ABSTRACT
Background: Migraine is a most common and highly prevalent neurologic disorder characterized by recurrent moderate-to-severe headaches often in association with a number of autonomic nervous system symptoms. Sodium valproate and topiramate are the two newer antiepileptic agents which are commonly prescribed for the migraine prophylaxis in India. Aims and Objectives: The aims of the study were as follows: (1) To compare the efficacy of sodium valproate 15–30 mg/kg/day and topiramate 2–3 mg/kg/day as prophylactic therapy for migraine in adults and (2) to study cost-effectiveness and safety profile of sodium valproate and topiramate. Materials and Methods: It is an open-label comparative study; 100 migraine patients of age group between 20 years and 50 years of both sexes were enrolled in the present study according to the inclusion criteria. Patients were diagnosed as migraine as per the International Criteria For Headache Disorders-3. Before starting treatment and after diagnosis, investigations have done, that is, complete blood picture, liver function test, renal function test, random blood sugar, and thyroid profile. Randomization was done by choosing every alternate patient and study drugs were prescribed. One hundred patients were divided into two groups, Group-A: 50 patients administered Tab. sodium valproate 500 mg twice daily orally and Group-B: 50 patients administered Tab. topiramate 150 mg once daily orally for a period of 6 months. Results: In Group-A, the severity of pain value before starting treatment was 6.440 ± 2.130 which is reduced to 1.820 ± 1.024 at the end of the treatment which was statistically significant (P < 0.0001) and the frequency of headache value before starting treatment was 4.220 ± 1.298 which is reduced to 1.320 ± 0.7407 at the end of the treatment, P < 0.0001 which was statistically significant. In Group-B, the severity of pain value before starting treatment was 6.200 ± 2.119 which is reduced to 1.840 ± 0.9765 after starting treatment which was statistically significant (P < 0.0001) and the frequency of headache value before starting treatment was 4.300 ± 1.199 which is reduced to 1.340 ± 0.6884 after starting treatment, P < 0.0001 which was statistically significant. In between the two groups severity of migraine pain and headache frequencies the P value was statistically significant. Conclusion: The results of the present study demonstrated that both sodium valproate and topiramate were well tolerated, having similar efficacy in reducing the severity of the pain, headache frequencies, and improving the quality of life. Sodium valproate is preferred because of cost-effectiveness.
ABSTRACT
Background: Antipsychotic drugs are commonly used pharmacological agents, which have varied adverse reactions. There is a need to investigate the prevalence of these adverse reactions due to the implications for clinical practice and research. Studies on the prevalence of these adverse reactions are few, especially from Indian subcontinent. Aim and Objectives: The objectives of this study were as follows: (i) To investigate the drug emergent adverse drug reactions (ADRs) in patients who are on antipsychotic drugs and (ii) to study the severity of ADRs due to antipsychotic agents and association between the adverse reaction and the suspected drug. Materials and Methods: This is a prospective observational study, in which 99 patients out of 120 patients suffering with mental illness were enrolled. Base-line investigations such as CBP, ESR, serum creatinine, serum electrolytes, serum cholesterol, serum prolactin, and FBS (fasting blood sugar) were performed and the same were repeated at 1st month and 3rd month and checked for any abnormality. Any suspected ADRs were noted after 1 month and 3 months in patients after starting the treatment with antipsychotic drugs. The patients were assessed with semi-structured interview, the patient rated side effects scale (LUNSERS), and an adverse drug probability scale (Naranjo probability scale). The results were analyzed with SPSS software. The ADRs in patients were also compared between in-patients and out-patients. Results: The atypical drugs particularly risperidone and olanzapine were commonly prescribed for the patients, than typical antipsychotic drugs such as haloperidol. Out of the 99 patients, risperidone was prescribed for 56.6% of patients, olanzapine was prescribed for 40.4% patients, amisulpride was prescribed for 1% of patient, and haloperidol for 2% of patients. About 79% of the patients under study developed ADRs within a month and 21% developed after a month. These drugs were given twice-daily dosage regimen for 89.9% of the patients than once daily dosage regimen, which is 10.1%. Forty-one were in-patients and 58 patients were out-patients. Among the in-patients, risperidone drug was given for 28 (68.3%) patients, olanzapine was given for 11 (26.8%) patients, amisulpride for 1 (2.4%) patient, and haloperidol for 1 (2.4%) patients. The most common ADRs in in-patients was EPS (90.24%) with a statistically significant P < 0.0001. In out-patients, risperidone was prescribed for 28 (48.3%) patients, olanzapine was given for 29 (50%) patients, and haloperidol for 1 (1.7%) patient. The most common ADR among out-patients was sedation (82.75%) with P = 0.0001, which is statistically significant. The ADRs were “significant” according to LUNSERS overall score and are “probable” according to Naranjo’s probability assessment scale. Conclusion: The most common antipsychotic drugs used were risperidone and olanzapine. The common drug emergent adverse reactions were EPS and sedation when the drugs were prescribed twice-daily dosage regimen. The time taken for these ADRs to emerge is ?1 month. The ADRs are significant according to LUNSERS and probable due to suspected drug according to Naranjo’s probability assessment scale. In comparison between in-patients and out-patients, EPS was found more among in-patients and sedation in out-patients. Depending on the intensity of the ADRs, the antipsychotics drug dosage was reduced or drug changed or another was added to combat the ADRs.
ABSTRACT
Background: The injudicious and indiscriminate use of antimicrobials has led to the development of antimicrobial resistance (AMR), particularly in the low- and middle-income countries. Antimicrobial Stewardship (AMS) is the coordinated intervention to enhance the appropriate use of antimicrobials. Antimicrobial stewardship program (ASP) is a multidisciplinary program with interventions and strategies to encourage AMS to prevent emergence of AMR. Aims and Objectives: This study aimed at evaluating the knowledge, awareness, and practice (KAP) of AMS among prescribers of a teaching hospital in South India. Materials and Methods: A cross-sectional questionnaire based study conducted after obtaining Institutional Ethics Committee approval was conducted among prescribers of a teaching hospital from September 2022 to October 2022. Responses to the questionnaires issued to the prescribers through Google Forms were analyzed by descriptive statistics using Microsoft excel. Results: A total of 230 prescribers submitted the filled in questionnaires. The definition of AMS was known to 62%. The constitution and functioning of ASP was known to 59%. However, only a few (38%) prescribers agreed that antimicrobials are avoided in viral infections. More than 60% had good awareness of AMS. However, only 25% were aware of an ASP program is their hospital. Fifty percent agreed to the practice of reviewing antimicrobial use after 48–72 h and only 38% to the practice of obtaining cultures before prescribing antimicrobials. Conclusions: The prescribers had moderate knowledge and awareness and poor practice of AMS. To address these gaps, educational interventions and capacity building approaches are required.