Prescribing pattern of anticancer drugs in the medical oncology department of a tertiary care teaching hospital

Background: To study drug utilization of anticancer drugs in the oncology inpatient department (IPD) of Kamineni Hospitals, L.B. Nagar, Hyderabad, India.Methods: One hundred prescription records were screened and analysed as per the study parameters from the oncology IPD of Kamineni Hospitals, Hyderabad. Commonly used anticancer drugs were recorded; furthermore, different types of carcinomas were noted.Results: Age group of patients was in between 04 and 80 years, 62 were females and 38 were male patients. The most common type of carcinoma was carcinoma of the breast (28%). Cisplatin was the most commonly used anticancer drug (29%). Adjuvant drugs were used in 98% of the patients.Conclusions: Incidence of cancer is more in females than males. Adjuvant and cytoprotective drugs used may have had a bearing on the relatively lower incidence of adverse effects.

An evaluation of knowledge, attitude and practice of pharmacovigilance among medical students and doctors at a tertiary care hospital

Background: Drugs are one of the most commonly used interventions in medical therapeutics. Spontaneous reporting of adverse drug reactions (ADRs) is the backbone of pharmacovigilance (PV) program. Under-reporting of ADRs by prescribers was possibly due to lack of knowledge, attitude and practices regarding PV. This study was done to assess the knowledge, attitude, and practice (KAP) of medical students (grouped to sixth and eighth semester) and medical doctors about PV in a tertiary care hospital.Methods: It was a questionnaire based cross-sectional study administered to 246 medical students and doctors. Study tool was a validated questionnaire containing 15 questions to evaluate KAP of PV among medical students and doctors. A descriptive analysis of data was done where necessary, statistical significance for associations between the group and their responses to questionnaire was provided using Pearson Chi square test and Fisher exact test.Results: Sixty-eight percent of the participants (90% doctors; 76% eighth-semester and 46% sixth-semester medical students) know the correct definition of PV. Sixty-one percent of the participants (67% sixth-semester, 61% doctors and 53% eighth-semester) think that reporting is a professional obligation for them. Only 15% of the participants have ever been taught or trained on how to report an ADR.Conclusions: Medical doctors and students lack adequate knowledge and practice of reporting ADRs, but they seem to have a positive attitude towards the PV program. Our study findings strongly suggest that there is a great need to create awareness amongst them to promote reporting of ADRs.

A novel rapid - acting oral inhalation human insulin for diabetes mellitus: Afrezza.

Afrezza is rapid-acting oral inhalation insulin that is administered at the beginning of each meal. The U.S Food and Drug Administration has approved Afrezza (insulin human) inhalation powder, a rapid-acting inhaled insulin to improve glycemic control in adults ≥18 years of age with Type 1 or Type 2 diabetes mellitus (T1DM or T2DM). Afrezza must be used in combination with long-acting insulin in patients with T1DM. Afrezza may be used with either oral anti-diabetic drugs or basal insulin in patients with T2DM. Afrezza should be administered via oral inhalation using Afrezza inhaler. Dosage adjustment is needed when switching from injection insulin to oral inhalation Afrezza. It is contraindicated in individuals with chronic lung disease and smokers because of the risk of the acute bronchospasm. Before initiating, Afrezza, a complete medical history, physical examination and spirometry (forced expiratory volume 1 sec) results is required in all individuals to identify the potential lung disease. Common adverse reactions in individuals treated with Afrezza include hypoglycemia, cough, throat pain or irritation, headache, and diarrhea.

Hepatoprotective activity of Eclipta alba against carbon tetrachlorideinduced hepatotoxicity in albino rats.

Background: Despite the tremendous scientific advancement in the field of gastroenterology over the recent years, there is not even a single effective allopathic medication available for the treatment of liver disorders. Hence, the study was conducted to elucidate the hepatoprotective activity of aqueous extract of traditional medicinal plant Eclipta alba against carbon tetrachloride (CCl4) induced toxicity in male albino rats. Methods: The hepatoprotective effect of the aqueous extracts of E. alba was evaluated by biochemical parameters such as serum alanine transferases (ALT), serum aspartate transferases (AST), alkaline phosphatase (ALP), total serum bilirubin, and serum protein, and confirmed by histopathology of liver. The hepatotoxic agent CCl4 was used to induce liver toxicity and silymarin was used as a control drug. The aqueous extracts of E. alba were administered at the doses of 250 mg/kg/day and 500 mg/kg/day orally for 4 days. One-way Analysis of Variance was used for the statistical analysis of data. A probability value of p<0.05 was considered as significant. Results: E. alba administration at doses 250 mg/kg and 500 mg/kg orally demonstrated significant hepatoprotective activity by preventing the increase of ALT, AST, ALP, and serum bilirubin and also confirmed by histopathology of the liver. The results were comparable to that of silymarin. Conclusion: The results of the study confirmed the hepatoprotective activity of aqueous extracts of E. alba at doses of 250 mg/kg and 500 mg/kg against CCl4 induced hepatotoxicity in rats. However, the dose adjustments may be necessary to optimize the similar hepatoprotective efficacy in clinical settings.

Evaluation of hepatoprotective activity of Boerhaavia diffusa against carbon tetrachloride induced liver toxicity in albino rats.

