Introduction: In this era, health-care facilities have improved greatly which has increased the life expectancy of humanity, but all these costs and so the role of economic evaluations of health-care interventions has become increasingly important especially in developing countries like India. Objective: To estimate the expenses of a patient in Intensive Care Unit (ICU), disease wise expenditure and area of expenses (therapeutic and diagnostic). Materials and Methods: This prospective observational study was conducted in tertiary care hospital of private setup in Mumbai region. The inclusion criterion was admitted patients in medicine ICU (MICU) on the basis of the clinical presentation during January 2014–February 2014 (2 months). The cost of treatment included the bed charges in the hospital ICU, diagnostic cost (routine and special investigations), therapeutic cost, cost of oxygen, monitor, nebulization, ventilator, cost of drugs, and other consumables were assessed. Results: Totally fifty patients were admitted in above period to MICU. The average stay of a patient in MICU amounts to 4 days (approximated for 4.01) with the least being 1 day for unstable angina and maximum 11 days for congestive cardiac failure. Conclusion: The major shares of expenses in treatment in MICU were on medicines, and this can be reduced using generic drugs.

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Various researches have been conducted for the improvement of diagnostics and therapeutic systems of health care. Novel and advanced technologies focus more on diagnosing and identifying diseases and then providing an effective therapy conjugated with the diagnostic agents itself. Theranostics based on nanotherpay with personalized medicines do have better prognosis and prevent turning up of curable disease into fatal one due to late diagnosis, especially for the common poor from the third world nations. In the treatment of cancers, various biofluids and tumors are isolated and then analyzed for various biomarkers such as soluble markers, immune histocomplexes, proteins as products from mutated genes, altered proteins, antigens, or differently expressed proteins. Providing treatment on right time depends very much on right-time diagnosis with high specificity and accuracy. Improved diagnosis helps in prescreening the profile of target molecules to develop biomarkers based on disease-specific therapy. With making it the less expensive, with less off-target toxicity and high efficacy and specificity, with real-time analysis for thorough observation and guidance and studying effects and side effects to develop further therapeutic options. This review focuses more on personalized medicines with theranostic approach.

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Background: Water pipe smoking (WPS) is associated with many adverse health effects, diseases, and cancers. Few studies exist on the effects of WPS on the human body and, to our Knowledge, this is the first study on levels of glucose and electrolytes in WP smokers. Aim: This study was done to determine the effects of WPS on concentrations of glucose and some electrolytes in WP smokers compared to concentrations in nonsmokers. Materials and Methods: This study was done on 85 randomly chosen healthy controls (21 female and 21 male WP smokers, and 21 female and 22 male nonWP smokers) with an age range of 20–35 years from Jeddah and Al-Muzaylef, Saudi Arabia. Blood samples were collected to determine the plasma concentrations of K⁺, Na⁺, P⁻³, Mg⁺², Ca⁺², Cl⁻, and glucose. Results: The results show no significant differences for electrolytes and glucose levels in female and male smokers compared to female and male nonsmokers respectively, with the exception of a significantly higher Cl⁻ concentration for male smokers. Comparing female and male smokers, Na⁺, Mg⁺², Ca⁺², and glucose concentrations were significantly lower for females, whereas the remaining electrolytes were not significantly different. Comparing female and male nonsmokers, K⁺, Na⁺, Ca⁺², and glucose concentrations were significantly lower, and Cl⁻ concentration was significantly higher in females, while the remaining electrolytes were not significantly different. Conclusion: The data suggest that WPS affects Cl^- levels in males and affects K⁺, Mg⁺², and Cl^- levels when comparing the differences between female and male smokers with nonsmokers.

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Background: Pain is one of the most common associated symptoms in cancer patients. It develops a number of devastating physical and psychological symptoms. Aim: The purpose of this study is to evaluate the current pain assessment and management plans in cancer patients. Settings and Design: This prospective multicenter observational study was carried out in 3 university hospitals in Lebanon over 6 months from October 2014 to April 2015. Materials and Methods: Men and women aged 18 years and above were observed if they have had any type of cancer, more than 1 day of hospitalization, cancer-related pain, and receiving analgesics. A total of 508 patients were screened over 1 year, where 100 patients have met the eligibility criteria and were observed. The primary outcome measure was an evaluation of pain assessment adherence to the National Comprehensive Cancer Network (NCCN) guidelines. Secondary outcomes included evaluation of adherence of pain management approaches. Statistical Analysis Used: Data were analyzed with SPSS version 21.0. Adherence to the guideline recommendations for assessment was compared using t-test, whereas, adherence to guideline recommendations for treatment was compared using linear regression. Results and Conclusions: Most patients were not adhered to the pain assessment guidelines (82% vs. 18%, P = 0.002), where although patients were assessed by a health-care provider during initial hospitalization, yet, no tool was used for assessment, and there was no documentation of measured pain intensity. For the pain management adherence, 76% were adhered versus 24% were not adhered, P = 0.006. The mis-adherence was in the choice of opioid agent (61.8% vs. 38.2%, P = 0.003), and dosing of these agents (75.5% vs. 24.5%, P< 0.001). Well adherence was observed in terms of nonopioid analgesics use (72.5% were adhered vs. 27.5% were not, P = 0.01). Poor overall adherence to NCCN guidelines was found, and the gaps were related to pain assessment and management recommendations.

