DRUG UTILIZATION STUDY IN A RADIOTHERAPY UNIT OF A TERTIARY CARE TEACHING HOSPITAL IN RURAL WEST BENGAL, INDIA

Objective: Drug utilization studies lay special emphasis on the medical social and economic consequences of use of medications in special settings. This study was undertaken to identify the pattern of drugs prescribed frequently among patients attending the radiotherapy department. Methods: This is a prospective study undertaken between January 1, 2018, and December 31, 2018. Prescriptions and patient records were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Results: We encountered a total of 618 patients during the study period. Among them, 340 (55.01%) were female. The most common age groups presenting were between 21 and 60 years. Carcinoma breast was the most common type encountered (total cases 181, 29.28%), followed by carcinoma lung (total cases 92, 14.88%), carcinoma cervix, hematological malignancies, carcinoma prostate, and carcinoma rectum. Total number of drugs prescribed was 3008 in total 618 prescriptions making it 4.86 drugs per prescription on average. Among them on average per prescription, 2.82 drugs were cytotoxic drugs (1745 total), whereas 2.04 drugs were supportive or adjunct drugs (1263 total). Among the drugs prescribed, 96.24% were in generic names, 6.95% prescriptions contained antibiotics, and 96.44% (596) prescriptions contained injections. About 85.23% of drugs were prescribed from essential drug list. Average consulting was 8.2 min and dispensing time for adjunct drugs was 4 min on average. On average, 52.42% of patients (324) had complete correct knowledge of the dosage and schedule prescribed. Adverse drug reactions were common, out of 618 patients, 542 (87.7%) experienced ADRs most common being gastrointestinal and dermatological ADRs. The most common implicated drug was cisplatin. Six serious adverse events were encountered. Conclusions: This study provides a clear picture of drug use in this special clinic in rural Bengal and paves the way for larger and long-term study

Fluoxetine enhances maximal electroshock seizure threshold in Albino rat model when compared to phenytoin

Background: Individuals with epilepsy have a higher incidence of psychiatric disorders than person without epilepsy. Epidemiological studies have shown that the co-morbidity of epilepsy and depression to be high as 50%. The conventional anti-depressants are believed to lower the seizure threshold making it difficult to treat the co-morbid depression, but animal studies have shown SSRIs, a common anti-depressant, to have anti-convulsant properties. So, we propose to study the anticonvulsant effects of fluoxetine, a SSRI, in albino rats against maximal electroshock seizure and to compare against a standard antiepileptic drug phenytoin.Methods: The anticonvulsant effect of fluoxetine was observed in model of maximal electroconvulsive seizure threshold in albino rats. The animals were divided into 3 groups having 6 animals each, receiving distilled water, fluoxetine and phenytoin respectively. The drugs were given orally, and the effect was observed on day 7, 14 and 21. Tonic hind-limb extension was taken as the parameter of electroshock seizure. The effects were compared against a standard anti-seizure drug phenytoin.Results: Fluoxetine showed significant elevation of the seizure threshold following 14 days of administration (P value 0.031). The effect was comparable to phenytoin with no significant difference after 7, 14 and 21 days of treatment (P-value 0.485, 0.699 and 0.818 respectively) though phenytoin showed significant anti-seizure effect since day 7 of treatment.Conclusions: Fluoxetine showed significant anti-seizure activity against electroconvulsive seizure in albino rats

A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India

Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion

Perception of second professional undergraduate medical students and teachers about pharmacy practical classes in pharmacology curriculum

Background: The practice and teaching in the MBBS curriculum has changed over the last few decades and most of it caters to the making of the Indian Medical Graduate (IMG) and the first contact physician of the community. The most notable change in pharmacy in modern times has been the virtual disappearance of the preparation and compounding of medicines. Pharmacy practical classes still form a part of the MCI curriculum in Pharmacology undergraduate teaching in many states of India including West Bengal. This study was undertaken to assess the attitude of students as well as teachers towards continuation of these practical classes in the curriculum and possible alternatives.Methods: Second year pharmacology students were included in the study (n=143). Along with this 10 faculty members were provided a structured and pre-tested questionnaire to be answered anonymously.Results: It was seen that 89 percent students and 100 percent faculty members wanted these practical classes to be discontinued. The most popular alternative to these classes were ADR reporting from the faculty members (90%) and demonstration of clinical effects of drugs and dosage calculation (86%) among the students.Conclusions: Given the lessening importance and relevance of the pharmacy practical classes in today’s day to day practice, a change in curriculum and examination system in Pharmacology must be considered

Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal

Background: Dilated cardiomyopathy (DCM) is an important underlying cause of congestive heart failure and/or arrhythmias. The introduction of therapy combining diuretics, digoxin and angiotensin converting enzyme inhibitors (ACEI) has significantly decreased mortality and morbidity. The aim of the study was undertaken to identify the pattern of drugs most commonly prescribed for DCM and to assess the rationality behind such use.Methods: This was a prospective study undertaken between 1st July and 31st August 2015. Prescriptions were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Rationality and cost of therapy per prescription was also evaluated.Results: We encountered 78 patients of DCM in the OPD of Cardiology (prevalence of 4.94%). The average number of drugs per prescription was 6.64. Generic prescriptions were made in 90% encounters. As part of therapy, diuretics and ACE inhibitors or angiotensin receptor blockers, were prescribed in all cases. Our results show a distinctive drug use pattern where beta blockers were used more commonly than digoxin. Other commonly prescribed agents were antiplatelet drugs and statins. Antibiotics were prescribed in 8.7% cases and no injectable drug was prescribed. Average drug cost per encounter was 10.63 INR.Conclusions: To conclude, we found a typical and rational pattern of drug use. Diuretics, ACEI and beta blockers were found to be most commonly used agents. This study provides a clear picture of drug use in this special clinical condition in rural Bengal and paves the way for larger and long term studies

Patient-reported outcomes with medical management of benign prostatic hyperplasia: a prospective study in a tertiary care teaching hospital of rural West Bengal, India

Background: Effectiveness of pharmacotherapy in benign prostatic hyperplasia (BPH) is generally evaluated by clinical measures. Outcome of the treatment from the patient’s perspective however cannot be evaluated which may result communication gap between the patient and the physician. Patient-Reported Outcomes (PRO) studies can bridge this gap. This study was undertaken to evaluate outcomes and to assess the impact of medical management of BPH on general health-related quality of life.Methods: In this prospective, observational study, eligible patients with BPH attending a Urology clinic in a tertiary care rural hospital of West Bengal were enrolled and followed up on third and sixth months from baseline. Symptom assessment of BPH were assessed through International Prostate Symptom Score (I-PSS), BPH Impact Index (BII) and Health Related Quality of life questionnaires. Tools of descriptive statistics were used for analysis of data.Results: In the study population of 66 patients, 50% were treated with monotherapy (alpha blockers) and 50% were treated with combinations (alpha blocker and 5alpha reductase inhibitors). After 6 months of medical management, I-PSS was decreased from 18.86±5.53 to 11.76±3.94 (p <0.001), BII score decreased from 9.65±2.59 to 5.89±2.24 (p <0.001) and VAS score increased from 51.44±10.03 to 54.24±11.38 (p <0.001).Conclusions: We found medical management definitely improved quality of life in BPH patients and significantly decreased symptoms. This study is a step in the direction of development of larger and longer term PRO studies in BPH management

Comparative efficacy of inhaled ciclesonide, budesonide, and fluticasone in mild to moderately persistent bronchial asthma

