STUDY ON PRESCRIBING PATTERN OF ANTI-DIABETIC DRUGS AMONG TYPE 2 DIABETES PATIENTS WITH COMPLICATION IN SOUTH INDIAN TEACHING HOSPITAL

ABSTRACTObjective: To evaluate the drug utilization pattern of anti-diabetic agents with respect to glycosylated hemoglobin A1c (HbA1c) level in a Type 2diabetes patient with complication.Methods: This retrospective observational study was conducted as per the protocol approved by the Institutional Ethics Committee. The patientsdiagnosed with Type 2 diabetes mellitus with complication were identified, and those who had measured HbA1c level during previous follow upswere included in the study. All demographic, drug prescriptions, and clinical data of patients were collected and documented in a suitably designedcase report form. Descriptive analyses were performed using Statistical Package for the Social Sciences Version 20.Results: Based on the study criteria, 644 patients were selected and enrolled for the study. The majority of study subjects 494 (76.7%) were male and415 (64.4%) were belonged to the age group 45-64 years. 252 (39.1%) of the patient, had normal weight followed by 234 (36.3%) were overweight,and 142 (22.1%) patients were obese. The prescription pattern showed the majority of patients 509 (79%) patients had 1-2 anti-diabetic medicationfollowed 133 (20.7%) patient prescribed with 3-4 anti-diabetic drug. An insulin was prescribed in 507 (63.4%) patients and among oral anti-diabeticdrugs, metformin 283 (43.9%), glimepiride 140 (21.7%), and voglibose 88 (13.7%) was most commonly prescribed.Conclusion: Among all the anti-diabetic drugs, the insulin was highly preferred over oral hypoglycemic agents (OHAs) to control the glycemic level,and metformin accounted for the most commonly prescribed OHAs. In the second generation of sulfonylureas class, glimepiride and glipizide weremost prescribed.Keywords: Anti-diabetic agents, Diabetes mellitus, Prescription pattern

CORRELATION OF GLYCOSYLATED HEMOGLOBIN LEVELS WITH FASTING AND POSTPRANDIAL GLUCOSE IN SOUTH INDIAN TYPE 2 DIABETIC PATIENTS

Objective: To assess the correlation of glycosylated hemoglobin levels with fasting and postprandial glucose in South Indian type 2 diabetic patients.Methods: This retrospective observational study was carried out as per the protocol approved by the institutional ethics committee (IEC) and case records of patients (≥ 40 y old) diagnosed with type 2 diabetes mellitus (T2DM) and complications, that fasting blood sugar (FBS), postprandial blood sugar (PPBS) and HbA1c measured during previous follow-ups were included in the study. Statistical analyses were carried out using SPSS Ver.20 and p ≤ 0.05 were considered statistically significant. Results: Based on the study criteria, 633 case profiles were selected and enrolled in the study. Most of the patients were males 488 (77.1%) and the mean age of patients was 59.7 y (SD=9.6). The mean fasting glucose and postprandial glucose were 9.42 mmol/l (SD=4.2), 13.39 mmol/l (SD=5.2) respectively. Patients were suffering from different type of diabetes complications, and most of them had poor glycemic control as the mean HbA1c was found to be 8.7 % (SD=2.2). The FBS and PPBS were plotted against HbA1c values showed moderate correlation and the sensitivity, specificity, positive predictive value and negative predictive value of postprandial glucose level was better than the fasting blood glucose level.Conclusion: This present study showed that there is the significant correlation between PPBS and HbA1c values. Since PPBS is performed routinely, its interpretation in terms of long term glycemic control will help clinicians to tailor their therapeutic strategies

DEMOGRAPHIC, CLINICAL CHARACTERISTICS AND DRUG PRESCRIPTION PATTERN IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SOUTH INDIAN TERTIARY CARE HOSPITAL

