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Introduction: This study assumes significance as it compareshead on DPP-IV inhibitors along with other oral hypoglycemicagents with respect to glycemic and non-glycemic targets.Study was done to evaluate the DPP-IV inhibitors andother oral hypoglycemic agents (OHA) either alone or incombination, with reference to glycemic targets like fastingplasma glucose (FPG), post prandial glucose (PPG) andglycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus.Material and Methods: This was an open labelledcomparative study and included 90 patients with Type 2 DM.These patients were divided into 3groups: Each group wascontaining 30 patients i.e. Group A: DPP-IV inhibitors (n=30); Group B: Oral hypoglycemic agents other than DPP-IVinhibitors (n= 30) and Group C: DPP-IV inhibitors + other oralhypoglycemic agents (n= 30). The patients were given drugson the basis of physician’s discretion, depending upon theglycemic of the patients at the time of presentation. A detailedhistory regarding age, sex, profession, duration of disease,treatment history, family history and personal history wastaken for each patient. After stabilization patients observed at0 weeks, 6 weeks, 12 weeks and 24 weeks.Results: Mean duration of diabetes was 5.35±0.53 years, andthe mean age of onset of diabetes was 46.98±0.91years. Therewas no significant difference between the study groups withrespect to FPG, PPG, and HbA1c levels. The HbA1c showedsignificant improvement in each group at the end of studyperiod.Conclusion: In summary, this study showed that treatmentwith sitagliptin, either alone or in combination with other oralhypoglycemic agent led to clinically meaningful reductionsin HbA1c, FPG and PPG over a 24 week period. Sitagliptinpresents an alternative therapeutic strategy for patientswith type 2 diabetes and, in general, showed significantimprovements in glycemic control and is well tolerated,particularly with regard to weight change and hypoglycemia.
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Background: Postgraduates when join Pharmacology department, they don’t have much idea about guidelines and methods to do animal experiments. This study was designed to sensitize postgraduate students to animal experiments by evaluating the anti-inflammatory effects and the efficacy of diclofenac, tramadol and etoricoxib in reducing paw edema in wistar rats.Methods: The wistar rats of 225-250gram were divided into four groups (n=10 each). In all the groups the paw edema on right paw was created using 0.1ml of 1% formalin subcutaneously. Group 1 rats (control), group 2 were given diclofenac, group 3 were given tramadol and group 4 were given etoricoxib orally. The parameters assessed were water displacement in plethysmography after 2, 4, 24, 48 hours of giving the drug. The circumference of edematous paws after 4 hours, licking of paw was observed over 30minutes of giving the drug and was compared. Pre and post study feedback were obtained from the students by using a preformed questionnaire to assess the knowledge gained by the students.Results: The test showed that all the drugs were effective in reducing inflammation, circumference of edema and the licking duration significantly (p<0.05). The post study answering of questions by postgraduate was 100% in comparison to pre-study answering which was 33%.Conclusions: A short animal study conducted as a teaching tool to postgraduate students was able to teach the guidelines of animal experiments and handling of animals effectively.
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Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup. Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant. Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p<0.01). At 4 and 16 weeks DBP in Group I was 79.6±2.37 and 81±0.54 mmHg (p>0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p<0.05) have been observed and no significant changes in BMI and WHR in Groups I and II (p>0.05), respectively. Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension.
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Background: Adverse drug reactions (ADRs) are one of the major causes of hospital admissions. The objective of this study was to ascertain the various ADRs occurring in a tertiary care teaching hospital at Dehradun, Uttarakhand. Methods: The ADRs were collected from January 2010 to June 2014 by the Department of Pharmacology in Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand. A total of 123 ADRs were collected, analyzed and assessed on WHO causality assessment scale. Results: A total of 123 ADRs were assessed. Male:female ratio was 1.5:1. Age-wise distribution of ADRs was done: 0-15 years had 15 (12.19%), 16-30 had 50 (40.65%), 31-45 showed 25 (20.32%), 46-60 years 22 (17.88%) and >60 years had 11 (8.94%). 112 (91.05%) ADRs were serious, and 11 (8.94%) were non-serious. As per the WHO causality assessment scale, 91 (73.98%) ADRs were probable, 30 (24.39%) were possible, and 2 (1.62%) were certain. Most commonly occurring ADRs were fixed drug eruption in 42 (34.14%) patients, erythematous maculopapular rash in 20 (16.26%) patients and urticarial rash in 15 (12.19%) patients, followed by others. The drugs most frequently associated with ADRs were non-steroidal antiinflammatory drugs (NSAIDs), fluoroquinolones, penicillins, cephalosporins and phenytoin sodium, followed by others. Conclusions: Majority of ADRs were probable according to WHO causality assessment scale. Most common ADR was fixed drug eruption. Most frequent drugs associated with ADRs were NSAIDs. ADRs contribute to increased morbidity and mortality in patients; thereby pose a huge burden on the society.
