Study of drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of tertiary care hospital

Background: Mental disorders are now widely recognized as a major contributor to the global burden of disease. The drug use in psychiatric illness is a complex process and because of this the optimal benefits of drug therapy in patient care is not achieved. This often leads to increased cost of medical care, drug resistance, adverse effects and patient mortality. Hence, this study is undertaken to study the drug utilization pattern and adverse drug reactions of psychotropic drugs in psychiatric inpatient department of a tertiary care hospital.Methods: A prospective, observational study was undertaken from 1st February 2015 to 31st July 2016. A total of 250 prescriptions were analysed. Defined daily dose of the drugs were calculated. ADR’s were recorded in the format of the National Pharmacovigilance Programme of India (PvPI).Results: In 250 prescriptions most, common drug prescribed was antipsychotics (48.5%). Total drug utilization in terms of DDD/100 bed days was 669. The total number of adverse drug reactions observed was 8%. Antipsychotics were the most common class of psychotropic drugs causing ADR’s.Conclusions: In conclusion, it has been found that the psychotropic drugs used in our psychiatry department was rational and was based on clinical knowledge, expertise and the guidelines available in the field of psychiatric practice.

Study of evaluation of anti-inflammatory activity of macrolide antibiotics in rats: an experimental study.

Background: Inflammation is a complex and dynamic condition in which many changes take place at the site of inflammation, as well as systemically. In general, inflammatory response acts to protect the host, but many times it goes unchecked with tissue destruction leading to a spectrum of inflammatory disorders. Antiinflammatory drugs have long been used to treat spectrum of inflammatory conditions. Anti-inflammatory agents, in use today, though have efficacy, cause a variety of side effects causing major problems during their clinical use. Amongst newer approaches to treat inflammation, macrolides, the anti-bacterial agents, seem to be beneficial in decreasing the inflammation. Still there is much speculation about the antiinflammatory activity of macrolide antibiotics. So, we planned this study to assess anti-inflammatory activity of macrolide antibiotics (erythromycin, roxithromycin, azithromycin, and clarithromycin) and to compare their anti-inflammatory activity with control and indomethacin (standard non-steroidal anti-inflammatory drugs). Methods: To assess anti-inflammatory activity of macrolides, we used acute (carrageenin-induced paw edema and turpentine oil-induced arthritis), as well as chronic model of inflammation (cotton pellet induced granuloma). Results: All the macrolides, i.e., erythromycin, roxithromycin, azithromycin and clarithromycin showed significant (p<0.05) anti-inflammatory activity in acute models of inflammation as compared to control group. However, macrolides showed insignificant activity as compared to indomethacin (acute and chronic models of inflammation) and as compared to control (chronic model of inflammation). Conclusions: This study shows macrolide antibiotics have anti-inflammatory activity in animal models of acute inflammation.

Evaluation of antidepressant activity of tramadol in mice: an experimental study.

Background: In spite of availability of effective antidepressant drugs, depression continues to be a major problem. Hence, great interest is being taken in development of innovative antidepressants. Tramadol (TRM) is a centrally acting opioid agonist, which is clinically effective in the treatment of moderate to severe pain. By virtue of its action of inhibiting norepinephrine and serotonin uptake, it can function as an antidepressant like venlafaxine. Hence, this study was planned to evaluate antidepressant activity of TRM in comparison and in combination with fluoxetine (FLX) in albino mice. Methods: TRM (20 and 40 mg) and FLX (20 mg) were administered i.p., alone and in combination once daily for acute (7 days) and chronic (14 days) period to Swiss albino mice of either sex. The immobility period of control and treated mice was recorded in forced swimming test (FST) and tail suspension test (TST). The open field test was also done for same period to test the locomotor activity in animal. The antidepressant effect of TRM was compared with FLX and normal saline treated group for acute and chronic study period. Results: TRM (20 and 40 mg) treated group produced significant antidepressant effect alone and in combination with FLX (20 and 40 mg) as indicated by reduction in immobility period compared with control group in FST and TST. TRM and FLX treated groups did not show significant activity in open field test when compared with control group. Conclusions: This study shows TRM has antidepressant activity in standard models of depression.

