A study on pattern of prescription of drugs in pregnancy with complications in a tertiary care teaching hospital: A cross-sectional study

Background: During pregnancy, women undergo various physiological changes and also suffer from some common illnesses like morning sickness, which may increase the prescription and use of drugs. Thalidomide tragedy of 1960 has created the concern regarding the use of medications during the pregnancy. Prescriber should be very vigilant, while prescribing the drugs for pregnant women because health of mother and fetus may be at risk. To prevent the morbidity and mortality of the mother and the fetus, safer and effective drugs have to be selected with utmost care. Aims and Objectives: Main objectives of our study were to determine the drugs used during complicated pregnancies and to assess the safety of drugs prescribed using the World Health Organization prescription indicators. Materials and Methods: After getting approval from the Institutional Ethics Committee, this cross-sectional study was carried out in the obstetric department of tertiary care teaching hospital for a period of 3 months. Case sheets of pregnant women with complications were collected and the details regarding demography and complete prescription were collected in a predesigned proforma. The data collected were analyzed using descriptive statistics. Results: Among 160 pregnant women, 71% were multigravida and most of the participants belonged to age group of 20–30 years 84% (134). Disease pattern among pregnant women in our study revealed that common illnesses complicating pregnancy was anemia (51%), followed by pregnancy-induced hypertension, oligohydramnios, and gestational diabetes mellitus. The study showed that hematinics, calcium supplements, and protein powders were the class of medications used in most of the prescriptions, and then by antibiotics, antiemetic, and tocolytics agents. Category A of food and drug administration pregnancy drug category was used more, constituting about (45.12%). No drugs from Category X and D were prescribed to pregnant women and 45% of drugs belonged to generic drug. Conclusion: Anemia was the most common condition, complicating pregnancy and common class of drug used were hematinics and protein supplements. Category A drugs, which were the safest class, were prescribed more in our study. No drugs from Categories D and X were used. This indicates that prescribers are well aware of safer drugs in pregnancy.

Anemia and nutrition in end stage renal disease patient

Anemia and malnutrition are common complications of end-stage renal disease. They increase the morbidity and mortality of end-stage renal disease patients and affect their quality of life. However, the mechanisms of anemia and malnutrition are already known, and their therapeutic guidelines are being established. Appropriate iron supplementation and the development of erythropoiesis-stimulating agents have made anemia easier to manage than in the past. In addition, adequate protein and calorie intake have allowed end-stage renal disease patients to maintain a neutral or positive nitrogen balance. These therapeutic approaches have decreased the morbidity and mortality of these end-stage renal disease patients. This review is a summary of the treatment of anemia and nutrition in end-stage renal disease, based on the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline on anemia and other anemia guidelines, and also on the KDOQI guideline on nutrition and European Best Practice Guideline (EBPG) on nutrition.

Critical review on the pharmaceutical vistas of Lauha Kalpas (Iron formulations).

Iron is one among the major metals present in the earth’s crust and is essential for sound sustenance of human body. Its defi ciency leads to various health ailments. Contemporary medicine advises iron supplements in iron defi ciency anemia. Ayurvedic classics also quote signifi cant information about administration of iron. Lauha Kalpas are the unique compound herbo-mineral formulations where iron (Lauha) is used as a major ingredient. Relevant literature (Bhaishajya Ratnavali, Charaka Samhita, Rasendra Sara Samgraha etc.) reviewed to gather information about Lauha Kalpas. Critical analysis of these Lauha Kalpas reveals that ancient seers administered iron in a better acceptable form. Unlike popular understanding these are not only Khalviya preparations; but Churna (powders), Avaleha (confectionaries), Rasakriya (solidifi ed decoctions), and Putapaka (incinerated) form of preparations are also found. Apart from solid dosage forms, semisolid dosage forms mentioned in classics are very much useful. Unfortunately most of the formulations are not found in the market. Hence Pharmaceutical fi rms may bring these unique dosage forms in to the market to supply the healthcare needs of the community. It is interesting that iron preparations are used in Ayurveda in different medical conditions apart from anemia (Pandu). This leaves a scope for further researches on different dosage forms of iron and their indications.

Hemoglobin Variability Associated with Different Erythropoiesis Stimulating Agents in Hemodialysis Patients / 대한신장학회지

PURPOSE: This study was undertaken to examine whether differences exist in the hemoglobin variability according to the types of erythropoiesis stimulating agent (ESA) in hemodialysis (HD) patients. METHODS: Clinical data were retrospectively analyzed from 72 patients on maintenance hemodialysis who were using darbepoetin alfa (n=27), epoetin beta (n=27), and epoetin alpha (n=18). As parameters of hemoglobin variability, hemoglobin cycling, the variance of hemoglobin and the SD/mean of hemoglobin were analyzed. Hemoglobin cycling was defined as the presence of cycles with an amplitude >1.5 g/dL and lasting more than 2 months. RESULTS: Hemoglobin cycling was present in 53 (73.6%) out of 72 HD patients. Hemoglobin cycling in patients receiving darbepoetin alfa had greater frequency (1.63+/-0.93 vs. 1.00+/-0.88 times/year, p<0.05), amplitude (2.88+/-1.48 vs. 1.88+/-1.60 g/dL, p<0.05), and velocity (1.21+/-0.74 vs. 0.73+/-0.66 g/dL/month, p<0.05) than that in patients receiving epoetin beta. The variance of hemoglobin in patients receiving epoetin beta (0.79+/-0.53 g/dL) was smaller than that in patients receiving darbepoetin alfa (1.29+/-0.70 g/dL, p<0.05) and epoetin alfa (1.08+/-0.52 g/dL, p<0.05). Also, the ratio of SD/mean of hemoglobin in patients receiving epoetin beta (8.20+/-2.59%) was lower than that in patients receiving darbepoetin alfa (10.81+/-2.10%, p<0.05) and epoetin alfa (10.30+/-2.10%, p<0.05). CONCLUSION: Hemoglobin variability is differential according to various ESAs, and it may be less with epoetin beta compared with darbepoetin alpha and epoetin alpha.