Journal, Indian Academy of Clinical Medicine最新文献

{"title":"Analyzing Antidiabetes Drug Prescriptions With World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose Index to Assess Drug Utilization Pattern in Elderly Population of Rural Eastern India","authors":"S. Lahiry, Avijit Kundu, Ayan Mukherjee, Shouvik Choudhury, Rajasree Sinha","doi":"10.1177/1177393617703343","DOIUrl":"https://doi.org/10.1177/1177393617703343","url":null,"abstract":"Objective: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. Methods: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. Results: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class (P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. Conclusions: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78133684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I'm Not Sure What Bothers Me in this Chest X-Ray but an HRCT May Help?","authors":"R. Takhar, Ratan Kumar, Motilal Bunkar, M. Singh, Kuldeep C Gupta, Rakesh Biswas","doi":"10.4137/IJCM.S32479","DOIUrl":"https://doi.org/10.4137/IJCM.S32479","url":null,"abstract":"There are some inevitable risk factors of patient exposure to problems arising from human errors, including missed subtle radiological findings, early identification of which may alter the patient outcomes. Here we are discussing a patient who presented with a prior diagnosis of seasonal allergic rhinitis with symptoms assumed to be bronchial asthma. A second review of chest radiograph after discussion over an online platform (Tabula Rasa group on Facebook) revealed some subtle findings which we missed initially. Further workup of the case revealed some astonishing findings. This case illustrates the importance of discussing unsolved cases on online platforms with peers and also to proceed for higher imaging to detect what has been missed on plain radiography.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90699004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Tobaccco and Mortality in India","authors":"P. Mohan, H. Lando","doi":"10.4137/IJCM.S25889","DOIUrl":"https://doi.org/10.4137/IJCM.S25889","url":null,"abstract":"This comprehensive review includes large-scale pan-India surveys and regional studies. Every aspect of smokeless tobacco, including variations in social, economic, demographic, gender, and education stratifiers, is presented. This evidence-based presentation thereby provides insight not only to assess the burden but can serve as a base, leading to the development and encouragement of research in closing the existing gaps in knowledge. It can also provide a track to formulate tobacco control strategies as well as to reinforce and potentially guide tobacco control policy aimed at addressing the tailored needs in the Indian context. The recommendations expand the tobacco control spectrum and are the first of their kind in the literature to focus on cessation programs as a paramedical subject to draw the attention of not only policymakers but also to integrate medical and dental educational institutions, health care professionals, and tobacco users to synergistically develop successful tobacco control measures.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83914049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fungal Partial Transverse Myelitis of the Cervical Spine in an Immunocompetent Individual: A Case Report","authors":"G. Kasinathan","doi":"10.4137/ijcm.s22459","DOIUrl":"https://doi.org/10.4137/ijcm.s22459","url":null,"abstract":"This case report describes the presentation of new onset of worsening bilateral proximal and distal upper and lower limb weaknesses for the past three months in a 48-year-old man. His past medical history includes only essential hypertension. He denied any fever, diarrhea, or recent vaccination prior to the onset of his symptoms. He had vague patchy sensory loss in both right upper and lower limbs with no clear dermatomal distribution. The magnetic resonance imaging (MRI) of the cervical spine revealed features consistent of partial transverse myelitis. Cerebrospinal fluid (CSF) analysis showed raised opening pressure with evidence of yeast cells on gram stain examination on three different occasions. His neurological symptoms and signs responded to a two-week course of intravenous amphotericin B and oral flucytosine, but there remained minimal residual neurological deficit.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74738847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbidity Pattern and Outcome of Patients Admitted into a Pediatric Intensive Care Unit in India","authors":"B. Abhulimhen-Iyoha, S. Pooboni, N. Vuppali","doi":"10.4137/IJCM.S13902","DOIUrl":"https://doi.org/10.4137/IJCM.S13902","url":null,"abstract":"Background Intensive care has become very important in the management of critically ill children who require advanced airway, respiratory, and hemodynamic supports and are usually admitted into the pediatric intensive care unit (PICU) with the aim of achieving an outcome better than if the patients were admitted into other parts of the hospital. It becomes important to audit admissions and their outcome, which may help to modify practices if necessary following thorough introspection, leading to better patient outcomes. Objective To evaluate the morbidity pattern and outcome of admissions into the PICU of a tertiary care center in India. Methods A retrospective study in which records of admissions (from August 2012 to June 2013) were obtained from the PICU records. Information retrieved included age, sex, diagnosis, duration of stay in the unit, and outcome. Results Mean age of the studied 341 patients was 40.01 ± 45.79 months; 50.7% were infants and 59.8% were males. The three most common disease categories admitted were cardiovascular disease (41.1%), neurological disorders (12.0%), and respiratory disease (10.0%). The mean duration of stay in PICU was 3.2 ± 4.5 days. The overall mortality rate was 2.1%. Conclusion Mortality is low in our PICU. We conclude that a well-equipped intensive care unit with modern and innovative intensive care greatly facilitates the care of critically ill patients giving desirable outcome. An expansion of the pediatric wards is advocated to enhance cost–-effective management of patients and avoid unnecessary stretch of the PICU facilities.