Rm Gupta

ABC and VED Analysis in Medical Stores Inventory Control

BACKGROUND The basic principle of inventory control is ABC based on cost criteria and VED on criticality. METHODS Based on ABC-VED matrix, economic analysis of drug expenditure of priced vocabulary of medical stores (PVMS) section 01 for the year 2003 of a 190 bedded service hospital was under taken. RESULT Out of 493 drugs in PVMS section 01, only 325 drugs were being used in the reference hospital. The total cost of drugs used was Rupees 55,23,503. Of these 325 drugs, 47(14.4%) drugs were Category A, consuming 70% of total expenditure, 73 (22.46 %) drugs Category B consuming 20% and rest 205 drugs (63.7 %) Category C drugs cost only 10% of expenditure. VED categorization done by consensus opinion of medical officers, found 24 (7.3%) drugs vital, 160 (49.3%) essential and rest 141 (43.3 %) desirable. CONCLUSION On coupling the two techniques ABC-VED matrix was made and drugs were classified in to Category I (AV+BV+CV+AE+AD) comprising 68 drugs, Category II (BE + CE +BD) 159 and Category III (CD) 98 drugs. The management of Category I drugs was monitored by top management resulting in better control on the annual expenses and at the same time making available the vital Category II by middle and Category III at lower mangerial level.

Spectrum of Childhood Tuberculosis in BCG Vaccinated and Unvaccinated Children

BACKGROUND Childhood tuberculosis remains a major public health problem in India. We evaluated the impact of BCG vaccination on childhood tuberculosis and the underlying risk factors. METHODS 100 consecutive children below 12 years diagnosed to have tuberculosis based on the WHO and IAP consensus statement were included in the study. RESULT Majority(42%) of children with tuberculosis were below four years of age. History of contact with a case of tuberculosis was present in 41 cases. BCG scar was present in 77 cases indicating a poor coverage/uptake of BCG vaccination. Pulmonary form of tuberculosis was seen in 52 and extra pulmonary form in 41 cases. Tubercular lymphadenitis was seen in seven cases, of which more than 70 % were in BCG vaccinated group. There was no statistically significant difference in the type of tuberculosis (pulmonary or extra pulmonary) and BCG vaccination. In the extra pulmonary form, 13 children had neuro-tuberculosis, of which 66% were in BCG unvaccinated group, which was statistically significant (p=0.011). The underlying risk factors were poor socioeconomic status (62%), malnutrition (61%) and poor immunization coverage. CONCLUSION Higher incidence of pulmonary tuberculosis in BCG vaccinated group was not statistically significant. However, high incidence of neuro-tuberculosis in BCG unvaccinated group was statistically significant. The underlying risk factors were poor socio-economic status, malnutrition and poor immunization coverage and should be taken into consideration in order to prevent morbidity and mortality due to tuberculosis in children.

Congenital Hypoplasia of Depressor Angularis Oris Muscle.

Congenital hypoplasia of depressor angularis oris muscle (CHDAOM) is one of the rare causes of asymmetric crying facies in newborn. Major congenital anomalies have been reported to be associated with this facial defect in 45-70% cases [1, 2]. We report a case of CHDAOM in a neonate.

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL

BACKGROUND Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens. METHODS This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patients rehabilitation were studied. RESULTS The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day. CONCLUSION Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.

PREVALENCE OF ANTIBODIES TO HEPATITIS C VIRUS IN HOSPITALIZED POPULATION SUBSETS

Prevalence of antibodies to hepatitis C virus (anti-HCV antibody) was ascertained in different subsets of hospitalized patients. Anti-HCV antibody testing was done using a third generation test The anti-HCV positivity in the sera of 308 tuberculosis patients, who had been given streptomycin, was 12.3 per cent It was 7.1 percent among 84 cardiac patients undergoing invasive cardiac procedures, 15.6 per cent in 77 patients on haemodialysis and 41.2 per cent patients with surgical jaundice. It is surmised that hospitalization, particularly parenteral therapy and invasive procedures during hospitalization, puts patients at higher risk of contracting HCV infecticn.

Stavudine Induced Acute Pancreatitis in Paediatric Human Immunodeficiency Virus Infection

Acute pancreatitis (AP) is a rare but life threatening complication associated with paediatric human immunodeficiency virus (HIV) infection due to virus itself or side effects of antiretroviral therapy with nucleoside reverse transcriptase inhibitors (NRTI) particularly didanosine [1, 2]. We report a case of acute severe pancreatitis due to stavudine.

Phacotrabeculectomy Versus Conventional Combined Technique in Coexisting Glaucoma and Cataract.

