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Background: There are a handful of sodium glucose co-transporter 2 (SGLT2) inhibitors available in the global and Indian markets to manage type II diabetes mellitus (T2DM). However, head-to-head comparison between different SGLT2 inhibitors is scarce. Therefore, the present study was aimed to analyze the effect of different SGLT2 inhibitors on glycemic control and body weight in Indian patients with T2DM. Methods: This was a prospective, interventional, nonrandomized study that included patients (N = 480) of either sex, aged ?30 years, with inadequately controlled T2DM having HbA1c > 8.5%, and were receiving either Canagliflozin, Empagliflozin, Dapagliflozin or Remogliflozin on the background of triple-drug therapy. In this study, patients were evaluated for HbA1c, fasting blood sugar (FBS), post-prandial blood sugar (PPBS), body weight, and systolic and diastolic blood pressure at baseline, 12 and 24 weeks. Results: A total of 480 patients who received either Canagliflozin (n = 120), Empagliflozin (n = 120), Dapagliflozin (n = 120), or Remogliflozin (n = 120) were included in this study. There was a significant reduction in levels of HbA1c, FBS, PPBS, body weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) at week 12 and 24 in all treatment groups. The difference in mean values of glycemic parameters and body weight was comparable across the treatment groups at week 12 and 24 but was not significant. Out of all 480 patients, 10 patients (2.08%) reported urinary tract infection (UTI), and five (1.04%) reported genital mycotic infection. All the five patients were females and treatment for UTI and mycotic infection was provided as required. Rest of the patients tolerated the therapy well. Conclusion: Overall observations indicate that all the four SGLT2 inhibitors are effective in reducing HbA1c, FBS, PPBS, body weight SBP, and DBP. Therefore, gliflozins can be the best choice to start early in patients with inadequately controlled T2DM receiving triple-drug therapy which helps in controlling the parameters of glycemia and significantly reducing the body weight. Hence SGLT2 Inhibitors could be considered as an add-on to all antidiabetic agents currently used for the management of diabetes in Indian setting.
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Background : The geriatric population in India is projected to increase from 8% to a staggering 20% by 2050. The combination of a population boom along with advances in medicine resulting has resulted in an increase in life span, leaving India with a potential geriatric healthcare crisis in its hands leaves India with a potential geriatric healthcare crisis in its hands. India currently produces as few as 20 geriatricians per year due to limited PG seats and has only a handful of fully functioning Geriatric Departments in the public healthcare sector. Thus, there is a need to fully assess the knowledge, attitudes and current practices in geriatric healthcare among medical professionals and interns across the country. Objective: To investigate the knowledge, attitudes and practices and perceived needs of physicians towards specialised geriatric healthcare and to assess the views towards geriatric medicine as a career option among medical interns in India. Design: Cross-sectional, web-based survey by forwarding the link via social media platforms. Setting: MBBS graduates undergoing their rotatory internship and residents/postgraduate doctors in specialties relevant to the care of older persons throughout India. Participants: A total of 800 Indian medical interns and professionals. Measurements: Demographic characteristics of medical professionals and interns included age, gender, branch of practice, working sector, availability of any geriatric facility in their workplace, etc. Responses were weighted to maintain nationwide representativeness. Knowledge, attitudes, current practices and perceived needs regarding specialised geriatric healthcare were the primary outcome measurements. Results: Insufficient knowledge (48.5% of professionals) regarding any specialised branch of geriatric healthcare was found. Only 9.0% medical professionals performed ‘Comprehensive Geriatric Assessment’ and even the mean score of practice of CGA was low. 96% professionals and 92% interns felt the need for specialised geriatric services throughout India with majority feeling the need for specialised OPDs. 32.7% of Interns were willing to opt for post-graduation in Geriatrics, if given a choice and those with any specialised geriatric facility available at their institute were more willing. More than 85% professionals and interns had affirmative attitudes towards the possible benefits of specialised healthcare. Conclusion and Implications: There is poor practice of specialised geriatric healthcare throughout India and also a high prevalence of perceived needs among professionals and interns regarding facilities like OPDs, wards and departments. Highly affirmative attitudes were observed among both interns and professionals indicating the acceptance of suggested strategies. Majority of interns were convinced of opting for post-graduation in geriatrics when incentivized, indicating the need for prioritizing interns for capacity building in the future.
