Pattern of use of anti-hypertensive drugs amongst hypertensive patients in a tertiary care hospital: a cross sectional, observational study

Background: Hypertension is one of the primary modifiable risk factors for cardiac and renal diseases and is the single most important risk factor for stroke. Despite different guidelines for management of hypertension like Joint National Committee, British Hypertension Society, National Institute for Health and Care Excellence; there are still the clouds of controversy. The objective of the study was to evaluate the prescribing pattern of antihypertensive drugs among the patients attending medicine outpatient department of a tertiary care teaching hospitalMethods: A cross-sectional, observational study was conducted in our hospital over a period of six months. Relevant information was collected from medical records of 209 hypertensive patients fulfilling inclusion criteria. The collected data were sorted and analyzed.Results: Out of 209 patients, maximum were of age group of 45-65 years (55.02%). 115 (55.02%) were male and 94 (44.97%) were female. Diabetes mellitus (24.4%) was the most common associated disease with hypertension. Most of the patients had received single antihypertensive drugs (49.28%). Among the monotherapy category calcium channel blocker (82.78%) was the most commonly prescribed antihypertensive drug class followed by angiotensin receptor blocker (36.36%). Amlodipine (81.82%) was the most common among calcium channel blockers. The most frequent fixed drug combination prescribed consisted of amlodipine and atenolol. Most of the drugs were prescribed in generic name (90.9%).Conclusions: The treatment pattern, in general, conformed to standard treatment guidelines

Drug utilization study in patients with type 2 diabetes mellitus attending diabetes clinic of a tertiary care hospital in rural Bengal

Background: Diabetes mellitus (DM) is a common and important health problem affecting the citizens of developed as well as developing nations. Not only does it require long term therapy, it is also crippling in terms of cost of management. Drug utilization studies help to determine rational drug use especially in poorer and rural populations. The objective of this study was to evaluate drug utilization pattern in type-2 diabetes patients in a diabetic clinic of a tertiary care teaching hospital in rural Bengal.Methods: This was a prospective observational study including 181 patients for a period of 6 months in Bankura Sammilani Medical College. Patients diagnosed as type 2 diabetes mellitus were included in the study. The demographic data, disease data and utilization of different classes of oral hypoglycaemic agents and insulin as well as other individual drugs were analysed using the World Health Organization (WHO) indicators for drug utilization studies.Results: The study population was predominantly male (61.33%) and nearly a third (30.9%) belonged to the age group of 50-59 years. Co-morbid conditions were found in 74% patients, among which hypertension (51.1%) was the most common co-morbid condition. The average number of drugs per prescription was 4.22 and the average number of antidiabetic drugs per prescription was 2.18. Metformin was the most commonly prescribed drug (79.6%), followed by sulfonylurea class of drugs (66.9%). Nearly 17.7% patients were on insulin preparations. Glimepiride and metformin was the most common combinations used (45.5%). Antibiotics were included in 15.5% prescriptions and proton pump inhibitors were prescribed in 32% cases. All the medicines were prescribed as generics and injections were prescribed in 17.7% cases.Conclusions: This study gives a picture of the pattern of drug use among diabetes patients in our set up. While metformin was the commonest drug used, glimepiride and metformin combination was the commonest combination therapy

Comparative efficacy of inhaled ciclesonide, budesonide, and fluticasone in mild to moderately persistent bronchial asthma

Background: Bronchodilators and glucocorticoids have been proven to be very effective and safe in asthma treatment, which recommend the use of steroids and β2-agonist (long or short acting) as the first line of treatment in of asthma. This study was aimed to compare the efficacy of three different inhaled corticosteroids ciclesonide, budesonide, and fluticasone in bronchial asthma.Methods: A total of 30 patients with mild to moderately persistent bronchial asthma was selected as per the NAEPP classification in the expert panel report (EPR) update 2002, NHLBL USA 2003. They were randomly divided into 3 groups of 10 patients each, and they were given 3 different steroid inhalers (ciclesonide or budesonide or fluticasone). Baseline and post-therapy spirometry were performed on day 1 and after 2 months and 6 months of treatment. Data were analyzed using SPSS software.Results: It was observed that most of the cases (43.3%) were between 26 and 35 years of age with female preponderance (56.6%). Significant symptomatic improvement was observed in all 3 groups. The percentage of improvement in mean peak expiratory flow rate was 17%, 18%, and 18% in ciclesonide, budesonide, and fluticasone group, respectively. The percentage improvement of forced expiratory volume in 1 second (FEV1)/forced vital capacity after bronchodilatation was 18%, 18%, and 19% in ciclesonide, budesonide, and fluticasone group, respectively. The improvement in mean FEV1% predicted was 20%, 19%, and 21% in three groups, respectively.Conclusion: Steroid therapy along with β2-agonists showed a significant improvement in symptoms. There was no difference among the three different types of steroids

