Prithpal S Matreja

Efficacy and safety of add on low-dose mirtazapine in depression.

Objectives: Although antidepressant medications are effective, they have a delayed onset of effect. Mirtazapine, an atypical antidepressant is an important option for add-on therapy in major depression. There is insufficient data on mirtazapine in Indian population; hence this study was designed to study the add-on effect of low-dose mirtazapine with selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD) in Indian population. Materials and Methods: In an open, randomized study, 60 patients were divided into two groups. In Group A (n=30) patients received conventional SSRIs for 6 weeks. In Group B (n=30) patients received conventional SSRIs with low-dose mirtazapine for 6 weeks. Patients were evaluated at baseline and then at 1, 2, 3, 4, 5, and 6 weeks. Results: There was significant improvement in Hamilton Depression Rating Scale (HDRS), Montgomery and Asberg depression rating scale (MADRS) scores (P<0.05) in both groups. Mirtazapine in low dose as add on therapy showed improvement in scores, had earlier onset of action, and more number of responders and remitters as compared to conventional treatment (P<0.05). No serious adverse event was reported in either of the groups. Conclusion: Low-dose mirtazapine as add-on therapy has shown better efficacy, earlier onset of action and more number of responders and remitters as compared to conventional treatment in MDD in Indian patients.

To Assess the Quality of Life (QOL) of Caregivers and Patients Suffering from Chronic Obstructive Pulmonary Disease (COPD)

Rationale: Chronic Obstructive Pulmonary Disease (COPD) is associated with physical and psychological burdens. The impact of disease has been studied on patients but it also has a profound and pervasive effect on family and friends resulting in psychological strain, social isolation, relationship strains and financial strains from the added responsibilities of managing the patients. Few studies have found a significant burden on both caregivers and patients alike, but the data from the Indian setup in lacking. Hence, we designed this study to assess the Quality of Life (QOL) of caregivers and patients suffering from COPD. Methods: A cross-sectional study was carried out with forty-six COPD patients and their primary caregivers. Patients were assessed with St. George’s Respiratory Questionnaire (SGRQ), and WHO-QOL-Bref scores. The caregivers were divided into two groups. Group 1 volunteers were caregivers of patients recently diagnosed with COPD (Last 1 year), whereas Group 2 were caregivers of patients with COPD diagnosed more than 1 year back. The caregivers in both the groups were subjected to Zarit Burden Interview (ZBI) and WHO-QOL-Bref scores. Results: 46 patients and caregivers were enrolled in the study. Majority of patients were over the age of 50 years (55.67 ± 12.45), and 67% caregivers were females. Patients had poor QOL as per SGRQ. The caregivers in Group 1 had significantly lower (p < 0.05) burden as compared to Group 2 as evident by ZBI scores. The WHO-QOL-Bref scores in all the 4 domains were significantly higher in Group 1 which predicts a better quality of life. Conclusion: COPD takes a toll not only on the patient but also the caregiver of the patients. The amount of burden increases as the disease progress with worsening quality of life.

A case report of a spontaneous oesophageal pleural fistula.

We are reporting a case of an asthmatic patient who presented to us with retrosternal chest pain, constipation, and shortness of breath, with features which were suggestive of a hydropneumothorax and shock. On recovery from the shock, the patient was found to have increased chest tube drainage, which was suggestive of an oesophageal rupture. The Computerized Tomography (CT) scan showed a fistulous track. The patient was diagnosed as a case of a spontaneous oesophageal pleural fistula (Spontaneous EPF) on the basis of her clinical and radiological findings.

Comparison of computer simulation and graphical illustration for teaching experimental pharmacology to undergraduate students

Background: Nowadays, medical schools all over the world are incorporating newer methods of teaching experimental pharmacology like computer simulation, besides using graphs, charts, didactic lectures. The present study compared the effectiveness and acceptance of two commonly used methods, namely, computer simulation and graphical illustration in teaching experimental pharmacology to undergraduate medical students. Methods: 90 students of 2nd Prof MBBS were divided into 2 groups and were given either computer simulation or graphical illustration via a cross-over design at two settings, which was followed by a post-test for that particular session. Feedback was taken from the students and the faculty. The data obtained was analyzed using descriptive statistics. Results: The average marks scored by the students in sessions using CAL (67.8%) was significantly high (p=0.008) as compared to teaching by graphical illustrations (60.4%). 71% of students found CAL improved their learning skills better than graphical illustrations. 85% students and 80% faculty agreed that there should be a judicious mixture of CAL and graphical illustrations for a better understanding of drugs. Conclusions: CAL is a beneficial and effective learning tool in teaching experimental pharmacology. For better understanding, graphical illustrations should be used as an adjuvant to CAL.