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Background: The overall prevalence for hypertension in India was estimated to be 29.8%. Patient’s optimal adherence with antihypertensive drug therapy is essential for preventing serious complications with hypertension over the long term. Therefore, the present study was undertaken to evaluate the prescription pattern of the drugs prescribed to hypertensive patients.Methods: Present study was a prospective cross sectional observational study carried out in the outpatient of department of general medicine of MGM Hospital, a tertiary care teaching hospital, in Aurangabad. Prescriptions of 120 diagnosed hypertensive patients were analysed. Data was recorded as mean±standard deviation.Results: The mean age of the patients was 57.13±10.94 years with range 18-80 years. 82.5 % (99) of patients were male and 17.5% (21) of patients were female. Mean duration of hypertension was 3.97±2.55. Most of the patients 57 (47.5%) were on Mono therapy significantly higher than dual therapy, triple therapy and poly therapy, 39 (32.5%), 15 (12.5%), 9 (7.5%) respectively. Calcium channel blocker was the frequently used class of drug for monotherapy (20%). Polytherapy was seen in 7.5% patient. Among 120 patients’ only 37 patients were reported ADR. Maximum no of ADRs were reported from patients receiving ACE inhibitor.Conclusions: This type of studies gives the base line idea of prescription pattern and ADRs of antihypertensive drugs. These help to design policy for rational use of drugs and motivation of physician for rational use of drugs.
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Background: Emergence of bacterial resistance in hospital settings due to the liberal use of antibiotics which led to an altered impact on its therapeutic efficacy and outcome, thereby increasing the treatment costs in patients. In this regard the study aims to evaluate the cephalosporins utilization and compliance to the hospital antibiotic policy in general medicine ward.Methods: A prospective observational study was carried out over an eleven-month period in patients prescribed with cephalosporins. Clinical data of inpatients were collected and evaluated by using World Health Organization (WHO) core prescribing indicators and defined daily dose per 100 bed-days. The comparison between the cephalosporins prescribed in the chart records to the recommendations mentioned in the institutional antibiotic policy v.2.0, help to determine the deviations in their usage pattern.Results: A total of 370 patients were enrolled in the study, of which 54.6% were females. Cephalosporins were empirically prescribed in 240 (64.9%) cases. The average number of total antibiotics and cephalosporins per encounter was 1.6 and 1 respectively. Among the total antibiotics, 63.7% were cephalosporins. Third generation cephalosporins (98.4%) were commonly prescribed, with ceftriaxone (93%) in parenteral form for respiratory tract infections (31.9%). Total parenteral antibiotics prescribed were found to be 68.8% of which 88.6% were cephalosporins. Utilization pattern of cephalosporins amounted to be 4.95 DDD/100 bed-days. Overall compliance was achieved in 191 (51.6%) prescriptions.Conclusions: The rate of prescribing of cephalosporins was marginally high. There was a low rate of compliance towards policy which reflects the urgent need for repetitive intervention to comply antibiotic policy.
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Background: In India the number of people with diabetes is increasing day-by-day. Due to a sole “Asian Indian Phenotype,” Indians develop diabetes an era earlier and have an earlier onset of complications. Therefore, it is essential to evaluate more effective treatment strategies at an earlier stage of disease progression.Methods: The present study was prospective, open label, comparative, randomized, parallel group, single center study. Comparison of two post prandial active treatment groups over a period of 3 months. Sixty patients of either sex in the age group of 30-60years with newly diagnosed type II diabetes mellitus, with prandial blood glucose levels >180mg% and <250mg% at screening as per ADA. The effect of repaglinide and voglibose were observed on various parameters i.e. HbA1c, FBS, PBS, BMI.Results: In repaglinide group the mean change in HbA1c from baseline to 3 months was 8.05 to 7.04 (-1.01); on the other hand, in voglibose group from baseline to 3 months was 8.0 to 7.18 (-0.82). Whereas, FBS from 137.57 to 122.90 (-16.67) in repaglinide group; in voglibose group from 139.87 to 125.13 (-14.74). Repaglinide statistically highly significant than voglibose group in improving glycemic indices.Conclusions: Though repaglinide and voglibose were equally effective in improving glycemic indices yet repaglinide showed better results in improving HbA1c, FBG, PBS as compared with voglibose. Repaglinide had minimal side effects as compared to voglibose.
