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Introduction: The sensory innervation below the knee is provided by the saphenous nerve and sciatic nerve. Drugs deposited in the Adductor Canal (AC) at the Adductor Hiatus (AH) level spread both proximally up to the mid-canal and distally to the popliteal fossa through the perivascular space. The Adductor Canal Block (ACB) is a newer technique by which both nerves can be blocked in a single procedure. Aim: To evaluate the efficacy of ACB for postoperative pain management in below knee surgeries. Materials and Methods: This randomised controlled study was conducted in a tertiary care hospital. A total of 81 patients with American Society of Anaesthesiologists (ASA) I and II physical status were randomly allocated to either group A (ACB) or group B (Control), scheduled for below knee orthopaedic surgery. Group A patients received a mixture of 40 mL of 0.125% bupivacaine and 8 mg dexamethasone in the AC at the hiatus level under ultrasound guidance. Group B patients received standard care for pain management. The duration of sensory and motor block, mean Visual Analogue Scale (VAS) scores, amount of opioid drug requirement, drug-related side-effects, and satisfaction scores were compared between the two groups. Data were presented as mean±Standard Deviation (SD) for continuous variables and frequency (%) for categorical data and were analysed using t-tests and Chi-square tests. Results: The mean age in group A was 42.9±13.5 years and in group B was 46.3±13.1 years. In group A, there were 30 males and 11 females, while in group B, there were 32 males and 8 females. The mean Body Mass Index (BMI) between group A and B was 27.4±3.2 kg/m2 and 26.3±3.1 kg/m2, respectively. The mean duration of sensory block was longer in group A (12.3±4.6 hours) compared to group B (4.7±0.7 hours). The mean VAS scores (1.351±0.659 vs 3.240±0.590) were significantly lower in group A. The total opioid requirement was 42.9±73.6 mg vs 205.9±26.0 mg between the two groups, which was significantly lower in group A. Conclusion: In distal ACB, a single procedure with 40 mL of 0.125% bupivacaine significantly reduces postoperative VAS scores and analgesic requirements while increasing patient satisfaction levels. Therefore, this block is safe and recommended for postoperative pain management in below knee surgeries. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is more prevalent in middle- and higher-income groups and is spreading at an alarming rate. Drug therapy is compulsory because of the chronic and progressive nature of the disease. With such multifactorial background of high prevalence, progressive nature of the disease leading to various complications, increased healthcare cost, and availability of multiple therapeutic regimens prescribed, this study has been done to evaluate the cost-effective analysis of oral hypoglycemic agents. Materials and Methods: This is a prospective, parallel group, and comparative observational study conducted by the Department of Pharmacology in collaboration with the Department of Endocrinology at Kalinga Institute of Medical Sciences, Bhubaneswar. The duration of the study was of 2 years. A total number of 220 patients were selected and based on body mass index, patients were categorized into preobese (new and old diabetic patients) and obese (new and old diabetic patients) categories. In this study, cost-effectiveness analysis (CEA) was done to evaluate the cost differences between two or more medication groups, with a similar clinical effect. Results of CEA are expressed as an average cost-effectiveness ratio or as an incremental cost-effectiveness ratio. Results: From this study, it is observed that in terms of benefit, dual therapy of Metformin and Dapagliflozin was most efficacious followed by Metformin and Sitagliptin as well as Metformin and Glimepiride combinations. If cost is considered, Metformin montherapy and metformin and Glimepiride dual therapy was most cost-effective. In triple regimen, MET+VOG+GLIM combination was seen to be more cost effective than gliptin combination, both in terms of control of FBS as well as PPBS. The cost of treatment goes parallel with duration of disease, being higher in the old cases of long-standing duration. Conclusion: The present study shows that SGLT2 inhibitors are better class of oral hypoglycemics in terms of longterm benefits and this group is prescribed as dual therapy more frequently but cost of therapy is the greatest barrier. Metformin and Sulfonylureas remain the most beneficial combination, both in terms of efficacy and cost. The cost of treatment was varying, depending on the duration of disease, being higher in old cases and lower in new cases. [ABSTRACT FROM AUTHOR]

Background: Drug prescription pattern for the treatment of falciparum malaria differs widely from place to place; but there is also some intra organizational variation of prescription pattern of anti-malarial drugs for the treatment of falciparum malaria. Aims and Objectives: The present study was planned to study the drug utilization pattern for the treatment of falciparum malaria in a tertiary care teaching hospital in eastern India. Materials and Methods: It was a hospital based study conducted in the department of medicine among the patients admitted with confi rmed diagnosis of falciparum malaria. Drugs prescribed, average number of drugs per prescription, percentage of drugs prescribed in generic name, percentage of prescription with co-prescription of antibiotics, percentage of prescription having at least an injection prescribed, percentage of drugs prescribed from essential drug list or formulary and average drug cost per prescription are the parameters studied in this study. Results: Average number of drugs per prescription in the present study was 3.96. Artesunate and Mefl oquine were the most common anti-malarial drugs prescribed among study subjects. 22.9% patients received oral Chloroquine as anti-malarial drug. 43.3% prescriptions had antibiotics co-prescribed. Only 16.9% drugs were prescribed in generic name. 85.4% of the prescribed drugs were from essential drug list. Average drug cost per patient was Rs. 282/- with minimum of Rs. 55/- and maximum of Rs. 1750/-. Conclusion: Though Artesunate combination therapy is getting popularized gradually but a sizable proportion of patients (22.9%) were prescribed with oral Chloroquine therapy. Generic prescription of drugs should be encouraged among the physicians. Multi-centric study regarding drug prescription can give a broader picture in changing scenario. [ABSTRACT FROM AUTHOR]

