Quality of prescriptions in hospitalized children suffering from acute and persistent diarrhoea

Background: Diarrhoea is a major public health problem in children worldwide. It continues to be a major health challenge, especially in developing countries, despite the availability of regularly updated standard treatment guidelines. Non-compliance to such guidelines by the physicians has been a long standing story. The treatment is often marred with incapacitating prescription of drugs besides neglecting even the basic tenets of good prescribing. As a result, the quality of such prescriptions for diarrhoeal disorders in children remains poor. To gauge the magnitude of this problem in this setup towards possible corrective measures, the study was aimed to audit prescription practices in the management of acute and persistent diarrhoea in hospitalised children up to five years of age.Methods: An observational study was conducted in 100 patients of either gender in the age group up to 5 years admitted with acute and persistent diarrhoea. A detailed medical history from the parents/guardians and the details of prescription from the time of admission till the discharge of the patient were obtained. Quality of prescriptions was analysed using prescription quality index (PQI) tool, a validated comprehensive tool described by Hassan et al in 2010. Based on this tool, prescription with the total PQI score of ? 31 were interpreted as poor quality, scores with 32 to 33 as medium quality and scores 34 to 43 as high quality with a possible maximum score of ��.Results: Based on the PQI tool for 100 children, 60 prescriptions were found to be of poor quality. Only 2 prescriptions were of medium quality, whereas 38 prescriptions were in high quality range. Average mean盨D score of prescriptions with poor quality was 25.2�48, ranging from 21 to 31. The mean盨D of prescriptions with medium quality was observed to be 32�and for prescriptions of high quality was 38.07�28. The total average mean score of all prescriptions was 30.23�50. Poor quality prescriptions were particularly observed for the patients with the diarrhoea with No dehydration.Conclusions: Prescription appropriateness in spite of available guidelines continues to be a big challenge in the adequate management of patients with diarrhoeal disorders under the age group of five years in a tertiary care centre in India.

Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13�1 years and 2.08�1 years and mean age of the patients was 14.67�9 years in group A and 16.20�6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30�1 (p value <0.05) and change group B was -0.20�4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17�1 and -0.70�1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

Adverse Drug Reaction Monitoring in Psychiatry Outpatient Department of a Tertiary Care Teaching Hospital.

To study the pattern of adverse drug reactions (ADR) in patients attending psychiatry OPD of a tertiary care teaching hospital. Patients attending psychiatry OPD with ADRs due to drugs prescribed for various psychiatric illnesses over a period of 1year were included in the study. Adverse event history, medication history and other relevant details were entered in the PvPI format. Causality was assessed by WHOUMC criteria. A total of 103 ADRs were reported from 85 prescriptions with a female preponderance. Majority of ADRs (45.7%) were seen with antidepressants as they were the commonly prescribed drugs followed by antipsychotics (33.3%) and others by sedative hypnotics and anticonvulsants. ADRs like somnolence topped the list (21.9%) followed by weight gain (18.4%), akathesia (6.8%) and drug induced restless legs syndrome (RLS) (5.8%). The reported ADRs were assessed for causality and maximum (80.6%) belong to the "possible" category. Maximum ADRs were seen with antidepressants followed by antipsychotics. Sedation and weight gain were the most commonly occurring ADRs.

Comparison of the Effect of Glitazones and DPP-IV Inhibitors in Type 2 Diabetics as Add on Therapy on Insulin Sensitivity and Serum hs-CRP Levels.

To study & compare the effect of glitazones and DPP-IV inhibitors as add on therapy on Insulin sensitivity and serum hs-CRP levels in type 2 diabetes mellitus patients.Thirty patients (previously known cases of type 2 DM), aged above 18 years, were randomly included in the study. Group A, Glimepiride + Metformin + Pioglitazone (G + M + P) and Group B, Glimepiride + Metformin + Sitagliptin (G + M+ S). The study drugs were given on the basis of physician's discretion and the doses of study drugs were fixed according to their clinical presentation & followed up for a period of 3 months.The glycosylated haemoglobin (HbA1c) at the start of study (day 0) of group A was 10.39 ± 0.67 and in group B was 10.10 ± 0.62.The mean value of HbA1c at the end of the study period (day 90) in group A was 9.46 ± 0.61 and in group B was 9.04 ± 0.58. Insulin resistance at the start of the study (day 0) in group A, was 5.549 ±0.59 and in group B was 6.66 ± 0.76, The mean values of IR at the day 90, in group A was 3.42 ± 0.37 and in group B was 3.82 ± 0.61. The mean value of hs-CRP at the start of study (day 0) in group A was 4.34 ± 0.77 and in group B was 6.78 ± 1.18. The mean value of hs-CRP at the end of the study period (day 90) in group A was 2.8 ± 0.63 and in group B was 4.51 ± 0.73. There was no significant intra group or intergroup difference found in the above mentioned study paramaters .Both the study drug groups reduced HbA1c, insulin resistance, though there was no any significant difference. There was decrease in hs-CRP levels in both the groups. Moreover these combination therapies were safe and no serious adverse effects were reported.

