A prospective study on drug utilization pattern of anti-diabetic drugs in a tertiary care teaching hospital of eastern Uttar Pradesh, India

Background: Diabetes mellitus is a metabolic disorder with common denominator of hyperglycemia, arising from a variety of pathogenic mechanisms. The aim of the study was to evaluate the drug utilization pattern of anti-diabetic drugs in diabetic patients and observe adverse drug events (ADEs) associated with anti-diabetic therapy in a prospective way.Methods: A prospective study was carried out in diabetic patients visiting the Departments of General Medicine in a tertiary care teaching hospital. Demographic data, drug utilization pattern and ADEs due to Anti-diabetic drugs were summarized.Results: In the present study, 153 (54%) of the 282 diabetic patients were males and 129 (46%) were females. Majority of patients were in the age group of 51-60 years (31.20%) and most of the patients (31.56%) had a diabetic history of 11-15 years. Metformin was the most commonly prescribed drug (64.89%). Majority of the patients (36.87%) were on multidrug therapy. Co-morbid condition was found in 232 patients (82.26%) where hypertension (22.69%) being the most common co-morbid condition. 32 ADRs were observed with Nausea being the most common ADR reported.Conclusions: The present study helps to find out current prescribing pattern of oral diabetic medications with different co-morbidities with respect to diagnosis, cost of treatment and it also highlight the need for comprehensive management of diabetic patients, including life style changes, dietary control, hypoglycemic agents, cardiovascular prevention, treatment of complications and co-morbidity. Therefore, through the existing prescribing patterns, attempts can be made to improve the quality and efficiency of drug therapy.

Preoperative topical flurbiprofen-Na+ in extracapsular lens extraction role in maintaining intraoperative pupillary dilatation.

Induction of intraoperative pupillary constriction, is predominantly a prostaglandin mediated process. The most potent antiprostaglandin NSAID, Flurbiprofen was used topically to study its efficacy against the above. In a prospective double blind clinical study, 50 brown eyes undergoing planned E.C.C.E., the pupils were dilated with 10% phenylephrine and 2% homatropine 1%/tropicamide. 25 eyes received 0.03% Flurbiprofen-Na+ eye drops 1/2 hourly starting two hours before surgery. The maintained intraoperative mydriasis in the two groups before anterior chamber entry (stage I) vs at the end of complete cortex wash (stage III) was: in control group (stage I) 8.46 +/- 0.48 mm vs (stage III) 3.56 +/- 0.43 mm (highly SS); in flurbiprofen group (stage I) 8.60 +/- 0.48 mm vs (stage III) 8.01 +/- 0.63 mm (NSS). The pupillary area available for surgical manipulation in the control group was significantly decreased from 56.18 mm2 in state I to 9.94 mm2 in stage III, while in flurbiprofen group it changed insignificantly from 58.05 mm2 in stage I to 50.24 mm2 in stage III. Postoperatively after cataract was observed in 44% eyes of control group as compared to only 8% of eyes of flurbiprofen group. Thus a maintained intraoperative mydriasis in flurbiprofen group led to better E.C.L.E. which is a mandatory prerequisite to preferred and better present day posterior chamber IOL implantation.

Clinical profile, therapeutic approach and outcome of gouty arthritis in northern India.

Thirty patients with gouty arthritis were studied over 3 years. The diagnosis was established with the help of polarised light microscopy. All the patients were males, with a median age of 45 years. They belonged to the middle or upper socio-economic class and were obese (mean body mass index 29.7). Chronic alcoholism, diabetes mellitus and hypertension were present in one patient each. No patient had symptomatic coronary artery disease. Although 6 patients had a history of renal colic, only one had gouty nephropathy with chronic renal failure. Six patients had a positive family history of gout. The disease involved mostly the joints of the lower extremity and podagra was observed in 70% of patients. Eight patients had tophi at various sites. There were 17 'over producers' and 13 'under excretors' of uric acid. The treatment consisted of patient education, symptomatic control with non steroidal anti-inflammatory drugs and/or colchicine and antihyperuricaemic therapy. The overproducers were treated with allopurinol while the under excretors were treated with [corrected] sulfinpyrazone. In general, there was a good response to therapy as indicated by lowering of serum uric acid and the number of painful episodes per year. The overall profile of the disease appears similar to that seen in the West.

Sequential release of cellulose enzymes during germination of Trichoderma reesei spores.

The pattern of release of extracellular cellulase during the germination of Trichoderma reesei spores has been examined. The four enzymes namely, filter paper degrading enzyme, β-1,4 endoglucanase, β-glucosidase and xylanase appear sequentially in the culture broth during germination of the spores. The order of enzyme appearance is not altered by the type of carbon source in the germination medium. Measureable quantities of filter paper degrading enzyme is detected only after the outgrowth has occurred. A possible mechanism of spore germination and induction of the enzymes by insoluble cellulose is suggested.