Showing papers in "International journal of basic and clinical pharmacology in 2019"
TL;DR: Oral administration of Coriandrum sativum seed extract at a dose of 40 mg/kg has shown antihyperglycemic activity in streptozotocin induced diabetic rats, which may have considerable therapeutic benefit as an antidiabetic agent and can be suggested as a potential dietary add on.
Abstract: Background: Diabetes mellitus (DM) can be defined as chronic hyperglycemia due to lack in insulin secretion and/or action. This study was designed to compare the antidiabetic activity of Coriandrum sativum L. with the standard antidiabetic drug, Metformin in Streptozotocin induced diabetic rats.Methods: Streptozotocin (STZ) was used to induce diabetes in the rats. Standard drug was metformin and test drug were Coriandrum sativum seed extract. 4 groups of 8 rats each were taken (normal control, diabetic control, streptozotocin + Coriandrum sativum and streptozotocin + metformin). Blood Sugar Levels (BSL) and HbA1C levels were estimated on day 0, 14 and 28 and day 28 respectively.Results: Streptozotocin administration resulted in significant rise in BSL. This rise was reduced with the administration of CS seed extract, but the reduction was more with chronic administration. It also reduced the HbA1C levels but couldn’t attain total normoglycemia. However, the reduction of BSL was superior with Metformin compared to the test drug.Conclusions: Oral administration of Coriandrum sativum seed extract at a dose of 40 mg/kg has shown antihyperglycemic activity in streptozotocin induced diabetic rats. Thus, Coriandrum sativum may have considerable therapeutic benefit as an antidiabetic agent and can be suggested as a potential dietary add on.
10 citations
TL;DR: Different modes of drug promotion are used by the pharmaceutical companies which include visual aids, drug reminders and audio visuals, which claim to provide vital and accurate information regarding the drug that is being promoted to the physician.
Abstract: Background: Large numbers of new drugs are introduced into the market every day and pharmaceutical companies are in the business of development and selling of new drug. There are different modes of drug promotion which include visual aids, leave behind leaflets and audio visuals. Drug Promotional Literatures (DPL’s) claim to provide vital and accurate information regarding the drug. To ensure rational use of drugs a set of standards laid by the WHO for ethical drug promotion.Methods: A cross sectional observational study was performed in Department of Pharmacology at a tertiary care teaching hospital of Navi Mumbai. A total of 100 drug promotional literatures were randomly collected from different outpatient departments and were evaluated by using WHO guidelines.Results: None of drug promotional literature fulfilled all WHO criteria. Generic name, Brand name, active ingredients were mentioned in all. The problem causing ingredient was not mentioned in any of the cases. Safety information was not complete, adverse drug reactions were mentioned in only 45% of the cases, contraindications and drug interactions were mentioned in 39% of the cases. Manufacturer details including name and address of manufacturer was mentioned in 67% of the DPL’s. References were mentioned in 80% of the literature out of which 84% were from journal articles.Conclusions: None of the DPL’s satisfied all the WHO criteria. Incomplete information may lead to irrational prescription of drugs. Therefore, more strict regulations need to be implemented and physicians must critically evaluate DPL’s before considering the same for prescribing.
8 citations
TL;DR: The understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research are highlighted.
Abstract: Data from drug utilization research is an invaluable resource for all stake holders involved in drug and health policies. Drug utilization is “marketing, distribution, prescription and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences”. Research on drug utilization includes factors related to prescribing, dispensing, administering and intake of medication and its associated events. The ultimate purpose of drug utilization research is to estimate the optimal quality of drug therapy by identifying, documenting, analysing problems in drug utilization and monitoring the consequences. It encourages the prescribers to prescribe correct drug at appropriate dose and affordable price. It contributes to the knowledge of rational use of drugs in the society; whether the drug is being prescribed appropriately, whether the drug is taken in correct dosage, whether the drug is available at affordable price or misused. It provides valuable feedback about the rationality of the prescription to the doctors. It also assesses whether an intervention affects the drug use in the population by examining the outcomes of different types of intervention given to improve rationality in drug use. Drug utilization research can be qualitative or quantitative and can be done by various methods. This review highlights the understanding of various aspects, different designs and WHO guidelines for conducting drug utilization research.
7 citations
TL;DR: Vitamin D is a fat-soluble vitamin (sunshine vitamin), known for its antirachitic activity, and refers to Vitamin D3 which can be synthesized endogenously.
Abstract: Background: Vitamin D deficiency is a common nutritional disorder that has assumed epidemic proportion. One of the major reasons for the worldwide spread of this disorder has been deficient awareness about the importance of vitamin D, its benefits on health, and prevention of deficiency state across different populations. Vitamin D deficiency (VDD) is widely prevalent in this part of the country (Kashmir valley, India), the prevalence being higher in females. This study was conducted to assess the awareness of female medical students regarding the importance of vitamin D and the prevention of its deficiency among them.Methods: This cross-sectional study was carried out among 113 female medical students. A self-administered questionnaire consisting of two parts was used to collect data. The first part was for identifying socio-demographic characters and the second half was a 12-question, multiple-choice survey focussing on vitamin D. Data was entered and analysed using computer software MS Excel.Results: The results of the study showed that the participants had good knowledge regarding some aspects while knowledge for other aspects was poor. The majority of participants had adequate knowledge about main source/dietary source of vitamin D, the site of synthesis, effect of vitamin D on bone health, main effects of deficiency on bone health, identification of high-risk groups and importance of supplements in management of deficiency. However, majority had inadequate knowledge about the epidemic state of VDD, RDA, time/duration of sun exposure and other effects of deficiency.Conclusions: The present study showed that there are some gaps in awareness about vitamin D, its benefits, and management of deficiency among female medical students.
