Prescribing Trend And Drug Cost Analysis Of Oral Hypoglycemic Agents Using Drug Utilisation Review

@#Drug utilization of oral hypoglycemic agents (OHAs) in a private healthcare setting is useful to examine the prescribing pattern of OHAs, especially the newer fixed dose combination (FDC) products. This study was aimed to evaluate the prescribing pattern of OHAs indicated for Type 2 diabetes mellitus (T2DM), to determine the costs of OHAs prescribed and total cost per prescription in the treatment of T2DM in an outpatient department of a private hospital located in central Malaysia. Retrospective review of electronic medical record (EMR) study design was adopted. Patient’s demographic characteristics, medications prescribed, prescribers’ details and cost per prescription were documented. Defined daily dose (DDD) of OHAs and drug cost were calculated. Research ethics protocol was approved and no personal data was collected. Out of the 396 EMR screened, 135 fulfilled the inclusion criteria and subsequently were analysed. In term of demography, mean age of the sample was 51 years old with 59% were male and ethnicity composition of 71% Malay and 19% Chinese. Metformin and “metformin+dipeptidyl peptidase-4 inhibitor” (DPP-4i) were the most commonly prescribed single-drug and FDC OHA, respectively. Average cost of OHAs and total cost per prescription was less than USD 68 and USD 185, respectively. Meanwhile, FDC covered 28.91% of incidences of prescriptions, but 44.6% of cost and SGTL-2i covered 9% incidences of prescriptions and 16.29% of cost. Prescribing pattern of OHA was appropriate based on patient’s T2DM diagnosis, however, dosage given were not in accordance with WHO DDD.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives:To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan.Methods:Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species.Results:An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis.Conclusions:In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Molecular detection of Leishmania species in human and animals from cutaneous leishmaniasis endemic areas of Waziristan, Khyber Pakhtunkhwa, Pakistan

Objectives: To detect Leishmania species in human patients, animal reservoirs and Phlebotomus sandflies in Waziristan, Pakistan. Methods: Tissue smears and aspirates from 448 cutaneous leishmaniasis (CL) suspected patients were analyzed. To sort out role of the reservoir hosts, skin scrapings, spleen and liver samples from 104 rodents were collected. Furthermore, buffy coat samples were obtained from 60 domestic animals. Sandflies were also trapped. All human, animals and sandfly samples were tested by microscopy, kinetoplastic PCR and internal transcribed spacer 1 (ITS1) PCR followed by restriction fragment length polymorphism for detection of Leishmania species. Results: An overall prevalence of 3.83% and 5.21% through microscopy and ITS1 PCR respectively was found. However, the statistically non-significant correlation was found between area, gender, and number of lesions. The presence of rodents, sandflies, domestic animals and internally displaced people increased the risk of CL. Using ITS1-PCR-RFLP, Leishmania tropica (L. tropica) was confirmed in 106 samples while 25 of the isolates were diagnosed as Leishmania major (L. major). Similarly, 3/104 rodents were positive for L. major and 14 pools of DNA samples containing Phlebotomus sergenti sandflies were positive for L. tropica. None of samples from domestic animals were positive for leishmaniasis. Conclusions: In the present study, L. tropica and L. major are found to be the main causative agents of CL in study area. Movement of internally displaced people from CL endemic areas presents a risk for nearby CL free areas. To the best of our knowledge, we report for the first time L. major infection in rodents (Rattus rattus) and L. tropica in Phlebotomus sergenti sandflies trapped in Waziristan, Pakistan.

Body mass index in medical students and its association with gender and academic year

Background: Students are generally prone to weight related problems due to sedentary lifestyle and disordered eating habits. The objective of current study was to evaluate the body mass index among MBBS and Physiotherapy students of Peshawar and to see its association with gender and academic year

Methods: This was a cross-sectional study conducted among MBBS and Physiotherapy students in Peshawar, from Sep 2016 to Sep 2017. A self-administered questionnaire was distributed among 250 students of different institutes, 213 filled questionnaires were returned. Body mass index [BMI] was used to classify underweight, overweight, and obesity grade I and grade II. Data was analyzed using SPSS-20

Results: Mean age of participants was 21.77+/-1.45. Females were 137 [64.3%] while males were 76 [35.7%]. Unmarried participants were 192 [90.1%], while 21[9.9%] were married. Mean height, weight and BMI of the participants were 1.654 meter, 61.1 Kg, and 22.8 respectively. One hundred and thirty [61.0%] were MBBS, and 83 [39.0%] were Physiotherapy students. Out of 213 respondents, 109 [51.2%] had normal BMI, 21[9.9%] were underweight, 41 [19.2%] were overweight, 31 [14.6%] were grade I obese and 11 [5.2%] were grade II obese. Majority of 1[st] year [68.0%] and 4[th] year [72.7%] students had normal BMI. BMI was not associated with gender or academic year [p>0.05]. Mean BMI in MBBS students was higher than the physiotherapy students [23.3 vs 22.1 Kg/M[2], p=0.03]