Biological response modifiers: Current use and future prospects in cancer therapy.

Over the past few decades, considerable success has been achieved in the field of cancer treatment with biological response modifiers (BRM), which are agents that improve the body's ability to fight cancer by immunostimulation. Biological agents, such as interferons and interleukins, provide nonspecific active immunity, whereas the monoclonal antibodies provide passive immunity. Apart from this, other biological agents, such as antiangiogenic agents, matrix metalloprotease inhibitors, tyrosine kinase inhibitors, and tumor vaccines, are also increasingly being used in cancer treatment. Hematopoietic factors, such as granulocyte colony-stimulating factor, are used to increase the general immunity and prevent opportunistic infection. BRM are basically used alone or as adjuvants to cancer chemotherapeutic agents. This review sheds light on the current use and the future development of cancer immunotherapy. Search strategy included Pubmed, using the terms "Biological response modifiers in cancer" citations relevant to the topic were screened.

Comparative Efficacy and Tolerability of Sumatriptan, Ergotamine, Naproxen and Rizatriptan in Moderate to Severe Acute Attack of Migraine.

A double-blind, randomized, parallel study was done to compare sumatriptan, ergotamine, naproxen and rizatriptan in 40 outpatients treating a single migraine attack of moderate to severe intensity. Among these groups, significantly more number of patients had headache relief at 2 hours postdose in naproxen and rizatriptan group as compared to ergotamine. Naproxen, rizatriptan and sumatriptan were better than ergotamine in causing freedom from the associated symptoms of nausea, vomiting, photophobia and phonophobia at 2 hour postdose. Naproxen, rizatriptan and sumatriptan were also efficacious in causing functional normalization at 2 hours postdose as compared to ergotamine. The overall results of the study suggest that naproxen is as efficacious as triptan group of drugs but better than ergotamine group in treatment of moderate-severe acute migraine attack. It is more cost effective than triptans and also a well tolerated drug.

Modulation of pain perception by ramipril and losartan in human volunteers.

The angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are a well known entity and have been used in therapeutics for various indications like hypertension, myocardial infarction and CHF. However, there is a renewed interest in these compounds in terms of their effects on pain perception in animals as well as in human beings. They have yielded contradictory results, showing hyperalgesia in some studies but analgesia in others. Hence this study was undertaken to evaluate the effect of Ramipril (an ACE-I) and Losartan (an ARB) on pain perception in human volunteers using cola caps and handcuff of sphygmomanometer. A total of 30 healthy, normotensive individuals with no previous history of intake of analgesics during or 4 weeks prior to the study were selected after an informed consent. The first group received a single dose of placebo, the second group received Ramipril (2.5 mg) & the third group received Losartan (50 mg). Pain perception threshold (the point at which an individual first experiences pain) and the maximum tolerated pain were assessed using the above method. The control group showed no significant changes in pain threshold, but the group receiving either Ramipril or Losartan showed a decline in threshold for maximum tolerated pain. Only Ramipril and not Losartan decreased the pain perception threshold. Our study revealed that single dose treatment of healthy volunteers with Ramipril and Losartan may cause algesia as early as after ingestion of the first dose and further studies are needed to study their long term effects on pain perception.

Prescribing Pattern of NSAIDs in Orthopaedic OPD of aTertiary Care Teaching Hospital in Uttaranchal

The present prospective study was planned and conducted in the Department of Pharmacology and in Orthopaedics OPD of a tertiary care teaching hospital, Himalayan Institute of Medical Sciences (HIMS), Dehradun during year 2003-04. The aim of the study was to analyze the prescribing pattern of NSAIDs in patients attending Orthpaedics OPD and to correlate the use of selective COX-2 inhibitors and older conventional NSAIDs in practice in the present scenario. The result of present study suggests frequent use of selective COX-2 inhibitors although conventional non-selective NSAIDs topped the list of various selective and non-selective NSAIDs. Concomitant gastroprotectives were also used. Fixed dose combinations were also prescribed.