7 citations
TL;DR: Pharmacoeconomics facets must be taken into deliberation by healthcare practitioners while prescribing antibiotics to the patients for infectious disease treatment to assist compliance, reduce antibiotic resistance and treatment failure.
Abstract: Background: The objective of the present study was to analyse price differences between parenteral antibiotics available in a tertiary care teaching hospital.Methods: The study was done in the Department of Pharmacology of S. D. M. College of Medical Sciences, Dharwad, Karnataka. Latest volume of current index of medical specialties or Indian Drug Review was used to analyze the prices of parenteral antibiotics.Results: Overall, prices of 17 single drug antibiotics available in 37 strengths marketed and 8 fixed-dose combinations available in 16 strength marketed were analyzed. It was observed that the maximum cost variation among the single ingredient parenteral antibiotic was with cefpirome 1000 mg. The price difference being Rs. 283 and the cost variation being 90.7%. The minimum price variation was seen with Ampicillin 100 mg of Rs. 4.3 and the cost variation being 40.2%. Additionally the highest price difference was also seen teicoplanin 400 mg i.e., Rs. 610 and its cost variation being 68.5%. Among the fixed-dose combination (FDC’s) the maximum price variation was observed in the combination of cefoperazone+sulbactum 1000+1000 of Rs. 340. Whereas the cost variation of the same was 212.5 %. The minimum price variation among the FDC’s was of the combination of ceftriaxone 250 mg + tazobactum 31.25 mg Rs. 3.3 and its cost variation being 7.9 %.Conclusions: Pharmacoeconomics facets must be taken into deliberation by healthcare practitioners while prescribing antibiotics to the patients for infectious disease treatment. This will assist compliance, reduce antibiotic resistance and treatment failure.
7 citations
TL;DR: Self medication is a widely used practice which is increasing day by day and it has become the first choice for common health problems.
Abstract: Background: Self-medication is a very common practice which is gradually spreading all over the world. Analgesics are the most commonly available over the counter (OTC) drugs. They are used for pain relief in many diseases. Use of these analgesics has become a serious ailment because self- medication practices of analgesic drugs are increasing among general population as well as medical students. Being future medical practitioners, self-medication has a special impact in medical students. Various data are available regarding usage of OTC analgesic drugs but still data in Jharkhand are lacking. So, the present study aims to provide an insight into the practice of OTC analgesics among 3rd and 4th year medical students in RIMS, Ranchi, Jharkhand.Methods: It was a cross-sectional study conducted among medical students in RIMS, Ranchi, Jharkhand in November-December 2018. Data were collected through questionnaire filled by the students and results were expressed as percentage frequency.Results: Questionnaire were filled completely by 253 students out of 287 students. 85.8% of males and 90.41% of females were practicing self-medication. Advice from seniors and books were the major source of information about the drugs. Paracetamol was the most common drug used (54.87%) and headache (27.43%) was the most common indication. Mild nature of illness (30.34%) and quick relief (29.10%) were the most common reason of self-medication. About 83.39% of them were using these drugs according to need.50.98% had not felt any side effects. 51.38% students were of the view that self-medication practices are not always acceptable.Conclusions: Medical students use OTC analgesics for various kinds of pain like headache, muscle pain, menstrual pain etc. They generally use different non-steroidal anti-inflammatory drugs (NSAIDS) among which paracetamol is the most common. But self-medication practices are always associated with some risks. So, the students must be educated properly regarding their rational use and advantages and disadvantages of OTC drugs.
7 citations
TL;DR: In the past few decades there has been an exponential growth in the global human population and India accounts as 17.4% (1.37 billion population till August2019) in the world and the disease rate is also directly proportional to the mortality of the people globally.
Abstract: Background: Drugs are double edged weapons, they are used in treatment of the patients but in return can harm as well. The safety of drug prescribing has become a need of the hour topic in medicine. Safety monitoring of patients via Pharmacovigilance tool has become an integral part of pharmacotherapy. This study has been undertaken to analyze the various individual case safety reports including the Special situation cases of medicational error and over dose and to promote the reporting of adverse drug reactions (ADRs) among the healthcare professionals (HCPs).Methods: A retrospective non-interventional observational study was done for indexed period of six months at AMC-PvPI under Osmania Medical College and General Hospital. The reported individual case safety reports (ICSRs) are evaluated on basis of demographics of age and gender, seriousness criteria, outcome parameters and causality assessment of suspected drug (s) and suspected ADR/AE (s) as per the ICH guidelines and WHO causality assessment scale.Results: A total of 177 ICSRs are reported out of that 137 were ADRs, 36-medication error cases and 4-cases of over dose. The incidence of ADRs in females are high compared with males was identical. The occurrence of ADRs in adult patients (61%) was significantly higher than other age groups. Of total ADRs, most of them were with analgesics (26%) and highly reported system organ classification was CNS. Overall, 79% patients were recovered from ADRs.Conclusions: The results depicted an insight to the HCPs on the importance of monitoring and reporting of ICSRs. Our study results emphasized need to roll out a pharmacovigilance practice tool to ensure the safe use of drugs for better Pharmacotherapy and development of pharmacogenomic studies.
6 citations
TL;DR: Hemovigilance is defined as the surveillance of adverse drug reactions that occur in both donors and recipients and the epidemiological monitoring of donors as well.
