Drug utilization review of general anaesthetic agents in a tertiary care hospital

Background: Drug utilization review plays a key role in helping the healthcare system to understand, interpret and improve the prescribing, administration and use of medications. The principle aim of drug utilization review was to facilitate rational use of drugs, which implies the prescription of a well documented drug in an optimal dose on the right indication.Methods: An observational study of anaesthetic practice was carried out in the department of Anaesthesiology in tertiary care hospital, Varanasi after approval from institutional ethical committee. The data of patients who underwent surgery under general anaesthesia were collected in predesigned patient profile form and were analyzed for drug utilization review.Results: 110 patients were enrolled with mean age 35.30±17.99 years and mean weight 51.32±15.32kg. Laparoscopic cholecystectomy (43.63%), otorhinolaryngology surgeries (36.36%), cardiothoracic vascular surgery (4.54%), neurosurgery (4.54%) and other surgeries (10.93%) required general anaesthetic agents were reviewed. Propofol (93.63%) and etomidate (6.36%) were used for induction of anaesthesia. Propofol (45.45%), isoflurane (53.63%), sevoflurane (0.90%) were administered for maintenance of anaesthesia in various surgeries. Adverse outcomes observed were hypotension (7.27%), bradycardia (6.36%), hypertension (3.63%) and post operative nausea and vomiting (PONV) (2.72%).Conclusions: Propofol is most commonly prescribed drug for induction of anaesthesia. Isoflurane is most commonly prescribed inhalational anaesthetic agent for maintenance of anaesthesia followed by Propofol. Hypotension is most common adverse outcome observed.

An Evaluation of Antibiotic Therapy in Pediatric Dentistry Outpatients.

Background: Antibiotics are commonly used on presumptive basis in treating oro-dental infections in children .These are sparse studies on patients of antibiotics usage including information on choice, processed, outcome assessment. Present study was precisely an assessment of antimicrobial therapy in Pedodontics outpatients of our university hospital focusing on clinical and laboratory application in management .The practical difference in antibiotics usage is described and rationally aspect is discussed. Methods: The study was carried out in pediatric dentistry outdoor patients, faculty of Dental Science, B.H.U, from March 2015 to May 2016 under routine care of Pediatric Dentistry Department. Pediatric age group (3 to 14 years) patients with oral and dental problem requiring use of antimicrobial drug were selected for study. Results: It is clear from above that all three regimen significantly decrease salivary bacterial counts. Oro dental pain/toothache decrease after treatment with cefixime. Conclusion: Antimicrobial chemotherapy of pediatricoro-dental infection is by subjective decision not by definitive microbiological diagnosis.

Current state of pharmacology and therapeutics in irritable bowel syndrome with special reference to brain-gut axis.

Irritable bowel syndrome (IBS), principal morbidity being visceral hypersensitivity, consumes significant speciality gastroenterologic and general practitioner’s care. The complex etiology perhaps varying among the patients makes therapeutic address very challenging. Continuous researches on neurophysiological aberrations in IBS have continued. The drugs and the neurophysiological understanding with regard to addressing visceral hypersensitivity are relevant to be appraised. The translation of research wisdom into clinical practice may be facilitated by gastroenterology experts. The issues of effectiveness of the options in general and in particular patients may thus be addressed.

Comparative effectiveness study of vinpocetine vs. nimodipine on functional recovery in patients of head injury.

Background: Head injuries are increasing cause of overall disability which needs aggressive researches on neuroprotective agents to prevent or rectify the sequelae of brain damage. The outcomes on functional recovery following add on therapies either nimodipine or vinpocetine was done to compare merits of either therapies. Methods: 90 head injury cases admitted to S.S. hospital were divided into standard treatment group given neither vinpocetine nor nimodipine & other two groups given either nimodipine or vinpocetine dependent entirely on clinician’s discretion. The patients data on initial severity on GCS scale and functional recovery on Barthel Index, head injury watch scale, Disability rating score were collected at discharge & at one month follow up thereafter to compare the recovery profiles. Results: Vinpocetine treatment proved superior to nimodipine or standard treatment on examining the outcomes. Significance of time since injury was emphasized for improved outcome to nimodipine but not so necessary for vinpocetine. Conclusions: Nimodipine delayed administration had no consequence while vinpocetine is useful treatment at any stage to enhance functional recovery in cases of head injury.

The analgesic and anti-inflammatory activities of the hydroalcholic extract of "Shirishadi compound" in animal model.

