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Background: To assess the prescribing indicators in prescriptions of private practitioners in Kolkata. Methods: In the observational, retrospective, cross-sectional survey, 1830 prescriptions of private practitioners were collected over a 5 years period and assessed using core prescribing indicators as per the World Health Organization “How to investigate drug use in health facilities” tool. Results: Overall the average number of drug per prescription was 3.05±0.91. No drug was prescribed by generic name. Prescriptions with an antibiotics and injections were 30% (549/1830) and 8.12% (149/1830), respectively. Drugs prescribed from essential drug list (EDL) were 29.38% (1640/5582). Conclusion: Poly-pharmacy, lack of generic prescribing, low rate of prescriptions from EDL is the present prescribing scenario of private set-up based practitioners of Kolkata. Regulation and intervention is required to improve the irrational prescribing practices.
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Background: The increasing incidence of drug resistance in Leishmaniasis necessitates evaluation of combination chemotherapy. Miltefosine and amphotericin B are established anti-leishmanial drugs, while artemisinin has shown significant leishmanicidal activity in experimental models. In this study, we have evaluated the additive/synergistic effect of artemisinin with amphotericin B or miltefosine. Methods: Leishmania parasites were isolated from the bone marrow aspirate of a patient with visceral leishmaniasis. Parasites were typed as Leishmania donovani by restriction fragment length polymorphism of internal transcribed spacer 1 region of Leishmania genome. Promastigotes were incubated in a fixed ratio combination of artemisinin (0-500 μM) and amphotericin B (0-100 nM) or miltefosine (0-100 μM) and cell viability was assessed. An isobologram was constructed to evaluate the additive/synergistic effect, wherein it was considered additive if the mean sum fractional inhibitory concentration (mean ΣFIC) at the IC50 level was <2, but ≥1 and synergism, if the mean ΣFIC was <1. Results: The isobologram showed an additive effect for three combinations of artemisinin-amphotericin B and artemisinin-miltefosine, the mean ΣFICs ranging from 1.02 to 1.44 and 1.08 to 1.33 along with a synergistic effect with one combination, the mean ΣFICs being 0.58 and 0.81 respectively. Conclusions: This study supports the combination use of artemisinin-amphotericin B and artemisinin-miltefosine, worthy of future pharmacological consideration.
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Background: Laryngoscopy and tracheal intubation after the induction of anesthesia are nearly always associated with a sympathetic hyperactivity. To attenuate the pressor response, various drugs have been tried, but studies to compare the effects of dexmedetomidine or clonidine on the hemodynamic response during laryngoscopy and tracheal intubation are anecdotal and sparse. This study aims to find the drug, which was best suited for this purpose and to compare their effects on sedation and anesthetic requirements. Methods: This was a prospective study, which involved three groups of patients. Each group had 20 patients who presented for elective, non-cardiovascular surgeries. The patients in group I (control) were given normal saline and the groups II and III were given dexmedetomidine and clonidine, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and Ramsay sedation score were recorded at 1 and 2 min after completion of administration of study drug. Induction was done with propofol and required dose is noted. HR, SBP, and DBP were again assessed during intubation and at 1, 3, 5, and 10 min after intubation. The obtained clinical data were analyzed statistically with analysis of variance. Results: In our study, HR, SBP, and DBP all increased during intubation and thereafter in all three groups. Pretreatment with dexmedetomidine 1 μg/kg and clonidine 2 μg/kg significantly attenuated the cardiovascular and catecholamine responses to tracheal intubation. However, attenuation was significantly more with the dexmedetomidine group with a quicker return to baseline. Dexmedetomidine also fared in terms of anesthetic requirement (propofol) and sedative action. Conclusion: Preoperative administration of a single dose of dexmedetomidine blunted the hemodynamic responses more than clonidine or placebo during laryngoscopy, and reduced anesthetic requirements.