Pharmacoeconomic analysis of drugs used for peptic ulcer in India

Background: Acid peptic disorders are common medical problems in daily clinical practice leading to a significant economic burden on healthcare expenses. Due to lack of information on comparative drug prices and quality, it becomes difficult for physicians to prescribe the most economical treatment. So the present study was planned to analyse the price variations of various anti-ulcer drugs available in India.Methods: The cost of a particular anti-ulcer drug being manufactured by different companies, in the same dose and dosage forms, was obtained from latest issue of ‘‘current index of medical specialties’’ January to April, 2016. The difference between the maximum and minimum prices of same drug was analysed and percentage variation in the prices was calculated.Results: Overall, the prices of a total of 12 anti-ulcer drugs belonging to four different categories available in 38 different formulations were analysed.  Among the proton pump inhibitors, pantoprazole (40 mg; EC tablet) showed the maximum price variation of 500.75%. With regard to H2 blockers, ranitidine (50 mg; injection) showed the maximum price variation of 989.92%. The maximum price variation among various formulations of ulcer protective was seen with sucralfate (1000 mg; tablet) of 166.00% while misoprostol (200µg; tablet) was the only drug present in prostaglandin analogues and it showed a price variability of 14.33%.Conclusions: The average percentage variations of different brands of the same anti-ulcer drugs in same dose and dosage form manufactured in India were very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-ulcer drugs and thereby minimizing the economic burden on the patients

A prospective study of prescribing pattern of drugs among in-patients of gynaecology department in a tertiary care teaching hospital in South India

Background: Analysis of prescribing pattern can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs. Even though drugs used for gynaecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyse the prescribing pattern of drugs among in-patients of gynaecology department in our institute.Methods: A prospective observational study was carried out in a total of 162 in-patients of department of gynaecology in our institute for a period of one year. Along with baseline demographic data, the total number and categories of drugs prescribed, percentage of individual drugs in each category, their dosage forms, percentage of drugs prescribed by generic name and drugs prescribed from essential drug list were analysed.Results: Overall a total of 1647 drugs were prescribed. Antimicrobial agents (35.76%), vitamin and mineral preparations (28.29%) and anti-ulcer drugs (10.32%) were the top three categories of drugs prescribed in our study. Metronidazole (27.34%) was the most commonly prescribed antimicrobial drug whereas ferrous sulphate (31.97%) was the highest prescribed vitamin and mineral preparation. Among the anti-ulcer drugs, ranitidine (89.42%) was the most frequently prescribed drug. Most commonly used analgesic was diclofenac (59.05%), antiemetic was ondansetron (77.92%) and intravenous fluid was ringer lactate (37.03%). Tablet was the most common dosage form (38.01%) followed closely by injection (33.27%). The percentage of drugs prescribed by generic name was 26.17% and from essential drug list was 84.86%.Conclusions: Antimicrobial agents and vitamins and mineral preparations were the most commonly prescribed drugs. Usage of injections should be reduced as they were relatively more commonly prescribed in our study. Prescription of drugs by generic names must be increased substantially to reduce the economic burden on patients

Loop diuretic-induced hyponatremia: a case report

Hyponatremia is the most common encountered electrolyte abnormality where the serum sodium concentration is <136 mEq/L. The most common causes are either the concurrent illnesses or the medications. Diuretics top the list of drugs inducing hyponatremia and this occurs more frequent within 2 weeks of initiating therapy. Though thiazide diuretics are frequently the culprits of inducing hyponatremia, the role by/risk with loop diuretics cannot be ignored. Prompt diagnosis and management of hyponatremia needs a sound knowledge with which permanent neurologic sequelae and morbidity could be prevented. Here, we report a case of hyponatremia induced by loop diuretic and spironolactone combination, where the presenting complaints of the patient were only intractable nausea and altered taste. The patient was successfully managed with hypertonic saline and the vasopressin receptor antagonist, tolvaptan, which belongs to a new class of drugs called aquaretics

Middleware Layer Reliability Assessment in Multi Cloud Computing System

Enterprises are majorly adopting cloud computing which offers a large pool of services to users. But the capability of cloud computing is limited and some enterprises often require various cloud centers to integrate in order to deliver services to business users. So Multi Cloud Computing System (MCCS) provides integrated services across multiple autonomous clouds. Based on the dynamic parameterization of Virtual Machines (VM) an MCCS platform can build effectively. Thus multiple VMs can collaborate to provide as service with a transparent manner, facilitates a scalable environment, allocate resources dynamically and supports unlimited computing and storage service capabilities. Thus VM plays an important role in MCCS. This paper focuses on middleware layer and proposes framework for reliability assessment mechanism of middleware layer of MCCS

Prevalence, severity, causes and drugs used for depression, stress and anxiety among junior doctors in a tertiary care teaching hospital in South India

Background: Due to various reasons, junior doctors experience high level of stress in their workplace. However, very few studies have been done to analyze the stress levels and pertinent causative factors among junior doctors in India. So the present study was done to investigate the prevalence, severity and causes of depression, stress and anxiety among junior doctors along with the drugs used to mitigate them.Methods: A cross sectional, questionnaire based study was conducted on a total of 114 junior doctors who include 80 interns and 34 post graduates belonging to  2013-14 batch, utilizing the 21-item depression, anxiety and stress scale (DASS 21). A personal interview was also conducted to enquire into the causes responsible for the stress and the medications employed by them to overcome it.Results: Among the interns, the mean depression score was 5.64±3.85, mean anxiety score was 6.69±3.86 and mean stress score was 7.33±3.22. Among the post graduates, the mean depression score was 4.73±2.15, mean anxiety score was 5.18±3.19 and mean stress score was 7.82±2.68. The percentage of junior doctors who had severe or extremely severe scores of depression was 11.40%, anxiety was 40.35% and stress was 9.65%. Alcohol was the most commonly used psychotropic drug (60.87%). Frequent calls during night duties and late working hours were the leading causes for stress among junior doctors.Conclusions: Overall higher stress was observed among post graduates compared to interns and females compared to males. Anxiety was more severe compared to depression and stress among junior doctors. Reducing working hours and increasing workplace flexibility are some measures to reduce stress among the junior doctors

