Context: Multiple chronic illnesses associated with ageing population demands the role of polypharmacy. Drug utilization study in terms of description of drug use pattern in the geriatric patients aids in monitoring polypharmacy as well as to determine the factors contributing to it. Objectives: To analyse the drug utilization pattern in geriatric patients at a rural health training centre. Subjects and Methods: A cross-sectional study was conducted in a rural health centre to assess the drug utilization pattern using the WHO core drug prescribing indicators. Polypharmacy was defined as usage of 5-8 drugs and excessive polypharmacy as intake of 10 or more drugs. The drugs were coded using Anatomical Therapeutical Chemical classification. Univariate and bivariate analysis were done using SPSS to present the data. Results: Among 207 patients, 29.5% were on polypharmacy and 1.5% patients on excessive polypharmacy. About 75% of patients had one or more comorbid medical condition. A total number of 829 drugs were prescribed and the average number of drugs per prescription was 4.02. Conclusion: The drug utilization pattern analysis in the geriatric patients reveals deviation of the average number of drugs per prescription from the WHO standard recommendation. The most common comorbid condition among the geriatric patients was diabetes mellitus. This drug utilization study imparts knowledge about the use of polypharmacy, comorbidities and the pattern of commonly used drugs among the geriatric patients in rural area. Periodic assessment of the pattern of drug utilization in the elderly aids to improve the prescribing pattern and minimize patient harm.

No abstract

Background: Neonatal jaundice is generally harmless, but high concentrations of unconjugated bilirubin may rarely cause kernicterus. Hyperbilirubinemia is the most common cause of neonatal readmission to the hospital, in the majority of cases. Aims: The study aims to determine incidence rate of neonatal jaundice as well as evaluate the commonest cause and determine the efficacy of continuous phototherapy. Study Design: A Prospective observational study. Place and Duration of Study: The study was conducted in Avis Ankura hospital for women and children. It is a well-recognized, authorized hospital where obstetrics and neonatal care is provided. The study was conducted between October 2018 to March 2019. Methodology: The study was conducted in Avis Ankura hospital for women and children. It is a well-recognized, authorized hospital where obstetrics and neonatal care is provided. A total of 162 neonates were considered. Informed consent was obtained from all the subject’s care takers. Subjects enrolled in the study were admitted in NICUs’. This study appraises the conventional cause of NNJ, evaluates the efficacy of continuous phototherapy and detects the phototherapy induced adverse reactions by using Naranjo’s causality assessment scale. Results: Among 162 patients, 94 patients (58%) were found to be males and 68 patients (42%) were found to be females. Low birth weight neonates (43.20%) were found to be more prone to neonatal jaundices. In this study, it was found that duration of phototherapy was longer in extremely low birth weight neonates (34 hours) in relation to birth weight and average duration of phototherapy. Based on the conventional cause, physiological cause (56.79%) was observed to be highest among other causes of neonatal jaundice. The short term adverse reactions due to phototherapy were identified using Naranjo’s Causality Assessment Scale. The TSB levels were increased before phototherapy (pre- treatment) and decreased after phototherapies (post-treatment) which were assessed by using American Academy of Pediatrics guidelines. Conclusion: From this study, it was concluded that males were more prone to develop neonatal jaundice when compared with females. Physiological jaundice contributes majority of cases   among the total cases. The use of phototherapy was inversely related to gestational age and birth weight.

Brain tumors, the second common cancer following hematological malignancies account for up to 21% of all malignancies below 14 years of age. Medulloblastoma is a common form of Primitive neuro ectodermal tumor and likely arise from either the external granular layer (e.g., desmoplastic variant) or the subependymal matrix cells of the fourth ventricle (e.g., classic variant), or both. The clinical course of the disease is aggressive in children than in adults. The tumor can invade the CSF through the ventricles or even cause metastases to bones and lymph node. With the emergence of advanced technologies and treatment facilities, the morbidity and mortality of the disease is greatly improved with a five-year survival of up to 75%. However, the presence of disease in children <3 years or evidence of dissemination on diagnosis carries poor prognosis. Here we are discussing a case of 5-year-old girl who presented to OPD with vomiting for 1 month.