Conclusion: The prevalence of obesity appears higher in our students

Surveillance report on endemic measles in district Bannu

Objective: The objective of the current study was to report the surveillance of endemic measles in district Bannu and its peripheries

Study Design: Observational / descriptive study

Place and Duration of Study: The study was conducted in Women and Children Teaching Hospital Bannu and various BHUs and dispensaries of countryside's of the district from Jan, 2016 to March, 2016

Materials and Methods: Patients up to 16 years old were screened for febrile rash illnesses at women and children teaching hospital district Bannu and BHUs/dispensaries. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria.16 most critical patient's blood samples were sent to CMH hospital laboratory Peshawar, KPK for further confirmation where test was done by ELISA technique utilizing IgM antibodies

Results: Results showed that male children were highly infected than female. Children from 1-3 years were most affected, followed by children with 1 to 12 months. Least no of cases were reported in children from 4-8 years. Bannu city surrounded areas like mammashkhel, shiekhan, surrani were more affected from measles outbreak while nearby areas are at constant threat

Conclusion: It is concluded that the peripheries were more affected from measles outbreak while nearby areas are at constant threat. In light of our findings, it can be stated that proper steps should be taken by government and non- government organization to control the situation in affected areas and to prevent the nearby areas specially the city from the current outbreak

Allergic broncho-pulmonary aspergillosis presenting as flitting opacities on chest radiograph

Allergic broncho-pulmonary aspergillosis [ABPA] is hypersensitivity reaction to Aspergillus fumigatus in the bronchial tree of young asthmatic patients. A 28 years old female patient presented with one year history of fever with generalised body aches and pains and had already received treatment for pulmonary tuberculosis. Her chest radiograph showed flitting opacities in both lung fields with a TLC of 13.2 x10[9]/L having 25% eosinophils and ESR of 87 mm at first hour. Her serum IgE were markedly raised and CT scan of the chest showed dilated large and medium sized bronchi forming mucocoeles, finger in glove appearance and nodular shadowing in the lung parenchyma. Sputum also showed fungal hyphae by direct microscopy. All the findings were consistent with the diagnosis of ABPA, which responded to oral Itraconazole and Prednisolone. ABPA is a potentially destructive lung disease requiring high index of suspicion for an early diagnosis to prevent irreversible lung damage

Primary perisplenic hydatid cyst

Splenic parasitic cysts due to flat worm Ecbinococi resuling in hydatid disease are a rare presentation as primary site even in the endemic regions. Primary splenic parasitic cysts have an incidence of 0.5-4%. A 21-year-old male with pet dogs at home, presented with 3 months history of gradually increasing discomfort in the left hypochondrium and tender splenomegaly. He had marked eosinophilia with normal liver function tests and positive serum IgM Echinococcus antibodies. Ultrasonography showed a cyst in the hilar region of spleen having septations with internal echos. An upper midline laparotomy was performed and a perisplenic cyst was removed along with spleen from the sub-diaphragmatic location. Histopathological examination confirmed acellular fibrous wall of hydatid cyst with germinal layer and scolices in the centre. Postoperatively, patient was continued on oral Albendazole for one month

Attributes of an effective clinical teacher: a survey on students' and teachers' perceptions

To identify the attributes of effective clinical teacher, using a self-filled survey questionnaire, that students and faculty value most, and to compare the opinion of student and faculty regarding the same. Cross-sectional study. The Aga Khan University Hospital [AKUH], Karachi from October 2006 to January 2007. Clinical faculty at AKUH and students in clinical years were included in this survey after taking their written informed consent. Data were collected through a structured questionnaire administered to all participants. Responses were compared. A total of 119 students in clinical years [3, 4 and 5] and 89 faculties involved in clinical teaching responded to the questionnaire. The most important attributes in faculty's and students' perspective were knowledge, interest in teaching and clinical competency. In students and faculty perspective, the fourth and fifth attributes were good communication skills and being non-judgmental. Students in clinical years and clinical teachers valued knowledge, interest in teaching and clinical competency as the most important attributes for an effective clinical teacher. There were various areas of agreement and disagreement between faculty and students about attributes of effective clinical teacher

Myocardial ischaemia and reperfusion injury: reactive oxygen species and the role of neutrophil

A growing body of evidence suggests that oxygen radicals can mediate myocardial tissue injury during ischaemia and, in particular, during reperfusion. This review focuses on the role of neutrophil as a mediator of myocardial damage. Upon reperfusion, neutrophils accumulate and produce an inflammatory response in the myocardium that is responsible, in part, for the extension of tissue injury associated with reperfusion. It has shown that the inhibition of neutrophil accumulation and adhesion is associated with decreased infarct size. This strongly suggests that myocardial cells at risk region undergo irreversible changes upon reperfusion and accumulation of neutrophils. Several pharmacological agents [ibuprofen, allopurinol, prostacyclin, and prostaglandin E analogues] protect the myocardium from reperfusion injury. In addition, the mechanisms by which these agents act and directions of research that may lead to therapeutically useful approaches are also discussed in this review