Background With the goal of improving the affordability of medicines, governments across the globe have instituted various forms of price controls. Since 2013, India has been regulating the prices of drugs included in its national list of essential medicines (NLEM). Here we evaluate the cost variations among available cardiovascular drugs and perform cost-analysis comparing essential and non-essential drugs.Methods Data on listed prices of selected cardiovascular drugs – essential (NLEM) and non-essential (NNLEM) – were sourced from multiple drug information compendia. Price of medications was calculated in cost-per-defined-daily-dose (DDD)-units and NLEM vs. NNLEM drugs were compared. Regression analysis was used to explore the determinants of percentage cost variation (PCV) of drugs.Results The median-cost/DDD of essential medicines was lower as compared to non-essential ones for all therapeutic drug classes, with greatest difference observed for antianginals and least for heart failure medicines. There were substantial cost variations with values in excess of 1000% for six medicines, all being essential. The regression analysis failed to demonstrate a significant effect of essentiality on PCV (β = 0.19, P = 0.314).Conclusions Our analyses demonstrate considerable cost variations for some essential cardiovascular medicines. Given the need for prolonged and often, lifelong-treatment, there is significant potential for cost savings based on chosen brand, highlighting the need for patient as well as prescriber education.
Although the awareness of malnutrition among elderly people is well established, the risk of Refeeding Syndrome (RFS) is often neglected, especially in the frail elderly population. This partly relates to the unspecific clinical presentation and laboratory changes in the geriatric population. We present a case of RFS presenting as severe hypoglycemia in an elderly patient after initiating enteral nutrition.
In India, the level of economic activity cannot be truly represented by few selected macroeconomic variables as most of the indicators are published to lags and are frequently revised. Therefore, to fill in this research gap of true and timely monthly representation of the level of economic activity in India, the primary objective of this study is to identify the coincidental business cycle indicators with the help of advanced econometric tools for a period ranging between the years 1994 to 2014. The results of the study based on the robust methodological framework suggest that non-oil exports and oil imports represent the state and level of the Indian economy.
26Jun 2017 Effect of three regimens of prophylactic antibiotics in pregnant women with preterm premature rupture of fetal membranes: A randomised comparative study. Geetika Arora , S. S. Trivedi , Sharda Patra and Manisha.
Sir, Amyotrophic lateral sclerosis (ALS) is a rare fatal neurodegenerative disease characterized by rapidly progressive muscular paralysis.[1] We report anaesthetic management of a 48-year-old male, weighing 50 kg presented with a painful abdomen and fever for 3 days. Appendicular abscess suspected by ultrasonography was confirmed by a computed tomography (CT) scan. He was planned for exploratory laparotomy under general anaesthesia. He was a diagnosed case of ALS for five years when he had developed a slow onset, progressive, asymmetric weakness of upper limbs and lower limbs with associated difficulty in walking, had a progressive course and developed dysphagia and dysarthria and was on oral Riluzole100 mg/day for last 3 years. The patient was hemodynamically stable and routine laboratory investigations were within normal limits except for raised white blood cell (WBC) count. Arterial blood gas (ABG) revealed PCO2 of 43.1 mmHg and oxygen saturation of 92% on room air. Pulmonary function tests could not be performed in view of emergency surgery. The patient was induced with 80 mcg fentanyl and 2 mg/kg of propofol. 10 mg of rocuronium was administered, prior to endotracheal intubation. Prior to the start of surgery, the patient was given a bolus of 1.5 mg/kg lignocaine followed by an infusion of 0.5 mg/kg/hr to decrease post-op pain. Anesthesia was maintained with continuous infusion of propofol at 0.05-0.1 mg/kg/min. No additional top-up of muscle relaxant was given. Surgery was completed without any significant sequelae, and total anesthesia time was 150 min. Glycopyrrolate (0.2 mg) and neostigmine (2.5 mg) were used to reverse the effects of muscle relaxants. On meeting the extubation criteria, the patient was extubated and was observed in the post-anesthesia care unit (PACU) for about 1 hour until he reached the discharge criteria. ABG conducted in PACU showed PCO2 47.5 mmHg and oxygen saturation of 91% on room air. The patient was comfortable, pain-free (visual analogue score (VAS) 1-2) and did not demand any analgesic in the postoperative period for the first 24 hours. ALS causes the degeneration of upper and lower motor neurons.[2] leading to muscle atrophy, muscle spasticity, and muscle weakness.[1] In the majority of ALS patients, the respiratory failure and death are mainly caused due to atrophy and weakness of the respiratory muscles.[2] limiting the survival to 2-5 years after the onset of the disease.[3] Aspiration or ventilatory depression can be caused by general anaesthesia due to abnormal response of muscle relaxants whereas spinal anesthesia can exacerbate the preexisting neurological diseases.[4] Thus, anaesthesia needs modification, short-acting agents must be used to prevent an unpredictable response to muscle relaxants and to ensure quick reversal in a patient of ALS.[5] The depolarizing neuromuscular blocking drugs may increase rhabdomyolysis and massive hyperkalemia in such patients.[6] Therefore, the use of succinylcholine was avoided in this patient admitted for emergency laparotomy. The non-depolarizing neuromuscular blocking drugs and reversal agents both should be used judicially, under a peripheral nerve stimulation monitor due to increased susceptibility of patients with motor nerve diseases.[7] The normal intubating dose of rocuronium (a non-depolarizing muscle relaxant) is 1.0 mg/kg, therefore, a low dose (only 10 mg) was used in this case. No additional top-up was given and the patient was maintained on propofol infusion. Epidural was avoided as it can exacerbate the disease condition. The presence of muscle rigidity can decrease the post-operative respiratory function hence the opioids should be used with caution. Therefore, an infusion of lignocaine was used peri-operatively to provide postoperative analgesia and to reduce the opioid requirement. The patient tolerated lignocaine infusion without any adverse effects. Paracetamol was given intravenously four times a day postoperatively. Though PCA with fentanyl was attached for the relief of postoperative pain. However, the need for any bolus was not required for the first 24 hours. The patient was discharged in a stable condition at postoperative day 7. Thus, in patients who require general anesthesia, one can use lignocaine infusion that has little effect on the progression of the disease as well as significantly decreases the requirement of opioids for pain relief. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
ABSTRACT Aim: Guided endodontics (GE) represents a cutting-edge shift in dental practice, utilizing three-dimensional imaging to enhance treatment precision and safety in endodontics. Since its introduction in 2016, GE has shown promise in reducing complications by guiding dental procedures with minimal invasiveness. This study evaluates its acceptance and application among North India’s dental community, aiming to identify educational gaps and operational challenges. Methodology: An online survey, approved by ethical standards, was distributed to dental professionals in North India, collecting 265 responses on their familiarity, application, and training needs regarding GE. Results: Findings reveal a general awareness of GE among respondents, with a notable lack of specialized training. While GE’s benefits in various dental treatments were acknowledged, a significant interest in further training was expressed, underlining the necessity for enhanced educational programs. Conclusion: The research highlights a keen interest in GE among dentists, despite existing educational gaps. There is a clear call for integrating GE-focused training into dental curricula to equip practitioners with the skills needed for its effective use, potentially transforming patient care in endodontics.
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