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Background: Over past few months due to COVID-19 lockdown, our society has been in indoor settings where the education, work and entertainment are through digital platform. This created an increase in rate of digital eye strain. Method & materials: An epidemiological observational study conducted during lockdown period among people of Kerala with a structured and validated questionnaire using Google form. People with age ≥ 18 years, using digital screen on continuous basis were included in the study.Inform consent were collected from the participants before the survey.The statistical analysis were done using SPSS software. Results and Discussions: A total of 584 were participated in the study where more than 86% reported at least one symptom. Smart phone and computer were the major platform used by participants mainly for learning and entertainment.31% of participants were continuously using digital screen for >2hours.One fourth of participants were using the screen for >9 hours and a 20% uses the screen in dark room or dim light for >5 hours. 66% had mild and 2.2% had severe symptoms.Headache was the common symptom found followed by eye pain and neck/shoulder/joint pain. Females were found to be more prone to develop CVS. Headache, eye redness, burning, etc. were correlated with duration of use. Conclusion: The digital screens demands high visual strain, much attention and care should be taken for vision problems and related issues.Since we are depending on digital screens for many of the daily activities, the information related to CVS and associated discomfort along with the prevention strategies should be explained by health professionals. Keywords: Digital Eye Strain, Computer vision syndrome, Lockdown, COVID-19

To assess the clinical outcomes of levosimendan and dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function in Indian scenario. Cardiac, renal, electrolytes and hepatic parameters as well as the clinical outcomes were assessed. Levosimendan and dobutamine improved ejection fraction significantly. Levosimendan in comparison to dobutamine, increased cardiac output (0.76 vs. −0.38 at 48 h, 1.15 vs. −0.31 day 7, -2.02 vs. −1.51 day 30), cardiac index (0.89 vs.-0.13 at 48 h, 1.16 vs. −0.07 at day 7 and 1.05 vs. −0.25 at day 30) and eGFR (−1.4 vs. −0.75 at day 30) significantly. Levosimendan reduced ICU stay (p = 0.038) significantly whereas dobutamine decreased the hospital stay duration (p = 0.015). There was no major difference in re-hospitalization and mortality between groups. Ventricular tachyarrhythmia was the main adverse event noted in Levosimendan arm. Levosimendan showed improved cardiac as well as renal outcomes within a month when compared to dobutamine and it is the first study to determine the renal parameters of Levosimendan in an Indian setting.

Objectives: To compare patient health outcomes like mortality and rehospitalisation among heart failure patients receiving focussed care under HF clinics and those receiving usual care under regular cardiac outpatient department. Methods: A total of 200 heart failure patients who consulted in Heart Failure clinic and general cardiology outpatient department during the year of 2017 who satisfied the inclusion and exclusion criteria were selected for the study. The study was carried out in a tertiary care Interventional Cardiology and Cardiac Surgery hospital with a dedicated well established heart failure clinic in Kerala, for a period of 1 year. Patients were followed retrospectively for a period of one year and relevant patient data were obtained from the electronic medical record. The data collected were then evaluated for health outcomes like rehospitalisation and mortality among the two groups. Results: Among the total number of rehospitalisation’s reported, only 32.8% of them were from Heart Failure clinic while 67.2% of reported rehospitalisation’s were from general cardiology outpatient department. Chi square test was applied and statistically significant difference was obtained when mortality rate was compared between the two study groups. 80% of reported cases of death was among patients who consulted in general cardiology outpatient department while only 20% was from Heart Failure clinic. Conclusion: Management of heart failure patients in heart failure clinic was associated with significant reduction in one year mortality and rehospitalisation. Key words: Heart Failure, Heart failure clinics, Rehospitalisation, Mortality, Cardiology, Cardiac care.

