RESUMO
This study deals with the pharmacoeconomical evaluation of the prescribing trends and prescription cost analysis of anti-diabetic drugs in UK from 1999-2015. The trend and cost estimation have been performed by the help of prescription cost analysis [PCA] data provided by National Health Service [NHS], UK. In addition to PCA, the trend of prescribing new drugs developed for type-II diabetes has also been studied. A dramatic increase in cost and number of diabetic drugs dispensation has been observed. The total number of diabetic prescriptions from 1999 to 2015 has significantly increased from 1,01,70,700 to 4,17,92,000 while the rise in total cost during the same period is found to be from pound 13,66,13,200 to pound 74,71,36,500. The largest proportion of cost was spent on insulin until 2013 followed by oral hypoglycemic agents, in spite the fact that they were three times more prescribed than insulin. However, in the last two years, the cost of oral hypoglycemics has superseded insulin. Biguanides [metformin]were the highly prescribed drugs among oral hypoglycemic followed by sulfonylureas and thiazolidinones. The relatively two new groups of drugs i.e. glucagon like peptide-1[GLP-1] mimeticsand dipeptidyl peptidase [DPP-IV] inhibitors are comparatively more expensive than the conventional anti-diabetic drugs but still a rise in their prescribing has also been noted from the year 2007 and onwards. A decrease in prescribing of alpha glucosidase inhibitors has been observed. It is concluded that the prevalence of diabetes is constantly increasing with the passage of time and it would be a great challenge in future to control it due to aging and high obesity rates in UK
RESUMO
Mitral valve prolapse is the commonest valvular heart disease in western countries. In Pakistan there is paucity of data regarding its prevalence. One important symptom among patients of mitral valve prolapse is atypical chest pain. Most of these patients are labeled functional if no obvious cause for their chest pain is found on initial examination. This prospective study was carried out in Mayo Hospital Lahore to find out the incidence of mitral valve prolapse in patients presenting with atypical chest pain. Case series. Fifty consecutive patients presenting with atypical chest pain in various departments of this hospital were evaluated clinically as well as echocardigraphically for presence of mitral valve prolapse. Out of these fifty patients 13 [26 percent] were found to be suffering from mitral valve prolapse. Six of them were male and seven were females with an average age of 30 years. Mean blood pressure was lower in patients with mitral valve prolapse. 54 percent patients had systolic murmur compared to presence of this feature in 5 percent of those without mitral valve prolapse. Majority of mitral valve prolapse patients complained of fainting and palpitations but none had panic attack or thromboembolism. If high index of suspicion is maintained for diagnosing mitral valve prolapse in patients presenting with atypical chest pain, one quarter of them are found to be suffering from mitral valve prolapse. These patients may be helped by reassurance, giving beta blockers and prophylaxis for infective endocarditis where appropriate