Drug utilization study of antipsychotics among schizophrenia patients in a tertiary care teaching hospital: a retrospective observational study

Background: Aim of the study was to evaluate the drug utilization pattern of antipsychotics in schizophrenia patients in a tertiary care hospital.Methods: A retrospective observational study was conducted over a period of one year. Demographic data and drug utilization pattern of antipsychotics was collected from the surveyed prescriptions. Using WHO prescribing indicators data was analysed. Results were expressed in percentage.Results: Out of 300 prescriptions analysed, males were 58% and females 42%. Majority of schizophrenia patients were in age group of 15 to 45 years 70.33%. Olanzapine 75% was most common antipsychotic drug prescribed followed by risperidone 10.7%. Haloperidol 9.6%, fluphenazine 3.7% and chlorpromazine 1% were the other antipsychotics prescribed. Atypical antipsychotics 85.7% were commonly prescribed than conventional ones 4.3%. Concomitant drugs prescribed were anticholinergics, antihistaminics, sedative-hypnotics, antidepressants, mood stabilizers, antiulcer drugs and vitamin B complexes. Average number of drugs prescribed per prescription 3.26.Conclusions: Nowadays atypical antipsychotics are preferred over conventional ones because of their less side effects. Drug utilization study helps in rational usage of drugs important for patient care

A prospective evaluation of efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% after cataract surgery

Background: Different medications are used to reduce pain and inflammation after cataract surgery. Hence this study was taken up to compare the efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% in reducing anterior chamber inflammation and pain after cataract surgery.Methods: Total of 100 patients who underwent uneventful cataract surgery with posterior chamber intra ocular lens (IOL) implantation were randomly allocated to receive bromfenac 0.09% and flurbiprofen 0.03% topically from first post-operative day onwards for 6 weeks. Assessment of anterior chamber inflammation and pain was done by slit lamp and visual analogue scale respectively on each follow up days. Analysis was done by unpaired t test and Fischer’s exact test.Results: The response to treatment was earlier in bromfenac group for all the inflammatory changes (significant difference was found on day 7, p<0.05) except for corneal edema where both the groups showed similar response. On 7th day after surgery, 72% patients in flurbiprofen group and 12% in bromfenac group had pain (score1), while on the 14th day none in the bromfenac group complained of pain whereas 4% in flurbiprofen group still had pain. Both the drugs were safe and no clinically serious adverse effects were observed in either of the groups.Conclusions: This study showed both the medications, topical bromfenac 0.09% and topical flurbiprofen 0.03% effective and safe in reducing pain and anterior chamber inflammation after cataract surgery but the response was earlier with bromfenac 0.09%

Study of adverse drug reactions among tuberculosis patients in a tertiary care hospital: a retrospective observational study

Background: The aims of the study was to study adverse drug reactions (ADRs) among tuberculosis (TB) patients in a tertiary care hospital and to determine causality, severity and outcome of ADRs.Methods: A retrospective observational study was conducted in a tertiary care hospital over a period of 6 months. Data was collected from records of TB patients in RNTCP centre of a tertiary care hospital regarding information of patients, drugs used, ADRs. It was evaluated using appropriate scales. Simple descriptive statistics was used for analysis.Results: Out of 37 patients who experienced ADRs, 22 (59.45%) were male and 15 (40.54%) were female. Majority of patients were in the age group of 36 to 45 years (37.83%). 36 (97.3%) patients were diagnosed with pulmonary TB and 1 (2.7%) patient had extra pulmonary TB. Among 37 ADRs gastrointestinal (GI) reactions were most common 11 (29.72%) followed by musculoskeletal 9 (24.32%). Causality assessment showed 19 (51.35%) as probable and 18 (48.65%) ADRs as possible, Severity assessment was 24 (64.8%) reactions were in mild, 10 (27.02%) in moderate and 3 (8.1%) in severe grades. Outcome assessment was 26 (70.3%) patients were recovering from reactions, 9 (24.32%) had recovered and 2 (5.4%) did not recover at the time of reporting.Conclusions: Proper monitoring of ADRs helps in reducing patient’s burden of repeated hospital visits and expense occurring due to admissions. This can be prevented by educating patients about early reporting of ADRs

