Background: Folic acid deficiency occurs in some epileptic patients on long term treatment with enzyme inducing antiepileptic drug (AED) particularly phenytoin and this may lead to the development of atherosclerosis due to the lipid profile alteration. Objective: The present study was planned to investigate folic acid level and lipid profile among patients with epilepsy on antiepileptic drug treatment. Materials and Methods: A 25-week, prospective study was conducted in 250 bedded private hospital, Salem, Tamil Nadu, India. In this study, an attempt was made to compare the folic acid level, lipid profile and atherosclerotic risk including Framingham risk score between the normal healthy volunteers (Control), patients with newly diagnosed cases of epilepsy (Supercontrol) and patients with more than one year of antiepileptic drug treatment (Cases). Results: Folic acid level (in ng/dl) was found to be lower in cases (7.26 ± 2.98) than control (12.69 ± 5.64) and super control (9.35 ± 2.73) - the difference was statistically significant (p less than 0.05). Normal total cholesterol (TC) level (162.0 ± 23.22 mg/dl) and normal very low density lipoprotein (VLDL) level (40.5 ± 12.89 mg/dl) was observed in cases. But decrease in high density lipoprotein (HDL) level (36.5 ± 12.45 mg/dl), elevated triglycerides (TGs) level (202.5 ± 64.44 mg/dl) was noted in cases and the difference was found to be significant (p less than 0.05) as compared to control and supercontrol. TC/HDL ratio, LDL/HDL ratio and TG/HDL ratio were increased in cases when compared with control and supercontrol. Framingham risk score reveals slightly higher risk in cases as compared to control and supercontrol. Conclusion: The result of this study reinforces the results of previous reports in terms of folic acid deficiency with AED treatment and the correlation between folic acid deficiency and cardiovascular risk needs to be established.

Neuroprotectors such as phenytoin, fosphenytoin, clonazepam or levetiracetam are often used prior conditioning regimen to prevent seizures caused due to busulfan, during bone marrow transplant. Fosphenytoin and levetiracetam are used instead of phenytoin as they are readily soluble and do not need a vehicle such as polyethylene glycol or ethanol which increases risk of tissue and cardio toxicity. We report a case of acute toxicity in the form of cerebral bleed during intravenous administration of fosphenytoin and its subsequent management in patient undergoing busulfan treatment prior to allogenic transplant.

Antimicrobial prophylaxis is the periprocedural systemic administration of an antibiotic, used to reduce the risk of postprocedural local and systemic infections. The present retrospective study was done in 100 patients who had undergone elective genitourinary surgery in a tertiary care hospital to investigate the rationality of prophylactic use of antibiotics in genitourinary surgery according to the American Urological Association recommendations 2011. All patients undergoing genitourinary surgery had received antibiotics. Injectable antibiotic was administered within 1 hr before surgery in 95% cases and 1-2 hrs before surgery in 5% cases. Preoperatively single antibiotic was used in 92%, two in 7% and three in 1% cases whereas postoperatively single antibiotic was used in 91%, two in 7% and three in 2% cases. Most commonly administered antibiotic group preoperatively as well as postoperatively was a second generation cephalosporin, cefuroxime along with a beta lactamase inhibitor, sulbactam (90% cases) followed by the combination of cefuroxime and an aminoglycoside, amikacin (4% preoperatively and 5% cases postoperatively). The number and group of antibiotic used preoperatively and postoperatively were quite identical. The average duration of antibiotic use was 3-10 days. The prophylactic use of antimicrobials in genitourinary surgeries in this hospital was rational with respect to time of administration and choice of antibiotic group. However, the duration of antimicrobial use was highly irrational which must be controlled to prevent the emergence of resistance strains and decrease the adverse effects and cost of health care to the patient.

Chylothorax, an accumulation of chyle in the pleural cavity, is a rare complication of penetrating or blunt trauma to the neck. It could result from damage to or obstruction of thoracic duct. Though rare in incidence, chylothorax can lead to significant morbidity and mortality. A milky fluid with high level of triglycerides in pleural fluid confirms diagnosis. This report is about a rare case of left chylothorax secondary to bull horn injury in the right side of neck and its management. A 48 year old male patient presented with bull horn injury on right side of neck with left side chylothorax. Initial management was conservative with pleural drainage. Later because of persistent chylous pleural fluid more than 1500 - 2000/day for more than 5 days, we explored and ligated the thoracic duct in the neck. Post operative period was uneventful and patient was symptom free at 6 months follow up. Isolated thoracic duct injury in trauma cases is even rarer. Early diagnosis and timely surgical management saves the patient.

Background: Most of the food and drug interactions (FDI) remain unnoticed and under reported due to either lack of proper history, follow up or unawareness. Certain foods and specific nutrients in foods, may affect the overall bioavailability, pharmacokinetics, pharmacodynamics and therapeutic efficacy of medications. FDI occur due to extension of drug action or due to interaction between the drug and herbal medicines as well as dietary supplements and food products. Objectives: To evaluate the knowledge, attitude and awareness regarding the common FDI among the doctors in their day to day practice.Materials and Methods: Survey included randomly selected 200 doctors divided into 3 groups [65 Professors, 83 Post Graduates (PGs) and 52 Interns] from JSS Tertiary care hospital, Mysore, India. Assessment was through FDI Questionnaire which consisted of 32 questions (included dichotomous, multiple choice and open ended questions). The differences between groups were compared using one-way ANOVA followed by Bonferroni’s post-hoc test. The level of significance was set at p less than 0.05.Results: The mean scores (mean ± SD) on the overall test were 26 ± 4.08, 22.89 ± 3.72, 21.35 ± 4.2 for professors, PGs and interns respectively, with 31 being a perfect score. Professors had good knowledge about FDI compared to others (p less than 0.001). Only 33% participants have noticed FDI during their practice. A majority of doctors had heard, felt necessary to report and update their knowledge about FDI along with adequate patient counseling. Conclusion: The study showed professors had better expertise compared to others. Intensive FDI training and integration of knowledge among healthcare professionals, especially in the younger health care professionals, is a requisite.