ABSTRACT
Background: No pharmacotherapeutic agent is completely free from noxious and unintended effects and thus adverse drug reactions (ADRs) are inevitable consequences of drug therapy. Incidence of ADRs in Indian population ranges between 1.8% and 25.1%. However, ADR reporting in India is inadequate. Developing awareness inpatients and healthcare professionals (HCPs) will help in reducing the ADRs, its suffering and socioeconomic impact. Hence, the present study of ADR monitoring in the outpatients and inpatients of the medicine department in a tertiary care hospital is undertaken. The main objective of this study was to assess the ADR reporting patterns in outpatient and inpatient of medicine department. The study was also aimed to assess the causality, severity, and preventability of these ADRs and comparison between spontaneous reporting by HCP and patient selfreporting of suspected ADRs. Methods: This study was a prospective observational study conducted in 111 consecutive patients who experienced ADRs in the department of medicine. The study plan included analysis and assessment of the clinical pattern, spectrum of ADRs reported based on causality, severity, preventability factors. The impact of ADRs on emotional, occupational, and social life of patients was evaluated. The assessments were compared between patient reporting and HCP reporting of ADRs. Results: The clinical spectrum of ADRs ranged from the more common mild reactions such as skin rashes, itching, nausea, and vomiting to moderately severe reactions prolonging the hospital stay. The predominant causative drugs were antimicrobials, antiretrovirals, non-steroidal anti-inflammatory drugs and antihypertensives. The majority of ADRs were probable in causality assessment, moderate in severity and probably preventable. Comparison of ADR reporting between patient and HCP revealed that ADRs reported by patient’s been less in incidence, similar in qualitative analysis to HCP with very elaborative narration and highlighted emotional and occupational impact due to ADRs than HCP reports. Conclusion: A wide range of ADRs are possible in medicine department. Adequate awareness of ADR reporting and precautions, while prescribing drugs are essential. Including patients as additional reporters of suspected ADR may add to the benefit of pharmacovigilance.
ABSTRACT
Background: Psoriasis is a chronic skin disease, characterized by chronic and recurrent scaly plaques with itching. The treatment modalities for psoriasis include topical, systemic, and phototherapy (PT). The pattern of therapy may vary depending upon the type, severity, and duration of the disease. As there are few reports in the Indian literature regarding the pattern of drug use in psoriasis and evaluating the efficacy and patient compliance to treatment, the present study was conducted. Methods: This was a prospective, observational study conducted on 121 newly diagnosed and untreated patients with psoriasis, who attended Dermatology outpatient department of a tertiary care hospital. The severity of the disease was assessed by baseline psoriasis area severity index (PASI) score. Most of the patients were treated with topical therapy consisting of glucocorticoids (GC) monotherapy or combination with, salicylic acid, calcitriol and coal tar. Systemic therapy and PT were considered only for severe cases of psoriasis with baseline PASI score >4. The patients were monitored every 2 weeks for 3 months. Results: The topical medications induced effective resolution of lesions in most of the patients, along with adequate symptomatic relief. The response to GC monotherapy was found significant (90.47%; p<0.001) and there was 76.13% decrease in PASI score in chronic plaque psoriasis, indicating significant improvement (p<0.001) after 12 weeks of therapy. More than 94% of study patients showed good compliance to medications and only 0.27% showed poor compliance, whereas the other patients showed a moderate compliance of 80-95%. Conclusions: Most of the patients with psoriasis can be effectively treated with topical medications, and additional systemic and/or PT may be required only for severe cases of chronic plaque psoriasis with baseline score >4. Regular follow-up is required not only to monitor the treatment response, but also to ensure good patient compliance by proper counseling.
ABSTRACT
Background: Palliative care forms an integral part in the treatment of terminally-ill patients. To care for dying patients requires a thorough medical education, which is lacking in today’s undergraduate curriculum. The objective was to compare the attitude and knowledge about palliative care among the undergraduates of medical, nursing, and physiotherapy before and after an educational session on palliative care. Methods: A pre-validated 20-point questionnaire on attitude and knowledge about palliative care was distributed to 2nd year medical (22), nursing (28) and physiotherapy (20) students before and after palliative care educational session. Results obtained were compared within and in between the groups. Paired t test was used for within the group and one-way ANOVA for in between the group comparison. p-value <0.05 was considered to be statistically significant. Results: All groups showed statistically significant improvement in knowledge, attitude, and pain management scores following palliative care educational session. The pre-session evaluation showed that physiotherapy students had better knowledge and attitude about palliative care. Pre-educational assessment of knowledge about pain management was similar among the three groups statistically. After the session, mean improvement in palliative care knowledge scores was more in medical, followed by physiotherapy and nursing students. On inter-group comparison, statistically significant improvement in knowledge scores was seen in medical and physiotherapy students compared with nursing students. All three groups showed statistically similar improvement in attitude and pain management scores. Conclusion: Significant improvement was seen in attitude and basic knowledge about palliative care in the students following an educational session. Therefore, including palliative care in the curriculum enables them to deliver appropriate end-of-life care to patients.
ABSTRACT
Objective: To compare the efficacy and tolerability between trandolapril and enalapril in mild-to-moderate hypertension. Material and Methods: This was a prospective, double-blind, parallel, comparative clinical trial involving 120 patients with mild-to-moderate hypertension. Patients were randomized to receive trandolapril 2-4 mg once-daily and enalapril 5-10 mg once-daily. The participants were followed for eight weeks. Results: Both the drugs achieved effective control of blood pressure (BP) at the end of eight weeks. The mean reduction in systolic BP (SBP) was 22.17 mmHg with trandolapril and 21.47 mmHg with enalapril group; the mean reduction of diastolic BP (DBP) was 9.57 mmHg with trandolapril and 11.13 mmHg with enalapril. Adverse events developed in 11 (18.3%) and 12 (20%) patients in trandolapril and enalapril group, respectively. Conclusion: The efficacy and tolerability of trandolapril was comparable to enalapril in mild-to-moderate hypertension with minor adverse events.