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Background: Objectives of the study was to study the effect of Azilsartan 40mg once daily versus Telmisartan 40mg once daily in patients with Grade I-II essential hypertension.Methods: A prospective study was conducted at MGM Medical college and Hospital which included 80 patients in each group with Grade I–II essential hypertension. The sex, age, presenting illness, and family history of the patients were recorded. Investigations such as blood sugar, urine analysis, kidney function test, lipid profile, and ECG were performed before starting the treatment. Any adverse effects during the treatment were noted. Blood pressure was recorded at baseline and during follow-up. One group received Azilsartan 40mg once daily and another group Telmisartan 40mg once daily. Patients were followed-up every week for 5 weeks.Results: Patients receiving Azilsartan 40mg and Telmisartan 40mg showed a significant fall (P <0.05) in systolic (SBP) at the end of fifth week, when compared to baseline and diastolic blood pressure (DBP) significant fall at fourth and fifth week. The difference in fall in SBP and DBP was insignificant between the groups, after first, second and third week (P >0.05). Adverse effects such as Nasopharyngitis, Upper respiratory tract inflammation, Gastroenteritis, headache, dizziness, and fatigue were reported with both drugs.Conclusions: Reduction of blood pressure with Azilsartan and Telmisartan was similar, but fall in blood pressure from baseline was highly significant in both groups.
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Background: To study cost-effective and cost-benefit analysis of antibiotic prescription in patients who had enteric fever and was given intravenous ceftriaxone. Methods: This was a prospective observational study conducted in a tertiary care hospital. 200 patients who have been diagnosed with enteric fever and were prescribed ceftriaxone were studied and their prescriptions were analyzed. 5 brands of most commonly prescribed ceftriaxone injections were chosen to analyse costeffective and cost-benefit analysis. Our study showed that there was a major difference of prizes between generic and 5 most commonly prescribed brands of the same drug. Use of branded drugs was associated with increase cost of treatment and in many cases was responsible for failure to take complete treatment as prescribed by treating physician. Results: This Study was conducted on 100 patients, 68 males and 32 females, diagnosed with enteric fever. Out of these patients Maximum number of patients were seen between age group of 30-40 years (34) and minimum patients belonged to age group of more than 60 years (8). Analysis of prescriptions revealed that 80 patients were prescribed Branded drugs and 20% were prescribed generic drugs. Out of these 80 patients who were prescribed branded drugs most common 5 brands were studied. The analysis of the cost of single dose of inj ceftriaxone revealed that branded drugs were 3.12 % to 200.84 % more in comparison with generic IV ceftriaxone. Analysis of cost of 1 day of treatment with IV ceftriaxone 1gm revealed similar figures. Total cost of treatment was Rs 595 for generic drug and 1790 for branded drug with maximum MRP. The Analysis of patients who discountinued treatment before completion revealed that most of them belonged to Brand E (30%) and minimum number of patients belonged to Generic group (5%.Conclusion: The cost of most commonly prescribed branded drugs was significantly higher (3%-200%) than generic drug and prescribing branded drugs was associated with failure to take complete treatment as prescribed by treating physician.
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Background: Hypertension and certain alteration in serum lipoproteins are complementary coronary risk factors. The effect of antihypertensive agents on lipid metabolism exhibits a wide range. Numerous studies have established that vasodilating beta-blockers are associated with more favorable effects on glucose and lipid profiles than non-vasodilating beta-blockers. The study was conducted to study the comparative effects of nebivolol and metoprolol on lipid profile in patients of essential hypertension. Methods: A prospective, randomized open label single center study was conducted in the Department of Pharmacology in collaboration with Department of Medicine, MGM’s Medical College and Hospital, Aurangabad in newly diagnosed patients of essential hypertension. Sixty patients of either sex in the age group of 30-65 years with blood pressure (BP) of ≥140/90 mmHg with deranged lipid parameters according to National Cholesterol Education Program were randomized into two groups. Group I received metoprolol (50 mg) and Group II received nebivolol (5 mg), both given once daily for 12 weeks. BP and lipid parameters were evaluated at baseline as well as at the end of 12 weeks. Results: There was significant reduction in BP values (p<0.0001) as compared to baseline in both the groups, however no significant difference was observed between two drugs revealing that their efficacy in reducing systolic BP/diastolic BP is comparable. Furthermore, both the drugs had a favorable effect on lipid profile, but more significant results on lipid profile were observed in the nebivolol group as compared to metoprolol group (p<0.0001). Conclusions: In our comparison study, it is seen that the favorable effect of nebivolol on serum lipids and its good tolerability profile make it a good choice for control of hypertension as well as preventing the long-term cardiovascular morbidities and mortalities.