Objective: The objective of the study was to describe demographic, clinical features and drug treatment pattern among rheumatoid arthritis (RA) patients in a south Indian tertiary care hospital.Methods: In this retrospective study, a total of 789 patients diagnosed with RA were enrolled from October 2013 to December 2015 in tertiary care hospital irrespective of age and gender. Data of the patients were obtained from Medical Record Department (MRD), and all the data were documented in a suitable designed Case Record Form (CRF). The data were analyzed using SPSS 20.0 and Excel 2013.Results: There were 628 females and 161 males with mean age 47.6±12.6 and 47.1±14.4 y respectively. The ratio of male to female was 1:3.9. Most of the RA patients were housewives (66.4%). The mean disease duration was 4.3±4.5 y. The majority of patients (59.3%) had disease duration of more than 24 mo. Hypertension (21.5%) was the most common comorbid condition in our study population. Iron deficiency anemia (IDA) was observed in 10.6% of RA patients. Serum C-reactive protein (CRP) was positive in 89.3%. The majority of patients (87.7%) received DMARDs. As the disease, duration increased the severity of disease also increased. Majority of patients were prescribed with dual DMARDs in combination (52.3%).Conclusion: We observed female was dominant over the male in number and majority of patients had a later stage of the disease probably due to lack of medical facility or financial problems in the lower income groups. We observed that methotrexate plus hydroxychloroquine combination was commonly used in both high and moderate disease activity groups which may be due to a better outcome and minimal adverse effects

FATAL PROGNOSIS OF H1N1 INFLUENZA IN LATE TRIMESTER OF PREGNANCY: DESCRIPTIVE ANALYSIS OF FOUR CASES

Influenza infection in late trimester associated with complications is attributable risk factors for critical illness among pregnant women. We have analyzed the medical records of four pregnant women retrospectively who were admitted in a medical intensive care unit of tertiary care center with influenza-like symptoms of breathlessness, fever, headache, myalgia and cough. Their mean age was 26.5 (19-30). They were confirmed to have H1N1infection by real-time reverse transcriptase polymerase chain reaction assay. Chest x-ray of all patients showed abnormalities like pulmonary edema and suggestive of acute respiratory distress syndrome. Arterial blood gas analysis of all four patients shown severe hypoxia and all of them was mechanically ventilated. Oseltemivir was started for all four from the day of admission. Pipracillin-tazobactum combination along with other antibiotics was given as prophylaxis and treatment of different infections. Midazolam and morphine were given together to reduce the restlessness and ventilator-associated distress. Furosemide was given to all for breathing problems and pulmonary edema. Despite of all the management provided none of the patients survived due to the progression of H1N1 into septic shock and multiple organs dysfunction syndromes.Â

FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS IN PATIENTS WITH DENGUE FEVER IN A TERTIARY CARE HOSPITAL IN SOUTHERN INDIA

 Objective: Denguefeveris one of the important tropical disease of public health significance caused by flavivirus. It is a major cause of morbidity and mortality worldwide. Identification of factors associated with severity of dengue can improve the prognosis of the disease.This study tried toassess the factors associated with severity of dengue.Methods: A record based study was conducted in a tertiary care hospital setting in southern India. A total of 550 case files were reviewed to ascertain demographic, clinical and laboratory parameters among confirmed cases of dengue. The severity of dengue was categorized using WHO 2009 classification.Results: Of 550 records reviewed, 449 (81.6%) were classified as non-severe dengue and 101 (18.4%) as severe dengue. Factors associated with severe dengue on univariate analysis were: gender, backache, skin rash, nausea and vomiting, abdominal distension, haemorrhage, breathlessness, oliguria, hepatomegaly, splenomegaly, ascites, leukopenia, hypoproteinemia, and elevated serum alanine transaminase (ALT) >63 IU/L.On multivariate analysis,haemorrhage (OR=11.75, 95%; CI=6.38-21.62), oliguria (OR=4.01, 95%; CI=1.32-12.15), ascites (OR=2.68, 95%; CI=1.19-6.01), ALT>63 IU/L (OR=1.77, 95%; CI=1.01-3.1) and hypoproteinemia (OR=5.57, 95%; CI=2.82-10.98) were found to have significant association with the development of severe dengue.Conclusion: This study indicates thatwhen dengue patients present with bleeding episodes, ascites, oliguria,raised ALT and low serum protein levels, clinicians should be alert to the appearance of severe complications. Early identification of these factors will help clinicians to recognise the severity of dengue illness and enable them to implement appropriate interventions

