A comprehensive evaluation of rationality of cough and cold medicines available in Indian market.

To analyse various cough and cold formulations available in the Indian market and to study their pharmacological rationale and cost effectiveness, a cross-sectional, observational study was carried out for evaluation of the drugs listed in Current Index of Medical Specialities (CIMS) India, September 2010.The formulations were assessed for their total number, type of dosage form, number of constituents in each formulation, their pharmacological group and rationality. The total daily cost and its association with type of dosage form was analysed. Out of a total 1297 preparations evaluated, 94% were fixed dose combination. The mean number of constituents was 3.20 +/- 1.03. Liquid oral formulations were largest in number (64.4%). The formulations contained various antitussives (30.30%), expectorants (33.92%), antihistamines (71.09%), mucolytics (35.62%), decongestants (56.28%), bronchodilators (16.81%) and analgesics/antipyretics (31.30%). None of the preparation was listed in the Model list of Essential Medicines, WHO (March 2011) under section 25 of "Medicines acting on the respiratory tract". Only 2% of the preparations had pharmacological rationale for their use in cough and common cold; 9.6% were containing more than one ingredient of the same pharmacological group and 6.85% were containing both antitussive and expectorant having opposing action. Highest number of preparations (36.85%) was having cost of therapy of Rs 6-10 per day. Liquid oral dosage forms had significantly higher cost than solid dosage form (p < 0.0001) and topical nasal dosage forms had significantly higher cost than liquid (p < 0.03) and solid (p < 0.001) dosage forms. It is conducted that various cough and cold medicines available in Indian market lacked therapeutic rationale for their use, leading to wasteful expenditure.

Evaluation of the appropriateness of prescribing in geriatric patients using Beers criteria and Phadke's criteria and comparison thereof.

OBJECTIVES: To evaluate appropriateness of prescribing medicines in geriatric patients using both Beers criteria and Phadke's criteria and compare them for validation of Phadke's criteria as a tool to evaluate rationality of prescribing in elderly. MATERIALS AND METHODS: A cross-sectional prospective observational study was conducted and the baseline data were collected from different inpatient and outpatient departments in Shree Krishna Hospital (SKH), Karamsad. A total of 400 patients of geriatric age group (≥65 years) from various inpatient and outpatient departments of SKH were included in the study. Relevant information from patients included in the study was recorded in a structured proforma from their case files. Data were evaluated for appropriateness of prescribing by using both Beers criteria and Phadke's criteria and comparison between the two criteria was also carried out. RESULTS: Out of total 400 patients, 291 (72.75%) patients were prescribed appropriately according to Beers criteria. Based on Phadke's criteria, 158 (39.5%) prescriptions were rational, 129 (32.3%) were semirational and 113 (28.3%) were irrational. Mean rationality score on a 30-point semiscientific scale was found to be 18.47 ± 9.66 (mean ± SD). The comparison of outcome by both the criteria showed no significant difference in appropriateness of prescribing (P>0.05). CONCLUSIONS: Inappropriate prescribing is common in elderly patients. Beers criteria is a well-established method for evaluating appropriateness of prescribing. This study has shown that Phadke's method of evaluating rationality of prescriptions compares equally well and hence can be a valuable objective tool for assessing appropriateness of prescribing in geriatric patients.

G2/M cell-cycle arrest and apoptosis by n-3 fatty acids in a pancreatic cancer model.

BACKGROUND: n-3 fatty acids (n-3FA) have anti-inflammatory and anti-proliferative effects including modulation of pro-inflammatory cascade mediators and cytokine elaboration (i.e., TNF-alpha, IL-10 and PGE(2)) in many cell lines. However, mechanisms of anti-proliferative effects have not been clearly defined. MATERIALS AND METHODS: MIA PaCa-2 pancreatic cancer cells were treated either with n-3FA (treatment), media (control), or n-6FA (control) for all experiments. Cellular proliferation was evaluated with WST-1 reagent. Cells were stained with propidium iodide and analyzed by flow cytometry for cell-cycle arrest, which was further analyzed by cdc2 expression. Membrane and media lipid concentrations were analyzed by high-performance liquid chromatography. Apoptosis was evaluated by AnnexinV-FITC flow cytometry and reconfirmed by poly (ADP-ribose) polymerase (PARP) cleavage and B(cl)-2 expression. RESULTS: Propidium iodide flow cytometry of MIA PaCa-2 dosed with n-3FA showed a decrease in cells in G1 phase (11-17%) and an increase cells in G2 phase (7-13%) from controls. cdc2 expression was also decreased at 24 h compared to controls. Annexin-V staining of n-3FA-treated cells demonstrated time-dependent increased apoptosis and PARP cleavage was present only in the n-3FA treatment group. Phospho-B(cl)-2 was also decreased in the n-3FA-treated cells compared to controls. CONCLUSIONS: Co-incubation of MIA PaCa-2 cells with n-3FA results in both dose- and time-dependent cell-cycle arrest. Cells also progress to cell death via apoptosis. These data support the potential applicability for n-3FA as an antiproliferative and pro-apoptotic strategy.