Poor adherence with ACE inhibitors is a risk factor of CVA with oral hypoglycemic agents in diabetic patients

Poor adherence with medicine declines the clinical outcome of pharmacotherapy. It may carry serious sequelae especially in case of antihypertensive drugs like cerebrovascular accident [CVA]. This study has been planned to find the association of poor adherence with anti-hypertensive with CVA in diabetic and non- diabetic patients. One hundred CVA patients who were admitted through Emergency in Abbasi Shaheed hospital, a tertiary care hospital in Karachi, were recruited from Jun 2013 till Dec 2013. The criteria of inclusion was, diagnosed case of CVA, with primary hypertension, availability of patient's therapeutic record, consent of the patient or legal successor/heir. The criteria of exclusion was, secondary hypertension, newly diagnosed primary hypertensive patients and complete adherence with medication. Morisky medication adherence scale was applied. Therapeutic record was accessed. The mean age was 62.15 years with 3:1 male to female ratio. Adherence to medicine was graded <6. Patients with hypertension were 41 and with diabetes and hypertension were 59. Majority of patients were on monotherapy as compared to polytherapy [62% versus 38%].The mode of therapy was significantly different [P<0.05] in the two groups. ACE Inhibitors, Calcium Channel Blockers, Beta Blockers and other agents were used by 45.16%, 35.48%, 16.12% and 03.24% patients respectively. The aforementioned drugs were used by 57.14%, 33.33% and 09.52% respectively in 21 patients who were on antihypertensive and oral hypoglycemic agents. A statistical significant difference [P<0.05] was seen in the case of ACE Inhibitors. Similarly they were used by 42.10%, 39.47% and 18.42% in 38 patients respectively, who were on antihypertensive and insulin. No statistical significant difference [P>0.05] was seen in any combination [p>0.05]. Thus it is concluded that poor adherence with ACE inhibitors may be a risk factor of CVA in diabetic patients using oral hypoglycemic agents

Knowledge of guidelines of drug use in geriatric patients can avoid high misuse of antibiotics in these patients

Objective: To determine the knowledge of drug prescribers, it's impact on their prescription and the basis of their decisions in geriatric patients

Study design, settings and duration: Prospective cross sectional study in medical units of three tertiary care government hospitals of Karachi, Pakistan from 1[st] June till 31[st] August, 2014

Subjects and Methods: Two hundred seven [207]house officers, Postgraduates, Residents and Medical officers who completed their undergraduate degree programs in five different medical universities and working in three tertiary care government hospitals, were asked to complete a questionnaire to check their knowledge about the selection of medications in the geriatric patients. The questions were aimed to check the awareness of prescribers regarding different facts which should be considered before prescribing drugs in geriatric patients and to explore the choice of drugs in these patients as per standard criteria. Detail of medications which were purchased from different medical stores outside the hospital and were used in geriatric patients was collected to link the knowledge of prescriber and its impact on prescription. Same physicians filled another questionnaire to justify their prescriptions when their knowledge of the use of drugs in geriatric patients was found to be poor

Results: Assessment of knowledge of 124 prescribers [59.9% of 207 who responded the questionnaire] showed that only 32.2% knew the lower age limits of geriatric patients, 29.8% knew guidelines for drug use in elderly, 18.5% were aware of the factors effecting drug selection, 12.0% knew the factors causing over-prescription and 46.7% knew the factors influencing dose selection. Antimicrobial drugs were the most inappropriately prescribed drugs and 78.3% are prescribed irrationally. Cephalosporin was the most prescribed group and given to 71.2% of the patients. Within this group Ceftrioxone, a [3rd generation Cephalosporin] was mostly prescribed in 43.1% of the total patients. Fear was the most prevailing factor [41.1%] in prescribing an antibiotic in geriatric patients

Conclusion: Results show that poor knowledge of prescribers for appropriate use of drugs in geriatric patients results in excessive use of broad spectrum antibiotics and the decision is mostly based on illogical basis

Augmentation of oral submucous fibrosis by NSAIDs in the presence of risk factors