Indacaterol and salmeterol in COPD patients: a comparative study of efficacy and safety

Background: Chronic obstructive pulmonary disease (COPD) is an airway disorder characterized by airflow limitation that is not fully reversible. Indacaterol is a novel, inhaled, once-daily, ultra-long-acting β2-agonist bronchodilator recently approved in India for the treatment of chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the efficacy and safety of indacaterol compared to twice-daily β2-agonist, salmeterol, as an active control. Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a 12 week period. A total of 60 patients with moderate-to-severe COPD were randomised to treatment either with indacaterol (150 μg once daily) or with salmeterol (50 μg twice daily) and 51 (85%) patients completed the study. The efficacy parameters were change in FEV1, health related quality of life by measuring St George’s Respiratory Questionnaire (SGRQ) total score and severity of dyspnoea as measured by Transition Dyspnoea Index (TDI) score which were assessed at baseline first and at weeks 4, 8 and 12. Results: Indacaterol increased FEV1 at week 4 by 50 ml, at week 8 and at week 12 by 60 ml over salmeterol and the increase was highly significant (p<0.001) at all stages of the study. Both treatments improved health status (SGRQ total score) and dyspnoea (TDI score), with differences between them favouring indacaterol. Safety profiles were similar across the treatment groups, and both indacaterol and salmeterol were well tolerated without any severe adverse events. Conclusions: Once-daily treatment with 150 μg indacaterol had a significant and clinically relevant bronchodilator effect and improved health status and dyspnoea to a greater extent than twice-daily 50 μg salmeterol. Indacaterol should prove a useful addition in the treatment of patients with COPD

Success Indicators of Initial Coin Offerings

In a big data day and age, there is an abundance of information and we now have the tools to understand it with data mining and machine learning algorithms. With the rise and fall and rise again of Bitcoin, the finance industry and society itself is caught in between. There are many factors that an investor considers when choosing to invest in a particular coin and understanding those factors can allow the investor to make a more informed decision. Data on how an initial coin offering is presented on the rating platform, ICOBench, was collected and analyzed using the random forest classifier. This resulted in a prediction model regarding the success of a coin in terms of average rating and number of ratings to determine what factors hold the most influence

A STUDY ON PRESCRIBING PATTERN OF ANTIMICROBIAL AGENTS IN THE NEONATAL INTENSIVE CARE UNIT OF A TERTIARY CARE TEACHING HOSPITAL IN PUDUCHERRY, SOUTH INDIA

Objective: This study was done to evaluate the current prescribing and usage pattern of antimicrobial agents (AMAs) in the neonatal intensive careunit (NICU).Methods: A prospective, hospital-based, cross-sectional study (prescription audit) was carried out between May and August 2012 in the NICU of aTeaching Hospital. Data were collected by reviewing case records of all neonates admitted to the NICU during the study period.Results: A total of 120 case records were reviewed and 100 were eligible to be included in the study. Out of the 100, no antimicrobial prescriptionwas made in 35 case records. Remaining 65 (65%) were prescribed at least one AMA. 167 AMA prescriptions were made in total and averagenumber of AMAs utilized per neonate was 1.670. Cefotaxime (24.6%) was the most commonly prescribed AMA followed by amoxicillin (23.4%).Aminoglycosides (43.7%) were the commonly prescribed group of AMAs followed by penicillins (28.7) and cephalosporins (24.6%). Most of the AMAswere prescribed to non-bacteriologically proven infections (50.5%). Among the 167 AMA prescriptions, 104 (62.28%) were made in their brandnames and 63(37.72%) were made in their generic names. Discussion and Conclusion: This study highlights current usage of AMAs in the NICU of a tertiary care teaching hospital in Puducherry. AMAs were found to be prescribed frequently without bacteriological evidence and in their brand names. This necessitates the need for motivating doctors to improve AMA prescriptions with supportive bacteriological evidence and in generic names.Keywords: Antimicrobial agents, Neonatal intensive care unit, Generic drugs, Non-bacteriologically proven infections

Comparative study of wound healing effect of topical Acacia catechu extract and silver sulfadiazine on excisional wound model in guinea pigs

Background: Impaired and aberrant wound healing imposes a huge financial burden and places an enormous drain in health care resources in the developed world and an insurmountable problem in the developing countries too. In this study, authors have compared the wound healing effect of topical application of Acacia catechu extract with silver sulfadiazine in excisional wound model in guinea pigs.Methods: Twelve guinea pigs were randomly divided into two groups (n=6). The wound healing was observed in excision model. The standard group is treated with silver sulfadiazine (group 1) and the test group with Acacia catechu extract (group 2). The mean wound size expressed in mm2 and the mean percentage of the wound healed was measured on day 0, 4, 8, 12, 16 and 19. Biopsy was done on day 21 for histopathological examination (HPE).Results: Statistical analysis was done by using unpaired t test for between the groups comparison and by using paired t test for within the group comparison. The mean percentage of the wound healed with-in the groups was found to be statistically highly significant (p value 0.05). A comparable increase in collagen content and granulation tissue was found on HPE in both the groups on day 21.Conclusions: Wound healing effect of the Acacia catechu extract is equal to and comparable with that of silver sulfadiazine

Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute.Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed.Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation.Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription