A prospective observational study of adverse drug reactions to antiretroviral therapy: type and risk factors in a tertiary care teaching hospital

Background: To collect demographic details of patients receiving antiretroviral therapy (ART) and study type of adverse drug reactions (ADRs) and risk factors for ADRs to ART and to assess causality, severity, and preventability assessment of the reported ADRs.Methods: A prospective observational study was conducted for 6 months from January 2012 until June 2012 at ART Center, KR Hospital of Mysore Medical College & Research Institute, Mysore. Data were evaluated for patient demography, risk factors for ADRs, type of ADRs. ADRs were also assessed for their causality, severity, and preventability as per the standard algorithm, using SPSS for windows (version 16.0).Results: Out of 158 patients evaluated, majority were of age group of 21-40 years (66.5%). More number of illiterate patients (55.7%) showed ADRs to ART. Most patients were of CD4 count <250 cells/μl (65.82%). Most common regimen which caused ADRs was zidovudine + lamivudine + nevirapine. Most common type of ADRs was anemia (55.06%) and rash (25.31%). On evaluation of the causality of ADRs, majority were found to be possible (89.24%). The severity assessment showed that most of the patients ADRs were of level 3 (93.05%). The preventability assessment showed that 30.38% patients ADRs were preventable.Conclusion: Identifying risk factors are of crucial importance to optimize the initial choice of ARVs regimen before initiating therapy and to prevent severity and complications caused by ART, thereby improving the quality of care to patients on ART

A study of drug utilisation pattern in patients of chronic kidney disease at a tertiary care hospital

Background: Chronic kidney disease (CKD) is a major public health issue and widely prevalent non-communicable disease in India. CKD has a complex pharmacotherapy and it inevitably requires poly-pharmacy. CKD patients require to take medications for a lifelong period, which makes it very important to study the prescribing trends on a regular basis. The main objective of the study was to analyse current prescribing trends in the management of CKD patients and to know whether the prescribing rationality was maintained.Methods: After Institutional Ethics Committee approval, a prospective         Cross-sectional study was carried out at Nephrology department of a tertiary care hospital for a period of six months from 1st June 2017 to 30th November 2017. Patients diagnosed with CKD by treating Nephrologist were included and their prescriptions were analysed to study the prescribing patterns.Results: A total of 120 cases were analysed during the study, of which 81.7% were males and 18.3% were females. Analysis of WHO core drug prescribing indicators showed that the average number of drugs prescribed per patient was 5.13, percentage of drugs prescribed by generic name was 30.03%, percentage of patients with an injection prescribed was 16.6%, percentage of drugs prescribed from essential medicine list was 65.8% and percentage of patients prescribed with an antibiotic was 10.8%. Antihypertensive drugs (39.9%) were the most commonly used drugs, followed by, calcium salts (12.01%), multi-vitamins (7.6%), oral iron supplements (6.8%), erythropoietin (6.3%) and ulcer protectives (6.1%).Conclusions: Maximum number of drugs were prescribed from cardiovascular class of drugs. Calcium channel blockers and diuretics were the commonest group of antihypertensives prescribed. The principle of rational prescribing was followed

Potential drug-drug interactions among hospitalized cardiac patients

Background: Drug-drug interactions (DDIs) are a major cause for concern in patients with cardiovascular disorders due to multiple co-existing conditions and the wide class of drugs they receive. The objective of our study was to identify potential drug-drug interactions among hospitalized cardiac patients and to identify the risk factors associated with these interactions.Methods: After obtaining approval from Institutional Ethical Committee, a prospective observational study was carried out among 367 hospitalized cardiac patients in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru. Cardiac patients prescribed at least 2 drugs and having hospital stay of more than 24 hour duration were enrolled into the study. The prescriptions were analysed for potential DDIs using MEDSCAPE multidrug interaction checker tool. Descriptive statistics, Student ‘t’ test, ANOVA and Pearson correlation coefficient were used to analyse the results.Results: The incidence of potential DDIs was 98% with 360 prescriptions having at least one potential DDI. A total of 38 potentially interacting drug pairs were identified among which majority were of significant grade while only 3 were serious. Majority of interactions were pharmacodynamic (76.3%) in nature. Aspirin/clopidogrel (71.1%) and pantoprazole/clopidogrel (69.8%) were the most common interacting pairs. Drugs most commonly involved were aspirin, clopidogrel, heparin, pantoprazole and ramipril. Age, female gender, polypharmacy, prolonged hospital stay, stay in ICU and diabetes mellitus were the risk factors found associated with the potential DDIs.Conclusions: Proper therapeutic planning, routine monitoring of cardiac in-patients and usage of online DDI database will avoid potentially hazardous consequences in cardiac in-patients

Clinico-epidemiological study of topical steroid dependent face in a tertiary care hospital at Mysore

Background: Topical steroids are the most commonly prescribed drugs in dermatology. The adverse effects of steroid misuse are noticeable 3 to 4 weeks after application. Steroid rosacea, hypertrichosis and acneiform eruptions are few of them. A new entity known as topical steroid dependent face, topical steroid dependent face (TSDF) has been recently coined to encompass symptoms such as erythema, burning sensation on attempted cessation of topical steroid application.Methods: A questionnaire-based analysis was done among patients attending dermatology outpatient department of government medical college hospital, Mysore between November 2018 to May 2019. Prior approval of the institutional ethics committee, and consent of patients were obtained. A total of 200 outpatients with facial dermatosis using topical steroids on face for a period greater than one month were taken up for study.Results: The results included population across different age groups, between 16 to 60 years. 56% belonged to the age group of 16 to 30 years. Most common steroid abused was mometasone cream 0.1% (50%), betamethasone valerate cream 0.1% (24.5%) followed by clobetasol ointment 0.05% (21.5%). The major adverse effect with steroid abuse, were acne 72% facial redness 67%. Hyperpigmentation 51%, hypertrichosis 32.5% and skin atrophy 21%.Conclusions: The present study highlights and creates awareness on the burden of facial topical steroid abuse and the poor attitude towards them

Antipsychotics in schizophrenia: a retrospective study of drug utilization pattern in outpatient department of psychiatry at a tertiary care hospital

Background: Psychiatric disorders are one of the major causes of morbidity and the burden of illness is enormous and remains grossly under represented. Psychotropic drugs have had a remarkable impact in psychiatric practice. Currently a large number of atypical antipsychotics available in the market are endorsed as better options for treating schizophrenia than the typical antipsychotics. The main objective of the study was to find the commonly prescribed antipsychotics in schizophrenia patients in a tertiary care center.Methods: After Institutional Ethics Committee approval, a retrospective cross-sectional drug utilization study of 400 prescriptions was under taken from 1st July 2015 to 30th July 2016 in the outpatient department of psychiatry of a tertiary care hospital. The prescribing pattern of antipsychotics in schizophrenia patients (N=107) was measured.Results: Out of 400 cases in the outpatient department, schizophrenia cases were predominant (N=107 i.e. 27%) out of which 42.1% were females and 57.9% were males. This was followed by mood disorders and neurotic & somatoform disorders. The most common antipsychotic used was olanzapine followed by risperidone. Least commonly used antipsychotic was haloperidol. Most of the patients who received risperidone also received an anticholinergic trihexyphenidyl (91.8%).Conclusions: Olanzapine and risperidone are the most commonly used antipsychotics. Anticholinergics should be used only in selected patients on antipsychotics as tolerance develops to extrapyramidal side effects. Anticholinergics are unnecessary after 3-6 months in all except 10% of patients. Moreover, it has its own side effects and adversely interacts with antipsychotics

Protective role of vitamin E on drug induced neuropathy

Background: The objective of this study was to look into the protective role of vitamin E (Vit.E) on drug‑induced neuropathy.Methods: The study involved 18 albino rats; rats were divided into 3 Groups; Group 1 ‑ control (n = 6), Group 2 - anti‑leukemic drugs treated rats (n = 6), Group 3 - anti‑leukemic drugs and Vit.E treated rats (n = 6). Anti‑leukemic drugs which included vincristine (VCR), L‑asparaginase (L‑Asp), doxorubicin (ADR), prednisolone (PDN), were administered to Group 2 and Group 3 rats according to acute lymphoblastic leukemia treatment regimen (MCP841). Group 3 rats were given in addition to the anti‑leukemic drugs, Vit.E (100 mg/kg bodyweight/orally) daily. Tests for neuropathy were done using tail clip method, tail flick method, hot plate method on the 2nd week and tail clip method on 4th week of therapy.Results: At the end of 2nd week by tail clip method and tail flick method the mean reaction time of the anti‑leukemic drugs alone treated group (Group 2) was increased showing the development of neuropathy. The mean reaction time of the anti‑leukemic drugs + Vit.E treated group (Group 3) showed a reduction in the reaction time, showing the protective role of Vitamin E. Hot plate method done at the end of 2nd week showed a decrease in mean reaction time in Group 2 rats compared with Group 3. This could be due to the hyperthermalgesia by VCR. Group 3 was protected by Vit.E.Conclusion: Observations showed a protective role of Vit.E on drug induced neuropathy

The conservation status of West African vultures: an updated review and a strategy for conservation

The vulture populations in West Africa are undergoing dramatic decline over the last 30 years. Their particular ecology and sociality makes them vulnerable to various risks, including environmental changes, poisoning and bioaccumulation of toxic substances from agricultural products, pesticides, and veterinary drugs used in cattle livestock. In addition, these birds are subject to direct persecution for the trade of products used in traditional medicine. This manuscript analyzes the conservation status of eight vulture species in West Africa and the threats affecting their survival. In order to assess the conservation status of vultures in West Africa, this paper analyzes all the available literature that has been published in scientific peerreviewed journals, including also technical reports and unpublished reports related to the whole West African region. Overall, and despite the high risk of extinction facing several vulture species all throughout the world, our literature surveys revealed that the scientific papers on the conservation of West African vultures are relatively few. Therefore, due to limited available literature, the main causes of vulture declines in West Africa remain relatively unclear. Apparently, all African vultures suffer from similar threats, especially poisoning, habitat alteration and conversion to agro-pastoral systems, loss of wild ungulates leading to a reduced availability of carrion, hunting for trade, for use in traditional medicine and bushmeat, persecution and human disturbance. Our review also addresses future steps that are needed for reversing the negative population trend of their free-ranging populations, including some specific conservation measures that are proposed to mitigate their decline

Entomologie.

Les principaux rabageurs de la culture cotonnière du C-4; Suivi des ravageurs dans l'écosystème et prise de décision; Méthodes de lutte intégrée; Lutte variétale; Contrôle chimique et techniques d'application; Techiques d'appliction des produits.bitstream/item/142479/1/Entomologie.pdfCOTON-4. Idioma: Francês e Português