Assessment of levetiracetam and valproic acid as monotherapy for quality of life in partial epilepsy patients

Background: Quality of life (QOL) is important in patients of epilepsy as it is affected both by disease as well as therapy. QOL is the most overlooked component of antiepileptic treatment.Methods: An observational analytical study was conducted in the Department of Pharmacology in collaboration with Department of Neurology of Himalayan Institute of Medical Science, Dehradun over 12 months. 80 patients satisfying inclusion criteria were enrolled and divided into two groups based on physician discretion and followed up for 12 weeks. Patients were evaluated at 0 and 12 weeks for quality of life using QOLIE-10 self-administered questionnaire, they were also assessed for seizure control and drug related adverse effects.Results: 60 patients were enrolled and divided into two treatment groups as per physician discretion, levetiracetam (30) and valproic acid (30) groups. Study groups showed significant improvement in QOL (mean change in QOL17.95�527 for LEV and 11.56�540 for VPA). Levetiracetam (LEV) group showed significant improvement over valproic acid (VPA) group (p=0.05) at 12 weeks. Patients who achieved total seizure control at 6 weeks were 93.33% patients in levetiracetam and 90% in valproic acid group, reason being non adherence which was 6.67% and 10% respectively. Adverse event recorded with levetiracetam (03), most common being drowsiness and with valproic acid (08), with most common being anorexia.Conclusions: Levetiracetam therapy has led to better quality of life and has the same seizure control as valproic acid, and has shown to have lower incidence of adverse effect.

The study of awareness and adherence in patients receiving anti-hypertensive drugs: a hospital based study

Background: Hypertension is an important worldwide public health challenge. It has changed from a trivial cause of death and disability to one of the global burden diseases. The biggest obstacle for inadequate therapeutic control of blood pressure is meagre knowledge, poor attitude, inadequate treatment practices and lack of adherence towards antihypertensive treatment. The present study was planned to assess the awareness of hypertension on various aspects and to evaluate treatment adherence in hypertensive patients.Methods: This cross-sectional study was conducted on 100 hypertensive patients of both genders visiting medicine OPD at HIMS, Dehradun over a period of six months. A structured and validated questionnaire was used to assess the knowledge, attitude and practice (KAP) among patients. Morisky 8-Item Medication Adherence Questionnaire was used to assess the adherence towards antihypertensive medications. For statistical analysis Chi square test was used.Results: Out of the 100 patients the median KAP scores were 6(5),5(1) and 10(4) respectively. Most of the subjects had high median scores on attitude but majority of the subjects had low knowledge and self-care practice scores. Further Analysis of data revealed that a poor score in self-care practice was significantly associated to the gender(p<0.004) as well as to the level of education(p<0.006).Only 40% patients were adherent to their medication, this result was statistically associated with the level of education (p<0.00001).Conclusions: Hypertensive patients in our community have good attitude but poor knowledge and self-care practices towards management of hypertension. Patients were also found to be non-adherent to their antihypertensive medications.

Comparative evaluation of levetiracetam and valproic acid as monotherapy on cognitive impairment in patients of epilepsy

Background: Cognitive decline with AEDs (Anti-epileptic drugs) is associated with learning and memory deficits especially in the younger age group. The data regarding the impact of levetiracetam and valproic acid as monotherapy on cognition in epileptic patients is scarce. The present study was done for evaluation of cognitive decline associated with the use of AEDs.Methods: Present study was a prospective study on 60 patients on AEDs for a period of 12 weeks. Patients were enrolled from the Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India and divided into group A (levetiracetam) and group B (valproic acid) with 30 patients in each group. Permission from the institutional ethics committee and written informed consent was taken from all the patients. They were analyzed for cognitive impairment using MMSE and MoCA scales at baseline and 12 weeks.Results: The mean duration of disease was 2.13�1 years and 2.08�1 years and mean age of the patients was 14.67�9 years in group A and 16.20�6 years in group B. GTCS was present in 31 patients (52%) followed by partial seizures in 29 patients (48%). The mean change in the MMSE scores from baseline to 12 weeks was significant in group A 1.30�1 (p value <0.05) and change group B was -0.20�4 not statistically significant. The mean change was observed in MoCA scores from baseline to 12 weeks was significant in both groups A and B by 1.17�1 and -0.70�1 respectively (P value <0.05).Conclusions: Patients on levetiracetam showed cognitive improvement, whereas patients on valproic acid showed a decline in the MMSE and MoCA scores.

