DRUG UTILIZATION BASED ADRS MONITORING OF ANTIHYPERTENSIVE AGENTS PRESCRIBED IN AL-QUWAYIYAH GENERAL HOSPITAL, SAUDI ARABIA

Objective: To monitor drug utilization based adverse drug reactions (ADRs) of antihypertensive agents prescribed in Al-Quwayiyah general hospital, Saudi Arabia.Methods: An open, non-comparative, observational study was conducted on hypertensive patients attending the medicine outpatient department of Al-Quwayyah general hospital, Al-Quwayyah, Saudi arabia. Data were collected by conducting patient interviews. Data were captured for adverse drug reaction monitoring based on Narinjo scale and WHO format.Results: 25 ADRs were observed out of 212 hypertensive patients. Incidence was found to be higher in patients more than 40 y age, and females experienced more ADRs (n = 16, 7.54%) than males, 9 (4.62%). Combination therapy was associated with more number of ADRs (64.0%) as against monotherapy (36.0%). Calcium channel blockers were found to be the most frequently associated drugs with ADRs (n = 8), followed by diuretics (n = 6), and β-blockers (n = 5). Among individual drugs, amlodipine was found to be the commonest drug associated with ADRs (n = 8), followed by torasemide (n = 4). ADRs associated with the central nervous system was found to be the most frequent (48.0%) followed by musculoskeletal complaints (20.0%) and respiratory system disorders (16.0%).Conclusion: ADRs were experienced by taking the antihypertensive drugs prescribed in Al-Quwayyah general hospital, Saudi arabia. The findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with ADRs

Unusual case of non-resolving necrotizing pneumonia: a last resort measure for cure.

Abstract To our knowledge, this is an unusual case of a community-acquired pneumonia (CAP) with sepsis secondary to Streptococcus pneumoniae that required lung resection for a non-resolving consolidation. A 74 year old previously healthy woman, presented with acute fever, chills and pleuritic chest pain in Emergency Department (ED). A diagnosis of CAP was established with a Pneumonia Severity Index CURB-65 score of 5/5. In the ER, she was promptly and appropriately managed with antibiotics and aggressive supportive therapy. She remained on ten days of intravenous antibiotics. However, 48 hours post antibiotic course, she returned to ER with fever and signs of sepsis. Despite timely and appropriate management, the consolidated lobe remained the focus of sepsis for over four weeks. The patient recovered after the offending lobe was resected. Histopathology of the lung tissue revealed acute and chronic inflammation. However, no malignancy, bacterial infection or broncho-pleural fistula was found. Eighteen months post-surgery, the patient remains well

The role of socio-economic factors responsible for non-compliance of directly observed treatment short-course among tuberculosis patients

Introduction: Tuberculosis has gone out of control in many parts of world. The therapeutic regimens given under direct observation as recommended by world Health Organization have been shown to be highly effective for both preventing and treating tuberculosis but poor compliance to anti-tuberculosis medication (ATT) is a major barrier to its global controls. Objectives: The role of socio-economic factors responsible for non-compliance of directly observed treatment short-course (DOTS) among Tuberculosis Patients. Materials and Methods: Cross sectional study, interviewed using a set of questionnaire. Participants were enrolled at DOTS centre of Lala Ram Sarup Institute of tuberculosis and Respiratory disease New Delhi, India. Patients who interrupted treatment for more than 2 months consecutively were classified as non-compliance cases. T-test was used for comparing the means of the control and case groups. Results: Majority of study population (45%) was in age group of 31 -45 years, which is the productive age. 85 % noncompliant patients believed anti TB drugs to be bad and 15 % accepted as good for them. Similarly 87 % believed to stop ATT very prematurely as soon as symptoms disappear while 13 % believed to continue as per DOTS volunteer advice. The study revealed that the non-compliance of DOTS was significantly high among those who were less educated, unskilled worker, low family income and upper lower class family. Conclusion: In Delhi region, the treatment of Tuberculosis was good and did not have much involvement of socio-economical role in the non-compliance of treatment. But still major hurdle is the inadequate education, occupation, and income

Gaschromatography/mass spectrometry analysis of degradation of ethylacetoacetate achieved in shake flask culture using a previously characterized yeast strain Tichosporon dermatis.