4(2) 50 Case Study Dapsone Hypersensitivity Syndrome in a Leprosy Patient

ABSTRACT Introduction: Dapsone Hypersensitivity Syndrome (DHS) is a rare potentially fatal systemic idiosyncratic adverse reaction, with multiorgan involvement also known as sulphone syndrome which is particularly seen in leprosy patients who are on world health organization recommended multidrug therapy (WHO-MDT regimen). DHS is a variant of drug rash with eosinophilia and systemic symptoms (DRESS syndrome) caused by dapsone. Even though reaction common in the leprosy patients there is need such reporting to identify the most venerable patient pool. Case: Here we present a case of DHS developed after 25 days in a female patient with a history of PB-MDT regimen treatment, high grade intermittent fever associated with nausea, myalgia, headache since 20 days; swelling of face, bilateral lower limbs and erythematous rashes were observed all over the body since 4 days. She was presented with fever (102.2 0 F), posterior cervical and axillary lymphadenopathy and moderate bilateral lower limb pitting pedal edema was present. Multiple erythematous papules coalesced all over body predominantly involved on the face, trunk and extremities. The main laboratory data on admission were showed, hemoglobin: 9.6 g/dL; WBC: 14.6 x 10³/ µL; neutrophils: 48% mild left shift, lymphocyte: 20% reactive forms; eosinophils: 16%; increased serum levels of aspartate amino transferase, alanine transaminase and alkaline phosphatase. Patient was improved and discharged on treating with antipyretics, antibiotics, oral and topical corticosteroids and antihistamines

The trade-off dilemma in pharmacotherapy of COVID-19: systematic review, meta-analysis, and implications

Introduction: The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide and has contributed to over 650,000 deaths. This review synthesizes the literature on COVID-19 pharmacotherapy to inform practice and policymaking. Areas covered: The authors systematically review the published literature on COVID-19 therapeutics, grouping candidate treatments into repurposed, adjunct, and experimental agents. They conducted meta-analysis where appropriate and provide recommendations based on compilation from real-time/interim therapeutic guidelines. They then advise on how to navigate and advance the evidence in the current context of uncertainty and urgency and provide expert opinion on suggested framework. Expert opinion: Current evidence does not support a clear role for pharmacotherapy in COVID-19. While promising signals have been found through limited number of RCTs, these must be interpreted with caution. Without proper protection from bias and confounding we risk exposing patients to treatments where the potential for benefit is at best unclear, yet the potential for harm from adverse effects is high leading to a trade-off dilemma in decision making. Advancing the evidence requires a coordinated effort to design and conduct robust trials and to systematically synthesize and critically evaluate findings. Therapies should be reserved for use in clinical trials, emergency or compassionate access until we gain more confidence in the balance of benefit and harm

Teaching and learning strategies of evidence based medicine: A meta-synthesis of learners and instructors perspective

Objective: Evidence Based Medicine (EBM) knowledge and skills have been recommended as a core competency of healthcare professionals worldwide. However, EBM teaching and learning approaches is quite heterogeneous. Hence, we aimed to conduct a meta-synthesis to identify various teaching and learning aspects of EBM from the learners and instructors perspective. Methodology: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. A comprehensive search strategy was used to retrieve articles from PubMed/Medline and Embase from inception till June 2022. To find additional studies, bibliographic search of included studies, review articles, a random search in Google Scholar, Research Gate and Google were carried out. This review evaluated studies published in English language that explained the teaching and learning aspects of EBM among healthcare professionals and students. Result: A total of 41 out of 8139 studies were included in this study. Both learners and instructors preferred tutorials, lectures, short courses, and workshops on EBM as a teaching method. To continue learning and practicing EBM, instructors suggested curricular changes as well as continuing education programmes. Learners preferred to learn EBM by direct clinical practice along with peers. Blended learning, group activities, assignments, workshops, journal clubs, task based learning, didactic teaching, team based learning, problem based learning, case based learning, blended learning, flipped learning and E-learning were the identified pedagogical approaches for teaching EBM. Conclusion: Different pedagogical approaches are used for teaching EBM among healthcare professionals. Continuous education programs for skill development must be held on a regular basis to improve the instructors and learners competency in EBM. Learners and instructors preferred learning approach should be considered while designing EBM educational studies as it is a life-long self-directed learning process

