ABSTRACT
Background: Depression is an important global public health problem and is a major cause of disability and premature death. The present study was conducted to compare effi cacy and safety of amisulpride and escitalopram on Hamilton anxiety rating scale (HAM-A) among depression patients in a tertiary care teaching hospital in Nepal. Methods: The study was conducted in patients for 1-year in the Department of Neuropsychiatry, Nepalgunj Medical College and Teaching Hospital. A total of 117 depression patients were divided into two groups. Group I (58 patients) received amisulpride tablet at a dose of 50 mg/day and Group II (59 patients) were given escitalopram at a dose of 10 mg/day. The patients were required to follow-up at 4, 8 and 15 weeks. The effi cacy of the drugs was calculated by HAM-A. Adverse drug reactions (ADRs) were monitored at every follow-up. Appropriate statistical tools using Graphpad instat 3.0 were used for analysis p<0.05 was considered signifi cant. Results: HAM-A score in group receiving amisulpride at 0 and 15 weeks was 19.83±0.33 and 8.17±0.32 (p<0.0001). HAM-A score in group receiving escitalopram at 0 and 15 weeks was 20.76±0.28 and 8.98±0.24 (p<0.0001). Gastrointestinal disturbances, sexual disturbances, amenorrhea, lactation, agitation, and insomnia were the commonly encountered ADRs. Conclusion: Both amisulpride and escitalopram were highly effective in the treatment of anxiety in depression patients during the study period. Further, more clinical studies with longer follow-up duration are needed to substantiate the therapeutic effects of amisulpride.
ABSTRACT
Background: Dry eye produces discomfort and reduced vision. The treatment of dry eyes has traditionally involved hydrating and lubricating artifi cial tears. The newer medications include non-steroidal anti-infl ammatory drugs (NSAIDs) for the treatment of dry eye disorders. This study was designed to compare the effect of topical carboxymethylcellulose (CMC) alone or in combination with topical NSAID for the treatment of dry eye in a tertiary care teaching hospital. Methods: A total of 60 patients diagnosed with dry eye were enrolled for a study period of 1 year. Patient of either sex (male/female), age between 18 and 70 years, and all diagnosed cases of dry eye in ophthalmology outpatient department were selected. Patients (n=60) were stabilized on CMC for 2 weeks and thereafter divided into two groups. Group I (n=30) received only topical CMC; Group II (n=30) received CMC+NSAID. The patients were followed up to 12 weeks. Diagnostic tests included Schirmer’s test and tear break up time (TBUT). Ocular Surface Disease Index (OSDI) was used for assessing the Quality of Life. Analysis was done using GraphPad InStat software. p<0.05 was considered signifi cant. Results: This was an open-label study revealing a mean age of 46.0±1.79 years. Females (56.67%) showed a signifi cantly higher prevalence of dry eye symptoms compared to males (43.33%). The mean duration of illness was 1.95±0.16 years. Schirmer’s test, TBUT test values and OSDI score in Group I and Group II at 0 and 12 weeks revealed signifi cant intragroup difference (p<0.0001). At 12 weeks intergroup comparison in Schirmer’s test value (p>0.05) and TBUT test value (p>0.05) showed no signifi cant difference while OSDI score revealed signifi cant difference (p<0.05). Burning, stinging, blurring of vision, photophobia, and hyperemia were among the common adverse effects seen. Conclusion: Both groups showed signifi cant improvement in Schirmer’s test and TBUT test value and OSDI score at the end of the study. Intergroup comparison showed a signifi cant difference with reference to OSDI score. Patients receiving NSAID reported more adverse effects.
ABSTRACT
Background: There is a need to introduce clinical pharmacology at the undergraduate level in order to improve rational prescribing of medicines. The present study was undertaken to analyze drug utilization pattern of genitourinary infections to teach certain basic skills to MBBS students which will form an integral component of practicing rational therapeutics. Methods: The retrospective study was conducted by Pharmacology Department in Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS). A total of 92 prescriptions were collected by second professional MBBS students and randomly evaluated for prescribing pattern using WHO drug indicators. Results: A total of 92 prescriptions were analyzed. Male:female ratio was 1.96:1. Age wise distribution was done: 0-15 years were 14 (15.21%), 16-30 years were 26 (28.26%), 31-45 years were 24 (26.08%), 46-60 years were 19 (20.65%), and >60 years were 9 (9.78%). A total of 260 drugs were prescribed. 116 (44.61%) antimicrobials, 70 (26.92%) antacids and antiemetics, 40 (15.38%) analgesics, 11 (4.23%) urinary alkalizers, 9 (3.23%) antifibrinolytics, and 14 (5.38%) miscellaneous drugs were prescribed. 144 (55.38%) injectable and 116 (44.61%) oral drugs were prescribed. Numbers of fi xed-dose combinations were 32 (34.78%). 2.82 drugs per prescription were prescribed. 171 (65.76%) drugs were prescribed from National List of Essential Medicines 2013 (NLEM 2013). Majority of drugs were prescribed by brand names. Conclusion: Majority of drugs were prescribed from NLEM 2013. The main purpose of undergraduate medical curriculum is to develop the requisite diagnostic and therapeutic skills of a basic doctor. It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs can be measured.
ABSTRACT
Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup. Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant. Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p<0.01). At 4 and 16 weeks DBP in Group I was 79.6±2.37 and 81±0.54 mmHg (p>0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p<0.05) have been observed and no significant changes in BMI and WHR in Groups I and II (p>0.05), respectively. Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension.
ABSTRACT
Background: Adverse drug reactions (ADRs) are one of the major causes of hospital admissions. The objective of this study was to ascertain the various ADRs occurring in a tertiary care teaching hospital at Dehradun, Uttarakhand. Methods: The ADRs were collected from January 2010 to June 2014 by the Department of Pharmacology in Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand. A total of 123 ADRs were collected, analyzed and assessed on WHO causality assessment scale. Results: A total of 123 ADRs were assessed. Male:female ratio was 1.5:1. Age-wise distribution of ADRs was done: 0-15 years had 15 (12.19%), 16-30 had 50 (40.65%), 31-45 showed 25 (20.32%), 46-60 years 22 (17.88%) and >60 years had 11 (8.94%). 112 (91.05%) ADRs were serious, and 11 (8.94%) were non-serious. As per the WHO causality assessment scale, 91 (73.98%) ADRs were probable, 30 (24.39%) were possible, and 2 (1.62%) were certain. Most commonly occurring ADRs were fixed drug eruption in 42 (34.14%) patients, erythematous maculopapular rash in 20 (16.26%) patients and urticarial rash in 15 (12.19%) patients, followed by others. The drugs most frequently associated with ADRs were non-steroidal antiinflammatory drugs (NSAIDs), fluoroquinolones, penicillins, cephalosporins and phenytoin sodium, followed by others. Conclusions: Majority of ADRs were probable according to WHO causality assessment scale. Most common ADR was fixed drug eruption. Most frequent drugs associated with ADRs were NSAIDs. ADRs contribute to increased morbidity and mortality in patients; thereby pose a huge burden on the society.