Knowledge, attitude and practice regarding use of fixed dose combination drugs among young prescribers a tertiary care teaching hospital in rural Bengal, India

Background: Use of fixed dose combination (FDCs) is a double edged sword with scope for irrational prescribing on one hand and improved pharmacotherapy and patient compliance on the other hand. Irrational FDCs are being marketed aggressively and often young prescribers including Post Graduate Trainees fall prey to the lure of FDCs. This was a Knowledge-Attitude-Practice study regarding of FDC use among the resident doctors working at a tertiary care medical college of rural Bengal.Methods: This was a cross-sectional, questionnaire based study including 50 resident doctors who were asked to fill a 10-question questionnaire on FDCs anonymously.Results: Ninety two percent of the study participants were aware of the FDCs. The most commonly perceived advantages were better patient compliance and synergistic effects. Most (96%) cited problems of titrating dosages and problems of more side effects. Only 37.6% knew about the banned FDCs. Preferred FDCs among them were antibiotics (94%), cough syrups (80%) and NSAIDs (68%). Residents of dermatology, orthopaedics, surgery and medicine most commonly prescribed FDCs. Sources of knowledge regarding FDCs were CME (92%), medical representative (76%), colleagues (72%), internet (68%), journals (48%) and textbooks (36%).Conclusions: The study showed that most participants were aware of the FDCs and also aware of the problems with irrational FDC use. Knowledge regarding banned drugs was poor as was the rationality of such combinations. More CMEs and inter department group discussions could be conducted to improve awareness and FDC prescribing practice among young prescribers

DRUG UTILIZATION STUDY IN A RADIOTHERAPY UNIT OF A TERTIARY CARE TEACHING HOSPITAL IN RURAL WEST BENGAL, INDIA

Objective: Drug utilization studies lay special emphasis on the medical social and economic consequences of use of medications in special settings. This study was undertaken to identify the pattern of drugs prescribed frequently among patients attending the radiotherapy department. Methods: This is a prospective study undertaken between January 1, 2018, and December 31, 2018. Prescriptions and patient records were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Results: We encountered a total of 618 patients during the study period. Among them, 340 (55.01%) were female. The most common age groups presenting were between 21 and 60 years. Carcinoma breast was the most common type encountered (total cases 181, 29.28%), followed by carcinoma lung (total cases 92, 14.88%), carcinoma cervix, hematological malignancies, carcinoma prostate, and carcinoma rectum. Total number of drugs prescribed was 3008 in total 618 prescriptions making it 4.86 drugs per prescription on average. Among them on average per prescription, 2.82 drugs were cytotoxic drugs (1745 total), whereas 2.04 drugs were supportive or adjunct drugs (1263 total). Among the drugs prescribed, 96.24% were in generic names, 6.95% prescriptions contained antibiotics, and 96.44% (596) prescriptions contained injections. About 85.23% of drugs were prescribed from essential drug list. Average consulting was 8.2 min and dispensing time for adjunct drugs was 4 min on average. On average, 52.42% of patients (324) had complete correct knowledge of the dosage and schedule prescribed. Adverse drug reactions were common, out of 618 patients, 542 (87.7%) experienced ADRs most common being gastrointestinal and dermatological ADRs. The most common implicated drug was cisplatin. Six serious adverse events were encountered. Conclusions: This study provides a clear picture of drug use in this special clinic in rural Bengal and paves the way for larger and long-term study

A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases

Perception of second professional undergraduate medical students and teachers about pharmacy practical classes in pharmacology curriculum

