Aim: To study the prescribing patterns of drugs used in Ischemic Heart Disease (IHD) patients and to identify Drug Related Problems (DRPs) associated with treatment. Methodology: 120 patients from the cardiology inpatient department who were suffering from IHD were included in this prospective, observational and analytical study conducted in Sagar hospitals, Kumaraswamy layout, Bengaluru, India. Results: Out of a total of 120 patients, 76 (61.67%) were males and 46 (38.33%) were females. Subjects of age group 61-70 (25.0%) were found to be more susceptible to IHD. Most of the prescriptions were prescribed with Lipid lowering agents (12.16%), followed by β-blockers (11.10%), Anti-Platelets (8.72%). A total of 221 DRPs were identified. Drug interactions (41.63%) were the most common drug related problems observed, followed by Untreated indications (25.79%), Medication use without indication (9.05%), Adverse Drug Reactions (ADRs) (9.05%), Overdose (6.79%), Sub-therapeutic dose (3.17%). The most common drug-drug interaction was Clopidogrel+Aspirin (6.52%), followed by Furosemide+Aspirin (6.52%) and Atorvastatin+Clopidogrel (5.43%). The most offending drug involved in the drug-drug interactions was observed to be Aspirin. Conclusion: Our study suggests that Statins, Anti-Platelet and Anti-Anginal/Ischemic drugs are major cardiovascular drugs used in the treatment of IHD. The various DRPs were observed to be due to polypharmacy practiced in the treatment of IHD which emphasizes the importance of early detection, evaluation and documentation of DRPs for better patient care and quality of life of patients with IHD.

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Eagle's syndrome is a rare cause of craniofacial pain caused by impingement of adjacent neurovascular elements by an elongated styloid process or by a calcified stylohyoid ligament. There is a wide spectrum of clinical presentations, which encompasses craniofacial pain, oropharyngeal pain, otalgia, headache, and vertigo. Typically, the glossopharyngeal nerve gets entrapped, giving rise to characteristic orofacial pain. The diagnosis of Eagle's syndrome is confirmed radiologically, and the management includes pharmacotherapy and surgical removal of the styloid process. Moreover, minimally invasive interventions in the form of glossopharyngeal nerve block and radiofrequency treatment can also be effective in providing pain relief. We report a case of an elderly male who presented with features of glossopharyngeal neuralgia secondary to an elongated styloid process and was managed successfully with pulsed radiofrequency treatment of the glossopharyngeal nerve.

Background: Modifications of curved and straight laryngoscope blades have been used for airway management since a long time. While McCoy blade with an elevated tip is commonly used to intubate patients with anticipated difficult airway, the Miller's straight blade is used for intubations in children and less commonly adults. In this study, we revisit the paraglossal technique of Miller's straight blade as a method to improve laryngeal view especially in difficult intubations. Aim: This study aimed to compare laryngoscopic view and ease of intubation (EOI) using McCoy blade elevated tip and Miller's straight blade paraglossal technique. Materials and Methods: A prospective single-blind study was conducted on 170 patients undergoing elective surgery under general anesthesia. They were randomly allotted to two groups. In Group A, laryngoscopy was performed by Miller's blade paraglossal approach, whereas in Group B, laryngoscopy was performed by McCoy blade with an elevated tip. Laryngeal view was graded using the modified Cormack–Lehane grading, and EOI was graded using EOI score. These were compared with preoperative intubation prediction score. Statistical analysis was done using “Medcalc“ version 19.0.3. Numerical and categorical data were analyzed by Student's t -test and Chi-square test, respectively. A P < 0.05 was considered statistically significant. Results: The paraglossal approach with Miller's blade offered better laryngoscopic view as compared with McCoy blade with an elevated tip in normal (54.1% vs. 25.9%) and difficult airway (44.7% vs. 11.8%). Tracheal intubation was easier with McCoy blade with an elevated tip although the success rate of intubation improved with the assistance of a bougie with Miller's straight blade paraglossal approach. Conclusion: The laryngeal view was significantly better with the paraglossal approach of Miller's straight blade even in difficult airway. McCoy blade with an elevated tip was also found to be a useful tool to have in difficult airway, as EOI is significantly higher. The study also highlights the usefulness of adjuncts such as a gum elastic bougie while intubating.

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