BackgroundThe usage of guideline-directed medical therapy (GDMT) in the treatment of heart failure (HF) has shown to reduce morbidity and mortality. However, majority of the HF patients do not receive GDMT or do not achieve the target dose. Literature has shown that the patients who are managed in HF clinics receive GDMT and target doses of disease-modifying drugs (DMD) when compared to those treated in other general cardiology outpatient departments (OPD’s). It was a retrospective hospital-based study in which patients treated in HF clinic and other cardiology OPD in the year of 2017 were included (200 patients in each arm). The aim of this study was to assess the impact of heart failure clinics in medication therapy management including usage of guideline-directed medical therapy, if target dose specified by the guideline is achieved and time to reach target dose in comparison to other general cardiology OPD’s. IRB and IEC approval were obtained before the commencement of the study. Data relevant to the study were obtained from the electronic medical record (EMR) and were compared between the study groups to see for the adherence to guideline and achievement of target doses. Data storage and analysis were performed using SPSS Version 24. A significance level of 5% was used.ResultsThe usage of GDMT was higher in HF clinic when compared to other cardiology OPD (81% vs 55%,P= 0.001). A significantly higher number of patients in HF clinic achieved target dose when compared to other cardiology OPD (58% vs 29% -betablockers, 45% vs 9% -ACEI/ARB/ARNI,P= 0.000). Moreover, the number of eligible patients receiving DMD was found to be higher in HF clinic (98% vs 85% -betablockers, 69% vs 44% -ACEI/ARB/ARNI, 76% vs 44% -MRA). Also, the patients in HF clinic attained the target doses faster when compared to other cardiology OPD. In addition, there was better improvement in ejection fraction, as well as decreased rate of rehospitalisation and mortality in patients managed in HF clinic.ConclusionHF clinics were compared with other cardiology OPD for various parameters and it was observed that HF clinics were better than other cardiology OPD in maintaining the medication therapy management.

Objectives To evaluate the parental knowledge, attitude and practice (KAP) regarding the antiepileptic medication therapy in childhood. Methods This study was carried out over a period of 10 months in the division of Pediatric Neurology of Amrita Institute of Medical Sciences. The cohort of patients was selected randomly meeting the inclusion and exclusion criteria. Parents' KAP regarding epilepsy and antiepileptic drug therapy was assessed using a questionnaire prepared by the authors and patient adherence towards antiepileptic drug therapy by using Pediatric Epilepsy Self-Management Questionnaire (PEMSQ). Results A total of 123 patients were selected and enrolled in the study. Seventy eight percent of the respondents knew that epilepsy is a brain disorder, while only 6% of them were aware about all the treatment options. The scoring in the domain of “Disease and Treatment Knowledge & Expectations of parents” was found to be significantly low (69.07%) when compared to other domains in the PEMSQ. Although socioeconomic status did not correlate with knowledge score of the parents (p = 0.216), it was significantly related to adherence (p = 0.042). Conclusion In this cohort, even though the parents had a fair knowledge about the nature of epilepsy, they were found to be less aware about its characteristics, causes and prognosis. The awareness about the nature and duration of treatment, its objectives, use of drugs, their side effects and importance of adherence to drug regimen was found to be significantly low with a potential for affecting the therapeutic outcome. Special awareness programs for parents of children with epilepsy may be needed to reduce the knowledge gaps in the management of epilepsy and to ensure compliance and optimal therapeutic outcomes.

The enlargement of the middle concha as a pneumatized cavity is defined as concha bullosa. Concha bullosa is one of the most frequently encountered anatomic variations inside the nose. Polyps, submucous cysts, ossifying fibromas and pyoceles have been found in concha bullosa. This is a case report where fungal mass was seen inside the concha bullosa. Clinicians should be aware that a chronic rhinosinusitis that is unresponsive to normal management with a hyper dense focus is highly suggestive of fungal ball. How to cite this article Sasindran V, Joseph A, Abraham SS, Gautam A. Fungal Mass in the Concha Bullosa: A Rare Entity. Clin Rhinol An Int J 2014;7(3):132-134.