Abstract: Abstract: Transfusion by blood and blood products forms an important part of treatment. But this is not free from transfusion reactions which may be in the form of fever, rashes, shivering, anaphylaxis or even death. Hemovigilance is a programme of reporting such events.Materials and Methods: The present study was conducted in a tertiary care hospital of Jammu, (J& K). Permission was taken from Institutional Ethics Committee, Govt. Medical College, Jammu. A pretested questionnaire was prepared and circulated among practitioners. They were given time of 15 minutes to fill that questionnaire. After 15 minutes, the filled questionnaire were collected and were analysed. The data was presented in tabulated form.Results: Total 50 practitioners were included in the study. All the practitioners had knowledge about transfusion reactions. Only 10% of the practitioners had knowledge that transfusion reactions can be prevented, 40% of the practitioners had knowledge about hemovigilance programme and had an idea that transfusion reactions can be reported. But only 10% of the practitioners knew where to report and who can report, 6% knew how to report. Only 48% of the practitioners thought that transfusion reactions should be reported, 70% of the practitioners thought that transfusion reactions can be dangerous. 40% of practitioners told that seminars/CMEs should be planned. 80% of practitioners had encountered transfusion reactions, but only 2% had documented the same. 10% of the practitioners had attended seminars, CMEs. Many reasons were quoted for not reporting transfusion reactions.Conclusion: Overall, most of the practitioners have a positive attitude towards transfusion reaction reporting but knowledge regarding the haemovigilance concept is poor and the majority of them never reported such reaction. Hence, our study demands increased awareness and continued training to strengthen the haemovigilance system.
6 citations
TL;DR: periodic evaluation of prescribing pattern is beneficial in redefining guidelines as per current pattern of drug use.
Abstract: Background: Diabetes Mellitus is a worldwide growing problem causing threat to patient's health because of its association with various complications and comorbidities. It is a chronic disease requiring lifelong medication which further adds to the economic burden. The objective of this study was to evaluate the prescribing pattern and to do pharmacoeconomic analysis of prescribed antidiabetic drugs.Methods: This observational cross sectional study was conducted for 12 months duration in Outpatient Pharmacy of tertiary care hospital. Prescriptions with antidiabetic drugs were captured and evaluation of prescribing pattern along with pharmacoeconomic analysis of antidiabetic drugs was done.Results: A total of 611 prescriptions with antidiabetic drugs were analyzed. There were total 4034 drugs in all prescriptions with a mean of 6.6 drugs per prescription. 4.28% of drugs were prescribed by generic name and 58.9% of prescribed drugs were from essential drug list. Dual drug therapy was prescribed in maximum number of patients (42.2%) followed by monotherapy (28.8%). More commonly prescribed class of antidiabetic drugs was biguanides as monotherapy (n=119) and its combination with sulfonylureas was prescribed maximally among dual drug therapy (n=158). Cost of monthly therapy for antidiabetic drugs prescribed as monotherapy was least with Biguanides (₹ 98.89/ month) whereas combination of biguanides and thiazolidinediones was least expensive among dual drug therapy (₹ 216/ month).Conclusions: Biguanides was the most common prescribed class of antidiabetic drugs among monotherapy and its combination with sulfonylureas was most prescribed as dual drug therapy and both of these therapies were economical.
6 citations
TL;DR: The data show that ADRs such as peripheral neuropathy and anemia are very frequent in the Malian population and the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population is highlighted.
Abstract: Background There are few reports in the literature from sub-Saharan Africa (SSA) regarding antiretroviral-induced adverse drug reactions (ADRs). Antiretroviral therapy (ART) is now widely available in SSA, and ADRs during HIV infection are also frequent. In this study, we reported the frequency and risk factors of ART-induced ADRs in a Malian population. Methods This prospective cohort study was performed in the HIV Care and Counseling Centre (CESAC) of Mali from 2011 to 2012. Adult patients infected with HIV and who had recently started ART were included and followed-up clinically Were included in this study, adult patients living with HIV and had recently started ART who were followed up for at least 6 months to determine the incidence of ADRs using Naranjo's classification scale. Results During this study, 357 (42.3%) patients presented ADRs (40.1% of our patients (n=338) experienced at least one ADR, and 2.2% (n=19) experienced at least two ADRs). The prevalence of ADRs by organ system was: 45.9% neurological (n=164); 29.4% metabolic (blood chemistry) (n=105); 15.4% hematological (n=55). High probable rate of ADR was observed as indicated by the Naranjo score in 83.7% of the cases. Zidovudine (AZT) and stavudine (d4T) use was identified as a risk factor for either anaemia or peripheral neuropathy whereas nevirapine (NVP) and female gender were risk factors for skin reactions. Patients with advance disease had the highest rate of ADRs compared to the others. Conclusions Based on the Naranjo probability scale, our data show that ADRs such as peripheral neuropathy and anemia are very frequent. These ADR was linked to AZT and D4T. Our findings highlight the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population.
5 citations
TL;DR: As responsible self medication is now increasingly being considered as a component of self-care, there is need for review of educational programs especially teaching of rational and judicious use of medicines to the undergraduate medical students.
Abstract: Background: Inappropriate self-medication is a cause of concern as it can result in wasteful expenditure, prolonged suffering, drug dependence, resistance and increase in morbidity. Self medication assumes significance among medical students as they have knowledge about ailments and medicines. The aim of the study was to assess the knowledge, attitude and practice of self-medication among undergraduate medical students.Methods: The present study was conducted in December 2017 among second professional undergraduate medical students in the Department of Pharmacology and Therapeutics, GMC Jammu after obtaining approval from the Institutional Ethics Committee of GMC, Jammu. A total of 123 students who took self-medication during last six months were included and given a questionnaire that included open and close ended questions about self-medication. Data was analysed using Microsoft Excel and presented as number and percentages.Results: Total of 123 second professional undergraduate MBBS students were analysed. 72 (58.53%) were males and 51 (41.46%) were females. 96 (78%) students practised self-medication. Allopathic drugs were most commonly used for self medication (93.5%), followed by Ayurvedic drugs. Fever and headache were common ailments treated with self medication. Common class of drugs used for self medication were antipyretics (66.6%), antibiotics (42.2%). Adverse drug reactions were perceived as the most common disadvantage of self medication. Analysis of source of information revealed that old prescriptions (33%), internet (18%) were the main sources of information. Regarding prevention of self medication, many students perceived that enhancing awareness was the most effective solution (72.3%) followed by stoppage of supply of medicines without prescription(39.8%).Conclusions: Self medication is practised by a majority of students. As responsible self medication is now increasingly being considered as a component of self-care, there is need for review of educational programs especially teaching of rational and judicious use of medicines to the undergraduate medical students.
