% versus 167.0; CI, 120.8% to 222.6%). After cessation of stimulation, reactive hyperaemia was observed in 3 of 5 animals with 1:1 21% burst stimulation, and in 5 of 5 animals with a 35% burst duration, but was not seen after 1:2 regimens. A significant (p < 0.01) increase in thoracodorsal venous lactate levels was present after 1:1 35% burst stimulation (34.9%; CI, 9.9% to 65.6%), but lactate levels tended to fall when a 1:2 ratio was used (15.9%; CI, -3.2% to 31.5%; p < 0.1). CONCLUSIONS: One-to-one stimulation regimens may be detrimental to latissimus dorsi blood flow, and an adaptive, rather than fixed, burst duration may be preferable. These findings have important implications for the cardiomyoplasty procedure.

Factors affecting the integrity of latissimus dorsi muscle grafts: implications for cardiac assistance from skeletal muscle.

BACKGROUND: Severe latissimus dorsi muscle damage may compromise cardiomyoplasty performance. We analyzed factors underlying the damage produced in 20 sheep latissimus dorsi muscles by isolating the influences of electrical stimulation, mobilization (with some loss of vascular supply), loss of normal resting tension, or a combination of these. METHODS: In group I (n = 3), the muscle was mobilized except for its neurovascular pedicle and reattached at normal resting length. In group II (n = 3), the muscle was mobilized and reattached at about 80% of resting length. Groups III (n = 6) and IV (n = 4) were as groups I and II except that continuous indirect stimulation at 2 Hz was added after 2 weeks. In group V (n = 4), the undisturbed muscle received stimulation alone. After 10 to 12 weeks, muscle samples were taken for morphometric analysis. RESULTS: Loss of resting muscle tension appeared to be the single most damaging intervention, though mobilization and stimulation had further deleterious effects. The worst damage was seen when all three factors were combined, when 60% of the muscle cross section was occupied by connective tissue and fat. The changes were significantly more severe in the distal than in the proximal part of the muscle, implicating ischemia as a contributory factor. CONCLUSIONS: Fiber damage reduces the effectiveness of muscle grafts used for cardiac assistance and merits further systematic investigation.

Anaesthesia for cardiomyoplasty.

Cardiomyoplasty is a new surgical procedure for the treatment of severe heart failure, but early mortality has been high in the preliminary experience of many centres. This report describes the anaesthetic techniques used for the first two successful cases to be performed in the UK.

Infant mortality trends in Varanasi (rural): 1940-1979.

PIP: Trends in infant mortality in rural Varanasi, India, are analyzed by caste, education, and socioeconomic status of household for the period 1940 to 1979. Data were obtained from the Demographic Survey of Varanasi (Rural), undertaken in 1969-1970. The findings indicate that the infant mortality rate is higher for females, minimum in upper castes, and higher among illiterates.^ieng

Changing pattern of type of households in Varanasi (rural): some preliminary results.

PIP: Changes in the composition of households in rural Varanasi, India, between 1970 and 1980 are examined. Households are classified according to the number of couples each comprises. Categories are: one couple, two couples, three couples, and four or more couples. Data are taken from the Demographic Survey of Varanasi (Rural), conducted in 1969-1970, and from a second survey of the same households in 1979-1980. The authors examine the relationship between changes in the distribution of the different types of household and factors such as caste, education, size of landholding, and size of village. All of these factors are found to be significant. The number of households of each type from which one or more couples departed during the 10-year period is also shown. The greater number of departures has occurred, as expected, from the households originally containing the greater number of couples.^ieng