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Abstract

AIM: To study the prescribing pattern in an Intensive Care Unit (ICU).

METHOD: A prospective - observational study on prescription pattern was done in the ICU Department of a tertiary care teaching hospital in Bangalore for a period of 6 months. All patients admitted in the ICU above 18 years were included in the study and patients who were admitted in ICU for less than 24 hours were excluded. Patients satisfying Inclusion criteria were enrolled after obtaining Informed Consent (IC) and their medication orders were observed for Prescription Pattern and analysed.

RESULTS and DISCUSSION: A total of 120 cases were observed and analysed in which 45% were females and 55% were males. Majority of the patients belong to the age category of above 50 years. A total of 1165 drugs were prescribed out of which 20% were antibiotics followed by broncho dilators (9.2%), anti-hypertensives (9.4%), corticosteroids and analgesics (7.4%) each, anti-diabetics (5.6%), antidotes (1.6 %) and others (38.8%). Antibiotics were the uppermost class prescribed, among which Ceftriaxone or Cefaperazone -Sulbactum combination was widely found. Atropine (52.6%) was the most commonly prescribed antidote. Among bronchodilators, combination of anti-cholinergics and beta blockers was prescribed more (49%). Short acting glucocorticoid and para- aminophenol derivatives with 81.6% and 85% respectively, were the most prescribed corticosteroid and analgesics.

CONCLUSION: The results of the study highlights areas that need improvement among which most importantly, there is a need to implement local antibiotic management program or infectious disease specialist consultation which could lead to marked reductions in antibiotic consumption. There are considerable variations in the practice of emergency medications by various professionals in the ICU, hence preparation and implementation of emergency medication practice guidelines may bridge the variations among practitioners and continually improve the quality of care to the patients.

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AIM: To identify the socio demographic determinants associated with selfmedication practice in the population of selected area.

METHODOLOGY: A community based cross sectional study was conducted in East Bengaluru area over the period of 6 months using pre tested semi structured questionnaire.The subjects were asked to recollect self medication practice for one year recall period.

RESULTS& DISCUSSION: The data on socio demographic characteristics and practice of self medication were collected from 427 study participants. A significant correlation was observed particular age group ( 24 - 30 years)[Prob>F = 0.0056, Prob>|t| = <0.0001]; while a moderate correlation for education[Prob>|t| = <0.0001], occupation [Prob>|t| = <0.0001] and economic status[Prob>|t| = <0.0001] of the survey respondents. And no particular correlation was observed for gender, familial types and the area of domicile of the participants.

The frequency of self medication use ranged from minimum of one time to all the time.Fever (68.67%), pain (54.56%), and cough (42.15%) were the most common illnesses where self-medication is common. Pain killers (68.85%) and antipyretics (50.58%) were the most commonly used self medicating drugs. Telling the symptoms to pharmacist (89.69%) was the commonest method adopted to procure drugs by the users. The major reason for self medication was lack of time to visit doctor (32.31). Only 33.34% of the subjects agree self medication is harmful; but most of them (66.97%) did not advise others to use self-medication drugs.

CONCLUSION: Self medication is more prevalent among the younger population of the respondents, irrespective of their educational backgrounds andeconomic status. A newer approach to connect with andeducating these consumers is essential.

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Aim: The aim of this study is to assess KAP of TB patients in DOTs centers

Methodology: A Prospective-Educational Interventional study on 113 patients, receiving DOTS therapy was conducted on DOT's centres in Hoskote region for a period of six months.Patient's level of knowledge attitude and practice were assessed using suitable KAP questionnaire.

Result & Discussion: Out of 113 patients studied, 46.9 % (N=53) were found to have poor KAP, 52.2 %( N=59) were found to have medium KAP and 0.88% (N=1) were found to have high KAP during the baseline interview. Only sixteen percent of the respondent's family had acceptable attitude whereas eighty two percent of the respondents had non-acceptable attitude. From the study it was clear that there is still a need to strengthen the educational activities on TB through mass media; they are excellent venues for information-dissemination and pharmacist assisted care/counseling.

Conclusion: The prospective-educational study revealed that although knowledge regarding curability and duration of treatment were satisfactory, but knowledge about symptoms, mode of transmission, preventive measures, life style modifications were not up to the mark. There is still a great need to educate individuals on priority basis.

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Here report a case of TEN in 23 year old male following the ingestion of Tab. Nimesulide. Nimesulide is a nonsteroidal antiinflammatory (NSAID) drug with antipyretic and analgesic properties. There have been very few previous reports of SJS/TEN induced by the ingestion of Nimesulide in the medical literature.