TL;DR: In this paper, the authors investigated the use of various drugs used in the medical intensive care unit (MICU) and clinical outcome of these drugs and found that the most common drugs used were ranitidine (99.71%), anti-emetic (ondansetron) and ondansetral ( 99.43%), among antibiotics cephalosporins were most commonly used.
Abstract: Background: The medical intensive care unit (MICU) is a setting were patients who are critically ill are admitted and thus usually receive a large number of drugs of different pharmacological classes due to life threatening illnesses which may be fatal. The various drugs used in MICU and there clinical outcome was investigated in this study. Methods: Patients admitted between January 2017 to June 2018 in Medicine ICU of GMC Aurangabad were included in this study. Results: Total of 351 prescriptions was analyzed from the medicine intensive care unit. Out of 351 patients 243 (69.23%) were male, while 108 (30.77%) were female. The mean age of the patients admitted in MICU was 42.78±18.14 years. The most common type of patients admitted in MICU have the diagnosis of organophosphorous poisoning (25.36%), followed by cerebrovascular accident (15.95%), pneumonitis (10.26%), snake bite (7.12%), chronic kidney disease (5.98%), diabetic ketoacidosis (5.70%) and seizure disorder (3.42%). The most common drugs used were ranitidine (99.71%) and ondansetron (99.43%). Among antibiotics cephalosporins were most commonly used, ceftriaxone (39.03%), cefotaxim (40.46%), cefoperazone and sulbactum (24.22%). Other antibiotics most commonly used were metronidazole (61.25%), amoxicillin and potassium clavulanate (26.78%), piperacillin and tazobactum (11.68%), meropenem (11.40%). Conclusions: In conclusion, we found that in MICU utilization rate of gastroprotective (ranitidine), antiemetic (ondansetron) and antibiotics (cephalosporins) was high. The present study provides valuable insight about the overall pattern of drugs used in medicine intensive care unit.
TL;DR: Teaching traditional sources of drugs through I-tray impart higher order social, place based and experiential learning of medicine.
Abstract: Background: Complementary and alternative medicine is very robust in some parts of the world. The study was done to impart the experiential learning related to sources of drugs in a pharmacy practical class for MBBS students.Methods: We used ingredient-tray (I-Tray) teaching tool consisting of two parts to generate experiential learning in MBBS students about ethno pharmacological sources of drugs. Innovatively designed I -tray filled with two sizes plastic containers (100 ml and 50 ml sizes used for collecting biological samples of sputum and urine) containing crude drug medicinal sources which were arranged in gutters of the tray. They were sorted into five categories such as plants (flowers of Vinca rosea, bark of Terminalia arjuna, roots of Rauwolfia serpentine and Eucalyptus leaves); animals (formalin preservatives freshwater leech, shells and vaccines); minerals (kaolin, potassium permanganate and charcoal); oils and others. Three charts of 4 square feet sizes were used for demonstration of synthetic, microbiological and genetically engineered drug sources.Results: The students’ approval rate of I-tray was mean yes value of 105.78 for a tool of active learning out of total 113 students. Around 100%, 98.23 % and 97.35% students utilised application of concept (cognition), faculty of smell (affective) and volunteering (psychomotor) in the class. However female students had statistically significant score against this set up of the class depicting gender specificity of the learning process.Conclusions: Thus teaching traditional sources of drugs through I-tray impart higher order social, place based and experiential learning of medicine.
TL;DR: Incidence of cancer is more in females than males, and adjuvant and cytoprotective drugs used may have had a bearing on the relatively lower incidence of adverse effects.
Abstract: Background: To study drug utilization of anticancer drugs in the oncology inpatient department (IPD) of Kamineni Hospitals, L.B. Nagar, Hyderabad, India.Methods: One hundred prescription records were screened and analysed as per the study parameters from the oncology IPD of Kamineni Hospitals, Hyderabad. Commonly used anticancer drugs were recorded; furthermore, different types of carcinomas were noted.Results: Age group of patients was in between 04 and 80 years, 62 were females and 38 were male patients. The most common type of carcinoma was carcinoma of the breast (28%). Cisplatin was the most commonly used anticancer drug (29%). Adjuvant drugs were used in 98% of the patients.Conclusions: Incidence of cancer is more in females than males. Adjuvant and cytoprotective drugs used may have had a bearing on the relatively lower incidence of adverse effects.
TL;DR: In this paper, a study of II MBBS pharmacology question papers (n=18) of RGUHS, Bengaluru from the year 2010 to 2018 was done, and the data was analyzed according to modified Blooms levels of taxonomy, cognitive domains, areas of importance and weightage given to different topics in Paper 1 and 2 in comparison to university syllabus.