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Background: Prescription auditing studies are a part of drug utilization studies, are beneficial in clinical practice for rational prescribing of drugs and helpful for minimizing the medication errors. They are important tool to promote rational prescribing. Methods: This was a prospective drug utilization study conducted by the Department of Pharmacology in Psychiatry out-patient department at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun for a period of 6 months. A total of 311 prescriptions were evaluated for prescribing pattern using World Health Organization drug indicators and National Essential Medicine List (NEML) 2011. Results: A total of 311 prescriptions were evaluated, 157 (50.48%) were females, and 154 (49.52%) were males, mean age was 37.14±0.8 years. Majority of patients were married 207 (66.56%), housewife 116 (37.30%) and belong to middle socioeconomic group 205 (65.92%). A total of 1250 drugs were prescribed, anti-anxiety (anti-A) 379 (30.32%), anti-depressants (anti-Ds) 348 (27.84%), anti-psychotics (anti-Ps) 118 (9.44%), anti-epileptics (anti-Es) 64 (5.12%), mood stabilizer 20 (1.6%), anticholinergics 28 (2.24%) and others 293 (23.44%). Oral formulations 1247 (99.76%), 4.02 drugs/prescription, 100% drugs were prescribed by brand names. 220 (17.6%) fixed dose combinations were prescribed. Most frequently prescribed among anti-A drugs were propranolol 160 (42.22%) and diazepam 105 (27.70%), among anti-Ds drugs were amitriptyline 65 (18.68%) and escitalopram 59 (16.95%) and among anti-Ps risperidone 49 (41.53%) and olanzapine 38 (32.20%), respectively. About 51.36% drugs were prescribed from the NEML 2011. Result has revealed polypharmacy in the practice. Conclusions: Anti-A drugs were the most commonly prescribed drugs followed by anti-Ds, anti-Ps and anti-Es respectively. Rational prescribing requires further consideration with special reference to polypharmacy and providing feedback to the physicians.
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Background: Irrational prescribing is a common phenomenon, seen among medical practitioners. Knowledge, awareness, and attitude denote the practicing trends among the practitioners. The objective of this study was to describe the prescribing practices in Ophthalmology outpatient department (OPD) to promote rational prescribing. Methods: This study was conducted between January 2011 to June 2011, in Department of Pharmacology and Ophthalmology, SGRRIM and HS, Dehradun, Uttarakhand. A total number of 255 prescriptions were randomly collected from the Ophthalmology OPD and were analyzed for various parameters using national essential medicine list 2011 and World Health Organization drug use indicators. Results: A total number of 255 prescriptions were evaluated for prescribing pattern, 153 (60%) patients were between 16 and 45 years of age, the male: female ratio was 1.13:1. 237 (93%) patients from middle socioeconomic status. Diseases pattern observed were conjunctivitis 102 (40%), refractive error 45 (17.64%), stye 12 (4.7%), cataract 9 (3.52%), and miscellaneous 87 (34.12%). One hundred and thirty-eight (54.11%) patients received antimicrobial agents, fluoroquinolone (ofloxacin, moxifloxacin, gatifloxacin, etc.) were the most frequently prescribed antimicrobial drugs, analgesics (diclofenac and ketorolac) were prescribed to 45 (17.64%) patients, 54 (21.17%) received steroids (dexamethasone and prednisolone), 96 (37.64%) patients received other drugs (carboxymethylcellulose [CMC], multi-vitamins, zinc preparations, acyclovir, and anti-allergics). Fixed dose combinations (FDCs) were used in 90 (35.29%) patients, the most common combination was antimicrobials with steroids. All the drugs were prescribed by brand names and 1.9 drug/prescription was used. Conclusion: Topical antimicrobial agents are the most commonly used drugs in ophthalmic OPD in our setup; the most common FDCs prescribed were antimicrobials with steroids, the other commonly used drugs were analgesics, CMC and anti-allergic drugs.
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Background: Use of inhaled corticosteroids (ICS) are recommended in all grades of persistent asthma and once the symptoms are stabilized, “stepping down" of steroids is recommended to minimize their unwanted effects with the addition of a second medication with a complimentary mechanism of action. Aims & Objective: In our study a comparison of moderate dose ICS Fluticasone in “stepping down” strategy with combination of low dose Fluticasone with once-daily montelukast were assessed. Materials and Methods: 50 patients with moderate persistent asthma were randomly assigned in study. Initially stabilized on fluticasone propionate (FP) 250 μg twice daily, for four weeks, there after patients were given the medication as per the protocol Group-I (n=25)- fluticasone 250μg BD; Group-II (n=25)- fluticasone125 μg BD + Montelukast 10 mg in night. Patients were then followed up for 12 weeks. The primary efficacy variables were changes in FEV1%, PEFR%, ACS (asthma control symptom) score and asthma quality of life (QOL) score. Results: Changes in lung function at the end of study in Group-I and Group-II respectively as compared to 0 week (baseline) values, FEV1% value (p <0.05, p <0.05), PEFR% value (p <0.01, p <0.05), ACS score (p <0.01, p <0.05), AQOL score (p <0.05, p <0.05). ICS fluticasone 250 μg BD and low dose fluticasone 125 μg BD + Montelukast 10 mg in night are equally efficacious in improving lung functions, asthma symptoms and QOL. Montelukast group was more expensive with fewer adverse events. Conclusion: Moderate dose fluticasone did not show any benefit over combination of low dose fluticasone and Montelukast 10mg in night. Montelukast 10 mg in combination with low dose fluticasone can be an alternative in moderate persistent asthma.