Cost variation analysis study of oral anti-depressant drugs available in India

Background: Depression is a disorder of major public health importance, in terms of its prevalence and the suffering, dysfunction, morbidity and economic burden. In India, the overall prevalence of depression is reported to be 15.9%. Antidepressant drugs are available in many different brands and costs of all brands are different. Patients of depression have to take the antidepressant drug for a long duration, so cost of the antidepressant drug influence the patient adherence to treatment and it is one of the important part of rational prescription.Methods: The cost of a particular drug being manufactured by different companies in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October, 2015, and “DrugsUpadate.com”. The cost ratio and percentage cost variation was calculated.Results: The prices of a total of 28 drugs (22 single and 6 combination preparations) available in 64 different formulations were analyzed. In single drug therapy, among Tri cyclic antidepressants (TCAs), Reboxetine (2 mg) showed the maximum price variation of 900%. In SSRIs, Dapoxetine (30 mg) showed the maximum price variation of 2360%. In SNRIs, Venlafaxine (75 mg) showed the maximum price variation of 109%. In Atypical antidepressants, Bupropion (150 mg) showed the maximum price variation of 515.38%. In RIMAs, Moclobemide (150 mg) showed the maximum price variation of 246.15% and in combination therapies, Amitriptyline with Chlordiazepoxide showed the maximum price variation of 129.35%.Conclusions: This study shows a wide variation in the prices of oral Anti-depressant drugs available in India. Psychiatrist/ Physician should consider the cost while prescribing antidepressant drugs. India being developing country most of the people belong to poor socioeconomic status, so prescribing same generic drug with low cost reduces economic burden and improves patient adherence to treatment which results in better outcome

A 45-DAY RANDOMIZED, OPEN-LABEL, COMPARATOR STUDY TO EVALUATE THE SAFETY AND EFFICACY OF ZINCOVIT TABLETS WITH GRAPE SEED EXTRACT (NUTRITIONAL FOOD SUPPLEMENT) IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

ABSTRACTObjective: To evaluate the efficacy of Zincovit (ZVT) tablets with grape seed extract (GSE) in patients with Type 2 diabetes mellitus by testing thehypothesis of a greater reduction in plasma glucose levels (fasting blood sugar [FBS] and post-prandial blood sugar [PPBS]) from baseline and after45 days of therapy as compared to standard comparator.Methods: This was a randomized, open-label, comparative (2-arm), prospective 45 days study. Treatment consisted of 2 arms: Antidiabetic drugplus non-pharmacological measure alone or ZVT tablets with GSE plus non-pharmacological measures. A total of 30 patients (15 in each arm) wereincluded in the study.Results: ZVT tablet did not alter the FBS, PPBS, and HbA1c level in diabetic patients compared to diabetic patients treated with placebo. No changeswere seen in any of the safety parameters when given for 45 days.Conclusion: ZVT tablets do not possess antidiabetic activity in spite of good safety profile in our study design. This could be due to several limitationsof the study such as inadequate sample size, short duration of the study, and wrong selection of the patients. A long-term, double-blind, placebocontrolled study in a large sample of population measuring glycemic parameters, and cardiovascular outcomes could give a clear picture of the antidiabeticeffectof ZVT with GSE tablets.Keywords: Diabetes mellitus, Zincovit tablets, Grape seed extract, Antioxidant, Safety parameters

Antimicrobial drug sensitivity pattern of Pseudomonas aeruginosa in respiratory infections

Background: Pseudomonas aeruginosa, a gram-negative pathogen commonly associated with nosocomial infections is the most widespread multidrug-resistant pathogen causing pneumonia in hospitalized patients. Inadequate empirical therapy has been associated with high mortality and morbidity. Objective: To evaluate and analyze the antimicrobial susceptibility pattern of P. aeruginosa in respiratory infections in a tertiary care hospital.Methods: The study was carried out at Kasturba Hospital, Manipal from Jan 2011 to Dec 2011. Specimens of 63 in-patients were analyzed who were culture positive for P. aeruginosa.Results: Majority of patients were aged above 40yrs with a male preponderance. Specimens were taken from patients who were diagnosed with bronchiectasis, pneumonia, COPD, bronchial asthma etc. Overall the organism was most sensitive to carbapenems (87.3%) followed by cefoperazone-sulbactam combination (85.7%). Sensitivity to ceftazidime and cefepime was equal (82.5%) and was more when compared to piperacillin-tazobactam (81.5%). Overall resistance rate was highest for fluoroquinolones (23.8%) followed by aztreonam (22.2%).Conclusions: Hence we would like to recommend cefoperazone-sulbactam as the preferred antipseudomonal agent and carbapenems as reserved drugs in treating pseudomonal lung infections. Use of fluoroquinolones and aztreonam as monotherapy in resistant P. aeruginosa infections should be restricted