Background: The practice and teaching in the MBBS curriculum has changed over the last few decades and most of it caters to the making of the Indian Medical Graduate (IMG) and the first contact physician of the community. The most notable change in pharmacy in modern times has been the virtual disappearance of the preparation and compounding of medicines. Pharmacy practical classes still form a part of the MCI curriculum in Pharmacology undergraduate teaching in many states of India including West Bengal. This study was undertaken to assess the attitude of students as well as teachers towards continuation of these practical classes in the curriculum and possible alternatives.Methods: Second year pharmacology students were included in the study (n=143). Along with this 10 faculty members were provided a structured and pre-tested questionnaire to be answered anonymously.Results: It was seen that 89 percent students and 100 percent faculty members wanted these practical classes to be discontinued. The most popular alternative to these classes were ADR reporting from the faculty members (90%) and demonstration of clinical effects of drugs and dosage calculation (86%) among the students.Conclusions: Given the lessening importance and relevance of the pharmacy practical classes in today’s day to day practice, a change in curriculum and examination system in Pharmacology must be considered

Patient-reported outcomes with medical management of benign prostatic hyperplasia: a prospective study in a tertiary care teaching hospital of rural West Bengal, India

Background: Effectiveness of pharmacotherapy in benign prostatic hyperplasia (BPH) is generally evaluated by clinical measures. Outcome of the treatment from the patient’s perspective however cannot be evaluated which may result communication gap between the patient and the physician. Patient-Reported Outcomes (PRO) studies can bridge this gap. This study was undertaken to evaluate outcomes and to assess the impact of medical management of BPH on general health-related quality of life.Methods: In this prospective, observational study, eligible patients with BPH attending a Urology clinic in a tertiary care rural hospital of West Bengal were enrolled and followed up on third and sixth months from baseline. Symptom assessment of BPH were assessed through International Prostate Symptom Score (I-PSS), BPH Impact Index (BII) and Health Related Quality of life questionnaires. Tools of descriptive statistics were used for analysis of data.Results: In the study population of 66 patients, 50% were treated with monotherapy (alpha blockers) and 50% were treated with combinations (alpha blocker and 5alpha reductase inhibitors). After 6 months of medical management, I-PSS was decreased from 18.86±5.53 to 11.76±3.94 (p <0.001), BII score decreased from 9.65±2.59 to 5.89±2.24 (p <0.001) and VAS score increased from 51.44±10.03 to 54.24±11.38 (p <0.001).Conclusions: We found medical management definitely improved quality of life in BPH patients and significantly decreased symptoms. This study is a step in the direction of development of larger and longer term PRO studies in BPH management

Assessment of drug utilization pattern and rationality of drug use in treatment of dilated cardiomyopathy in a tertiary care teaching hospital of rural Bengal

Background: Dilated cardiomyopathy (DCM) is an important underlying cause of congestive heart failure and/or arrhythmias. The introduction of therapy combining diuretics, digoxin and angiotensin converting enzyme inhibitors (ACEI) has significantly decreased mortality and morbidity. The aim of the study was undertaken to identify the pattern of drugs most commonly prescribed for DCM and to assess the rationality behind such use.Methods: This was a prospective study undertaken between 1st July and 31st August 2015. Prescriptions were reviewed and analyzed using the World Health Organization (WHO) indicators for drug utilization studies. Rationality and cost of therapy per prescription was also evaluated.Results: We encountered 78 patients of DCM in the OPD of Cardiology (prevalence of 4.94%). The average number of drugs per prescription was 6.64. Generic prescriptions were made in 90% encounters. As part of therapy, diuretics and ACE inhibitors or angiotensin receptor blockers, were prescribed in all cases. Our results show a distinctive drug use pattern where beta blockers were used more commonly than digoxin. Other commonly prescribed agents were antiplatelet drugs and statins. Antibiotics were prescribed in 8.7% cases and no injectable drug was prescribed. Average drug cost per encounter was 10.63 INR.Conclusions: To conclude, we found a typical and rational pattern of drug use. Diuretics, ACEI and beta blockers were found to be most commonly used agents. This study provides a clear picture of drug use in this special clinical condition in rural Bengal and paves the way for larger and long term studies

A prospective analysis of adherence to standard treatment guidelines in management of snakebite in a tertiary care teaching hospital of rural Bengal, India