Public and regulatory interest regarding the presence of pharmaceutically active compounds in the environment its increasing adverse impact has increased in the recent years. Detection of a wide variety of pharmaceutical compounds in water environment has been a serious and growing concern in the last few decades. Understanding the biological degradation of pharmaceutical compounds is essential for accurately determining their ultimate environmental fate, conducting accurate risk assessments, and improving removal of such micro pollutants.  Present investigation was designed to accomplish biodegradation of ethylacetoacetate in shake flask culture using whole cells of previously isolated and identified yeast strain Trichosporon dermatis, from pharmaceutical effluents using enrichment culture technique. The strain was cultivated for two generations on an orbital shaker at 120 rpm at 28 ± 20C and the biomass was separated by centrifugation at 10,000 rpm for 20 mts. Normal saline washed cells were used in degradation carried out in Erlenmeyer flasks containing 500 ml of mineral medium containing ethylacetoacetate at standard conditions; wet cell weight= 20g/l; ethylacetoacetate concentration = 0.5% in mineral medium (w/v); time of biodegradation= 72 hrs; temperature= 28 ± 20C. Gas chromatography/mass spectrometry (GC-MS) analysis of microbially degraded product revealed that complete degradation of ethylacetoacetate in mineral medium was achieved in 72 hours using whole cells of Trichosporon dermatis yeast strain. Degradation of ethylacetoacetate by this yeast strain has not been reported before the present investigation. Keywords: ethyl acetoacetate, biodegradation, Gass chromatography/mass spectrometry and effluents

Distance between Midline and Vertebral Artery Groove of Atlas -A Real Aid to the Neurosurgeon

Abstract The knowledge of the relationship of the vertebral artery with the atlas is very important, in order to avoid any injury to the vertebral artery, during surgeries in the craniovertebral region. Different researchers have measured the distance of the vertebral artery from the midline along the posterior arch of atlas (oblique distance), but some authors have measured the perpendicular distance of vertebral artery from the midline. Usually, it is the perpendicular distance along which the surgeons are exploring in this region. Hence, the present study was planned to study and compare both oblique and perpendicular distances of the vertebral artery from the midline and find out statistical differences between these two parameters. It was carried out on 30 atlas vertebrae of Indian origin. The oblique and perpendicular distances of vertebral artery groove from midline and the thickness of vertebral artery groove were measured. The results suggest that dissection on the posterior aspect of the arch of atlas should remain 17.00 mm lateral to the midline and dissection on the superior aspect of the arch of atlas should remain 8.00 mm from the midline to prevent injury to the vertebral artery. It was also observed that "oblique distances of vertebral artery groove from the midline to the medial margin of inner and outer cortex are larger than the corresponding perpendicular distances from the midline". Although, the differences of oblique and perpendicular distances are not statistically significant but it may be clinically significant for the surgeons operating in the craniovertebral region. Hence, it is concluded that the surgeon should be aware of both the distances while operating in the craniovertebral region to avoid any iatrogenic injury to the vertebral artery