The study for sources of stress and management among medical students

Background: In recent years there has been a growing appreciation of the issues of quality of life and stresses involved medical training as this may affect their learning and academic performance. This study was carried out to assess the prevalence of sources and severity of stress and coping strategies among medical students.Methods: A questionnaire-based study was carried out among the undergraduate medical students of Himalayan Institute of medical sciences, Jolly grant, Dehradun from July July 2015 to January 2016. The questionnaire consisted of questions on the basis of Academic, Intrapersonal, Interpersonal, Social Related Stressors and also various methods adopted by them to overcome stress.Results: Out of 150 students only 136 (90%) responded. All the participants were of first and second professional MBBS course. Overall 56% Students felt studies are contributing to stress followed by 26% due to college, 18% due to friends and 9% due to family pressure. Due to academic stress performance anxiety for upcoming examinations was felt by 59% of the students. Among the personal stressor 58% experienced health related issues and their effect on level of fitness. Stress relievers like 67% of the total students preferred watching movies, while their preference for listening to music was observed in 38% to relieve stress.Conclusions: It was concluded that students have a high level of academic stress followed by the social and personal stress. Since the stressors cannot be permanently eliminated, authors have to necessarily devise efficient methods for managing them.

Prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus patients in a tertiary care hospital

Background: Prescription pattern studies are a tool for assessing the prescribing, dispensing and distribution of medicines. The main aim of assessing prescribing pattern is to facilitate rational use of medicines. So the main aim of the study was to assess the prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus, to assess the rationality of the prescribed drugs and also to assess the pattern of co-morbid conditions associated with type 2 diabetes mellitus in a tertiary care hospital.Methods: This cross sectional study was conducted in the Department of Pharmacology in collaboration with Department of General Medicine. Study was conducted from 1st June 2016 to 31st Aug 2016 (3 months). A total of 100 patients were enrolled after taking written informed consent. A structured case recording form was used to record demographic details and prescription details. The rationality of prescriptions was assessed using American Diabetes Association guidelines 2015.Results: Majority of the patients were prescribed combination therapy (54%) followed by monotherapy (46%). Oral anti-diabetic agents used as monotherapy other than metformin were inappropriate. Among the patients receiving combination therapy majority were receiving a fixed dose combination which were inappropriate.Conclusions: Majority of the patients were receiving fixed dose combinations without justifiable pharmacokinetic/pharmacodynamic benefits. Such kinds of studies are required to improve rationality of prescription of drugs, decreasing morbidity and mortality of patients and decreasing the cost of treatment.

Effectiveness of a module to promote competency in adverse drug reaction reporting in undergraduate medical students

Background: Adverse drug reaction (ADR) under-reporting is a hindrance to the implementation of Pharmacovigilance Program of India. This is essentially due to lack of ADR reporting culture among healthcare professionals. Thus, study was conducted to assess and enhance awareness about ADRs and strengthen reporting among medical undergraduates.Methods: This is an interventional crossover study. A total of 140 students of 2nd professional, MBBS were included and divided into two groups of 70 each. In phase 1, group A was given a didactic lecture (DL) on ADR and pharmacovigilance. Group B was also given DL with an addition of a case narrative exercise and they were asked to fill an ADR form. Both groups were assessed based on an MCQ questionnaire for knowledge and skill. After 15 days of washout period, groups were crossed and reassessed. Feedback from students was taken on a 5 point Likert抯 scale.Results: The mean scores of batch A without case was 17.5�out of a total score of 25 marks, which showed improvement with case narrative and mean increased to 19.6� 2.4 (p 0.05). Similarly, Batch B showed improvement as well and the mean 17.7�1 score without case narrative increased to 19.2�7 (p <0.05). Student抯 perception of the effectiveness of module-based teaching was positive.Conclusions: Case narrative in addition to didactic lecture enhanced awareness and may strengthen ADR reporting culture among the medical students.