Abstract: Background: Assessment is the backbone of curriculum development and an important component of medical education. Written exams are frequently used in medical education and question papers are important instruments of assessment of medical education. The present study is summative question paper based analysis study where the content validity, level of cognition, cognitive domains, marks distribution and time weightage in theory question papers were analyzed.Methods: Retrospective analysis of II MBBS pharmacology question papers (n=18) of RGUHS, Bengaluru from the year 2010 to 2018 was done. The data was analyzed according to modified Blooms levels of taxonomy, cognitive domains, areas of importance and weightage given to different topics in Paper 1 and 2 in comparison to university syllabus and with regard to time allotted in university syllabus.Results: Analysis of question papers revealed that topics like GIT, respiratory system, uterine drugs, antiseptics and disinfectants, immunosuppressant were consistently underrepresented in question papers. Also, majority of questions (68.06%) did not have any verbs associated with Blooms level of taxonomy and hence did not meet criteria of standard question paper. Comparison of time allocation to weightage of topics in syllabus revealed no significant variations in percentage distribution.Conclusions: Assessment in medical education should not be used merely for classification, grading and certification rather it should become an instrument for promoting growth of knowledge. For this the university should frame standard blueprint for question paper setters and the question paper setters should follow those guidelines strictly and ensure that weightage given for different topics is maintained.
TL;DR: ADRs are common, at times can be life threatening and in general leads to increased expenses and the clinicians are requested to be aware of the reactions that can be caused by the drugs before prescribing them.
Abstract: Background: Adverse drug reaction, usually reported by pharmacovigilance, either through health care professionals or the patients themselves is of utmost importance to give an accurate estimate of the severity of the drug and also if the ADRs are casual, preventable or severe.Methods: A total of 42 patients satisfied the WHO definition of ‘adverse drug reactions’ were included in the study. The demographic details were taken, and the regular physical examination and clinical examination was done for all the patients. The latest drug they were on and the dosage were analyzed and the type of reaction was assessed. The causality, severity and preventability were also assessed.Results: Majority of the ADRs were found in the medicine department, followed pulmonology, obstetrics-gynecology and paediatrics. B-lactams were the major cause of ADRs with 42.2%, followed by NSAIDs with 23.8%, fluoroquinolones with 19% and 9.5% due to antitubercular drugs. 66.7% of the ADRs were mild, 28.6% were moderate and 4.8% were severe. The most common type of ADR were skin rashes (40.5%), urticara (16.7%), headaches (26.2%), insomnia (21.4%), diarrhoea (21.4%), abdominal pain (14.3%) and vomiting (4.8%). Most of the ADRs were evaluated as probably preventable (69%), definitely preventable (26.2%), non preventable (4.8%).Conclusions: Most of the drug reactions are mild and preventable. More health care professionals as well as patients need to be aware of the drug reactions at much early age so as to prevent the condition before it becomes serious.
TL;DR: The different aspects of pharmacoepidemiology and pharmacohaemovigilance in the study established that the oral haematinics were reasonably beneficial and safe among the anaemic women population, in rural India.
Abstract: Background: Anaemia is a global health concern, associated with increased maternal and perinatal mortality, preterm delivery, low birth weight, extreme fatigue and impaired immune system; and controlled by oral haematinics; with a rise in haemoglobin concentration. The objective was to examine the various aspects of pharmacoepidemiology and pharmacohaemovigilance of oral haematinics, among the anaemic women population, in rural India.Methods: This was a multi-centre, retrospective, observational and analytical study of the hospital medical records of 250 anaemic patients, who were allocated into group A of 125 patients within 15-21 years and group B of 125 patients within 22-35 years. The patients were prescribed oral haematinics, containing 60 mg of elemental iron, thrice daily, with meals. The various aspects of pharmacoepidemiology and pharmacohaemovigilance of ferrous ascorbate, ferrous sulphate, ferrous fumarate and ferric ammonium citrate, including patients’ demographic characteristics, anaemic symptoms assessment, prescription patterns, and safety assessment, on 1st, 2nd, 3rd months and follow-up visits, were recorded and thoroughly analysed..Results: In groups A and B, the demographic characteristics of the patients were comparable; ferrous ascorbate was the most commonly prescribed oral haematinic, followed by ferrous sulphate, ferrous fumarate and ferric ammonium citrate, which controlled mild to moderate iron deficiency anaemia, with a gradual significant rise in haemoglobin concentration, in the successive 3 months; and adverse effects were observed to be statistically non-significant in either group.Conclusions: The different aspects of pharmacoepidemiology and pharmacohaemovigilance in the study established that the oral haematinics were reasonably beneficial and safe among the anaemic women population, in rural India.
TL;DR: Here is a conversation between two NSAIDs while travelling in anthropomorphic forms (human beings) and discussing the detailed pharmacology and therapeutics of NSAIDs.
Abstract: Metaphors are increasingly used for learning in medical education.1,2 Learning can be facilitated by giving homologous/analogous examples and story-telling.3-5 The undergraduate students are involved, and learning becomes enjoyable and stress-free. Here is a conversation between two NSAIDs while travelling in anthropomorphic forms (human beings) and discussing the detailed pharmacology and therapeutics of NSAIDs.
TL;DR: Once termed as a disease of the rich, DM has now transcended that definition to be among the commonest non-communicable diseases globally.