Background: Rural Bengal has one of the highest snakebite prevalence in India. This prospective observational study was initiated with the motive to analyse the effects and adherence to implementation of the new national snakebite protocol 2016.Methods: Data were collected from the patients admitted with snake bite on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 patients arrived in the hospital during the study period out which 53 were male (most in the age group of 31-40 years) and majority of them were farmers (26.6%) or housewives (25%). Maximum of them were bitten in the lower limbs (54.6%) and peak time of bite was between 6 am-12 pm (40%). Most of them reached the hospital late, i.e., beyond 2 hours (70.6%). It was found that there were 26 neurotoxic, 16 hemotoxic and 1 neuro-hemotoxic cases and the rest were non-venomous cases. Fifty-one of them received ASV and 4 died. There was 80% adherence in the indication of ASV administration, 73.3% in the ASV dose, 32% in the monitoring after ASV administration, 94.66% in the monitoring 20 WBCT, 100% in adherence to haemodialysis as indicated.Conclusions: The results showed good adherence in all the parameters. Protocol guided treatment has also resulted in rational use of ASV. So, from this study, it was concluded that protocol guided treatment is effective in snakebite management, but its continuous revision and amendments should be considered in future

A study of prevalence of metabolic syndrome in patients with type 2 diabetes mellitus in a tertiary care referral hospital in West Bengal

Background: The terms "metabolic syndrome", "insulin resistance syndrome" and "syndrome X" are now used specifically to define a constellation of abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease. It is a state of chronic low grade inflammation with the profound systemic effects. Several organisations gave several criteria to diagnose it. Effective preventive approaches include lifestyle changes, primarily weight loss, diet, and exercise, the appropriate use of pharmacological agents to reduce the specific risk factors.Methods: A cross-sectional study was done to evaluate the co-morbidity profile of patients, with metabolic syndrome and correlate clinical manifestations with specific components or metabolic syndrome, at the OPD of Bankura Sammilani Medical College and Hospitals, West Bengal. American Association of Clinical Endocrinologists criteria were chosen for diagnosis.Results: 100 patients were recruited having type II diabetes mellitus. Most of the patients were male between 20-70 years and maximum was on oral hypoglycemic agent with app 40% patient was without any glycemic control. In comorbidities hypertension was highest, followed by coronary artery disease, hypothyroidism and cerebrovascular accident. Waist-hip ratio was highest in female. All of the patients were having some cardiac risk factor assessed by ECG, echocardiography and thread mill test.Conclusions: The data demonstrates that metabolic syndrome is extremely common among diabetic patients. Frequency was much higher in women than men. Obesity is a key element in causing the metabolic syndrome and this factor was also more common in women

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

An observational comparative study of different doses of azilsartan and with chlorthalidone combination in moderate hypertension

Background: High blood pressure (BP) is one of the significant non-communicable diseases that are of high prevalence in our country. Hypertension (HTN) is responsible cause of 57% of stroke and 24% of coronary heart disease deaths in India. Eight classes of medications are currently used in the treatment of hypertension. Azilsartan medoxomil is a newly added FDA approved drug to the ARB class of antihypertensive agents. azilsartan and chlorthalidone combination is also got the FDA approval. There is limited study in between these two groups regarding efficacy especially in rural Bengal.Methods: A prospective observational study was done in medicine OPD of Bankura Sammilani Medical College for twelve weeks with two groups that are azilsartan (80mg) and fixed dose combination of azilsartan (40mg) plus chlorthalidone (12.5mg) in the age group of 18 to 55years of moderate hypertensive patients. Change of heart rate was assessed as safety parameter.Results: It was found that both the group of drugs are very much effective in lowering blood pressure constantly in respect of both systolic and diastolic BP but azilsartan monotherapy in high dose reduce systolic blood pressure slightly high. Significant change of heart rate was not seen with both the groups.Conclusions: Both the group was effective as well as safe in hypertensive patients