Evaluation of levetiracetam and valproic acid as monotherapy on quality of life in patients of generalized tonic clonic epilepsy

Background: Quality of life plays an important role in patients of epilepsy and is the most neglected part during management. The antiepileptic drugs treatment results in seizure control but adversely affect the quality of life in patients.Methods: An observational analytical study was conducted in the Department of pharmacology with Department of Neurology of Himalayan Institute of Medical Sciences, Dehradun over 12 months. 85 patients fulfilling the inclusion criteria with diagnosis of generalized tonic clonic seizures (GTCS) were enrolled and divided into two groups based on physicians discretion and followed up for 12 weeks. Patients were evaluated for quality of life by QOLIE-10 self administered questionnaire at 0 and 12 weeks, assessed for seizure control and drug related adverse effects.Results: 85 patients were enrolled and divided into two treatment arms as per physician discretion, levetiracetam (41) and valproic acid group (44). Study drugs showed significant improvement in quality of life, levetiracetam showed mean change that was significantly greater than valproic acid (p=0.003) at 12 weeks. Patients who failed to achieve seizure control at 6 weeks were 17% patients in levetiracetam and 20% in valproic acid group, reason being non-adherence which was 17% and 20% respectively. Adverse events recorded with Levetiracetam (10), most common being increased sleep and with valproic acid (18), with most common being increased sleep and weight gain.Conclusions: Levetiracetam treatment resulted in better quality of life, with similar seizure control but decreased number of adverse effect then Valproic acid.

Use of Computer Assisted Learning as an Alternative to Experimental Pharmacology Teaching: Student's Opinion.

To evaluate student opinion on use of CAL in the MBBS 2nd professional experimental practical pharmacology curriculum.Also to get their views on the advantages and disadvantages of using CAL over traditional methods. A cross-sectional questionnaire based study was conducted at HIMS, Dehradun and Uttarakhand. After explaining the purpose of the study, voluntary inform consent was taken from the subjects before the start of the study. Students were instructed on experiments followed by computer simulation of the same. Thereafter avalidated self-designed questionnaire form was duly filled by each respondent.Out of the total 98 students, 88 (90%) of these thought that CAL is an effective method of teaching practical aspects. They also agreed to the fact that CAL should be conducted as an adjuvant to practical classes. Majority of students agreed that using CAL was advantageous to them .CAL is accepted as a welcome change byundergraduate students. However on the other hand practical knowledge of how to do the experiment is lost.

Institutional Survey Of Student’s Opinion For Tutorial Classes.

Background & Objective: To know the student’s opinion about the current tutorial classes held in department of pharmacology of HIMS Methodology: The study was conducted on 250, second professional students of HIMS attending pharmacology department. A validated questionnaire of 15 questions was prepared. Each question had 3-5 options and lastly about their suggestions and comments. Students were briefed about the study before giving them the feedback form. They were given sufficient time to fill the form and were asked not to reveal their identity for unbiased opinion. Results: 97% of students agreed that tutorial helps them in understanding the topic better. Majority of students (68%) will attend tutorial classes even if attendance is not compulsory. When asked about the environment during the tutorial, 72% of the respondents said that it is strict but interactive. Majority of students were in favour that tutorial’s topic should run parallel with lecture topic and should be taken by postgraduate students only. When asked about the structure of tutorial, majority of students (52%) felt that discussing whole topic will help them most. Many students suggested that tutorials should be well planned, organized and cover difficult topics in pharmacology i.e General, ANS and CNS. Conclusion: Teaching is a novel teaching technique which enhances interest among students. With some modifications and suggestions we can enhance the effectiveness of our current tutorials.