The main objective of the present investigation is to evaluate the anti-inflammatory & analgesic activity of ethanolic extract of Shirishadi polyherbal compound on rats. Shirishadi compound consist of three herbal drugs namely- Shirisha (Albizzia lebbeck), Nagarmotha (Cyprus rotandus) & Kantakari (Solanum xanthocarpum).In Ayurveda (ancient Indian system of medicine) all these herbs alone or in combination with other herbs are commonly used in the managmant of bronchial asthma. In the carrageenan-induced rat paw edema test for acute inflammation, the extract of Shirishadi compound in doses of 50mg, 200 mg and 500 mg/kg body weight showed 77% and 79% and 81% inhibition of edema, respectively, at the end of 4h which is comparable to that of standard ( endomethacin) i.e. 92%. In the acetic acid induced writhing test the extract of Shirishadi compound ( 200 and 500 mg/kg body weight) showed a significant (p<0.001) reduction in the number of writhes with 65.6% and 70.9% of inhibition, respectively. In radiant heat tail-flick test the crude extract produced 58.1% (p<0.001) and 61.1% (p<0.001) elongation of tail flicking time 30 minutes after oral doses of 200 and 500 mg/kg body weight respectively . After 60 minutes the extract showed 56.3% (p<0.001) and 59% (p<0.001) elongation of tail flicking time. Experimental results showed that Shirishadi compound has persuasive anti-inflammmatory property along with significant analgesic activity.

Anti-inflammatory activity of seed extracts of Pongamia pinnata in rat.

Pongamia pinnata is a marsh growing Indian tree. Its seeds are used in febrile and inflammatory diseases in Indian system of medicine. Previous preliminary studies with ethanolic seed extract of this plant had exhibited an anti-inflammatory effect in rat. Different solvent fractionated extracts were evaluated in the present study for anti-inflammatory effect in chemically induced paw inflammation in rats. Anti-inflammatory effects of P. pinnata were best seen against bradykinin and PGE1-induced inflammation. In contrast minimal effects were seen against histamine and 5-HT-induced inflammation. The predominant action of extracts of Pongamia pinnata appears to be a modulation of eicosanoid-events in inflammation.

Immunopharmacological studies on Picrorhiza kurroa Royle ex Benth. Part VI: Effect on anaphylactic activation events in rat peritoneal mast cells.

Mechanism of inhibition of mast cell anaphylaxis by P. kurroa-extract (PK) treatment in rats was investigated. Mast cell-IgE binding, assessed from induction of passive sensitization, was not affected. Calcium-independent early activation events in mast cell anaphylaxis indicated on inhibitory influence of PK-treatment. Inhibition of membrane-protease release by PK-treatment was suggested by study of gastric secretion and exhibition of saturable synergism with Di-isopropyl fluoro phosphate on inhibition of anaphylactic degranulation. pH-independence of mast cell stabilizing effect negates any PK-influence on phospholipid transmethylation. The results complement findings of earlier studies on indirect effects of PK through alteration of membrane structure/function.

Immunopharmacological studies on Picrorhiza kurroa Royle-ex-Benth. Part IV: Cellular mechanisms of anti-inflammatory action.

In this work abroagation of anti-inflammatory effect of Picrorhiza kurroa extract (PK) by beta-adrenergic blockade was confirmed, which suggests alteration in cell-surface biology by PK treatment. Blockade of protein synthesis by cycloheximide pretreatment reduced PK effect, suggesting protein mediation. Metabolic inhibitor dinitrophenol inhibited inflammatory cedema equally in control and PK treated animals, and masking of PK effect was concluded. Discriminations of anti-inflammatory mechanism(s) of PK and the latter two cytotoxic agents was inferred from these observations and from existing knowledge. Selective PK influence on membrane linked activation events in inflammatory effector cells could be the basis of anti-inflammatory and perhaps other biological activities reported with the herb.

Immunopharmacological studies on picrorhiza kurroa Royle-Ex-Benth. Part V: Anti-inflammatory action: relation with cell types involved in inflammation.

Relative importance of various cells involved in inflammation and in anti-inflammatory action of P. kurroa extract (PK) was investigated in albino rats. Effects of chemical depletion of macrophages and polymorphs and a functional deprivement of mast cells and platelets were examined on carrageenin induced pedal inflammation as well as on anti-inflammatory effect of PK treatment in this test. Such depletions/functional deprivements altered the inflammatory response in conformity with the known role of these cells. The anti-inflammatory effect of PK treatment was counteracted at 1 hr, 3 hr and 5 hr post-insult intervals by mast cell, neutrophil and macrophage depletion respectively. Manipulation of platelets was without effect.

Immunopharmacological studies on Picrorhiza kurroa Royle-ex-Benth. Part III: Adrenergic mechanisms of anti-inflammatory action.

Nature of adrenergic mechanisms contributing to anti-inflammatory effect of Picrorhiza kurroa suggested from earlier studies was explored in Wistar albino rats. Water soluble fraction of alcoholic extract of rhizomes (PK) potentiated castor oil-catharsis on oral administration but direct subplanter PK-injections failed to exhibit any local irritancy and oedema. Propranolol pretreatment counteracted while phentolamine enhanced anti-inflammatory effect of PK in carrageenin-induced inflammation. 6-hydroxy-dopamine pretreatment antagonised the said PK-effect and in such animals both ephedrine and isoprenaline augmented anti-inflammatory effect of PK, the former interaction being more conspicuous. PK-treatment of rats did not influence adrenaline uptake by lung slices in vitro. The results suggest that a non-neural augmentation of beta-adrenoceptor function or consequent cellular events mediates the anti-inflammatory effect of PK.