Timely use of anti-snake venom improves maternal and fetal outcome: a case report.

Snake bite is a common medical emergency and an occupational hazard in a rural population of India. Though it is uncommon in pregnancy, it is associated with poor maternal and fetal outcome. Early gestational age and delay in the treatment are the factors responsible for unfavorable prognosis. Here, we report a case of primigravida, aged 22 years, with 22 weeks of gestation presenting with a history of snake bite on the left frontal region of the face. While on anti-snake venom treatment, patient developed anaphylactic reaction. In spite of this, the maternal and the fetal outcome were good in this case.

A study on the clinico-epidemiological profile and the outcome of snake bite cases in the tertiary care hospital.

Background: Snake bite is a common medical emergency and an occupational hazard in India. It is also a major public health issue in rural India where farming is a major source of employment. Very few studies describe epidemiology of snake bite from India. Hence, this study was planned to collect information on various aspects of snake bite in a tertiary care hospital. Methods: A prospective observational study of 167 patients of snake bite and unknown bite carried out from September 1, 2012 to August 31, 2013. Results: Among a total 167 cases, majority were males (54.49%), aged between 20 and 40 years (38.92%). Most of the cases were laborers (61.67%) and farmers (17.36%). Peak incidence was observed during monsoon (64.67%). Bite mark was seen in 46.70% cases, upper extremity being common site (52.09%). Most cases were of vasculotoxic bite (65.26%) and few were of neurotoxic bite (19.76%). Major complications were respiratory failure (4.79%) and acute renal failure (1.8%). Average bite to needle time was 365 min. Bleeding & clotting time was raised in 44.03% & 35.19% cases, respectively. Average dose of anti-snake venom (ASV) required was 17.1 vials. Allergic reactions to ASV observed in 8.38% cases. Mean duration of hospital stay was 4.3 days. Recovery rate was 94.01% with three cases referred to higher center. Mortality rate was 2.39%. Conclusions: Our study highlights various aspect of snake bite cases and tries to fi nd out ways to improve quality of life of patients, decrease mortality and morbidity and decrease economic burden on society.

Effect of Lagenaria siceraria fruit extract (Bottle gourd) on hepatotoxicity induced by antitubercular drugs in albino rats.

Background: Anti TB drug induced hepatotoxicity has higher incidence in Indian population [11.5%] than western population [4.5%]. Antitubercular drug induced hepatotoxicity is mediated through oxidative and free radical damage to hepatocytes. Lagenaria siceraria [Bottle Gourd] is reported to have antioxidant and hepatoprotective activity. Hence in the present study we tested hepatoprotective and antioxidant activity of fruit extract of L. Siceraria in anti tubercular drug induced hepatotoxicity. Methods: We administered antitubercular drugs alone and in combination with fruit extract of Lagenaria siceraria (EELS 100mg/kg and EELS 200mg/kg) in healthy albino rats by oral route for 15 days. On 16th day blood collection for biochemical analysis is done by cardiac puncture. Biochemical markers used are serum transaminases (SGPT/SGOT), serum alkaline phosphatase [ALP], total bilirubin, total protein, superoxide dismutase [SOD] and malondialdehyde [MDA]. Liver is dissected for histopathological examinations. Results: Groups that received EELS [100 mg/kg & 200 mg/kg], in combination with anti tubercular drugs, showed significant reduction [p value <0.001] in biochemical parameters for hepatotoxicity [SGOT, SGPT, ALP, Total bilirubin, Total protein] in comparison with group that received anti tubercular drugs alone. Combined treatment of EELS [100 mg/kg & 200 mg/kg] & Anti tubercular drugs showed significant reduction in oxidative stress [SOD & MDA, p<0.001] as compared to anti tubercular drug alone. Histopathological examination of liver showed grade I & grade 0 changes in combination group while grade IV changes in group receiving anti tubercular drugs alone. Conclusion: Ethanolic extract of Lagenaria siceraria fruit possesses significant hepatoprotective and antioxidant activity in antitubercular drugs induced hepatotoxicity.