Pattern of adverse drug reactions occurring at department of neurology of a tertiary care hospital in India

Background: The objective of the study was to study the pattern and trends of adverse effects of drugs used in department of neurology in a tertiary care hospital.Methods: A prospective, observational study was carried out for a duration of 12 months from November 2018 to October 2019 at Department of Neurology and Department of Pharmacology and Therapeutics, G.S.V.M. Medical College, Kanpur after getting an approval from institutional ethical committee. Data was collected by analyzing OPD prescription slip, treatment charts and investigation reports. All relevant information regarding adverse drug reactions (ADRs) were collected as per norms of Indian Pharmacopoeia commission (IPC).Results: During the study period, a total of 130 ADRs reported. Most of the ADRs were reported due to antiepileptic drugs followed by antiparkinsonian drugs. Dizziness was the most frequent ADR reported. Most of the ADRs were reported due to phenytoin. Other ADRs observed were drowsiness, nausea/vomiting, weakness, joint pain, dyskinesia.Conclusions: Most of the ADRs were due to anti-epileptic drugs. Most of the reactions were of mild severity

Postgraduate pharmacology curriculum in current scenario and future prospects: an educational forum

In India Doctorate of Medicine (MD) pharmacology is primarily knowledge oriented based on teaching, seminars, lectures and research related activities including animals and paper-based experiments and day to day management of undergraduate classes. MD pharmacology student should be competent of both clinical and experimental pharmacology. So, the postgraduate pharmacology curriculum should be competent to meet all the job requirements. Therefore, medical council of India (MCI) has introduced new post graduate curriculum which is based on knowledge, practical, clinical skills, thesis skills, and attitudes including communication and training in research. In India demand for skilled clinical research professionals is increasing day by day for growing pharma industries and good academician. So, there is an urgent need for the experienced and skilled pharmacologist to fulfil the requirements. MD pharmacology students should get posting in different clinical departments and observatory posting in industry, clinical research organization (CRO), regulatory body and research organisations. The course of MD Pharmacology should be like that fulfil all the skills that a pharmacologist must have

Role of free radical scavengers in oral malignancies treated with radiotherapy

Background: Radiotherapy has an important role in treatment of oral cancer, but it causes some deleterious effect on healthy cells. Radiation produces free radicals which cause lipo-peroxidation, alteration of protein, and DNA damage, and eventually cell death. This study is designed to evaluate protective role of antioxidants in oral malignancies treated with radiotherapy.Methods: This study is conducted in patients of oral cancer treated with radiotherapy. Patients were divided into two groups, control (n=7) and test (n=9). Patients in control group treated with radiotherapy alone and in test group were supplemented with oral antioxidants throughout the radiotherapy course. Pre and post radiotherapy levels of MDA, SOD and Glutathione reductase were measured in blood and cancerous tissue in both groups and statistically compared. TNM staging before and after radiotherapy and side effects of radiotherapy were also compared in both groups.Results: On statistical comparison of mean difference values of MDA, SOD & GR of control v/s test group, it was noticed that there was a significant reduction in MDA (p0.05) in test group in comparison to control group for both blood and tissue levels. TNM status of patients improved significantly after radiotherapy in test group. Comparison of side effects between both groups indicated that there was reduction in side effects in test group after radiotherapy.Conclusion: These findings indicated the protective role of antioxidants against free radicals produced in oral malignancies treated with radiotherapy

A cross sectional study to assess pharmacotherapeutic adherence among diabetes mellitus patients in tertiary care hospital

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that associated with abnormalities in carbohydrate, fat, and protein metabolism which results in chronic complications. Attainment of optimal blood sugar level is generally based on appropriate usage and proper adherence to prescribed medications. The study was, therefore, aimed to assess adherence to oral antidiabetic drugs among diabetic patients attending outpatient clinic of L. L. R. Hospital, G.S.V.M. Medical College, Kanpur, U.P.Methods: Hospital based cross-sectional study design was conducted from April 2017 to June 2018. The data was collected by interviewing T2DM patients receiving antidiabetic medications using Morisky’s four item adherence assessment questionnaire. The collected data was processed and analyzed with SPSS version 20.Results: From the 126 patients of diabetes, when asked about adherence to their medications as per the Morisky's four item method, 114 (90.47%) of them did not forget to take the drugs, 108 (85.71%) of patients reported that they had been being careful in taking their medications, 90 (71.42%) patients did not stop medications when they felt better and the other 108 (85.71%) patients reported that they did not stop medications when they felt worse while taking medications. This study shows that 54 (42.86%) respondents were adherent to their medications.Conclusions: This study revealed a moderate level of adherence among the participants and statistically significantly depended upon their socioeconomic status. Efforts are needed to increase the medication adherence of these patients’, so they can realize the full advantage of prescribed therapies