Abstract: Background: Diabetes mellitus (DM) poses immense challenge to the health of people worldwide. Current therapies are limited by cost and adverse effects. Solanum nigrum, a complex of many species in the family Solanaceae has been recorded to be used by many communities in the management of DM. The aim of this study was to evaluate the phytochemical, antidiabetic efficacy and safety of two species, namely; Solanum villosum and S. nigrum var sarrachoides using streptozotocin-induced diabetic mice model.Methods: Qualitative assessment for phytochemical constituents was carried out. Acute toxicity was conducted based on ‘Organisation of Economic Cooperation and Development’ 2001 guidelines. Diabetes was induced by injection of streptozotocin at a dose of 200 mg/kg body weight intraperitoneal after the mice fasted for 8 hours. Aqueous extracts were administered orally using an oral gavage at doses of 150, and 300 mg/kg body weight for each plant daily and monitored weekly for 28 days.Results: Both plants contain vital phytochemicals. Flavonoids, alkaloids, tannins, saponins, phenols, and glycosides were present in both plants. However, phytosterols and coumarins were absent in S. villosum. Additionally, both plants did not show toxicity. Both plants showed efficacy with S. nigrum var sarrachoides being more potent at both doses.Conclusions: The study validates the use of these plants by herbalists and recommends further studies on them with the aim of elucidating the active compounds that can be used as novel therapies for diabetes. Additionally, the study recommends the evaluation of other species in this complex for antidiabetic properties.
TL;DR: Fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidics acid-resistant impetigo and both drugs were well tolerated.
Abstract: Background: Impetigo is a contagious bacterial skin infection that affects both adults and children. Topical antibacterials such as mupirocin and fusidic acid are the most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of retapamulin in the treatment of secondary impetigo. However, its use in primary impetigo is limited. To this purpose, we compared the safety, efficacy and adherence to treatment of fusidic acid with retapamulin in primary impetigo.Methods: A total of 50 patients with a clinical diagnosis of primary impetigo, between 2-12 years of age, having <10 lesions, 3/5 signs and symptoms, skin infection rating score ≥4 and pus score ≥ one were involved. Patients who were having secondary impetigo leions were excluded. Twenty-five patients received 2% fusidic acid cream three times a day, and the remaining 25 patients received 1% retapamulin ointment two times a day for seven days. Skin Infection Rating Scale (SIRS) was used to assess the severity of disease at baseline and end of treatment. Clinical success was considered when SIRS score of zero each for pus, crust and pain and 0/1 each for erythema and itching. Clinical failure is a SIRS score of ≥1 for pus.Results: Baseline disease characteristics such as a number of lesions, the severity of disease (SIRS) and pus scores were statistically similar between the two groups. The clinical improvement observed with both fusidic acid and Retapamulin (20/25, 80%) and (21/25, 84%) treatments was not statistically different (p>0.05). Both drugs were well tolerated.Conclusions: Both fusidic and retapamulin showed similar clinical success in patients with primary impetigo. Since fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidic acid-resistant impetigo.
TL;DR: There is a significant variation in the price of various topical eye preparations in India as most of the preparations being prescribed on an out-patient basis, which was not covered undermost of the insurance program.
Abstract: Background: topical eye preparations are very commonly used in India for different eye diseases hence their prices should not be much different in Indian pharmaceutical industry. The common man therefore has to shell out more money with medicine prices spinning out of his reach. Aim of this study was to compare the cost of drugs of the different brand of topical ophthalmic drugs.Methods: cost of various topical eye preparations was compared using “Current Index of Medical Specialties” (CIMS) January-April 2019 and cost variation was recorded. Drugs were categorized into anti-infective and antiseptics, topical corticosteroids, mydriatics, anti-glaucoma drugs, anti-inflammatory and lubricants.Results: That of the 26 drug formulations studied, the percentage cost variation of 10 drug formulations was more than 100%, out of which one formulation of moxifloxacin had more than 1000% variation. Cost ratio of 10 drug formulations were more than two. Moxifloxacin 0.5% eye drops had maximum percentage cost variation of 5610.66% and cost ratio of 57.11, followed by ofloxacin 0.30% eye drops (310.92%, 4.11), timolol 0.50% eye drops (263.64%, 3.64), ciprofloxacin 0.30% eye drops (142.42%, 2.42), tobramycin 0.30% eye drops (120.14%, 2.20).Conclusions: There is a significant variation in the price of various topical eye preparations. As most of the preparations being prescribed on an out-patient basis, which was not covered under most of the insurance program. Out of pocket expenditure adversely affects the drug compliance in the long run. There should be a comprehensive action from policymakers, regulatory authorities, government agencies, doctors, pharmacists, and the general public to solve this issue of cost variation of drugs.
TL;DR: Intrauterine growth restriction (IUGR) remains an important cause of perinatal and neonatal morbidity as well as mortality, and there are no treatment options available.
Abstract: Intrauterine growth restriction (IUGR) remains an important cause of perinatal and neonatal morbidity as well as mortality. 1 Depending on the fetal stage of development, IUGR can be manifested as early symmetric or late asymmetric growth abnormality patterns, of which the latter is most common occurring in 70–80% of growth-restricted infants. 2 Although knowledge of IUGR has increased dramatically with increase in ultra-sonographies and asymmetric IUGR have been studied extensively, there are no treatment options available. 3 Oligohydramnios is a common finding in growth-restricted foetus and it is an important diagnostic parameter. Decreased amniotic fluid renders the umbilical cord vulnerable to compression, leading to variable decelerations, caesarean delivery, and possibly fetal death. 4 Oligohydramnios can be defined as amniotic fluid volume <5% for gestational age, amniotic fluid index (AFI) <5 cm or maximal deepest pocket <2 cm. 5 ABSTRACT
TL;DR: Most of the students had good knowledge, fair perception and positive attitude regarding the use of, and resistance to antimicrobial agents but not about stewardship programmes, according to an online questionnaire based cross-sectional study involving 338 medical students.
