ABC-VED Analysis of a Drug Store in the Department of Community Medicine of a Medical College in Delhi

A matrix based on coupling of cost (always, better and control) analysis and criticality (vital, essential and desirable) analysis was employed for drug inventory containing 129 items of drug store in the Department of Community Medicine of a Medical College in Delhi. The annual drug expenditure incurred on 129 drug items for the year 2010-2011 was found to be Rs. 4,35,847.85. On always, better and control analysis, 18.6, 24.0 and 57.4% drugs were found to be always, better and control category items, respectively, amounting for 69.1, 20.8 and 10.1% of annual drug expenditure. About 13.2 (17), 38.8 (50) and 48.0% (62) items were found to be vital, essential and desirable category items, respectively, amounting for 18.7, 49.5 and 31.8% of annual drug expenditure. Based on always, better and control-vital, essential and desirable matrix analysis there were 37 (28.68%) items in category I, 53 (41.09%) items in category II and 39 (30.23%) items in category III, amounting for 73.0, 22.2 and 4.8% of annual drug expenditure, respectively. To conclude, scientific inventory management tools are needed to be applied in routine for efficient management of the pharmacy stores as it contributes to not only in improvement in patient care but also judicious use of resources as well.     

Medial femoral condyle fracture following traumatic allogenic bone transfer – A case report

Open fractures can cause an “out-in” injury, wherein a foreign body can penetrate the skin causing fracture. There are few reports of allogenic bone getting embedded in soft tissue, but one causing fracture to the host bone has not been reported till date. We present a case, wherein a large cortical bony fragment from one individual penetrated the thigh of another person causing fracture of medial femoral condyle during a head-on collision involving two motorbikes.     

Gelatinase B (−1562C/T) polymorphism in tumor progression and invasion of breast cancer

Matrix metalloproteinases (MMPs) play an important role in breast cancer tumor invasion and progression. MMP-9 is a member of the MMP family and is also known as Gelatinase B or type IV collagenases (92 kDa) and possesses proteolytic activity against type IV collagen, a major component of the basement membrane. Our study aims to examine the association of Gelatinase B (?1562C?>?T) promoter polymorphism with breast cancer invasion and progression. The study involves 200 breast cancer patients and age-matched 191 healthy controls. The SNP-1562C?>?T (rs3918242) in MMP-9 promoter region was examined by allele-specific polymerase chain reaction and gel electrophoresis. The genotypes were determined and compared between patients and controls, and the influence of the polymorphism on clinicopathological data was analyzed. The T allele of the -1562C?>?T MMP-9 polymorphism was detected more frequently in breast cancer patients than controls (p?<?0.001). Our results suggest the clinical importance of MMP-9 gene polymorphism (?1562C?>?T) in breast cancer patients. The study may also help in identifying individuals at risk of developing breast cancer.     

Evaluation of quality indices during multifractionated pelvic interstitial brachytherapy for cervical cancer

PurposeTo evaluate the impact of needle displacements on quality indices during multifractionated pelvic interstitial brachytherapy (IBT).Methods and MaterialsPatients undergoing boost IBT were included. Postprocedure planning and verification CT scans were obtained. Three-dimensional needle displacements were measured. Clinical target volume and organ at risk were delineated. Coverage index (CI), dose homogeneity index (DHI), dose nonuniformity ratio (DNR), V₁₇₀, V₂₀₀, V₂₅₀, and dose received by 2 cc of organs at risk were obtained at baseline. The displacements were simulated by shifting dwell positions, and dose point optimized and graphically optimized plans were generated. Wilcoxon test determined statistical significance of differences in quality indices.ResultsFifteen patients were included and received five fractions of IBT over 3 days. Maximum displacements were observed in caudal direction (average, 19.1 mm). At baseline, CI of 0.94 (range, 0.91–0.99), DHI of 0.90 (range, 0.80–0.94), and DNR of 0.10 (range, 0.05–0.10) were attained. The CI, DHI, and DNR in Day 3 dose point optimized plans were 0.76 (range, 0.4–0.99), 0.76 (range, 0.40–0.94), and 0.23 (range, 0.06–0.64), respectively. The difference in CI, DHI, and DNR between baseline and Day 3 dose point optimized plans was statistically significant (p = 0.002, 0.007, and 0.001, respectively). Day 3 graphically optimized plans were superior to Day 3 dose point optimized plans (CI, 0.82 vs. 0.76; p = 0.01). Graphically optimized could however improve CI without compromise in DHI, DNR, V₁₇₀, V₂₀₀, and V₂₅₀ only in patients wherein caudal displacements ≤15 mm.ConclusionsCaudal needle displacements during multifractionated IBT cause significant deterioration of quality indices. Replanning with graphically optimized and/or needle repositioning maybe required for maintaining the quality of IBT.