Background: Bronchodilators and glucocorticoids have been proven to be very effective and safe in asthma treatment, which recommend the use of steroids and β2-agonist (long or short acting) as the first line of treatment in of asthma. This study was aimed to compare the efficacy of three different inhaled corticosteroids ciclesonide, budesonide, and fluticasone in bronchial asthma.Methods: A total of 30 patients with mild to moderately persistent bronchial asthma was selected as per the NAEPP classification in the expert panel report (EPR) update 2002, NHLBL USA 2003. They were randomly divided into 3 groups of 10 patients each, and they were given 3 different steroid inhalers (ciclesonide or budesonide or fluticasone). Baseline and post-therapy spirometry were performed on day 1 and after 2 months and 6 months of treatment. Data were analyzed using SPSS software.Results: It was observed that most of the cases (43.3%) were between 26 and 35 years of age with female preponderance (56.6%). Significant symptomatic improvement was observed in all 3 groups. The percentage of improvement in mean peak expiratory flow rate was 17%, 18%, and 18% in ciclesonide, budesonide, and fluticasone group, respectively. The percentage improvement of forced expiratory volume in 1 second (FEV1)/forced vital capacity after bronchodilatation was 18%, 18%, and 19% in ciclesonide, budesonide, and fluticasone group, respectively. The improvement in mean FEV1% predicted was 20%, 19%, and 21% in three groups, respectively.Conclusion: Steroid therapy along with β2-agonists showed a significant improvement in symptoms. There was no difference among the three different types of steroids

Fluoxetine enhances maximal electroshock seizure threshold in Albino rat model when compared to phenytoin

Background: Individuals with epilepsy have a higher incidence of psychiatric disorders than person without epilepsy. Epidemiological studies have shown that the co-morbidity of epilepsy and depression to be high as 50%. The conventional anti-depressants are believed to lower the seizure threshold making it difficult to treat the co-morbid depression, but animal studies have shown SSRIs, a common anti-depressant, to have anti-convulsant properties. So, we propose to study the anticonvulsant effects of fluoxetine, a SSRI, in albino rats against maximal electroshock seizure and to compare against a standard antiepileptic drug phenytoin.Methods: The anticonvulsant effect of fluoxetine was observed in model of maximal electroconvulsive seizure threshold in albino rats. The animals were divided into 3 groups having 6 animals each, receiving distilled water, fluoxetine and phenytoin respectively. The drugs were given orally, and the effect was observed on day 7, 14 and 21. Tonic hind-limb extension was taken as the parameter of electroshock seizure. The effects were compared against a standard anti-seizure drug phenytoin.Results: Fluoxetine showed significant elevation of the seizure threshold following 14 days of administration (P value 0.031). The effect was comparable to phenytoin with no significant difference after 7, 14 and 21 days of treatment (P-value 0.485, 0.699 and 0.818 respectively) though phenytoin showed significant anti-seizure effect since day 7 of treatment.Conclusions: Fluoxetine showed significant anti-seizure activity against electroconvulsive seizure in albino rats

PRESCRIPTION AUDIT FROM THE OUT-PATIENT DEPARTMENT OF A RURAL HOSPITAL IN WEST BENGAL, INDIA: A CROSS SECTIONAL STUDY

Objectives: Standards of the medical treatment at different levels of the healthcare delivery system influence the quality of life. A prescription audit is a kind of vigilant activity that can oversees the observance of these standards. We conducted a prescription audit study to evaluate the prescribing pattern in the out-patient department in a rural hospital in West Bengal. Methods: The study was a cross-sectional study spanning for a period of 1 month from 1st September 2021 to 30th September 2021. It was conducted at the general out-patient department (OPD) of a Rural Hospital in West Bengal. 490 First encounter prescriptions were collected from the out-patient department and was reviewed for analysis. Results: Out of 490 OPD all of them contained the name, age and gender of the patient but body weights of the patients were documented only in 12.4% of cases. Only 43.7% of prescriptions contained a proper diagnosis and the route of administration was mentioned in only 58.4% of cases. Generic name was written among 78.2% prescriptions and 2.9% contained an injection. Antibiotic was prescribed in 19.4% of total prescriptions collected and 32.3% of drugs were from the essential drug list. Correct duration of treatment was given in 32.7% of drugs. 26.4% of prescriptions followed the standard treatment guidelines. &nbsp;Conclusion: Our study showed encouraging trends regarding generic drug prescribing and limitation of antibiotic usage yet there are deficits in mentioning the diagnosis and vital drug related information like route of administration and duration of therapy