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87680206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mantle Cell Lymphoma: A Report of a Case with a Blend of Atypical Features","authors":"Firyal A Ibrahim, H. Omri, R. Taha, I. A. Hijji, M. Elkhalifa, A. Sabbagh","doi":"10.4137/IJCM.S10608","DOIUrl":"https://doi.org/10.4137/IJCM.S10608","url":null,"abstract":"Mantle cell lymphoma is an aggressive B-cell neoplasm with special clinical and pathological characteristics. As the morphological variants of mantle cell lymphoma are currently acknowledged, a practical challenge for achieving the correct diagnosis is encountered especially when the cytogenetic/molecular data are not widely available. Here we describe a case of mantle cell lymphoma (MCL) presented with a blend of atypical clinical, morphological, and immunophenotypic features that led to an incorrect diagnosis of B-cell prolymphocytic leukemia (B-PLL).","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"162 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84934666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monoclonal Antibodies: A Tool in Clinical Research","authors":"Waliza Ansar, Shyamasree Ghosh","doi":"10.4137/IJCM.S11968","DOIUrl":"https://doi.org/10.4137/IJCM.S11968","url":null,"abstract":"Monoclonal antibodies (MAbs) are an old immunological tool with applications in the fields of immunology, biotechnology, biochemistry, and applied biology. Production of monoclonal antibodies using hybridoma technology was discovered in 1975 by Georges Kohler of West Germany and Cesar Milstein of Argentina. Modern-day research on MAbs from laboratories worldwide is revealing additional applications in diverse branches of sciences. Recently, MAbs have been widely applied in the field of clinical medicine. Currently, MAbs account for one-third of all the new therapeutic treatments for breast cancer, leukemia, arthritis, transplant rejection, asthma, and psoriasis, with many more late-stage clinical trials being conducted. In this review, we outline the (i) production of MAbs, (ii) application of MAbs, (iii) antibody engineering, and (iv) pharmaceutical application of MAbs. The future prospect of this review lies in the applicability of monoclonal antibodies as a molecule for understanding and monitoring the biology of disease and its role in research, clinical, diagnostic, analytical, and pharmaceutical applications.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80146465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocarditis Complicating Pregnancy in Dengue Hemorrhagic Fever","authors":"J. Koshy, M. John","doi":"10.4137/IJCM.S10425","DOIUrl":"https://doi.org/10.4137/IJCM.S10425","url":null,"abstract":"Dengue hemorrhagic fever (DHF) is a spectrum of disease ranging from uncomplicated febrile illness to various devastating hemorrhagic manifestation and refractory shock. Cardiac complication in dengue fever (DF) is not common. Myocarditis has been a known complication of dengue fever. We report the case of myocarditis complicating DHF in a 34 years old female at 36 weeks of gestation with probable fetal myopericarditis.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75664252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Need to Increase Awareness among Urologists regarding the Possible Association between Pioglitazone and Bladder Cancer","authors":"S. Chandru, V. Janarthanan, V. Mohan","doi":"10.4137/IJCM.S10505","DOIUrl":"https://doi.org/10.4137/IJCM.S10505","url":null,"abstract":"No abstract supplied.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86011597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Glasgow Coma Scale Score and QTc Interval in Prognosis of Organophosphate Compound Poisoning","authors":"A. Deshpande, N. Gaikwad, S. Deshpande","doi":"10.4137/IJCM.S9807","DOIUrl":"https://doi.org/10.4137/IJCM.S9807","url":null,"abstract":"We assessed the applicability of the Glasgow Coma Scale (GCS) and the QT interval (QTc) to predicting outcomes in patients with organophosphate (OP) poisoning. In the hospital setting, QTc and GCS were monitored in each patient at admission. Patients with respiratory failure were compared to patients without these complications, and mortality was compared between groups. We found that the group with complications had a significantly longer QTc and a lower GCS score, a higher number of intubations, and worse outcomes (P < 0.05). GCS score and QTc have been shown to be equally good in predicting respiratory failure and hospital mortality in patients with OP poisoning. These results suggest that during initial out-of-hospital care of patients with OP poisoning, it is essential to monitor the QTc and the GCS score. The simplicity and promptness of these methods will allow providers to perform early and effective triage.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90689200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}