A psoas (or iliopsoas) abscess is an accumulation of pus in the region of iliopsoas muscle compartment. In regions where Mycobacterium tuberculosis is endemic, this is a frequent cause of psoas abscess. When an inguinal mass in a patient with a psoas abscess is painless, tuberculosis is a more likely cause than a bacterial infection. Here, the author report a rare case of psoas abscess of tubercular origin in a 31-year-old patient who presented with back pain and limping, with features of inflammation. Diagnosis was done based on history, physical examination, ultrasonography, microbiological investigation and Contrast-Enhanced Computed Tomography (CECT) scan of abdomen which revealed a large psoas abscess caused by M. tuberculosis. Patient was diagnosed with a psoas abscess due to Mycobacterium tuberculosis with secondary infection and treated empirically with Directly Observed Treatment Short-Course (DOTS) category I and antibiotics. He presented again with a chest abscess due to Multidrug-Resistant (MDR) tuberculosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Currently, we have a shortage of comprehensive information about newer antiepileptic drugs (AEDs) in the pediatric population. This might explain the discrepancies among pediatricians' preferences in this regard. Therefore, it is crucial to study the multifaceted impacts of these drugs on children. The endpoints of our study were non-AED predictors of the requirement of combination therapy for seizure management, seizure-free period >6 months and >12 months, change in Quality of Life in Childhood Epilepsy Questionnaire - 55 (QOLCE-55), and incidence of adverse events., Methods: This prospective, observational study was conducted in KIMS, Bhubaneswar, India, from January 2021 to November 2022. Children of 2-12 years of age were treated with monotherapy of either newer antiepileptics, e.g., levetiracetam, topiramate, and oxcarbazepine or older antiepileptics, e.g., valproic acid, phenytoin, phenobarbital, and carbamazepine. Univariate and multivariate analyses were performed for the assessment of predictors. We used R software (version 4.1.1) for data analysis., Results: One hundred and ninety-eight (91.7%) of 216 enrolled participants completed this study. The mean age of the study population was 5.2 years and 117 (59%) of them were males. The univariate analysis showed that male gender, low birth weight, preterm birth, assisted vaginal delivery and site-specific epilepsy, and maternal history of epilepsy were significant predictors of combination therapy and reduced seizure-free period. There was a non-significant difference regarding the improvement of QOLCE-55 scores. None of the adverse events were serious., Conclusions: Perinatal complications and maternal history of epilepsy contribute significantly toward the efficacy of antiepileptics. However, multivariate analysis did not yield statistically significant results., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rout et al.)

Introduction: Coronary heart disease and hyperlipidemia is a global problem in today's world. A large number of people suffer from hypertension, atherosclerosis and all these has strong association with the hyperlipidemia. There are many drugs for the treatment of hyperlipidemia, but statins are most commonly used. But, with high dose of statins, the side effect is also there which restricts its use in high dose. Ezetimibe is a comparatively new drug for the treatment of hyperlipidemia having lesser adverse effect as compared to statin. This study has been planned to find out the comparative efficacy of Ezetimibe and Atorvastatin alone and in combination on the lipid profile in rats., Methodology: This study was conducted in SCB Medical College, Cuttack. 60 rats were fed on atherogenic diet. These were divided in six groups having ten rats in each group and followed for 12 weeks. Group I received only atherogenic diet. All other groups received drugs after four weeks. Group II received Ezetimibe 1mg/kg, Group III received Ezetimibe 2mg/kg, Group IV received Atorvastatin 4mg/kg, Group V received Atorvastatin 8mg/kg and Group VI received Atorvastatin 4mg/kg and Ezetimibe 1mg/kg. Blood lipid profile measured at zero week, four weeks and 12 weeks., Results: All the lipid profile parameters improved significantly with treatment groups as compared with control group. There was no significant difference in the level of different lipid parameters between Group V (Atorvastatin 8mg/kg) and Group VI (Atorvastatin 4mg/kg and Ezetimibe 1mg/kg)., Conclusion: High dose of Atorvastatin is associated with more adverse effect. The efficacy of high dose of Atorvastatin is comparable to combination of low dose Atorvastatin with Ezetimibe. This combination has lesser side effects. So, this can be a good alternative.