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Primary infection with drug-resistant HIV-1 is well documented. We have followed up patients infected with such viruses to determine the stability of resistance-associated mutations. Fourteen patients who experienced primary infection with genotypic evidence of resistance were followed for up to 3 years. Drug resistance-associated mutations persisted over time in most patients studied. In particular, M41L, T69N, K103N, and T215 variants within reverse transcriptase (RT) and multidrug resistance demonstrated little reversion to wild-type virus. By contrast, Y181C and K219Q in RT, occurring alone, disappeared within 25 and 9 months, respectively. Multidrug resistance in 2 patients was found to be stable for up to 18 months, the maximum period studied. We conclude that certain resistance-associated mutations are highly stable and these data support the recommendation that all new HIV diagnoses in areas where primary resistance may occur should undergo genotyping irrespective of whether the date of seroconversion is known.

Despite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.

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The present study was aimed to appropriateness of NSAIDs use with secondary objectives of assessment of co-prescription with gastro-protective agents, the nature and severity of adverse drug reactions and drug-drug interactions with an intention to prevent the inappropriate use of NSAIDs. A prospective study was carried out in 400 In-patients of various departments of the hospital during the 6 months period. Results: Out of 400 patients, 237 were male and 163 were females, in which most of the patients (63.5%) were belonging to age group of 21-50years. The major complaint of the patient was arthritic pain (25.5%). Most of the patients (77%) were prescribed single NSAID as monotherapy in different dosage forms, although some patients were prescribed with combination of Aceclofenac + Paracetamol (13.75%). The preferential COX-2 inhibitors were widely prescribed (84.5%) as compared to non-selective COX inhibitor (15.5%). Among various NSAIDs prescribed, Diclofenac (45.90%) and Aceclofenac (15.96%) were mostly prescribed. NSAIDs were mostly prescribed by parenteral route (36.31%). Most of the patients were co-prescribed NSAIDs with gastro-protective agents (80.5%). In the study, moderate drug interactions were found between NSAIDs and antibiotics and no adverse drug reactions were reported during the study. The study concluded that, prescription of NSAIDs was found to be rational. Education program, counselling program, alertness of community pharmacy regarding OTC drugs can be helpful to minimize harmful effect of the drug to patients.

We report our experience with a 3-5-cm lower ministernotomy incision for closure of atrial septal defect in 53 patients. Fibrillatory arrest was used in 19 patients, and crossclamping with cardioplegia in 33. One patient had to be converted from fibrillatory arrest to crossclamping with cardioplegic arrest. The mean bypass time was 39.6 +/- 13.1 min, arrest time was 9.9 +/- 4.5 min, and crossclamp time was 20.7 +/- 8.69 min. All patients recovered without adverse events. They were fast tracked to recovery and extubated after 63.4 +/- 9.2 min. The mean intensive care unit stay was 1.07 +/- 0.33 days, and hospital stay was 3.07 +/- 0.38 days. The ministernotomy approach was used successfully in 51 patients; in the other 2, it had to be converted to a full sternotomy because of technical difficulties. Our experience confirms that this technique offers satisfactory cosmetic results, stable sternal reconstruction, good surgical exposure, minimal interference with respiratory mechanics, and minimal pain, allowing extubation in the operating room and a speedy recovery.

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