Retrospective study on cost distribution of antiretroviral therapy in a tertiary care hospital.

Background: Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV), which is an RNA virus. The first case of AIDS in human beings was reported in 1981, and now spread of HIV infection is alarmingly high with around 20 million deaths. The objective of the study was to determine the cost distribution of antiretroviral therapy among autoimmune deficiency syndrome (AIDS) patient attending the anti-retroviral therapy (ART) center of the tertiary care center. Methods: The objective of the study was to determine the cost distribution of antiretroviral therapy among AIDS patient attending the ART center of the tertiary care center. The study was retrospective, 20 patients included in different age groups and categories the cost incurred toward patients were divided under different heads: medication, laboratory diagnosis, transport, and miscellaneous costs. Results: It was found that major part of the cost is spent on drugs. The cost of transport and lab diagnosis varied based on age and stage of the disease. Miscellaneous costs were also high and were proportional to other costs. Conclusion: HIV infected population is more likely to have a lower socioeconomic status which has varied effect on the effectiveness of highly active ART. Some of the problems faced by them are access to health care, transport, economic instability, etc. all these factors have an impact on outcome of treatment. Overall it can be found that preventive measure than treating has better impact on quality of life.

Drug utilization study on antidiabetic medications at SIMS-Shimoga a tertiary care hospital.

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. DM is a leading cause of blindness, end stage renal disease, and nontraumatic lower extremity amputations. The objective of the study was to evaluate the drug utilization pattern of antidiabetic medications at a tertiary care hospital. Methods: Demographic details of the patient were noted. Evaluation of the written prescription was carried out according to the requirements in case record form followed by computerization of data and analysis. Results: DM was almost equal in male (51%) and females (49%), the risk of DM was high after 40 years of age. Out of all the case records and prescriptions reviewed it was found that 23% had Type 1 DM, and 77% had Type 2 DM. In 46.35% cases, there was a family history of DM while in 47.44% cases it was absent, 6% were unaware. The average number of drugs per prescription was 3.26±0.24 and antidiabetic drugs at 1.72±0.28. Insulin alone was prescribed in 25.54% cases. Single antidiabetic agents as lone drugs were seen in 39.05%; combined oral antidiabetic drugs accounted for 25.54% cases. The combination of insulin and oral antidiabetic agents were prescribed in 9.85% cases. Conclusion: Metformin was the oral hypoglycemic agents, which was the most frequent prescribed as was insulin and its analogs. These drugs being essential in the treatment of diabetic patients should be made available to patients all the time.

Analysis of usage of diuretics in medical intensive care unit of SIMS-Shimoga a tertiary care hospital.

Background: Patients are admitted in the intensive care unit (ICU) with a history of various acute and chronic clinical conditions associated with organ failures. Compared to the patients admitted in the general wards the mortality and morbidity are high in ICU patients. The patients in ICU are subjected to multiple drugs; diuretic agents are liberally and deliberately used in this setup despite the lack of evidence supporting their benefits. Methods: The main aim of the study was to know the extent of use of diuretics in the ICU set up, to categorize the use of diuretics in different clinical conditions and different classes of diuretics used. The study also tried to determine adverse events and outcome in critically ill patients. The study was a retrospective cross-sectional of 3 months duration conducted in all patients admitted in the medical ICU of the tertiary care center. The study mainly concentrated on the usage of diuretics and related aspects. Results: Loop diuretics (54.81%) composed the major class, thiazides (30.84%). Potassium sparing diuretics (7%) and osmotic diuretics (7%) and carbonic anhydrase inhibitors (1%) were the other class of diuretics. The classes of drugs used in ICU along with diuretics were antibiotics (30%), analgesics (9.5%), anti-inflammatory (6.36%), and drugs acting on blood (10.18%) of total drugs used in ICU. Antacids/ laxatives (7.3%) and antiemetic (4.8%), the rest of drugs (15%) of drugs used in ICU. Conclusion: In almost 95% of cases, the combination of other drugs along with diuretics was considered to be rational.

Genotoxic evaluation of ornidazole and secnidazole in albino mice: an experimental study.

Background: The present study was planned to explore the genotoxic potential of some commonly used antimicrobials like ornidazole and secnidazole in swiss albino mice. Methods: Therapeutic equivalent doses of ornidazole and secnidazole were given by intra peritoneal route. Single dose in individual groups of mice (n=5 in each) was administered for acute study. Doses were repeated every 24 hrs for 7 times in additional groups of mice (n=5 in each) for sub-acute study. Cyclophosphamide served as positive control while normal saline as negative control. After 24 hrs of single dose (acute study) and last dose of drug administration in sub-acute study, about 0.5 ml of blood was collected by retro orbital sinus for comet assay as described earlier (Rojas E et al, 1999) and later the mice were sacrificed to aspirate the femoral bone marrow for micronucleus test as described earlier by described by Schmid W (1975). In comet assay, the total comet length and head diameter was measured under microscope using ocular & stage micrometer to calculate comet tail length. In micronucleus assay, the stained bone marrow tissue smears were scored for the frequency of micronucleated polychromatic erythrocytes (MnPCE) and also the ratio between polychromatic erythrocytes (PCE) to normochromic erythrocytes (NCE) was obtained. Results: It was analyzed by one-way ANOVA followed by Dunnet’s multiple comparison tests. Significant (P< 0.01) increase in comet tail length and percentage of micronucleated polychromatic erythrocytes (% MnPCE) was observed in groups treated with single and multiple doses of Cyclophosphamide whereas ornidazole and secnidazole treated groups did not show any significant changes. Conclusions: The results indicate that Ornidazole and secnidazole are devoid of genotoxicity.

Evaluation of cost effectiveness and efficacy of commonly used different antacid gel preparations.

Background: Gastroesophageal reflux disease (GERD) is a common clinical condition in Indian population. Antacids, which are available as over the counter (OTC) are the commonly prescribed drugs for treatment of GERD. Antacids manufactured and marketed by various multinational and local companies are available in the market. There is need for evaluating the cost effectiveness and efficacy of these antacids as a matter of public concern. Hence the present study was conducted to evaluate the cost effectiveness and efficacy of the commonly prescribed antacid gel preparations. Methods: Seven different gel formulations of antacids manufactured by different companies were evaluated. Cost effectiveness was done by calculating the cost per ml of antacid and also by palatability test. Efficacy was evaluated based on acid neutralizing capacity (ANC) of antacid preparations. Results: The highest cost was 0.305 Rs. per ml and lowest was 0.135 Rs per ml. Palatability score was high at 26.80 and low at 23.85. The antacid with lowest ANC was 20.5 mEq and the highest was 26.5 mEq. Conclusion: Cost effectiveness studies are beneficial in improving the prescribing pattern. It will be a benefit for both doctor as well as patient.