Teerthanker Mahaveer Medical College Research Articles

English

The objective of this research is to study the pattern of antimicrobial prescription in outpatient (OPD) and inpatient (IPD) of the Department of Otolaryngology in a tertiary care teaching hospital of North India. This was a prospective study conducted at the Teerthanker Mahaveer Medical College and Research Centre, over a period of 12 months. All the patients who attended the Ear Nose and Throat (ENT) OPD and IPD were included. The results show that out of 4800 patients, only 54% (n=2600) of patients were included in the study on the basis of inclusion and exclusion criteria and 31.25 % (n=1500) were defaulters. Majority of the patients were male 60% (n = 1560). Majority of the patients had suffered from ear disorders, 55% (n=1430). The most frequently prescribed antibacterials were β-Lactams (75.68%) followed by aminoglycosides (9.43%). Among the penicillin group, the commonest drug prescribed was a combination of amoxicillin and clavulanic acid (9.58%), in cephalosporins was cefixime (37.98%) and in aminoglycosides was gentamicin (6.25%). In the concomitant medications antihistaminic were prescribed in 11.53%, proton pump inhibitors in 20.38% cases and NSAIDS in 7.26% cases. The average number of drugs used in each prescription was 2.70. All the drugs were prescribed with trade names. The average cost per prescription per day in OPD and IPD patients were Rs.45 and Rs.185, respectively. Out of 2600 patients; culture sensitivity tests were performed for only 71 patients (inclusive of OPD and IPD). Of which only 43 patients depicted a positive culture sensitivity tests. Our study showed that antimicrobials were mostly prescribed in patients of ear diseases while it was least in throat disorders. Proton pump inhibitors were the most common concomitant drug used. The cost of treatment in IPD patients were 4.11 times more than the OPD patients. Key words: Antibacterial agents, drug utilization, ear nose and throat (ENT) infections, prescribing pattern, pharmacoepidemiology.

Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study

IntroductionThe present study was designed to evaluate the efficacy of clonidine, butorphanol, and tramadol in control of shivering under spinal anesthesia, and to compare their side effects.MethodsThis randomized, prospective study was conducted in 90 patients who developed shivering under spinal anesthesia during various abdominal or orthopedic surgery procedures. On shivering, patients were randomly allocated to receive an intravenous, 1 mL bolus dose of 50 mg tramadol, or 1 mg butorphanol, or 150 μg clonidine, in a double blinded manner. Control of shivering, time taken for cessation, recurrence, hemodynamic changes, axillary temperatures, and side effects were noted and compared for all 3 groups. Collected data were analyzed using appropriate statistical tests.ResultsButorphanol and tramadol were more effective than clonidine in suppressing shivering. Butorphanol, tramadol, and clonidine completely controlled rigors in 83%, 73%, and 53% of cases, respectively, and incompletely suppressed rigors in 16%, 26%, and 46% of cases, respectively. Time taken to terminate rigors was significantly higher for clonidine (3.3 ± 0.9 minutes) than for butorphanol and tramadol (2.1 ± 1.0 minutes and 1.8 ± 0.5 minutes; P < 0.001).ConclusionButorphanol had an edge over tramadol in controlling shivering with lower chances of recurrence, though both were superior to clonidine for this purpose with an early onset of action. We conclude that both these opioids control rigors better than α-2 agonists.

Evaluation of fine needle aspiration biopsy as a diagnostic tool in pediatric head and neck lesions

correspondence: Deepti Agarwal Department of Pathology, Teerthanker Mahaveer Medical college, Moradabad, India Tel +91 983 700 5696 email deeptiagarwal@rocketmail.com Background: Fine needle aspiration (FNA) biopsy is a well accepted diagnostic procedure and considered to be a valuable test for initial assessment of head and neck swellings in adults. The technique has gained popularity in the pediatric population over the last decade, with varying degrees of acceptance rates, accuracy, and results among pathologists. Objective: This study was performed to evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses in children, taking into account the diversity of lesions observed in this subset of the population. Cytologic analysis was correlated with histologic results for evaluating diagnostic accuracy wherever possible. The applicability of FNA biopsy in diagnosing pediatric malignant lesions was also evaluated. Methods: This retrospective study conducted from January 2008 to December 2009 screened all pediatric cases referred to the departments of pathology at two tertiary care hospitals in India. Data from a total of 662 children aged 0–15 years presenting with head and neck masses who underwent FNA biopsy were collected. Cytologic results were interpreted and analyzed according to anatomic site. The lesions were then categorized into inflammatory, infective, and neoplastic. Results: Of the 662 lesions, 23 cases were excluded due to inadequate material, thus the data for 639 cases were finally evaluated. Lymph node lesions predominated, accounting for 570 cases (89.2%), of which 412 (72%) cases were diagnosed as reactive and 91 (16%) cases as tubercular lymphadenitis. Other lesions aspirated were thyroid (18 cases, 2.8%), salivary gland (12 cases, 1.8%), and miscellaneous surface lumps (39 cases, 6.1%). Of all the cases, 628 (98.27%) were reported as benign and 11 (1.67%) as malignant. The positive predictive value of cytologic analysis in diagnosing malignancy was 100%, although exact typing of lesions was possible only on histopathologic examination. Conclusion: FNA biopsy is a sensitive and minimally invasive first-line investigation in the diagnosis of head and neck masses in children. It is highly accurate in isolating and determining potentially neoplastic lesions, thus guiding the way for cases which truly require excision biopsy or other second-line investigations.