Abstract: Background: Inappropriate antimicrobial use contributes to antimicrobial resistance. Assessing knowledge, perception and attitude regarding antimicrobial use serves as a prelude to design and implement educational modules to promote rational antimicrobial use.Methods: An online questionnaire based cross-sectional study involving 338 medical students; under-graduates, interns and post-graduates was conducted in a medical college in south India. Chi-square test or Fisher exact test were used to determine association between variables.Results: Fifty percent of the participants (170/338) responded to the questionnaire. The responses were similar across undergraduates, interns and post-graduates. Majority of the responders had good knowledge regarding use of antimicrobials. Most of the participants (92.35%) expressed that a broad-spectrum antimicrobial should be started to treat a serious infection while awaiting culture and sensitivity reports and 88.82% did not prefer to use antimicrobial agents for common cold. Similarly, most of the respondents (93.56%) were aware of the fact that antimicrobial resistance is a global problem. However, many of them (74.71%) were not aware of antimicrobial stewardship programme in their college.Conclusions: This study revealed that most of the students had good knowledge, fair perception and positive attitude regarding the use of, and resistance to antimicrobial agents but not about stewardship programmes. Proactive measures are required to sensitise medical students on antimicrobial stewardship programmes.
TL;DR: A very wide price variation was observed amongst different brands of both oral and parenteral formulations of antibacterial agents, which may lead to resistance due to poor patient compliance due to prescription of expensive drugs.
Abstract: Background: Antimicrobial resistance is a serious problem. Resistance may develop due to irrational use including poor patient compliance due to prescription of expensive drugs. In present study, the variation in the price of commonly used antibacterial was analysed.Methods: The price of commonly used antibacterial agents listed in recent issues of CIMS and MIMS was analysed in respect of number of brands available, price range (10 tablets or capsules) and 1 ampoule or vial (parenteral preparation) i.e. minimum, maximum and average price and price ratio (maximum/minimum). FDCs and formulation with only 1-2 brands were excluded.Results: The number of brands of oral antibacterial agents varied from 3 (faropenem 200 mg) to 90 (azithromycin 500 mg). The maximum price variation amongst different brands was 21.64 for levofloxacin 500 mg followed by 14.28 and 11.26 for linezolid 600 mg and moxifloxacin 400 mg respectively. For parenteral preparations, the number of brands varied from 2 (gentamicin 80 mg) to 57 (ceftriaxone 1 g). The maximum price variation was 5.05 for meropenem 1 g followed by 3.69 and 2.63 for meropenem 500 mg and ceftriaxone 1 g respectively.Conclusions: A very wide price variation was observed amongst different brands of both oral and parenteral formulations of antibacterial agents. Prescribing expensive brands may lead to resistance due to poor patient compliance.
TL;DR: It is important to identify and reduce the PIM use in an elderly population, because the use of PIM is associated with higher rates of hospitalisation, health care costs and quality of life problems.
Abstract: Background: Use of inappropriate medication is an important problem in present geriatric clinical practice. No specific potentially inappropriate medications (PIM) tools are available considering the availability of drugs in India. Aim and objective were to assess prevalence and pattern of potentially inappropriate medication (PIM) use in elderly inpatients by updated Beers criteria 2015 and EU(7) PIM list 2015.Methods: This cross-sectional study was carried out on medical records of elderly patients (≥65 yrs) admitted in the internal medicine wards and intensive care units (ICU) over a period of 6 weeks. The medications were evaluated for the PIM use as per Beers criteria and EU(7) PIM list.Results: A total of 225 patients (mean age- 71.48 yrs) were admitted in internal medicine wards and ICU during study period. Total 184 PIM belonged to 33 different medications were used during study period. The prevalence of PIM in internal medicine wards and ICUs were 51.96% and 57.14%, respectively. The prevalence of PIM was significantly higher with the EU(7) PIM list than Beers criteria (49.77% vs. 21.77%) [p<0.0001]. The commonly prescribed PIM were dextromethorphan (13.33%), ranitidine (11.11%) and glipizide (10.22%).Conclusions: Elderly patients frequently receive PIM. EU(7) PIM list identifies more PIM among elderly inpatients than Beers criteria.
TL;DR: Peptic ulcer disease (PUD) is the most prevalent gastrointestinal (GI) diseases which consume more than 5 billion from the annual medical expenses.
Abstract: Background: Peptic ulcer disease is the most prevalent gastrointestinal diseases caused by an imbalance between gastric stimulant or aggressive factors and the mucosal defensive factors. The defence of flavonoids against the tissue oxidative stress is being proved in various animal models for wide pharmacological effects. The aim of the present study is to evaluate the anti-oxidant effect of quercetin in histamine induced gastric ulcers.Methods: Male guinea pigs were divided into 4 groups (n=6). Group I includes normal control. Group 2, 3 and 4 were induced gastric ulcers with histamine as intraperitoneal (IP) injection. Group 2 serves as the gastric ulcer control. Group 3 and Group 4 are pre-treated with quercetin 200 mg/kg per orally (PO) and ranitidine 100 mg/kg PO respectively 45mins before histamine injection. After 4 hours of histamine injection, the animals were sacrificed to collect blood samples and stomach tissue for estimation of plasma and tissue antioxidant levels.Results: On estimation of antioxidant levels both in plasma and stomach tissues the SOD and CAT levels increased in the Group 3 and 4 significantly and also a significant reduction in MDA levels were noted in the Group 3 and 4 compared to the gastric ulcer control group.Conclusions: Hence, with flavonoids quercetin utilization in histamine induced gastric ulcers, the antioxidants showed comparative levels with ranitidine treatment groups. So a permanent cure for the chronic gastric ulcers could be proved in further studies as this is the milestone, tough to achieve in general clinical practice.
TL;DR: It is suggested that Roselle extract constitutes an effective and safe alternate treatment for obesity and hyperlipidaemia.
