Comparison of artesunate and quinine in the treatment of severe falciparum malaria: a randomized control trial

Background: Severe malaria is a medical emergency that required prompt clinical assessment and management. Very few studies underwent to evaluate the best possible treatment for severe malaria.Methods: This is a prospective, randomized, open-labeled, study to evaluate the efficacy and safety of artesunate compared with quinine. Totally, 50 patients were included in each group. Patients above 18 years, peripheral smear positive and fulfilling the WHO criteria were included. The endpoint of the study was fever clearance time (FCT), parasite clearance time (PCT) and coma resolution time (CRT), and the adverse effect if any were compared for safety analysis.Results: FCT and PCT were much less with artesunate (29.64 and 39.72 hrs) as compared to quinine (51.12 and 55.20 hrs). CRT was less with quinine (25.80 hrs) than artesunate (42 hrs). The incidence of adverse effects such as hypoglycemia and QT prolongation are significant with quinine compared to artesunate.Conclusions: Artesunate is a better alternative for severe malaria with minimal side effects

Evaluation of granisetron as an antiemetic in patients undergoing abdominal hysterectomy under spinal anaesthesia

Background: PONV most common complications related to surgery and anaesthesia despite major advances in spinal, epidural and combined spinal-epidural anesthesia techniques IONV are still present in a significant number of patients. Ondansetron, used for controlling PONV induced by chemotherapy or radiation. Recently 5HT3 receptor antagonist granisetron has more potent, selective and longer acting activity than ondansetron. Granisetron is more active for control of PONV in cisplatin induced vomiting than ondansetron. It also reduces PONV in strabismus repair, tonsillectomy, and general surgeries, it has less side effects as compared to ondansetron. Objective of the study was to study efficacy and safety of granisetron and compare it with ondansetron for prevention of IONV and PONV.Methods: 80 ASA grade I and II women undergoing abdominal hysterectomy under spinal anaesthesia were studied. Patients in group A received injection granisetron 2 mg and group B injection ondansetron 4 mg,10 minutes prior to induction of spinal anaesthesia. Main outcome measures were occurrence of nausea, retching or vomiting in intraoperative and postoperative period at 6, 12, 18 and 24 hours’ post-surgery. The response of patient to therapy and side effects were evaluated in both groups. The results were analyzed by ‘z’ test (p<0.5) considered significant.Results: Demographic characteristics of both groups were comparable patients in granisetron (80%) had more complete response as compared to ondansetron (47.5%). Adverse effects were lower in granisetron group.Conclusions: Granisetron 2 Mg has better efficacy and safety profile than ondansetron 4 Mg

Prescription pattern study of antiasthmatics drugs in tertiary care centre

Background: Bronchial asthma is a social and economic healthcare burden. Drug Utilization studies can play a key role in helping the healthcare system to understand, interpret and improve the prescribing administration & use of medications.Methods: A prospective, Cross-sectional, Observational study was conducted at inpatient and outpatient Department of Medicine and Paediatrics in tertiary health care centre. As per inclusion criteria, 127 patients with asthma were interviewed, and prescription data was recorded in a pre-designed case record form from 1 October 2018 to 31 December 2018.Results: A total of 127 prescriptions were studied. It was observed that majority of the study patients were in the age group of 40-50 years, with 83 (65.5%) males and 44 (34.6%) females. Most of the patients were of Mild intermittent asthma 65 (51.18 %) followed by patients with Mild persistent asthma 31 (24.40 %). 10 different anti-asthmatics drugs were prescribed along with adjunctive medicines. Most of the patients received multiple drug therapy 98 (77.16 %). Prevalence of two drug combination was the highest 74 (58.26 %) followed by monotherapy29 (22.83 %). Most common route of drug administration was inhalational route followed by oral route. β2 agonists and corticosteroids were the most commonly prescribed combination drugs followed by methylxanthines. 103 (81.10 %) prescription contains both generic and brand drugs compared to generic names only 16 (12.59 %) and brand names only 8 (6.29 %).Conclusions: This study concluded that the present prescribing practice in asthma therapy in tertiary care centre is not sufficiently rational. Hence, it is necessary to encourage physicians to follow asthma guidelines while managing asthmatic patients