A prospective study to analyse antibiotic susceptibility pattern of Pseudomonas aeruginosa in a tertiary care hospital

Background: Pseudomonas aeruginosa, a gram-negative pathogen is commonly associated with nosocomial infections. Infections caused by P. aeruginosa can range from superficial skin infections to fulminant sepsis. Antimicrobial resistance is an area of prime concern in pseudomonal infections. The objective of the study was to evaluate and analyse the antibiotic susceptibility pattern of P. aeruginosa at a tertiary care hospital in South India.Methods: The study was carried out at Kasturba Medical College and Hospital, Manipal, India from January 2011 to December 2011. Ten different types of specimens were collected from patients who were culture positive for Pseudomonas aeruginosa. Antibiotic susceptibility was confirmed by disk diffusion technique on Muller-Hinton medium and was performed according to the Clinical Laboratory Standard Institute (CLSI) guidelines.Results: Out of 200 samples of P. aeruginosa 69.5% and 30.5% were from male and female patients respectively. Majority of the specimen from which P. aeruginosa was isolated consisted of sputum, pus and urine. Among the antimicrobial drugs tested, organism was most sensitive to carbapenems (77.5%), piperacillin-tazobactam (77%) and cefoperazone-sulbactam (72%). Resistance rates were high for fluoroquinolones (FQs) (43.5%), gentamicin (40.5%), tobramycin (40.5%), ticarcillin-clavulanic acid (39%) and aztreonam (38%) when compared to cefepime (31.5%), ceftazidime (32.5%), netilmicin (34.5%) and amikacin (35%).Conclusions: Carbapenems and piperacillin-tazobactam were the best antipseudomonal agents with highest sensitivity to P. aeruginosa. FQs, gentamicin and tobramycin were the least effective drugs against P. aeruginosa as monotherapy

Efficacy of zincoderm G cream against wound infection by Pseudomonas aeruginosa in Sprague-Dawley rats

Background: Zincoderm G cream is a fixed dose combination of clobetasol, gentamicin and zinc. Studies have been carried out for efficacy of each component such as clobetasol and gentamicin in bacterial infections, but as fixed dose combination including zinc has not been reported yet. Hence, a study was planned to assess the efficacy of Zincoderm G cream in experimental wound infection by Pseudomonas aerugionosa.Methods: In the experiment a total of 18 Sprague-Dawley rats (male, pathogen free, 6-8 weeks old) were used. The rats were divided into three groups of six rats each. 25-30 mg of test drugs (Zincoderm G cream with or without zinc) was applied on Pseudomonas aeruginosa infected burn wound affected area of back of rats for 2 weeks. Bacterial infection was assessed by quantification of bacteria.Results: There was 80% mortality observed in P. aeruginosa infected toxic control (cream base) group. Whereas, only 40% mortality was seen in both Zincoderm G cream with/without zinc groups, which were inoculated with P. aeruginosa. Bacterial concentration (Number of colony forming unit/ml wound fluid) was significantly decreased (p<0.001) in P. aeruginosa infected rats treated with Zincoderm G cream with zinc when compared with P. aeruginosa infected control (untreated) rats.Conclusions: We found that Zincoderm G cream with zinc exhibited distinct killing profiles against P. aeruginosa