ASSESSMENT OF ADVERSE DRUG REACTIONS OF ANTIDEPRESSANT DRUGS USED IN PSYCHIATRY DEPARTMENT OF A TERTIARY CARE HOSPITAL

Objective: The aim of the study was to analyze adverse drug reactions (ADRs) reported in patients prescribed antidepressants at tertiary care hospital. Methods: A prospective and observational study was conducted during January 2020–July 2021 at Department of Pharmacology in collaboration with the Department of Psychiatry, GSVM Medical College, and Kanpur. All patients diagnosed with depression and receiving pharmacotherapy were included in the study. ADRs were monitored using the standard form of the Central Drugs Standard Control Organization and causality was determined using the Naranjo algorithm. Data were evaluated for patient’s demography, risk factors for ADRs, and pattern of ADR. Results: A total of 293 ADRs were recorded from 110 patients. The most common ADRs observed were anxiety (47.42%) and insomnia (19.22%). Men (58.18%) were most commonly affected than women (41.82%). The most common causal drugs among antidepressants were Escitalopram (27.27%) and Venlafaxine (21.81%), respectively. The most common system involved was central nervous system (53.24%) followed by gastrointestinal system (41.63%). The majority of ADRs (97.95%) were possible according to the Naranjo’s scale. Conclusion: Anxiety, insomnia, and dizziness were the common ADRs which were associated with the use of antidepressants. This study offers a representative profile of the ADRs which can be expected in the psychiatry outpatients

Questionnaire-based assessment on knowledge, attitude and practice of fixed-dose combination in medical undergraduates of a tertiary care teaching hospital, Kanpur

Background: Aim was to assess knowledge, attitude and practice of second-year medical undergraduates towards FDC. Methods: A cross-sectional questionnaire-based study was conducted among second-year medical undergraduates of GSVM, medical college, Kanpur in the form of a pre-test, and after sensitizing the students about FDC, the same questionnaire was given as a post-test. Results: A total of 251 students, 157 students participated in the pre-test and 140 participated in the post-test. The percentage of male students in pre and post-test were more (58% and 61.4%) compared to female students (42% and 38.6%). After conducting a post-test survey, there is a significant improvement in knowledge and attitude toward FDC. Conclusions: The inclusion of FDC in the undergraduate curriculum is a good initiative by NMC but there is a need to conduct more CME, symposiums, and workshops in medical colleges to update the knowledge regarding FDC among medical undergraduates.

Effect of Sertraline on biomarker alterations in patients of multidrug resistant tuberculosis with depression: a prospective clinical trial

Background: Lipid profile parameters may be used as biomarker for depression. Sertraline belongs to selective serotonin reuptake inhibitors (SSRIs), the most commonly used group to treat the depression in multidrug resistant tuberculosis patients.Methods: A prospective clinical trial was carried out in department of Psychiatry and department of Tuberculosis and Respiratory disease G.S.V.M. Medical College, Kanpur. Diagnosed MDR TB patients were screened for depression applying Hamilton Depression Rating Scale (HDRS) and these patients were referred to Psychiatrist for diagnosis of depression. Total 25 diagnosed patients of MDR TB with mild to moderate depression were selected. HDRS Score and morning blood sample of 5ml were collected to analyze biomarker for depression before intervention. Same test was repeated in 18 patients who completed the study at day 30 and 120 after administering Sertraline (50mg). Data were compiled and analyzed using SPSS 20.0 and paired t - test.Results: The mean decrease in HDRS score from base line at day 30 and 120 of administering Sertraline were 6.22 (±1.26) and 2.72 (±0.67) which were significant (p˂0.001). The mean increase in serum cholesterol at day 30 was 153.94 (±19.31) and at day 120 was 157.83 (±19.36) which were significant (p˂0.001). Rest of Tg, HDLc, LDLc and VLDL cholesterole levels were not increased significantly.Conclusions: As the depression symptoms improved by sertraline. The biomarkers of depression were also increased (within the normal range) from baseline but significant increase was observed in serum cholesterol only

