ABSTRACT
Background: The primary treatment for epilepsy is Antiepileptic drug (AED) therapy. Non-compliance to AEDs can result in break-through seizure, emergency department visits, hospitalizations, fractures, head injuries and increased mortality. Thus, compliance to AEDs is crucial to be studied. Objective is to study compliance and factors influencing compliance with AEDs among patients with epilepsy.Methods: This observational study was conducted in 105 patients with epilepsy on AED therapy in community in Ludhiana (Punjab) after approval from Institutional Ethics Committee. Demographic data and drug history was collected. Monthly follow up for 6 months was done by paying home visits and data regarding type, dose, frequency of administration of AED was recorded on a semi-structured performa. Pill count was done by recording number of pills dispensed and number of pills remaining with patient. Response to Morisky’s Medication Adherence Scale (MMAS) was also recorded. Results were correlated with patient demographics, type, frequency and number of AEDs.Results: Out of 105 patients, 65 were males and 40 were females. Fifty-four patients were non-compliant with both pill-count and MMAS. Non-compliance was high in first month and decreased gradually. Poly-therapy, lower socio-economic status and multiple dosing regimens were most commonly associated with non-compliance.Conclusions: Under-dosing was more common among non-compliers, which explains the high reporting of forgetfulness to take medicine in MMAS. Both pill count and MMAS are effective non-invasive tools to study compliance.
ABSTRACT
Obesity is a major public health concern and one of the leading preventable causes of death worldwide. It has manifold adverse health consequences, potentially involving all major organ systems thus leading to a reduced life expectancy. The long-term successful management of obesity remains a herculean task and invariably requires a multifaceted approach including lifestyle and behavioral modification, increased physical activity, and adjunctive pharmacotherapy and bariatric surgery. However, effective pharmacological options are limited because of the previous history of several failed agents as well as the fact that presently available agents are few, and utilized only as monotherapy. The recent Food and Drug Administration (FDA) approval of the fixed drug combination of phentermine and extended release topiramate marks the first FDA approved combination pharmacotherapeutic agent for obesity. This review details the various pharmacological aspects of the use of phentermine and topiramate combination along with the results of clinical trials done so far and also the present role of this combination in the management of obesity. Beyond the significant improvement in weight, the findings from various clinical trials also show improvement in metabolic and glycemic parameters, blood pressure, and lipid profile suggesting its added utility in cardiovascular risk modification. The acceptability of this combination would usher in a new era in the pharmacotherapy of obesity that utilizes combination therapy to improve efficacy, enhance synergism and concurrently minimize the risk of adverse effects. As with any newly marketed drug, there may be yet-unknown benefits and risks associated with this combination, which would be known only after its long-term use.
ABSTRACT
The objective of an observational study was to evaluate the drug prescribing pattern in the pediatric population in a tertiary care teaching hospital. The most common illness, which warranted admission to PICU, was bronchopneumonia (33.3%) followed by bronchiolitis (17.5%) and bronchial asthma (7.9%). Average no. of Antimicrobial Agents received per patient was 3.9. Parenteral drugs accounted for 86.1% of the total drugs prescribed. The most common AMAs prescribed were cephalosporins (26.1%), aminoglycosides (20.9%), beta-lactams (excluding cephalosporins) (17.4%) and fluoroquinolones (11.1%). Beta-lactams contributed to 44% of the total AMA cost followed by cephalosporins (31.8%) and miscellaneous AMAs (8.5%). The total number of preparation encounter per prescription was 9.7±4.8 per patient. The total number of single drug prescription was 88.4% and fixed drug combinations were 11.6%. Among the total drugs prescribed, 45.26% were generic and 54.73% constituted branded drugs. Overall 51% of the total drugs prescribed were from the WHO List of Essential Medicine 2010. There should be more emphasis on prescribing generic drugs and in case of similar efficacy the drug with lesser cost should be preferred.
ABSTRACT
Multiple endocrine neoplasia type I or Wermer syndrome is characterized by primary hyperparathyroidism, enteropancreatic endocrine tumor, and a pituitary pathology. A 35-year-old male presented with visual field defects, hyperprolactinemia, and hypogonadism. He also had multiple infraumbilical skin-colored nodules. A syndromal association of Wermer syndrome was derived using the dermal, pituitary, parathyroid, and gastrointestinal hormonal manifestations of the tumor. The radiological and histological findings of lesion which underwent biopsy are discussed. The presence of collagenomas, lipomas, and hypopigmented macules in a patient with neuroendocrine symptoms should raise the suspicion of an underlying multiple endocrine neoplasia.