CORRELATION OF CLINICAL AND LABORATORY ASPIRIN RESISTANCE: A PILOT STUDY

Aspirin resistance may be biochemical or clinical. Data related to the presence of aspirinresistance in the Indian population is scarce. We conducted a cross sectional study toaddress the issue of clinical aspirin non responsiveness and to assess the associationbetween inhibition of platelet aggregation, clinical risk factors and occurrence of vascularevents. We studied platelet aggregation by optical aggregometry in 20 patients on aspirin.No patient was found to be aspirin-resistant on the basis of previously defined criteria.This led us to relook at the current cut offs for resistance, and an analysis of 60 normalpatients showed lower cut off values suggesting ethnic variability. The data wasreanalyzed using these cutoffs. An association between poor clinical aspirin response,older age, male sex, smoking and dyslipidemia was found, suggesting a trend, though notsignificant. 25% of patients had vascular events on aspirin suggesting clinical aspirinresistance. A lower cut off value for aspirin resistance in normal Indians may be neededto detect true prevalence of this entity. In patients with multiple atherothrombotic riskfactors lab detection of resistance may be useful in identifying patients with high risk forrecurrent vascular events. This may help to modify antiplatelet therapy to preventvascular events

Institution village linkage programme Coastal Agro Ecosystem & Interventions

Agriculture, animal husbandry and fisheries provide maximum employment in the primary sector and form the major source of income and livelihood security of about 70 percent of the population in India. After the introduction of the liberalisation policy and giving thrust for the adoption of improved technologies, there has been a spectacular increase in production in all these segments and the country has witnessed a rapid structural change. Massive adoption of scientific inventions and technological interventions witnessed revolutionary changes in all sectors of development and quality of life of people. Achieving self-sufficiency on food front has been one of the finest Indian successes of the post independence era. The food grain production increased four times (from 50.8 million tonnes during 1950-51 to 198.7 million tonnes during 2000-01) since independence as compared to the three-fold increase in population. Further significant advances have also been made in the production of milk, fish, oilseeds, fruits and vegetables. In fisheries, the country has ushered in the blue revolution with gross production reaching 5.6 million metric tonnes offish and edible invertebrates during 2000- 2001. India is the second largest Asian country in terms of culture fisheries and the third largest in terms of capture fisheries (NAAS, 2001). Due to concerted efforts on strategic research and production technology in oilseeds sector, the country witnessed yellow revolution with the production reaching 25 million tonnes per annum. This was possible as a result of strong agricultural research support provided by the National Agricultural Research System (NARS)

COMPARISON OF EFFICACY AND ADVERSE DRUG REACTIONS OF MONOTHERAPY VERSUS COMBINATION THERAPY OF ANTIHYPERTENSIVES AMONG DIABETIC HYPERTENSIVE PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: To compare the efficacy and adverse drug reactions of monotherapy and combination therapy of antihypertensive drugs in diabetic hypertensive patients.Methods: A prospective observational study of 18 months duration was conducted in the Department of Medicine of a tertiary care hospital in South India. A total of 200 patients were included in the study. Using a standard proforma, the details of patients such as demographic data and antihypertensive medications were collected and analyzed for efficacy and safety.Results: Of 200 patients studied, 50% received monotherapy whereas the remaining 50% received combination therapy. There was male preponderance (54%) in the study population, with the mean age being 60.07±11.32 years. In monotherapy group, most commonly prescribed drug was amlodipine (38%), whereas in combination group, angiotensin receptor blocker (ARB) or calcium channel blocker (CCB) + beta blocker (18%) was commonly prescribed among 2-drug group and ARB+ thiazide+ CCB (25.6%) among 3-drug group. Monotherapy and combination therapy were analyzed to be equally efficacious in reducing systolic blood pressure and diastolic blood pressure. Based on the adverse effect profile, monotherapy comparatively produced more adverse effects than combination group. Amlodipine-induced pedal edema (56.7%) was the most common adverse effect observed, and it was predominantly managed by changing it to be a better tolerable CCB, namely cilnidipine.Conclusion: The combination therapy may be a better treatment option in selected patient population.Keywords: Systolic blood pressure, Diastolic blood pressure, Amlodipine, Cilnidipine, Pedal edema

Reaching the unreached: Highlights of Institution Village Linkage Programme of CMFRI

Reaching the unreached: Highlights of Institution Village Linkage Programme of CMFR