Comparison of safety and efficacy of Oral Terbinafine with Amphotericin B gel and Sertaconazole cream for the treatment of Tinea Corporis and its effect on quality of life of patients

Tinea Corporis is a superfi cial fungal infection affecting 20-25% of the world’s population. Management involves using topical and oral antifungal drugs. Terbinafi ne has been used commonly for the treatment of tinea corporis to prevent the emergence of resistance combination of drugs is used. Hence, this study was designed to compare the safety and effi cacy of Sertaconazole and Amphotericin B when either is used with oral Terbinafi ne.

Single Layer Versus Double Layer Closure of Uterus during Caesarean Section – A Prospective Study in Index and Subsequent Pregnancy

Background: Suturing of caesarean incision leads to reduction in maternal mortality, suturing can be done in either single layer or double layer. Many studies have shown both of them to be effective, with no conclusive evidence of preference of any one of them. The objective of this study was to compare method of uterine closure by single-layer and double-layer closure keeping in mind the intraoperative and postoperative morbidity in index pregnancy and risk of uterine rupture in future pregnancy. Methods: This prospective randomized controlled study was done from March 2007 to January 2009, a total of 357 women were enrolled for lower segment caesarean section either to single layer (n=188) or double layer (n=169) closure of uterine incision. Primary outcome measures studied were operating time, intraoperative blood loss, and febrile morbidity in index pregnancy and chances of uterine rupture in subsequent pregnancy. Secondary outcome measures were cystitis, wound infection and hospital stay. Results were compared by Chi-square test. Results: Patients with single layer closure had significantly (p 0.05). Operative findings in subsequent pregnancy don’t differ much. Conclusions: Single layer closure was associated with lesser operating time, intra-operative blood loss, febrile morbidity and hospital stay in index pregnancy as compared to double-layer closure.

Prompt Response to single injection of Bevacizumab in a case of Fibrinous Central Serous Choroidopathy (CSC).

Purpose : Central Serous Choroidopathy (CSC) is a disease of young and middle aged adults as a localized detachment of the neurosensory retina. Though the cause of CSC remains unknown, it is believed that abnormalities in choroidal circulation make overlying retinal pigment epithelium dysfunctional, resulting in development of a serous retinal detachment. Subretinal fibrin accumulation is rare but vision threatening association of CSC. Methods : A young 31 years female with acute central serous chorioretinopathy received an Intravitreal bevacizumab (1.25 mg/0.05 ml) injection. At baseline and follow-up visits, patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA), and Optical Coherence Topography(OCT) imaging. Results : Patient showed resolution of fibrin, resolution of intraretinal or subretinal fluid promptly, and improvement in visual symptoms and acuity within 1 month. At 6 months patient is maintaining 20/20 vision without any recurrence. Conclusions : Intravitreal bevacizumab injection for acute fibrinous central serous choroidopathy may result in prompt resolution of neurosensory detachment and reduction of angiographic leakage. These short-term results suggest that Intravitreal bevacizumab injection may constitute a promising therapeutic option in fibrinous central serous chorioretinopathy. Bangladesh Journal of Medical Science Vol.16(1) 2017 p.157-160

Introducing objective structured practical examination as a method of learning and evaluation for undergraduate pharmacology

Objective: Assessment method can influence student learning. Use of objective structured practical examination (OSPE) has been reported in various institutes with great benefits. We evaluated OSPE for the assessment of practical skills in pharmacology examination for undergraduate medical students and compared it with conventional practical examination (CPE). Materials and Methods: After sensitizing the 2nd year MBBS students to OSPE, the students were divided into four batches with twenty students in each batch. Students were assessed by attending five OSPE stations, each for duration of 5 min. The effectiveness was assessed through a student’s feedback questionnaire and was checked for its reliability by Cronbach’s alpha. The result of OSPE was compared with that of CPE of the same batch. Results: Cronbach’s alpha of the feedback questionnaire was 0.71, with high internal consistency. The feedback given was categorized into three domains: cognitive, psychomotor, and affective, and an assessment was also done for its further use. In cognitive domain, 74% of the students felt that the questions asked and the syllabus taught were well correlated. In psychomotor domain, 81% agreed that it is excellent for assessing the applied part of the subject. Seventy percent of students opined that it was associated with lesser stress than CPE. On overall assessment, 76% rated this methodology as good/satisfactory and 23% as excellent in terms of better scoring. There was a significant difference in the mean score between the results of OSPE and CPE (P < 0.001, df = 158, confidence interval = 95%). Conclusion: OSPE is a feasible and skill enhancing tool for the assessment in pharmacology examinations for undergraduate students.