DRUG PRESCRIBING PATTERN OF VARIOUS ANTIFUNGAL DRUGS FOR DERMATOPHYTOSIS IN A TERTIARY HEALTHCARE AND TEACHING HOSPITAL

Objective: To analyze the pattern of drug prescription and the rationality of pharmacotherapy used in dermatophytosis. Methods: A prospective observational study was conducted from January 2021 to June 2022 in the Department of Skin and Venereal Diseases. Prescriptions included all newly diagnosed patients with cutaneous fungal infections of both genders who attended Dermatology OPD. Factors considered were sociodemographic parameters, clinical manifestations, combination and monotherapy along with prescribed topical and systemic agents, and details of prescribing indicators. Results: A total of 362 dermatophytosis cases were observed which included 230 males and 132 females. Patients in the age group of 13-40 years (65.47%) have shown the dominance of dermatophytosis infection with a high prevalence among the student category which accounts for 177. Tinea corporis (40.85%) was the prominent clinical manifestation of dermatophytosis infection. Among single topical agents, the most commonly prescribed drug is Clotrimazole (15.19%), and among topical combinations sertaconazole and ketoconazole (29.28%). Itraconazole (48.75%) is the most commonly used oral formulation followed by the itraconazole and terbinafine combination (22.56%). While imidazoles were the maximally prescribed topical antifungals according to the therapeutic class. Conclusion: Tinea corporis is the prominent clinical manifestation and the majority of prescriptions were for a combination of three agents mainly oral itraconazole with topical sertaconazole, and ketoconazole

A CROSS-SECTIONAL STUDY TO ASSESS THE PHARMACOTHERAPEUTIC ADHERENCE IN PATIENTS ATTENDING THE OUTPATIENT DEPARTMENT OF RESPIRATORY MEDICINE IN A TERTIARY CARE HOSPITAL

Objective: Nonadherence to anti-TB treatment may result in the emergence of multidrug-resistant TB, prolonged infectiousness, and poor tuberculosis treatment outcomes. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to Bronchial Asthma therapy. The objective of the study was to determine respiratory disease medication adherence in India. Methods: Hospital-based cross-sectional study design was conducted from Feb 2020 to July 2021. The data was collected by interviewing respiratory patients receiving Tuberculosis and Bronchial Asthma medications using Morisky’s four-item scale questionnaire. The data were analyzed with a chi-square test. Results: From the total 203 patients of respiratory diseases, of which 180 tuberculosis patients, when asked about adherence to their medications: 128 (71.11%) of them did not forget to take the drugs, 130 (72.22%) of patients reported that they had been being careful in taking their medications, 140 (77.77%), 130 (72.22%) patients did not stop medications when they felt better and when they felt worse while taking medications respectively while in 23 patients of bronchial asthma, when asked about adherence to their medications: 14 (60.86%) of them did not forget to take the drugs, 9 (39.13%) of patients reported that they had been being careful in taking their medications, 8 (34.78%), 11(47.82%) patients did not stop medications when they felt better and when they felt worse while taking medications respectively. Conclusion: This study revealed that 77.83% of patients were adherent while 22.16% of patients were non-adherent to the medication, of which total adherence in Tuberculosis patients was 85.52% while in Bronchial asthma patients, it was 34.78%

TO EVALUATE THE MAGNITUDE OF DEPRESSION IN MULTI DRUG RESISTANT TUBERCULOSIS PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL

Objective: To evaluate the Magnitude of Depression in Multi drug resistant tuberculosis Patients in a tertiary care teaching hospital. Method:  An observational study was carried out in department of Psychiatry and department of Tuberculosis and Respiratory disease G.S.V.M. Medical College, Kanpur for a period of 9 month. The diagnosed MDR-TB patients coming to in-patient and out-patient department of tuberculosis and respiratory disease taking RNTCP regimen (Category IV) for MDR-TB will be screened for depression applying Hamilton Depression Rating Scale (HDRs) score and those patients who showed depression in screening will further send to psychiatry department for the final diagnosis of depression. We also categorized the patients into mild, moderate and severe depression according to Hamilton Depression Rating Scale (HDRs) score. Data was tabulated in Microsoft excel sheet. All categorical variables were analyzed using percentage. Results: We screened 148 MDR TB patients who were taking drug for MDRTB. The average duration of treatment were 5.19 Month.  Out of 148 patients, 56 (37.84%) patients were found to be suffering from depression. Out of 56 Depressed MDR TB Patients 35 (62.5%) were male and 21 (37.5%) were female patients and 26(46.43%) were mild (HDRS Score-8 to 13), 28 (50%) were moderate (HDRS Score-14 to 18) and 2 (3.57%) were severely depressed (HDRS Score-19 to 20). Conclusion: The magnitude of depression in MDR TB Patients taking RNTCP regimen (Category IV) for MDR TB were 37.84 % and out of these patients, 46.43% were mild, 50% were moderate and 3.57% were severely depressed