Abstract: Background: Hibiscus sabdariffa L. or Roselle, is one of the most common flower plants cultivated worldwide. Traditionally, it is claimed to reduce weight and cholesterol level. The aim of this study was to evaluate the effects of anthocyanin-rich Roselle aqueous extract on the physical, biochemical and histological changes in obese-hypercholesterolaemic rat model.Methods: Thirty Sprague-Dawley male rats were divided into five groups (n=6 per group). Group 1 is normal control (NC) rat that was fed with normal diet. The remaining rats (Group 2-5) were fed with commercial high-fat diet (HFD) for 6 weeks to induce obese-hypercholesterolaemic (OH) rat. After induction, the OH rats were divided into 4 groups: OH-Untreated group, OH-ARTE; OH treated with 300 mg/kg Roselle aqueous (anthocyanin-rich) and 1% trifluoroacetic acid extract (ARTE), OH-Orlistat; OH treated with 37 mg/kg orlistat and OH-Atorvastatin; OH treated with 10 mg/kg atorvastatin. After the 3 weeks intervention period, all rats were sacrificed. Body mass index, lipid profile and liver enzymes were evaluated. The liver section was subjected to hematoxylin and eosin staining for histopathological evaluation.Results: This study showed that 3 weeks administration of ARTE significantly reduced BMI, improved levels of lipid profile and liver enzymes, and histopathological changes of liver when compared to OH-untreated rats. The results were also comparable to the standard drugs.Conclusions: This study suggested that Roselle extract constitutes an effective and safe alternate treatment for obesity and hyperlipidaemia.
TL;DR: The aqueous extract of MMC was able to decrease the elevated blood sugar levels in dose dependent manner and showed significant reduction in blood sugar level in comparison with standard drug metformin 100 mg/kg.
Abstract: Background: The aim of the present study was to evaluate the antidiabetic potential of Manomani chooranam (MMC), an indigenous polyherbal siddha formulation in Streptozotocin (STZ) induced diabetic female Wistar albino rats.Methods: Aqueous extract of MMC was prepared. Wistar albino rats were divided into six groups (n=6). Group 1 was kept as normal control, Group 2, 3, 4, 5 and 6 were induced diabetes. After induction, the group 2 was kept as diabetes control; Group 3 received the standard drug metformin (100 mg/kg), whereas Groups 4, 5 and 6 were treated with the aqueous extract of MMC at 500 mg/kg, 1000 mg/kg and 1250 mg/kg doses, respectively for the 21 days. Blood sugar was estimated at the end of each week. At the end of the study, rats were sacrificed and the pancreas was analyzed for histopathological changes. Data expressed as mean±standard error of the mean. Statistical analysis was done using one-way ANOVA followed by post hoc Tukey's test. p<0.05 considered statistically significant.Results: The groups which received aqueous extract of MMC at 500 mg/kg, 1000 mg/kg and 1250 mg/kg showed a significant decrease in the mean blood sugar level when compared to normal level. The groups which received MMC shows significant reduction in blood sugar level in comparison with standard drug metformin 100 mg/kg.Conclusions: The aqueous extract of MMC was able to decrease the elevated blood sugar levels in dose dependent manner.
TL;DR: This study finding showed significant cost variation in different brand of many anticancer drugs in India, indicating that greater price transparencies required.
Abstract: Background: Cancer is one of the most expensive and lethal noncommunicable diseases globally. Availability and affordability of anticancer drugs are the most important factors on which management of cancer depends. The objective of the study was to evaluate the variation of cost among different brands of anti-cancer drugs available in the Indian market.Methods: “Current Index of Medical Specialties” July-October 2018 and “Drug Update” Sept - 2018 were used to obtain cost in INR* (Indian National Rupees) of anticancer drugs manufactured by different pharmaceutical companies in India, in the same strength and dosage form. Percentage cost variations were calculated by minimum and maximum costs of anticancer drug of different brands.Results: Percentage variation in cost was analyzed for 41 different formulations of 27 anticancer drugs. Highest cost variability seen with Alkylating agent Carboplatin 150 mg injection (1100%) and lowest with Antimetabolite anticancer agent Cytarabine 500 mg injection (6.56%). Three formulations showed more than 500% cost variation, largest with Carboplatin 150 mg injection (1100%) followed by Anastrozole 1 mg tablet (870%) and Letrozole 1 mg tablet (508.42%).Conclusions: Present study finding showed significant cost variation in different brand of many anticancer drugs in India. These results indicated that greater price transparencies required. This price variation issue requires a much more in-depth analysis of the health care system.
TL;DR: The study showed that item analysis is a valid tool to identify quality items which regularly incorporated can help to develop a very useful, valid and a reliable question bank.
Abstract: Background: Multiple choice questions (MCQs) are a common method for formative and summative assessment of medical students. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), distracter efficiency (DE). The objective of this study was to assess the quality of MCQs currently in use in pharmacology by item analysis and develop a MCQ bank with quality items.Methods: This cross-sectional study was conducted in 148 second year MBBS students at NKP Salve institute of medical sciences from January 2018 to August 2018. Forty MCQs twenty each from the two term examination of pharmacology were taken for item analysis A correct response to an item was awarded one mark and each incorrect response was awarded zero. Each item was analyzed using Microsoft excel sheet for three parameters such as DIF I, DI, and DE.Results: In present study mean and standard deviation (SD) for Difficulty index (%) Discrimination index (%) and Distractor efficiency (%) were 64.54±19.63, 0.26±0.16 and 66.54±34.59 respectively. Out of 40 items large number of MCQs has acceptable level of DIF (70%) and good in discriminating higher and lower ability students DI (77.5%). Distractor efficiency related to presence of zero or 1 non-functional distrator (NFD) is 80%.Conclusions: The study showed that item analysis is a valid tool to identify quality items which regularly incorporated can help to develop a very useful, valid and a reliable question bank.