To study the levels of C - reactive protein and total leucocyte count in patients operated of open and laparoscopic cholecystectomy.

BACKGROUND The recovery from laparoscopic cholecystectomy (LC) is rapid and most of the patients are discharged on the 1st post-operative day. There is an increased concentration of certain serum proteins, known as acute-phase reactive proteins (APRP) during the post-operative period depends on the degree of tissue damage and the inflammatory reaction. There is a direct positive correlation between the concentrations of APRP, especially C-reactive protein (CRP), and the severity of inflammation. This study was done to study the levels of C - reactive protein and Total Leucocyte Count in patients operated either by Open Cholecystectomy (OC) and Laparoscopic Cholecystectomy (LC). MATERIALS AND METHODS This prospective study was conducted on 50 patients after approval from the Institutional Ethics Committee. Twenty five patients underwent open cholecystectomy and the other 25 had laparoscopic cholecystectomy. The pre and post operative concentrations of serum C-reactive protein (CRP) and total leukocyte count (TLC) were compared in both the groups. RESULTS There were no differences in the preoperative serum CRP and TLC concentrations - in both the groups. Serum CRP rose significantly following OC compared to that of patients who underwent LC (10.52 ± 1.96 mg% vs. 8.88 ± 1.23 mg %). There were also significant differences in the post-operative TLC ( 9.49 ± 1.05 m/mm3 for the OC group vs. 8.57 ± 1.31 m/mm3 for the LC group), and the post-operative hospital stay (5.5 ±1.5 days vs. 1.9 ± 0.9 days). There was no correlation between serum CRP concentrations and the other post-operative parameters. CONCLUSION The study provided the biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.

To Compare the Safety, Efficacy and Quality of Life in Patients with Allergic Rhinitis Treated with Levocetirizine and Desloratadine

Background: Allergic Rhinitis (AR) is a very common disease that affects almost 10-30% of the world’s population. Second-generation H1 antihistaminics are the preferred drugs for treatment of patients with AR. Levocetirizine and desloratadine are commonly prescribed newer non-sedating second-generation antihistaminics. Various studies show no difference in efficacy and quality of life (QOL) between the two drugs desloratadine and levocetirizine and that the drugs are quiet safe; however, some studies show negative impact on patients’ QOL with these drugs. Studies comparing the two drugs were insufficient in India; hence, this study was designed to evaluate and compare the efficacy, safety and QOL of patients with AR, following treatment with levocetirizine or desloratadine, in the Indian scenario.Methods: This 2-month randomized, prospective study was performed in 60 patients with AR visiting the department of Otorhinolaryngology. Patients were randomized into one of the two treatment groups, and prescribed levocetirizine 5 mg once daily for two weeks or desloratadine 5 mg once daily for two weeks. The outcome measures for the severity of AR symptoms used were Total Nasal Symptom Score (TNSS); and QOL was assessed using Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) Score.Results: Data from 54 patients who completed the study shows that both levocetirizine and desloratadine significantly (p<0.05) improved the AR symptoms and QOL at the end of 2 weeks study period, analyzed using TNSS and RQLQ scores, respectively. However, statistically non-significant differences in analysis of TNSS score between levocetirizine and desloratadine showed that the two drugs may be equally effective in patients with AR, with patients on levocetirizine showing slightly better response. The adverse events were low in patients on levocetirizine and no adverse event was seen with desloratadine. At baseline visit, rhinorrhoea was the most common and severe symptom, whereas nasal itching was the least common and severe symptom.Conclusion: Study findings showed that both levocetirizine and desloratadine were equally effective in patients with AR, however, desloratadine group showed better safety profile. The drugs were safe and well tolerated.