BACKGROUND To evaluate and compare efficacy and outcome after single site phacotrabeculectomy and conventional combined surgery in cases of coexisting primary open angle glaucoma and cataract. METHODS This prospective study on fifty patients of concurrent primary open angle glaucoma and cataract, who had undergone combined surgery as single site phacotrabeculectomy or conventional single site trabeculectomy with extracapsular lens extraction with IOL implantation in 25 cases each. Evaluation was based on operative and postoperative complications, control of IOP and visual outcome. The follow up period ranged between twelve months to eighteen months. RESULTS The mean medically controlled preoperative intraocular pressure was 22 mm of Hg (Range 18 to 35 mm of Hg) by applanation method of tonometry. The range of postoperative intra-ocular pressure after one year was 11 to 22 mm of Hg in first and 14 to 26 mm Hg in second group. Failure to maintain optimum postoperative IOP without Beta-blocker was more frequent after conventional combined procedure. There was no significant difference in incidence and pattern of postoperative complications. CONCLUSION Phacotrabeculectomy provides effective and sustained visual recovery and adequate control of intraocular pressure as compare to conventional combined procedure.

Acute Eye Conditions

Eye is one of the most vital sense organs, important for survival as well as for all the basic needs of day to day life. Eye physiology is a delicate balance between clear refractive media like the lens of a camera and retinal neural layer akin to the photographic film. Any disturbance in this delicate balance can lead to severe diminution of visual capacity leading to permanent incapacitation. In our country, acute eye conditions constitute the commonest group of preventable blindness. Access to proper eye care in India is as such very poor. According to statistics there is one Ophthalmologist for every one million Indians and out of them also, most are urban based. In Armed Forces scenario also, most personnel are in contact with Medical Officers who provide the primary care. Hence, it is important for general public as well as Medical Officers/General practitioners to be aware of common acute eye conditions as well as their emergency first aid.

BETA-2-MICROGLOBULIN LEVELS IN HUMAN-IMMUNODEFICIENCY VIRUS INFECTED SUBJECTS

We studied beta-2 microglobulin (β-2M) levels in 44 HIV infected subjects belonging to 3 clinical stages as well as in 25 healthy controls. The method used was a competition enzyme immunoassay. In this study, levels of β2-M were measured in two groups of HIV infected individuals, the asymptomatic and those with progressive and advanced disease, in order to affirm its role as a surrogate prognostic marker. It was found that mean β-2M levels were 1.28 mg/L in the controls (normal range 0-2.4 mg/L), 11.41 mg/L in the HIV infected subjects, 2.69 mg/L in the asymptomatic HIV infected, 12.14 mg/L in those with persistent generalized lymphadenopathy (PGL) and 39.29 mg/L in the patients with acquired immunodeficiency syndrome. It was concluded that β-2M levels were significantly higher in the HIV infected as compared to the controls. Further, the levels were much higher in the HIV infected with progressive diseasc/PGL and highest in those who had developed AIDS. β-2M is an important surrogate serological marker useful in prognostication of disease process in the HIV infected. Advantages of measuring β-2M levels over p24 antigen detection and CD4 counts were highlighted.

TOXOPLASMA ENCEPHALITIS (TE): A REPORT ON THREE FATAL CASES

Toxoplasma gondii is a ubiquitous protozoan parasite. Humans are accidental dead end hosts, cat being the definitive host. Since the advent of AIDS, the impact of infection with this protozoan has been fully appreciated [1]. Toxoplasmosis and toxoplasma infection are two different terminologies, the former describes an active disease process whereas the latter is defined by the mere presence of viable organisms [2]. Chronic or latent infection is present in all those infected since the parasite resides in the cystic stage in some tissues without any clinical disease. Reactivation occurs in immunocompromised patients [3]. The parasite is acquired per-orally, transplacentally or rarely, parenterally in laboratory accidents, by transfusion, or from a transplanted organ. Individuals with HIV infection/AIDS frequently develop toxoplasmosis; the disease usually involves CNS and is often fatal [1]. Toxoplasma Encephalitis (TE) is the most common presentation of toxoplasmosis in AIDS patients [4]. About one third of the patients with AIDS who are latently infected with the parasite will develop TE [5]. Congenital infection is considered to occur only when primary infection is acquired during gestation [6]. Immunocompromised women who acquire the primary infection within 6-8 weeks before conceiving are an exception to the above [7]. The risk of infection to the fetus varies with the trimester of gestation when the mother becomes infected, and increases with the period of gestation. We report below the 3 fatal cases of toxoplasmosis, including a case of congenital toxoplasmosis, to highlight the multiorgan disease, dominant CNS involvement and fatality caused therefrom, in the HIV infected group. Fatal Case No.1 A 39-year-old male presented with dry cough and fever of 2 weeks and cervical lymphadenopathy of 4 weeks duration FNAC of the lymph node showed evidence of tuberculosis. After one month of ATT, he developed eighth nerve palsy on the left side. CT scan of the brain revealed a large irregular ring enhancing lesion 3 cms in diameter in the left parietal region. Within a week after CT scan he developed signs of meningoencephalitis. A repeat CT scan revealed a space occupying lesion with compressed lateral ventricles, reported as tuberculoma of the brain. CSF showed raised proteins (80 mg/dL) with pleocytosis (20 lymphocytes/cmm). At this juncture, serum was tested for HIV and was positive for anti-HIV antibodies. Serum and CSF were strongly positive for toxoplasma IgG antibodies and borderline positive for IgM antibodies. He was put on therapy for toxoplasmosis and ATT was continued. He progressed in to coma and died. Autopsy was not carried out.