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Pediatric cases with myelomeningocele are susceptible to fractures of lower extremities. Impacted proximal tibial metaphyseal fractures are uncommon injuries in pediatric age and peak around 3–6 years of age. Impacted fracture in proximal tibia region consists of periosteal buckling associated with compression load, particularly in metaphyseal area. Proximal tibial is an uncommon site for impacted fractures and the injury pattern in a child with paraplegia associated with myelomeningocele has been a rare report. As the displacement of the fracture is main concern, so a good splinting is the mainstay of treatment. Our report depicts a rare site of fracture in this subset of patients as well as treatment consideration in the form of short-term, light weight and fabricated bracing as the splints. Periodic supervised assessment for recurrence or de novo comorbidities as well as proper nutrition and therapy for osteomalacia is instrumental as part of the holistic management of such cases.

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Background: The Macintosh blade is one of the most popular blades with a gently curved tongue which extends to the tip. The McCoy blade laryngoscope has a hinge on the tip to avoid the lifting force in the vallecula reducing the amount of force exerted in the vallecula causing less hemodynamic changes. Aim: An attempt had been made to compare hemodynamic changes during laryngoscopy with Macintosh and McCoy laryngoscopes in adult patients undergoing elective surgeries. Settings and Design: It was a prospective, randomized, observational study conducted between October 1, 2013, and April 10, 2015. Materials and Methods: Institutional Ethics Committee approval was taken before the commencement of the study. An informed and written consent was taken from every patient selected for the study. Sixty adults (18–60 years) of both sexes, American Society of Anesthesiologists Grade I and II, undergoing elective surgery under general anesthesia requiring endotracheal intubation were enrolled in this study. Patients were randomly divided into two groups. Group A – where McCoy laryngoscope blade was used for laryngoscopy and Group B – where Macintosh laryngoscope blade was used for laryngoscopy. After induction of anesthesia, laryngoscopy was performed, and trachea was intubated. The change in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was observed for 10 min post intubation. Statistical Analysis Used: It was done using SPSS. T-test and Chi-square test were applied according to the requirement. The level of significance was fixed at 95%. P < 0.05 was considered statistically significant. Results: McCoy group showed statistically significant lower values of mean HR, SBP, DBP, and MAP till 5 min after intubation when compared to Macintosh group (P < 0.05). Conclusions: HR, SBP, DBP, and MAP all did rise in both the group following laryngoscopy and intubation but changes with McCoy laryngoscope were less and statistically significant when compared to Macintosh laryngoscopes.

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Background: Acute pancreaticobiliary diseases are more prevalent and can often lead to severe maternal and fetal morbidity and mortality during pregnancy period. It is very important that early relieving biliary obstruction. Aims: To evaluate the safety and efficacy of individualized endoscopic treatment in managing acute pancreaticobiliary diseases in pregnant patients. Settings and Design: It is a single-center, retrospective study. Materials and Methods: Clinical data of 86 pregnant women with acute pancreaticobiliary diseases treated using individualized endoscopic treatment from January 2012 to January 2016 were analyzed retrospectively. The primary observed indicators included the operation success rate, recovery of laboratory indicators 1 week after the first endoscopic treatment, complications, prognosis, hospital stay, and different effect of individualized endoscopic therapy during different pregnancy period. Statistical Analysis Used: Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 13.0 statistical software. Descriptive statistics was used. Results: The operation success rate was 97.67% (84/86) in all patients. Postoperative abdominal pain, fever, and other clinical symptoms were improved rapidly in patients. The laboratory indicators 1 week after the first endoscopic treatment were improved significantly (P < 0.05). The complications included biliary bleeding, acute cholangitis, postendoscopic retrograde cholangiopancreatography pancreatitis, and hyperamylasemia in 2, 1, 2, and 2 cases, respectively. The complication rate was 8.14% (7/86). The mean hospital stay of patients was 16.02 ± 4.32 days. Moreover, there was not statistically significant difference in the effect of endoscopic therapy during different pregnancy period (P > 0.05). Conclusions: Due to the good safety, marked effect, and little complications, individualized endoscopic treatment should be preferred therapy for patients with acute pancreaticobiliary diseases during pregnancy when performed by experienced hands.

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Introduction: Labeled uses of drug use are approved by the regulatory authorities based on preclinical and clinical data which confirms their safety and efficacy. From the community pharmacist perspective, the most common off-label use is due to physician's prescriptions and usage of over-the-counter (OTC) medications. In India, huge number of medicines is easily available for off-label use from the community pharmacists with or without prescriptions. Objectives: It is a preliminary study to evaluate and describe the off-label drug use by community pharmacists in resource-limited settings. Materials and Methods: It is a prospective cross-sectional study conducted among community pharmacies located in and around of Anantapur district, a rural part of Andhra Pradesh, South India. The data were collected through questionnaire-based semi-structured interview and/or asked the community pharmacists to complete on their own at the spot to avoid manipulation of data. The questionnaire is of two types: the first type evaluates pharmacist perspective on off-label indication for randomly selected drugs (frequent moving) and the second type evaluates dispensing practice of drugs for off-label use based on symptoms. Results: The present study results show that the frequency of off-label drug use is high among community pharmacists; moreover, they dispense the drugs without aware of off-label or inappropriate indication, sometimes as OTC medications. It is an acceptable fact that off-label or unlicensed drug use is not illegal but has plenty of safety and other issues. Conclusion: Thus, the present study provides a preliminary data to frame future educational and interventional programs to improve the rational use of drugs with regard to it.

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