KNOWLEDGE OF MODIFIABLE RISK FACTORS OF HEART DISEASE AMONG PATIENTS WITH CARDIOVASCULAR RISK

Objectives: Cardiovascular disease (CVD) is one of the leading killer diseases of people around the world. The purpose of this study was to examine the CVD risk factor and perception among individuals with high CVD risk.Methods: An observational study was conducted for 6 months in the Department of General Medicine of a Multi-Specialty Hospital. Patients who were hypertensive, diabetic, and dyslipidemia with/without comorbid disease were included. Patients who are seriously ill, mentally retarded, physical disabilities, history of CVD, etc., were excluded. CVD risk assessment was done using Framingham risk score, and knowledge assessment was done using knowledge questionnaire on CVD risk. Patient counseling was given to the patients based on their risk and knowledge level and also to improve knowledge about CVD risk and therapeutic goals for the control of blood pressure, blood glucose, lipid profile, and smoking cessation.Results: A total of 100 patients were included in this study comprising 46 males and 54 female. Male has more risk than female. The factors, viz., age, smoking habits, high cholesterol, and diabetes mellitus showed a greater risk in CVD. Knowledge levels assessed in those patients are 28% patients having poor knowledge, 30% patients having fair knowledge, and 42% patients having good knowledge.Conclusion: The study concluded that the participants showed poor knowledge in CVD, which could turn into insufficient preventative behaviors and suboptimal patient outcomes. Pharmacist implementation is needed to assess CVD risk and to improve the health-related quality of life.Keywords: Cardiovascular disease risk, Framingham risk score, Knowledge questionnaire

PCSK9: A Multi-Faceted Protein That Is Involved in Cardiovascular Biology.

Pro-protein convertase subtilisin/kexin type 9 (PCSK9) is secreted mostly by hepatocytes and to a lesser extent by the intestine, pancreas, kidney, adipose tissue, and vascular cells. PCSK9 has been known to interact with the low-density lipoprotein receptor (LDLR) and chaperones the receptor to its degradation. In this manner, targeting PCSK9 is a novel attractive approach to reduce hyperlipidaemia and the risk for cardiovascular diseases. Recently, it has been recognised that the effects of PCSK9 in relation to cardiovascular complications are not only LDLR related, but that various LDLR-independent pathways and processes are also influenced. In this review, the various LDLR dependent and especially independent effects of PCSK9 on the cardiovascular system are discussed, followed by an overview of related PCSK9-polymorphisms and currently available and future therapeutic approaches to manipulate PCSK9 expression

A STUDY ON EFFECTIVENESS OF THE RURAL DEVELOPMENT PROJECT PROVIDING RURAL EMPLOYMENT, MANDYA

The Shri Kshethra Dharmasthala Rural Development Project (SKDRDP) has been a cornerstone of rural development efforts in India aimed at improving the socio-economic conditions of rural communities. This study explores the effectiveness of the SKDRDP in providing rural employment opportunities and the impact it has had on the livelihoods of the beneficiaries. The study indicates that the SKDRDP has played a pivotal role in providing rural employment opportunities to the local population. Through various initiatives, including skill development programs, micro-enterprise support, and infrastructure development projects, the project has significantly increased rural employment. Beneficiaries reported improved income levels and quality of result of their involvement in SKDRDP activities. The SKDRDP has proven to be effective in providing rural employment opportunities and enhancing the livelihoods of the rural population. It acts as a model for comprehensive rural development, emphasizing skill-building, self-reliance, and community empowerment. The study's conclusions underscore the importance of continued support for such initiatives to further rural development and reduce poverty in India