Various Risk factors initiate Submucous fibrosis which may be augmented by NSAIDs. A number of animal studies on their mechanism indirectly support it especially regarding alterations in prostaglandin synthesis. This study has been designed to find association of these drugs with Oral Submucous fibrosis in the presence of risk factors. Newly diagnosed patients of Oral Sub mucous fibrosis were recruited for this study who attended Dental Department of Karachi Medical and Dental College from July 1 till Dec 31,2013. A structured interview and medical record of each patient was used to determine the demographic profile, any addiction, previous and present illnesses and drug [s] used. Through examination of Oral cavity was carried out to access the severity of disease as per modified Khanna and Andrade Classification [1995]. Statistical Analysis was done by SPSS 15. Total 102 patients were recruited from dental OPD as per criteria of inclusion. Among these patients 36 [49.31%] were using NSAIDs in which Acetaminophen [30.55%], Acetylsalicylic acid [25.00%] and Diclophenac [19.44%] were 1[st], 2[nd] and 3[rd] most common drugs. Data shows that 14 patients [28.88%] had mild and 22[61.11%] had sever fibrosis which was significantly high [P<0.05]. Mild fibrosis was seen in 05 [45.46%] and Sever fibrosis in 06 [54.54%] out of total 11 patients who were using NSAIDSs since less than or equal to 6 months. Similarly mild fibrosis was seen in 09 [36.00%] and Sever fibrosis in 16 [64.00%] out of total 25 patients who were on NSAIDs since more than 6 months. No statistical significant difference [P>0.05] in severity of fibrosis is seen in patients who were using NSAIDs since less than or equal to 6 months but statistical significant difference [P<0.05] in severity of fibrosis is seen in patients who on these drugs since more than 6 months. Addiction burden was calculated by Average Duration x Average Frequency, which was 92.72 for Pan, 88.88 for Supari and 61.30 for Miscellaneous. No statistically significant difference [P>0.05] was seen in addiction burden of various substances in these patients. An association of NSAIDs with Oral Sub mucous fibrosis exists. The pathology is augmented if these drugs are used in the presence of risk factors. Therefore these drugs should not be prescribed to these patients until a clear benefit is not targeted

Thrombo-embolic risk in high estrogenic phase of normal menstrual cycle in healthy women

Objective: this study is conducted to compare the risk of thrombo-embolism during different phases of menstrual cycles

Methodology: 105 healthy premenopausal unmarried females of 18 -21 years with a history of previous three normal menstrual cycles and 32 age matched male volunteers were recruited in the study. The phase of menstrual cycle of female volunteers was established by taking menstrual history. Bleeding time was determined by Duke's method

Results: bleeding time in 105 females was 73.03 +/- 1.89 Seconds and in 32 males was 69.33 +/- 4.94 Seconds which were not significantly different statistically [p=0.063]. Among females, 69 volunteers were in follicular phase of their hormonal cycle. Bleeding time in 29 females in early follicular phase was 70.86 +/- 3.38 Seconds and 40 females in late follicular phase was 68.25 +/- 4.03 Seconds. Statistically significant difference was not seen [p=0.095] when the two phases were compared. Bleeding time is not found to be reduced in late follicular phase as compared to early follicular phase, even high concentration of estrogen is present in the body in this phase as per normal menstrual physiology

Conclusion: high Estrogen in normal menstrual cycle does not increase thrombo-embolic risk in healthy women

Concomitant use of lisinopril reduces the effect of aspirin on bleeding

To determine the Lisinopril and Aspirin interaction through their concurrent effect on bleeding in adult male rabbits. Twenty four healthy adult male rabbits were used. Bleeding time of each animal was determined by Duke's Method. They were divided randomly in three groups containing equal number of animals into Control, Aspirin, Lisinopril and Combination groups. After oral administration of the drug[s], the bleeding time of the animals was again determined by same method. Prolongation of bleeding time was significant [p<0.05] in Aspirin and combination groups but insignificant [p>0.05] in Lisinopril group after 1 hour. It was significant [p<0.05] in Aspirin and Lisinopril groups but insignificant [p>0.05] in Combination group after 24 hours. This change was observed after 48 hours too. Concurrent use of Lisinopril reduces the effect of Aspirin on Bleeding after a certain time period