Objectives: The main objectives of the study were to determine the treatment outcome of tuberculosis (TB) patients in a tertiary care hospital, factors associated with the success of treatment, the adverse drug reactions (ADRs) associated with anti-tubercular drugs, and the causality and severity evaluation of ADRs.Methods: It was a prospective study conducted for 10 months to evaluate the treatment outcome in TB patients in a tertiary care teaching hospital in Kerala, India. A total of 101 patients were studied as per the inclusion and exclusion criteria. Treatment outcome analyzed according to the WHO guidelines, causality and severity assessment was done by Naranjo and HARTWID-SIEGEL scale, respectively. A standardized data collection form was prepared, and necessary data were collected from patient’s medical records.Results: A total of 101 patients mostly in the age group of 30–50 years were male population dominates pulmonary TB (PTB) was seen in 57 (56.43%) extra PTB in 44 (43.57%) in which pleural effusion TB was common (34.09%) other types were lymph node TB (15.74%), spine TB, TB meningitis (9.09% each), bone TB (6.481%) treatment outcome found to be success in 85 (84%) 10 (10%)treatment completed 1 (1%) died 4 were defaulters, 1 not evaluated, 82 developed ADR. On causality assessment it was possible and severity of moderate level.Conclusion: By proper management and monitoring TB can be completely cured, and most of them have a favorable outcome with current treatment, and ADR can be managed by providing proper awareness of treatment modalities/disease.

Objective: The aim was to study the vision-related quality of life (QOL) for diabetic retinopathy (DR) among patients with Type 2 diabetes and to assess the direct medical cost of different treatment modalities. Methods: It was based on an individual-based analysis of QOL before and after the treatment for DR. The main objective of the study was to compare QOL between patients based on the different treatment modalities using vision function questionnaire (VFQ)-25, to evaluate the direct medical cost for DR patients undergoing different treatment modalities and to compare the cost and QOL of different treatment modalities in samples with non-proliferative DR (NPDR)/proliferative diabetic retinopathy (PDR) macular edema. The population included were patients with Type 2 diabetes with NPDR, with clinically significant macular edema and PDR, patients diagnosed to have diabetes above 5-year duration, adult patients, ocular pain those who are on regular follow-up and those who are willing to be a part of study. A total of 256 patients were selected out, of which 141 patients were satisfied the study criteria and participated in the study. Data relevant to the voice-related QOL study were obtained and recorded using VFQ-25 questionnaire. Other data relevant to the study were obtained and recorded in a semistructured data collection form by interviewing the patient or their caregivers and by direct examination of patient’s medical record. Expenditure was calculated in Indian Rupees. Results: After comparing the baseline QOL with QOL after treatment, it was found that the overall QOL of the study samples in accordance with the treatment undergone was found to be improved. The overall QOL had improved after the treatment for all samples and major improvement was seen on dependency, social functioning (SF), and mental health (MH). Conclusion: The overall QOL had improved after the treatment for all samples and major improvement were seen on dependency, SF, and MH. In conclusion, the study analyzed that intravitreal bevacizumab therapy is the cheapest one and with the comparatively same clinical outcome when compared with intravitreal ranibizumab therapy for macular edema cases in patients with NPDR and PDR.

In the past twenty years, thirteen new antiepileptic drugs (AEDs) have been introduced, each differing in their efficacy spectrum, mechanism of action, pharmacokinetics, safety and tolerability profiles. These newer AEDs symbolize a welcoming future in the management of epilepsy because they are able to produce a remarkable reduction in seizure frequency in up to 40% to 50% of the patients who had been refractory to old generation drugs. Despite the current availability of these new drugs, only a few patients with truly refractory seizures can be made seizure free. Although the newer agents are not superior to that of the older drugs, some have been shown to be non-inferior in terms of their efficacy. They offer additional advantages like better tolerability, ease of use, reduced interaction profile. Even though in most situations the older generation drugs still represent the best choice, advancing studies show that in many conditions, new generation drugs may be entirely vindicated for initial therapy. This urges a need for the search of novel and more efficacious new antiepileptic drugs in the management of uncontrollable seizures. More direct comparisons of newer versus newer and newer versus older drugs in clinical trials, both for monotherapy and adjunctive therapy must be conducted. More than 20 compounds with promising antiepileptic and neuroprotective properties have been discovered and are under various stages of drug development. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Chronic renal failure is an irreversible progressive condition responsible for high morbidity and mortality. Because it requires life-long treatment in the form of renal replacement therapy, the quality of life (QOL) of patients may significantly impair. Studies have revealed that patient education can play a significant role in improving the QOL in these patients. The primary objective of this study was to assess the QOL of patients on hemodialysis by using the World Health Organization Quality of Life assessment scale and also to study the impact of patient counseling in these patients. Fifty patients were selected for the study and they were randomly divided into two groups, control and test; counseling was given to the test group of patients. There was an increase in score in all the four domains (physical, psychological, environmental and social) among the test group when compared with the control group. Also, we found that the psychological domain showed significant increase in score compared with others. Our findings demonstrate that patient counseling plays an important role in improving the QOL by changing their psychological thinking and bringing them toward spirituality.