The patient was managed aggressively with parenteral corticosteroids, antimicrobial drugs, emollients, nutritional supplement and palliative care. This case highlights the importance of Nimesulide and other NSAIDS as the possible cause of SJS/TEN. Nimesulide has never been approved for use in countries like USA, UK, Canada, Australia, New Zealand, Japan and other countries in view of concerns over its safety profile.

However, in India, due to paucity of data, the drug is rampantly used and available as OTC product. Government of India and Regulatory Authorities should createawareness among practitioners to report all the ADRs to the Adverse Drug Reactions Reporting Centers.

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The lactic acidosis due to linezolid has been linked to injury to hepatic mitochondria and with microvesicular steatosis, but is usually rapidly reversed with withdrawal of therapy.

This case report is about a 70 year old female patient admitted in the Medical Intensive Care Unit (MICU) with the complaints of vomiting since two days,difficulty in breathing , facial puffiness and decreased urine output.ABG(Arterial Blood Gas) analysis showed elevated potassium,low sodium and correction started for the same.

Patient had a history of taking tablet Linezolid and tablet Diclofenac since one month status post her spinal surgery. On the second day of admission in MICU, the patient was found to have Linezolid induced lactic acidosis from the ABG analysis with lactate 87mmol/L and HCO₃-18mEq/L and linezolid was withheld.

Lab results also showedanemia,thrombocytopenia,abnormal creatinine , blood urea nitrogen values and bone marrow suppression after the admission.Anemia and thrombocytopenia was treated using thiamine adjunctive therapy from day 2.Urine culture test showed presence of Amp C Klebsiella(colony forming units-CFU=80,000) and was prescribed Injection Clindamycin 600mg and Meropenem((1gm every8hourly).

Acute Kidney Injury(AKI) was suspected but resolved with dialysis. As the patient's condition improved she was shifted to the general ward on the 8^th day but was found to have tachypenia and bradycardia thus intubated and mechanically ventilated.Gradually she became better but pleural effusion was noted in lung scan,tap was done and was transudative in nature.Therefore patient was extubated and later on 11^th day urine culture sensitivity showed Candida tropicalis(greater than 1 lakh fungal colonycount-FCC) for which Injection Fluconazole(400mg)was started.In the general ward her treated continued with intravenous antibiotics,regular medications and other supportive measures,improved with the treatment and was discharged in a stable condition.

Conclusion: Physicians should be aware about the adverse effects of antibiotics and closely monitor for the effects before starting longterm therapy of antibiotics.

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However, as these factors became more prevalent and competition within the industry intensified, many hospitals have been becoming increasingly aware of the critical needs of controlling the operating costs and meet and even exceeds the expectations of patient care quality.

This paper presents a model of Lean Six Sigma(LSS) to prove crucial in improving patient care, reducing costs, and ensuring sustainability by providing high-quality, reliability and care in patients. Six Sigma in healthcare simply means “a measure of quality that strives for perfection through a disciplined, data-driven approach and methodology for eliminating errors in patient health outcome” .

Lean and Six Sigma are typically combined in health care because they address two related, but separate, issues. Lean's concentration on cost reduction and efficiency is a perfect complement to Six Sigma's pursuit of accuracy and precision.

Methodology involves five step problem solving approach known as DMAIC:(Define, Measure, Analyze, Improve and Control). Organisation team for a six sigma process are divided into different belts based on their knowledge and experience.(Yellow, green, black, master black and champ).Benefits includes increased patient satisfaction and care, Increased prescription accuracy, Reduced waiting time and variation, Increased physician satisfaction, Reduced cost and savings, Fewer medication errors. A Lean Six Sigma project was carried out by a mid-sized hospital to change the policies and practices for minimizing following Medication Errors like route, patient related ,drug related, frequency, dose, omission.

The project team combined lean methods and Six Sigma techniques in the error reduction process. The results shows reduction in the medication errors from the month of February to June.

The DMAIC methodology, a consistent and standardized way of problem solving as used in Six Sigma method was applied throughout the organization. Through this method healthcare organizations can improve patient outcomes, and at the same time can remain competitive by cutting costs, better time management, reducing medication errors and improving quality.

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History: With a history that stretches as far as 510 B.C. when Pythagoras noted potentially fatal reaction of fava beans only on select individuals, the application of pharmacogenetics has come a long way and the recent attention is focused on the potential use of Single Nucleotide Polymorphism (SNPs) to determine the individual drug response.