Comparative study on efficacy and safety of morning dose versus evening dose of levothyroxine in treatment of hypothyroidism: an outpatient department based prospective interventional study

Background: One of the common endocrine disorders in India as well as in the world is hypothyroidism. The treatment of choice is giving levothyroxine supplement orally to the patient in an empty stomach mostly in the morning. Often many patients feel uncomfortable or inconvenient to take levothyroxine in the early morning. In those patients changing the administration time of levothyroxine may get necessary to increase the patient compliance.Methods: Drug naïve patients with primary hypothyroidism, randomly selected and assigned into two groups. Patients in group 1 received levothyroxine in the morning minimum one hour before breakfast and in group 2 levothyroxine was given at least two hours after dinner. Thyroid profile of the subjects was assessed at the baseline and reassessed after 8 and 24 weeks and compared with the baseline values.Results: After 24 weeks we found significant differences in the thyroid profile of the subjects between two groups. Serum thyroid stimulating hormone (TSH) was found to be 8.70 ± 3.3 in the morning group and 7.0 ± 2.3 in the evening group. TSH levels in the subjects taking the evening dose got closer to the therapeutic target range earlier than the ones taking the drug in the morning.Conclusions: Levothyroxine intake at bedtime can be a good alternative to levothyroxine intake in the morning for the patients taking concomitant medications

Role of vitamin D3 supplementation in allergic rhinitis: an outpatient department based prospective analytical observational study

Background: Allergic rhinitis is a common disorder characterized by sneezing, rhinorrhoea, nasal congestion, itching and lacrimation which adversely affect quality of life to a substantial degree. Evidence suggests that low serum vitamin D3 has correlation with severity of allergic rhinitis. The objective of the study was to evaluate whether vitamin D3 supplementation has any role to reduce the severity of disease spectrum among allergic rhinitis patients.Methods: This prospective analytical observational study was carried out in 6 months in ENT OPD of Midnapore medical college and Hospital. Only the persistent moderate to severe allergic rhinitis patients as per ARIA-WHO guideline, aged >12 years were included in this study. 64 subjects were randomised into two groups. The test group received oral vitamin D (60000 IU/week for 2 months) along with levocetirizine, fluticasone spray and montelukast while the control group received three drug therapies without vitamin D3. Allergy symptom score (ASS) was assessed at the start and end of the study period.Results: The study population (n=64) was predominantly female (37) and had a mean age of 39.79 years. The ASS score was 14.06±1.01 in Test group and 13.93±1.01 in Control group and the Post treatment ASS score was 2.65±1.12 and 6.06±0.87 respectively. This difference between groups was significant (p<0.001).Conclusions: There was significant reduction in the Allergy symptom score after vitamin D3 supplementation which alters the course of disease towards clinical improvement

Immunogenic Modulations Induced by Prospective Anti-Malarial Herbal Extracts in Murine Model

Keeping in view the ever increasing problem of drug resistance and affordability of the antimalarial drugs by the poor mass, herbal medicines can become an important and alternative sustainable strategy for malaria treatment. Aqueous extracts of three Himalayan herbs― _Equisetum ravense_, _Artemisia vulgaris_ and _Centella asiatica_, with reported antimalarial property were screened for clinical efficacy against a local strain of _Plasmodium vivax_ antigen in murine model. _E. arvense_ extract was consistent in boosting phagocytic activity, nitric oxide generation, acid phosphatase and alkaline phosphatase activities in the peritoneal macrophages. The effectiveness of the rest herbals was discrete. A need for further detailed investigation to evaluate the clinical efficacy of these herbals seems essential