Aim: To perform the prescription analysis of rheumatoid arthritis in tertiary care hospital. METHODOLOGY : A prospective, observational study was conducted for a period of 6 months in Rheumatology out-patient department of Amrita institute of medical sciences, Kochi. The datawere collected from patient medication charts. Results : 200 patients enrolled in our study, 82.5% were females with a mean age group of 52.6±10.136. In treatment all the patients were prescribed with DMARDs which is the main stay for the treatment of RA. Methotrexate was the most commonly prescribed DMARD (87.5%). Other DMARDs such as hydroxychloroquine (75.5%), sulphasalazine (50%) and leflunamide (25.5%) were also prescribed. NSAIDs and steroids were next treatment options. Frequently used NSAID was Etoricoxib (6.5%) and 2.5% of patients were prescribed with diclofenac gel. 37% of patients prescribed with steroids. Deflazacort was the commonly used corticosteroids. Other medicines such as folic acid, proton pump inhibitors, calcium supplements, ursodeoxycholic acid etc were also given to patients. 51.5% of patients were on PPI's. 44% of the study population was given calcium supplements. Majority of the patients were managed with combination therapy. Only 7.5% of patients were prescribed with 1 DMARD. In all the other cases patients were given 2 or 3 DMARDs. DMARDs were also given in combination with either steroid or NSAID or both of them. The combination of Methotrexate and Hydroxychloroquine was found to be the most frequently used combination. Conclusion : The study concluded that DMARDs is the main stay for the treatment of RA in which Methotrexate was the most commonly prescribed DMARD. NSAIDs and steroids were next treatment options. Early diagnosis and proper treatment can control the disease and its progression.

We present a case of high-riding jugular bulb that obscured the round window niche causing gradual hearing loss. Encounters with the jugular bulb in ear surgery are uncommon.

Since haemodialysis is an expensive treatment modality for chronic renal failure patients, it is very essential to assess the outcome of therapy in terms of quality of life. The primary objective of the study was to estimate the effect of patient counselling in quality of life of end stage renal disease patients opting haemodialysis using World Health Organisation Quality of life scale and to assess the variables affecting the quality of life of these patients. Quality of life was determined by World Health Organisation Quality of life scale questionnaire comprised of 26 items which measures four domains: physical, psychological, social and environmental domain. A total of 81 patients were selected and divided into test and control group and the test group patients received counselling regarding their disease, use of medications, importance of adherence and the complications experienced during and after dialysis. The quality of life data was collected at the interval of 1, 2, 3, 6 and 12 months and the patients were counselled at each interval. The demographic profiles revealed that majority of the patients were in the age group of 31-50 and there exists a male predominance. About the socioeconomic status, upper middle class people were mostly affected. Assessment of impact of patient counselling in the quality of life of haemodialysis indicated a significant improvement in each domain after counselling. And also found that the psychological domain showed a significant increase in the score compared to others. Patient counselling helped to gain benefits in terms of improvement in quality of life and delayed progression of renal failure. Early recognition and prevention is necessary to improve the quality of life of chronic renal failure patients. Patient counselling should be made mandatory by incorporating clinical pharmacist in the nephrology team to make the patient understand his illness and modifications in lifestyle also create a positive environment and result in better quality of life.

The clinical pharmacy has spread out drastically in terms of its professional services throughout the past few years. The clinical pharmacist become a crucial element of healthcare team and promotes patient care by interacting with physician and patient. The aim of this paper is to highlight the role of clinical pharmacists in various departments. It concludes that the features of interactions occurring between clinical pharmacists and physicians influence the teamwork between pharmacists and physicians and provide better patient care.