Teaching of Critical Analysis of Drug Advertisements to Medical Students

Background: Medical practitioners utilize drug promotional materials from pharmaceutical companies as a major source of information especially in developing countries. These promotional materials can be highly informative as long as they are critically appraised but when they are accepted without question, they lead to irrational prescribing. Aim: To sensitize the students regarding WHO criteria for medicinal drug promotion and to determine the impact of teaching critical appraisal of medicinal drug promotion to medical students. Design: The medical students of second year were given a pre test questionnaire to identify the violations in generic labeling, pharmacological information, claims, relevance and references cited in the drug advertisements. Later they were sensitized about the WHO criteria for medicinal drug promotion and how to critically appraise a drug advertisement. This was followed by a post test questionnaire with the same drug advertisement. Result: The number of students answering the post test correctly was significantly (p<0.05) more than that of pre test. Conclusion: Education of medical students regarding critical analysis of drug advertisements should be a part of the medical curriculum

Adverse drug reactions and cost effectiveness of non-steroidal anti-inflammatory drugs, muscle relaxants, and neurotropic drugs in patients with low back pain

Background: The objective was to evaluate the adverse drug reactions (ADRs) and cost effectiveness of different classes of drugs in therapy of low back pain.Methods: A prospective observational study was carried out over a period of 12 months (November 2012 to November 2013) in which a total of 300 patients with low back pain were enrolled and divided equally into three groups – Group 1 (non-steroidal anti-inflammatory drugs [NSAIDs]), Group 2 (NSAIDs ± muscle relaxant), and Group 3 (NSAIDs ± muscle relaxant ± neurotropic drugs). Any ADR developed after the initiation of treatment at 3 weeks and 6 weeks was noted. Prescription cost per day was also calculated.Results: There was a male predominance in the study population with a mean age of 39.76±9.40 years. A total of 262 ADRs were noted among which most were seen in Group 3 (119 ADRs). Gastritis was the most common ADR in Group 1. Drowsiness was the most common ADR in Group 2 (30%) and 3 (46%). Prescription cost per day was highest in Group 3 (30.28±11.24 Indian Rupee [INR]) followed by Group 2 (25.92±8.66 INR) and Group 1 (12.22±3.38 INR).Conclusion: Patient on combination of three drugs (NSAIDs, muscle relaxants, and neurotropic agents) had maximum ADRs and their prescription cost per day was highest among the three groups

Prevention of type 2 diabetes and its complications in developing countries: a review.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a significant global public health problem affecting more than 285 million people worldwide. Over 70% of those with T2DM live in developing countries, and this proportion is increasing annually. Evidence suggests that lifestyle and other nonpharmacological interventions can delay and even prevent the development of T2DM and its complications; however, to date, programs that have been specifically adapted to the needs and circumstances of developing countries have not been well developed or evaluated. PURPOSE: The purpose of this article is to review published studies that evaluate lifestyle and other non-pharmacological interventions aimed at preventing T2DM and its complications in developing countries. METHODS: We undertook an electronic search of MEDLINE, PubMed, and EMBASE with the English language restriction and published until 30 September 2009. RESULTS: Nine relevant publications from seven studies were identified. The reported interventions predominantly used counseling and educational methods to improve diet and physical activity levels. Each intervention was found to be effective in reducing the risk of developing T2DM in people with impaired glucose tolerance, and improving glycemic control in people with T2DM. CONCLUSIONS: The current evidence concerning the prevention of T2DM and its complications in developing countries has shown reasonably consistent and positive results; however, the small number of studies creates some significant limitations. More research is needed to evaluate the benefits of low-cost screening tools, as well as the efficacy, cost-effectiveness, and sustainability of culturally appropriate interventions in such countries

Case Report - Carbamazepine and sodium valproate cross reactivity

Epilepsy is defined as recurrent seizures provoked by any immediate unidentifiable cause. Drug therapy is the mainstay of treatment for patients with epilepsy. Phenytoin, sodium valproate, carbamazepine and ethosuximide are generally used as first line therapy for most seizure disorders. Carbamazepine is one of the most widely used medications for the treatment of partial-onset seizures. Sodium valproate is a broad-spectrum antiepileptic that has proven efficacy against all seizure types, which makes it a useful antiepileptic when exact seizure classification is unknown or multiple seizure type exists. The patients who do not respond to first line antiepileptics or develop side effects to them are invariably prescribed alternative drugs. Clobazam, a long acting benzodiazepine, is one such drug that is given as an adjunctive therapy in these patients. The aromatic antiepileptics viz. phenytoin, carbamazepine, phenobarbitone and primidone can cause hypersensitivity reactions. For example, carbamazepine can cause pruritic and erythematous rashes, urticaria, photosensitivity reactions, exfoliative dermatitis, alopecia, diaphoresis, erythema multiforme, Stevens-Johnson syndrome and Toxic epidermo necrolysis. In such a case carbamazepine is discontinued and nonaromatic antiepileptics like sodium valproate or a benzodiazepine is usually recommended as an alternative therapy. Here, we present a case in which there was development of acute hypersensitivity reaction to both aromatic and nonaromatic antiepileptics - a rarely reported phenomenon