Background: Malaria has been a problem in India for centuries. There are innumerable brands of antimalarial present in the market. Malaria can be extremely fatal if not treated promptly. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non-compliance leads to incomplete treatment which tends to increase morbidity. Increase in the patient medication cost was found to be associated with decreased adherence to prescription medication. Hence this study was done to assess the cost variation of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2017 edition and Drug Today January to March 2017, Vol 2. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets was calculated in case of oral drug and the cost of 1 ampoule or vial was noted in case of injectable drug. At last the cost ratio and % cost variation of various brands was compared.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Artemether injection showed the highest cost ratio and cost variation (cost ratio = 16.96 and % cost variation = 1596). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents. Chloroquine which is one of the most used antimalarial showed very low values for cost variation and cost ratio.Conclusions: The analysis showed that there is not much significant price variation among oral antimalarial drugs. The maximum variation shown by oral antimalarial was found to be for fixed dose combination of Artemether and Lumefantrine [cost ratio>2 (2.03) and % price variation >100 (103.7)]. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment.

Introduction: Kala-azar (visceral

Introduction: Medical Intensive Care Unit (MICU) is a setup where very serious patients are admitted and large numbers of drugs are administered to these patients. Usually, cost of these prescribed drugs is very high. The aim of the current study was to assess the pattern of prescriptions being made for antimicrobial agents in MICU of a tertiary care hospital of Bihar. Methods: This prospective study was under taken in MICU of Indira Gandhi institute of Medical Sciences, Patna, Bihar over a period of six months from January 2018 to June 2018. Patients’ records, prescription and treatment charts were reviewed. Rationality of different drugs used in MICU patients were also evaluated. Results: In MICU, meropenem was most commonly prescribed antimicrobial agent. It was seen among 24% patients, closely followed by clindamycin (22%), ceftriaxone (20%), piperacillin + tazobactam (18%) and metronidazole (12%). Majority (92%) of the patients admitted in MICU were given 2-3 antimicrobial agents and rest were given 4-7 such drugs. Most common indication for prescription was infection with septicemia. Conclusion: Management of critically ill patients in MICU should be focused not only on control of infection but also on proper use of antibiotic. This will help to minimize emergence of drugs resistance, unnecessary cost burden to the patients and adverse drug reactions.

BACKGROUNDStroke is the most common life-threatening neurological disease and is the third leading cause of death surpassed only by cancer and heart disease. Those who survive are usually left with permanent disability. Cerebral infarction is responsible for about 80% of all strokes, primary intracerebral haemorrhage for 10% and subarachnoid haemorrhage for 5%. These population are similar in all places where they have been reliably assessed by CT scan. Mortality statistics reveal that stroke type with high case fatality are intracerebral haemorrhage and total anterior circulation infarction.The aim of the current study was to determine the mortality rate and to evaluate the influence of various factors on the mortality of patients with intracerebral haemorrhage. MATERIALS AND METHODSThis is in-hospital based, cross-sectional descriptive study done on 62 patients in Department of Medicine and Radiology, Patna Medical College and Hospital, Patna. All patients above 14 years of age with features of primary intracerebral haemorrhage on CT scan were included. Patients with haemorrhages due to trauma, aneurysmal rupture, tumour, anticoagulant therapy and haemorrhagic transformation of cerebral infarct were excluded. RESULTSOut of 62 patients, 38 were males and 24 were females. The mean age for lobar and deep haemorrhages were 58.09 and 54.93 years, respectively. The mortality rate in acute stage was 43.54%. Remaining 65.4% survived till discharge at the end of acute hospitalisation. In present study, the location of intracerebral haemorrhage was lobar in 17.74%, deep ganglionic (ventricle) in 74.19%, cerebellar in 3.2% and pontine/midbrain in 4.8% of the patients. CONCLUSIONFactors independently associated with in-hospital mortality were Glasgow Coma Scale (GCS) score (≤8), hypertension, volume of haematoma, intraventricular haematoma and midline shift. Primary intracerebral haemorrhage is one of the common vascular insults with a relatively high rate of mortality and if survived results in multiple disabilities.

BACKGROUNDSingle small ring enhancing computed tomography lesion is a clinicoradiological abnormality being reported more frequently as imaging of the brain becomes more prevalent. It is a common abnormality on imaging in young patients of low socioeconomic status presented with acute symptomatic seizures in tropical and developing countries like India. Neurocysticercosis and Tuberculoma are the commonest ring forming granulomas. Apart from the seizure, many varieties of other neurological manifestations have been observed in these cases of single ring enhancing lesions found on the computed tomography scan of brain.The objective of the present study is to identify the non-epileptic manifestations of single ring enhancing computed tomography lesions.