Pharmacokinetic Studies on Oximes in Organophosphate Poisoning: A Mini Review

Organophosphate (OP) poisoning is one of the most common causes of poisoning in developing countries especially in Southeastern Asia. Poisoning with phosphorus-containing organic chemicals or OP compounds can be managed with antidotes like oximes which are potential reactivators of acetylcholinesterase (AChE). The efficacy of oxime therapy in OP poisoned patients mainly depends upon various factors such as different dose plans, infusion rate of oximes, genetic differences of patients, type of oxime used and chemical nature of the OP compound ingested. Studies on pralidoxime kinetics in OP poisoned patients have shown that reactivation of AChE depends on the plasma concentration of oximes as well as OP compounds. The plasma concentration of oximes mainly depends on the dose plan from intermittent injection to continuous infusion after a loading dose. The incontrovertible fact is that the intermittent dosing of oximes results in deep troughs in blood pralidoxime/oxime levels (BPL) whereas continuous infusion of oximes maintains steady state plasma concentrations. Many published literature also highlighted pralidoxime via continuous infusion results in better outcomes with minimum fluctuation in BPL compared to intermittent dosing. At therapeutic doses, adverse effects of oximes are reported to be minimal. But high BPL is associated with some common adverse effects including dizziness, blurred vision and diastolic hypertension. Considering all the facts, it is important to note that kinetic studies of oximes are useful not only in deciding the dose regimen, but also in predicting the possible side-effects

COVID-19 Vaccine Hesitancy: The Perils of Peddling Science by Social Media and the Lay Press

Introduction: Vaccines are the best tools to end the pandemic, and their public acceptance is crucial in achieving herd immunity. Despite global efforts to increase access to vaccination, the World Health Organization explicitly lists vaccination hesitancy (VH) as a significant threat. Despite robust safety reports from regulatory authorities and public health advisories, a substantial proportion of the community remains obsessed with the hazards of vaccination. This calls for identifying and eliminating possible causative elements, among which this study investigates the inappropriate dissemination of medical literature concerning COVID-19 and adverse events following immunization (AEFI), its influence on promoting VH, and proposals for overcoming this problem in the future. Methods: We searched PubMed, Embase, and Scopus databases, using the keywords “adverse events following immunization (AEFI)”, “COVID-19”, “vaccines” and “hesitancy” and related medical and subjective headings (MeSH) up to 31 March 2022, and extracted studies relevant to the COVID-19 AEFI and associated VH. Finally, 47 articles were chosen to generate a narrative synthesis. Results: The databases depicted a steep rise in publications on COVID-19 AEFI and COVID-19 VH from January 2021 onwards. The articles depicted multiple events of mild AEFIs without fatal events in recipients. While documenting AEFIs is praiseworthy, publishing such reports without prior expert surveillance can exaggerate public apprehension and inappropriately fuel VH. VH is a deep-rooted phenomenon, but it is difficult to zero in on the exact reason for it. Spreading rumors/misinformation on COVID-19 vaccines might be an important provocation for VH, which includes indiscriminately reporting AEFI on a massive scale. While a number of reported AEFIs fall within the acceptable limits in the course of extensive COVID-19 vaccinations, it is important to critically evaluate and moderate the reporting and dissemination of AEFI in order to allay panic. Conclusions: Vaccination programs are necessary to end any pandemic, and VH may be attributed to multiple reasons. VH may be assuaged by initiating educational programs on the importance of vaccination, raising public awareness and monitoring the inappropriate dissemination of misleading information. Government-initiated strategies can potentially restrict random AEFI reports from lay epidemiologists and healthcare practitioners