DRUG UTILIZATION BASED ADRs DETECTION OF ANTIBIOTICS PRESCRIBED FOR LRTI IN TERTIARY CARE TEACHING HOSPITAL, NEW DELHI

Objective: Aim of to present study was to assess drug utilization pattern of antibiotics use in Lower respiratory tract infection and their adverse drug reaction assessment.Methods: The present study was an observational and prospective study. 110 patients fulfill the inclusion criteria were included in study. Physician prescription records, patient's medication profile types of antibiotics prescribed were recorded and analyzed.Results: Out of 110 LRTI patients, 74 (67.27%) patients were male and 36(32.72%) patients were female. 72 patients were suffered from bronchitis while 38 patients were suffering from pneumonia. 30 patients were in the age range of 56-65 y, followed by 21 patients who were in the age range of 66-75 y. It has been observed that among all the prescribed antibiotic agent's frequency of β-lactam 199(45.53%), quinolones115 (26.27%), macrolides 53(12.12%) chloramphenicol44 (10.06%) sulphonamide 17 (3.89%) and aminoglycosides 9(2.05%) were prescribed to all the patients. Average 3.97 antibiotic agents were prescribed to all the patients. Majority of drugs were given by oral route (68.19%) and Prescriptions are mainly ordered in brand names. The most frequent co-morbid condition was found to be diabetes mellitus (25.45%) followed by hypertension (16.36%) and coronary artery disease (11.81%).45.45%. Only 23 ADRs were detected in 110 patients. The most common culprit was an amoxicillin with clavulanic acid.Conclusion: The present study provides an overall pattern of antibiotic usage in different patients. The area of concern in the present study is polypharmacy and use of antibiotics in LRTI without following any guideline. ADRs monitoring is also required to prevent noxious effects of drugs by the use of antibiotics

In-Vivo assessment of glucocorticoid loaded tea tree oil nanoemulsion gel

Optimized formulations were subjected to various in vivo studies like anti-inflammatory activity, Nickel induced dermatitis, irritation study and Acute and repeated dose dermal toxicity studies. Clobetasol propionate (CP) has anti-inflammatory, immunomodulatory, and antiproliferative activity. The aim of the present work was to test the hypothesis that the addition CP in nanoemulsions would result in enhancement CP delivery and leading to better antipsoriatic activity. Nanoemulsions were prepared by aqueous phase titration method, using Tea Tree oil, Tween 20, Transcutol P, and distilled water as the oil phase, surfactant, co-surfactant and aqueous phase, respectively.We developed a topical O/W nanoemulsion in which drug is incorporated in disperse phase of oil and evaluated its efficacy against different types of in vivostudies. It was also found that the significantly increased their anti-inflammatory activity. It was reported that CP-loaded nanoemulsion significantly increased NTPDase (Nucleoside triphosphate diphosphohydrolases) activity in lymphocytes. This membrane protein is responsible for the hydrolysis of extracellular ATP (Adenosine triphosphate) which is responsible for cell proliferation, differentiation and inflammatory processes. In vivoirritation studies did not show any irritation in spite of having high amount of surfactant. Group treated with CP loaded nanoemulsion gel showed no evident toxicity even on repeated exposure. On the basis of above in vivo study we conclude that developed nanoemulsion is safe for human. Keywords: Clobetasol propionate, In-vivo study, Nanoemulsion, Anti-inflammatory study, Toxicity stud

Effects of aliskiren on hemodynamic parametersin daunorubicin -induced acute cardiomyopathy in rats

Daunorubicin ((DNR)) used in oncological practice against a wide variety of solid organ tumors and hematologic malignancies, including leukemia, lymphoma, breast cancer, lung cancer, multiple myeloma and sarcoma. however clinical use of this agent is limited due to cardiomyopathy and cardiac heart failure. one of the important player in the development of cardic hypertrophy and reperfusion injury is renin-angiotensin system. Aliskiren (ALK) a recent drug of a direct inhibitor of the renin enzyme. It Protect cardiomyopathy by the inhibition of the renin activity. Present study is towards the evaluation of protective effcets of ALK 50 and 100 mg/kg/day in rats. The systolic, diastolic, mean BP and heart rate were significantly (P< 0.01) increased in DNR control group as compared to normal control group. Thus the results provide clear evidence that the ALK pretreatment offered significant protection against DNR-induced Hemodynamic parameters changes.  Keywords: Daunorubicin, Cardiomyopathy, Aliskiren, Telmisartan and Hemodynamic parameter