Current Scenario: The current scenario shows effective application of the concept of Pharmacogenetics in various fields like: (a) drug therapy where one such example is identification of the genetic defect underlying some patients with neonatal diabetes, (b) drug discovery (c) drug disposition study like effect of CYP2D6 genotype on the efficacy of tamoxifen for metastatic breast cancer. Also recently there are FDA-approved Drugs, like Abacavir and Amitriptyline, with pharmacogenetic information in their labeling which contain information on genetic biomarker and can describe (a) Drug exposure and clinical response variability (b) Risk for adverse events (c) Genotype-specific dosing (d) Polymorphic drug target and disposition genes. With the immense advantages of pharmacogenetic application on pharmacovigilance, it is an opportunity for a country like India to tap its intellectual resources for improving health care system. It could also help minimize failure rate and reduce economic burden in drug discovery programs. Even those drugs which might have failed in the early stages of clinical trials could be revived to test in different pharmacogenetic background of cell lines, animal models, or human populations.

Limitations: Despite the prospects, this approach for individually targeted drug therapy can be expensive and impact access to drugs, whereas, studies targeting certain groups within population need to be carefully implemented as generalized assumption on genetic variation might not always hold true. With the rapid growth in technology, the future of pharmacogenetics looks bright and affordable and the system of generic drug dealings further strengthen the scope of drug response monitoring based on pharmacogenetic profile of Indian population.

Conclusion: Pharmacogenetics has clear potential to influence the practice of medicine. The selection of drugs based upon a one-off acquisition of genetic information has the potential to facilitate the selection of the most efficacious drugs at the optimal dose, and avoid many severe adverse effects.

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Here a case of GBS in 50 year old women with past medical history of paresthesia was reported .According to medical literature the incidence of GBS is very rare syndrome. The patient was diagnosed with GBS with lumbar puncture that indicated albuminocytogical dissociation, a characteristic of GBS. The patient was managed with anticoagulant, anticonvulsant, anti-arrhythmic, digestive enzyme, nitrogen mustard- alkylating agent , chemoprotectant, antiemetic, PPI, gastro protectative agent along with plasmapheresis. The importance of correct diagnosis by the physician and the subsequent management is reviewed.

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PURPOSE OF THE STUDY: India is marked as world's highest Tuberculosis (TB) burden country in the year 2014 with an estimated incidence of 2.2 million cases.Patient adherence to the standard anti-TB therapy in developing countries has been estimated to be as low as 40%. Therefore we found our study is relevant to the situation.

DESIGN AND METHODOLOGY: A prospective- Educational Interventional study was conducted among 113 patients across DOTs centers in and around Bengaluru. Patient's level of knowledge, attitude and practice towards TB were assessed by conducting structured interviews using suitable validated KAP (Knowledge Attitude and Practice) questionnaire.

RESULT:Of the 113 patients, 46.9 % were found to have poor KAP, 52.2 % were found to have medium KAP and 0.88% of patients were found to have high KAP during the baseline interview.

IMPLICATION AND VALUE OF THE STUDY: A more comprehensive approach for patient education, incorporating easier access to drugs and emphasizing on motivating patients to come to the clinic to receive therapy are essential for completion of treatment course among TB patients.

CONCLUSION: Hence this study assessed level of Knowledge, Attitude and Practice (KAP) among patients with tuberculosis and revealed the need for providing more knowledge about tuberculosis and medications among patients.

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Abstract

Aim : The aim of case series is to describe the 3 Hemoglobin E ß-thalassemia cases, which are unique and requires special care and attention to diagnose/manage. Its natural history is little known, and also the reasons for their clinical diversity, or/and its management.

Presentation of case : 3 cases of transfusion dependent Hemoglobin E β -thalassemia major were included in the study. The patients reported similar complaints of weakness and delayed milestones. The patients were on regular red blood cell transfusion and iron chelation therapy from the age of 3 years. The beta-globin gene defects were defined in all the cases using similar techniques. Thalassemia mutation analysis by reverse clot blot testing showed a compound heterozygous for IVS 1-5 [G-C] and codon 26 [G-A] beta E mutation in the beta globin gene. Evaluation for iron overload showed severe cardiac iron deposit and severe hepatic iron deposit on MRI T2. During hospital stay, the patients received antibiotics and immune-suppressants in common.

Discussion & Conclusion : Patients are treated by lifelong blood transfusion every 15 to 30 days along with iron chelation therapy. Repetitive transfusions cause iron overload, with life-threatening complications, like such as cardiomyopathy, endocrine disorders, liver failures and, ultimately, premature death.Awareness, education and screening play the most important part in the prevention of life-threatening complications and control of thalassemia.

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