Background: Modern allopathic medicine has very little to offer for the treatment of liver disorders in spite of consistent effort for new drug discovery. Hence, this study was conducted to elucidate the hepatoprotective activity of aqueous extract of traditional medicinal plant Boerhaavia diffusa against carbon tetrachloride (CCl4) induced toxicity in male albino rats. Methods: The hepatoprotective effect of the aqueous extracts of B. diffusa was evaluated by biochemical parameters such as serum alanine transferases (ALT), serum asparate transferases (AST), alkaline phosphatase (ALP), total serum bilirubin, and serum protein, and confirmed by histopathology of liver. The toxicant CCl4 was used to induce hepatotoxicity and silymarin were used as control drug. The aqueous extracts of B. diffusa were administered at the doses of 250 mg/kg/day and 500 mg/kg/day orally for 4 days. One-way analysis of variance was used for the statistical analysis of data. A probability value of p<0.05 was considered as significant. Results: Administration of B. diffusa at doses 250 and 500 mg/kg orally demonstrated hepatoprotective activity by preventing the increase of ALT, AST, ALP, and serum bilirubin and also confirmed by histopathology of the liver. The results were comparable to that of silymarin®. Conclusion: The results of this study confirmed the hepatoprotective activity of aqueous extracts of B. diffusa at doses of 250 mg/kg/and 500 mg/kg/against CCl4 induced hepatotoxicity in rats. However, the dose adjustments may be necessary to optimize the similar hepatoprotective efficacy in clinical settings.

National list of essential medicines of India, National Essential List of Medicine 2011 – does it have any merit.

Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. The WHO Model List is a guide for the development of national and institutional essential medicine lists. The WHO Model List is updated and revised every 2 years by the WHO Expert Committee on selection and use of medicines. The 19th WHO Expert Committee on Selection and Use met in April 2013 to produce the following lists: 18th WHO Model List of Essential Medicines (2013) and 4th WHO Model List of Medicines for Children (2013). The concept of essential medicines is present in more than 150 countries which have their national list based on WHO Model List.

Evaluation of novel methods of assessments in pharmacology to develop new attitudes and skills in Caribbean Medical School.

Background: Assessment is said to drive student learning and define the curriculum. The problem-solving type of multiple choice questions (MCQs), which can be used to probe and assess medical students in pharmacology should have a clinical vignette containing presenting complaints, abstract history, physical examination and laboratory data, followed by a single or series of questions based on it. National Board of Medical Examination (NBME), USA has an extensive bank of problem-solving MCQs, and these questions are often regarded as similar in format and focus to MCQs of United States Medical Licensing Examination (USMLE). The objective assessment of teaching and curriculum in this study is done by comparison of students’ performance in pharmacology comprehensive exam of NBME, USA before and after curriculum changes. This study was designed to obtain an objective assessment of teaching and curriculum by comparison of students’ performance in terms of student mean grades, percentage of students passed, percentage of students failed, percentage of students with honors, and individual highest scores of five semesters before and five semesters after curriculum changes in pharmacology comprehensive exam of NBME, USA among the 5th semester students of American University of the Caribbean, School of Medicine, St. Maarten. Methods: We have compared the students’ performance of pharmacology comprehensive exam of NBME using five parameters like student mean grades, percentage of students passed, percentage of students failed, percentage of students with honor, and individual highest score of five semesters May 2009, September 2009, January 2010, May 2010 and September 2010 semester batches before the introduction of curriculum changes with subsequent semesters January 2011, May 2011, September 2011, January 2012 and May 2012 semesters after the introduction of curriculum changes. Results: The pre-curriculum student performances were compared with post-curriculum changes using the Student’s t-test. The students mean scores improved significantly from 50.76 before curriculum changes to 56.54, students passed (%) increased from 94.57% before curriculum changes to 96.93% after curriculum changes and students with honors (%) increased significantly from 64.72% before curriculum change to 75.51% after curriculum changes and also seem to have remained consistently better. The students failed (%) decreased dramatically from 5.43% to 3.07% after curriculum changes. The highest individual mean score also improved significantly from 72.4 to 80.8 after curriculum changes and have remained consistent in the following semesters. Conclusions: There seems to be obvious improvements in student performance as reflected by a significant increase in mean scores, students pass (%), and students with honors (%) probably due to inclusion of problem-solving MCQs in formative and summative assessments in new curriculum compared with declarative MCQs in old curriculum. The student failed (%) decreased dramatically, which could be attributed to the changes in teaching content and format brought by curriculum changes in pharmacology. The teaching of pharmacology principles as pathophysiology of drug therapy also seemed to have prepared students better for NBME comprehensive exam and also USMLE Step 1. The clinical pharmacology exercises in small groups as role playing sessions seem to have really improved students’ comprehension and retention of the basic sciences knowledge for clinical application based on students’ feedback.

Canagliflozin: a novel ‘glucuretic’ approach for the treatment of type 2 diabetes mellitus.

Canagliflozin is the first in a new class of glucose-lowering drugs, an oral inhibitor of sodium glucose cotransporter 2 (SGLT2). SGLT2, the transporter is responsible for reabsorbing the majority of glucose filtered by the kidney. SGLT2 inhibitors are a new class of oral drugs indicated only for the treatment of type 2 diabetes mellitus in conjunction with exercise and a healthy diet. They inhibit glucose re-absorption in the proximal renal tubules providing an insulin independent mechanism to lower blood glucose. Their use in clinical studies is associated with improved glycemic control, weight loss, and a low risk of hypoglycemia. They have been studied alone and with other medications including sulfonylureas, sitagliptin, and insulin.