Free heme exacerbates colonic injury induced by anti-cancer therapy

Gastrointestinal inflammation and bleeding are commonly induced by cancer radiotherapy and chemotherapy but mechanisms are unclear. We demonstrated an increased number of infiltrating heme oxygenase-1 positive (HO-1+) macrophages (Mø, CD68+) and the levels of hemopexin (Hx) in human colonic biopsies from patients treated with radiation or chemoradiation versus non-irradiated controls or in the ischemic intestine compared to matched normal tissues. The presence of rectal bleeding in these patients was also correlated with higher HO-1+ cell infiltration. To functionally assess the role of free heme released in the gut, we employed myeloid-specific HO-1 knockout (LysM-Cre : Hmox1flfl), hemopexin knockout (Hx-/-) and control mice. Using LysM-Cre : Hmox1flfl conditional knockout (KO) mice, we showed that a deficiency of HO-1 in myeloid cells led to high levels of DNA damage and proliferation in colonic epithelial cells in response to phenylhydrazine (PHZ)-induced hemolysis. We found higher levels of free heme in plasma, epithelial DNA damage, inflammation, and low epithelial cell proliferation in Hx-/- mice after PHZ treatment compared to wild-type mice. Colonic damage was partially attenuated by recombinant Hx administration. Deficiency in Hx or Hmox1 did not alter the response to doxorubicin. Interestingly, the lack of Hx augmented abdominal radiation-mediated hemolysis and DNA damage in the colon. Mechanistically, we found an altered growth of human colonic epithelial cells (HCoEpiC) treated with heme, corresponding to an increase in Hmox1 mRNA levels and heme:G-quadruplex complexes-regulated genes such as c-MYC, CCNF, and HDAC6. Heme-treated HCoEpiC cells exhibited growth advantage in the absence or presence of doxorubicin, in contrast to poor survival of heme-stimulated RAW247.6 Mø. In summary, our data indicate that accumulation of heme in the colon following hemolysis and/or exposure to genotoxic stress amplifies DNA damage, abnormal proliferation of epithelial cells, and inflammation as a potential etiology for gastrointestinal syndrome (GIS)

Comparison of safety and toxicity of liposomal versus conventional Doxorubicin: an updated review

Cancer persists to be a major cause of hospitalization and death every year. With the passage of time, new formulations of anticancer drugs are being introduced to the market and are drawing the concern of healthcare professionals in terms of the superiority, toxicology, and cost-effectiveness of the new formulations in comparison to the conventional formulation of the same drugs. Doxorubicin, a highly potent chemotherapeutic agent, it comes with three formulations (pegylated liposomal, nonpegylated liposomal and non-liposomal conventional formulations). English-language literature of the three formulations of Doxorubicin has been reviewed to inform the healthcare professionals regarding the differences between these formulations. Liposomal Doxorubicin promotes better toxicology profile than non-liposomal conventional Doxorubicin with an increased cost. Due to very limited studies, the cost-effectiveness of liposomal Doxorubicin is not well defined. Apart from that, this review highlights the inter patient variability in regard to the clearance and volume of distribution following the administration of liposomal Doxorubicin. In conclusion, further studies regarding the superiority of liposomal formulation of Doxorubicin , efficacy and dose standardization of liposomal Doxorubicin should be sought in the near future in a more better way

Assessment of depression among patients undergoing haemodialysis: a cross-sectional study

Background: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. The beginning of dialysis treatment causes subtle changes in the life of CKD patients, mainly in the physical and social spheres. It affects the self-care of these patients which lead to poor adherence to dialysis. Hence, the present study was conducted to screen for depression.Methods: This was an observational study among 100 patients undergoing haemodialysis at HIMS, HASSAN. After taking informed consent, subjects were requested to complete Beck, depression Inventory, a 21-question multiple-choice self-report inventory for measuring the severity of depression. Descriptive statistics was applied to infer the findings.Results: The study population showed depression of mild (31%), borderline (10%), moderate (17%), severe (7%) and extreme (3%) grade and the remaining subjects did not show depressive symptoms (32%).Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status of the patients, low literacy rate, gender and those started on dialysis recently

Adherence to treatment in patients undergoing dialysis

Background: Chronic Kidney Disease (CKD) is a silent disease that is frequently diagnosed in advanced stages. The prevalence and incidence of chronic kidney disease (end-stage renal disease) are continuously increasing, particularly in elderly patients. Poor adherence to complex multimodal therapies is a widely recognized problem in the daily care of dialysis patients, contributing to excess morbidity and mortality of this population. Aims and objectives was to assess the adherence to medications among patients undergoing haemodialysis and to explore the factors affecting non adherence.Methods: After obtaining approval from Institutional Ethics Committee, a prospective observational study was carried out among 150 patients, who were on dialysis in a tertiary care hospital, Hassan. An eight item Morisky Medication adherence questionnaire was used to assess medication adherence. Chi-square test applied to assess statistics.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non-adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to Dialysis. Other reasons contributing to non-adherence to treatment were forget fullness (86.66%), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11%) and lack of assistance (48.88%).Conclusions: In this study patient showed moderate adherence. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence