Drug utilization study of anti-hypertensive drugs at a tertiary care hospital

Background: The increasing prevalence of hypertension influence the prescribing patterns of antihypertensive drug. Prescribing against evidence-based guidelines in hypertension treatment leads to the increase cost of medications and problems in providing affordable prescriptions to population. The aim of present study was to analyse anti-hypertensive prescribing pattern in Government Medical College and Hospital, Aurangabad, Maharashtra, India.Methods: Study was prospective, observational, open label and descriptive clinical study. It included 336 patients admitted in MICU during January 2018 to June 2019 fulfilling inclusion criteria.Results: 54.46% patients were between 51-70 years of age, followed by 33.63% in 31 to 50 age group. Of total enrolled hypertensive patients 69% patients had various comorbidities. Drug prescribed was 28.27% ARBs, 26.84% CCBs, 17.62% beta blockers, 6.14% high ceiling diuretics, 4.50% ACE inhibitors, 2.45% thiazide diuretics and 2.04% received alpha blocker. As monotherapy, 31.82% patients received telmisartan as most commonly prescribed drug followed by 27.31% patients received Amlodipine followed by other drugs. In combination therapy telmisartan and hydrochlorothiazide was prescribed most commonly followed by beta blocker and CCB and ARB and CCB. 33.60% of drugs were prescribed in generic names while 66.39% of drugs prescribed in brand names. Average number of drugs prescribed per prescription was 1.45 of which 33.60% of drugs were prescribed by generic names.Conclusions: With average number of drugs per prescription in hypertension 1.45, the study showed that poly pharmacy is unavoidable in hypertension due to associated comorbid conditions

To study the prescription pattern of antibiotics in medicine intensive care unit at tertiary care hospital

Background: Drug utilization studies are crucial and create a positive awareness about proper use of drugs. Analysing the pattern of prescriptions is important in the settings of intensive care units where patients receive multiple antibiotics. The objective of this study was to analyse the use of antibiotics in a Medicine Intensive Care Unit (MICU) of Government Medical College and Hospital, Aurangabad, Maharashtra, India, a tertiary health care centre.Methods: Total 988 number of patients admitted in MICU from January 2017 to June 2018 were enrolled in the study and fulfilling inclusion criteria. Demographic details, disease state and prescription of antibiotic was recorded.Results: Out of 988, n=700 patients received antibiotics. Most common diseases for which patients were admitted in MICU included OP poisoning (24.86%), snake bite (15.14%), bilateral pneumonitis (12.71%), HELLP syndrome (12.14%), and the least common conditions were chronic obstructive pulmonary disease (COPD), meningitis, sepsis with multiple organ dysfunction syndrome (MODS), Guillen barre syndrome (GBS), lung abscess etc., Most common single antibiotic used in the studied cases was ceftriaxone (21.42%) followed by either alone or in combination piperacillin and tazobactam (12.04%), metronidazole (11.85%) etc.Conclusions: Total 700 patients received systemic antibiotics in present study bringing the incidence of systemic antibiotics use in MICU to be 70.85%. Ceftriaxone and combination of piperacillin and tazobactam are most commonly used antibiotics in MICU of the hospital. All patients admitted in this MICU received antibiotics as per the standard protocols of the hospital

Profile of highly active antiretroviral therapy failure human immunodeficiency virus patients at a tertiary health care centre of India: a success story of NACP

Background: Although HAART has successfully controlled the progression of HIV and helped to prevent the disease significantly, new challenges are heading up and ART failure despite of good adherence is becoming a major hurdle in the way of HIV control. Considering these facts present study was planned with an objective to study clinical and immunological profile of antiretroviral therapy failure HIV patients.Methods: This observational study was conducted at ART plus centre of one of the tertiary health care centre of India from February 2018 to September 2019. Patients satisfying inclusion and exclusion criteria were interviewed by using semi-structured questionnaire and were examined and investigated for any opportunistic infections and their CD4 counts were studied.Results: Among total 4098 patients alive on ART at present study centre 90.6% were responding well to the 1st line of ART, while 8.7% had failed to 1st line of ART but responding well to the 2nd line whereas 0.7% had failed to 2nd line and were initiated on 3rd line of ART. Failure of ART was the cause for change in regimen among 84.9% of patients. Median of rise in CD4 count at 6 months from switch to 2nd line was 137 cells/mm3.Conclusions: Antiretroviral therapy has significantly improved outcome of the disease. Failure of ART is the major cause for change in ART regimen. Majority of patients in failure had WHO clinical stage 1 and 2

An observational study to compare adenosine deaminase level among diabetes patients

Background: Obesity is a complex disorder that involves some degree of over-consumption1 coupled with a metabolic derangement. As ADA has been putatively associated with inflammation, and adipose tissue inflammation is the hallmark of insulin resistance in obese T2DM patients. This study attempted to compare serum ADA in T2DM subjects.Methods: This observational cross-sectional study was conducted in the Department of Biochemistry at MGM Medical College and MY Hospital. All the patients and controls were clinically examined, and routine biochemical tests were analyzed for all subjects. ANOVA has been applied to assess the variance between groups.Results: Mean age of controls was 56.91 years where as mean age in the group of a subject with Obesity with diabetes was 40.91 years and with Obesity without diabetes was 48.10 years. ADA level was more among diabetes patients having obesity than diabetes patients having no obesity and controls.Conclusions: This is very much evident through this study that ADA may be treated as prognostic predictor of diabetes either linked to obesity or not, though more studies are warranted in same direction to make this finding conclusive and acceptable biochemical evidence

Overlap syndrome of systemic lupus erythematosus and rheumatoid arthritis (“rhupus”) with systemic involvement – A rare case report

A 43 year old female, known hypothyroidism, presented with chest pain, breathlessness, without fever or rash, since 15 days. She had multiple joint pains since 11 months. Distal interphalyngeal joints were spared. She had hand deformities and tenderness in the metacarpophalyngeal and proximal interphalyngeal joints of all 10 fingers and both hips and knees. 2D-echo showed Pulmonary Hypertension. High resolution computed tomography of thorax showed non-specific interstitial pneumonia. She had anemia, raised C - reactive protein, positive indirect Coomb’s test. Her Anti-Nuclear antibody, rheumatoid factor, anti-Sm, anti-Sm/RNP and anti-Ro antibodies were positive. Her anti-Citrullinated peptide antibody was negative. As she satisfied the diagnostic criteria for both lupus and rheumatoid arthritis, she was diagnosed as a case of rhupus syndrome. She was treated with pulse injectable methylprednisolone for 3 days and then shifted to oral prednisone, along with hydroxychloroquine, oral methotrexate, sildenafil, pirfenidone and torsemide-spironolactone

'The stars seem aligned': a qualitative study to understand the effects of context on scale-up of maternal and newborn health innovations in Ethiopia, India and Nigeria.

BACKGROUND: Donors commonly fund innovative interventions to improve health in the hope that governments of low and middle-income countries will scale-up those that are shown to be effective. Yet innovations can be slow to be adopted by country governments and implemented at scale. Our study explores this problem by identifying key contextual factors influencing scale-up of maternal and newborn health innovations in three low-income settings: Ethiopia, the six states of northeast Nigeria and Uttar Pradesh state in India. METHODS: We conducted 150 semi-structured interviews in 2012/13 with stakeholders from government, development partner agencies, externally funded implementers including civil society organisations, academic institutions and professional associations to understand scale-up of innovations to improve the health of mothers and newborns these study settings. We analysed interview data with the aid of a common analytic framework to enable cross-country comparison, with Nvivo to code themes. RESULTS: We found that multiple contextual factors enabled and undermined attempts to catalyse scale-up of donor-funded maternal and newborn health innovations. Factors influencing government decisions to accept innovations at scale included: how health policy decisions are made; prioritising and funding maternal and newborn health; and development partner harmonisation. Factors influencing the implementation of innovations at scale included: health systems capacity in the three settings; and security in northeast Nigeria. Contextual factors influencing beneficiary communities' uptake of innovations at scale included: sociocultural contexts; and access to healthcare. CONCLUSIONS: We conclude that context is critical: externally funded implementers need to assess and adapt for contexts if they are to successfully position an innovation for scale-up

Sodium artelinate: A potential antimalarial

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Comparative analysis of MTP -493G/T and ABCG2 34G/A polymorphisms and theirs expression in HIV-associated lipodystrophy patients

HIV-associated lipodystrophy (HIVLD) is a metabolic condition with an irregularity in the production of lipoprotein particles, and its occurrence varies among HIV-infected patients. MTP and ABCG2 genes have a role in the transport of lipoproteins. The polymorphisms of MTP -493G/T and ABCG2 34G/A affect its expression and influence the secretion and transportation of lipoproteins. Hence, we investigated the MTP -493G/T and ABCG2 34G/A polymorphisms in 187 HIV-infected patients (64 with HIVLD and 123 without HIVLD) along with 139 healthy controls using polymerase chain reaction (PCR)-restriction fragment length polymorphism and expression analysis using real-time PCR. ABCG2 34A allele showed an insignificantly reduced risk of LDHIV severity [P = 0.07, odds ratio (OR) = 0.55]. MTP -493T allele exhibited a non-significantly reduced risk for the development of dyslipidemia (P = 0.08, OR = 0.71). In patients with HIVLD, the ABCG2 34GA genotype was linked with impaired low-density lipoprotein levels and showed a reduced risk for LDHIV severity (P = 0.04, OR = 0.17). In patients without HIVLD, the ABCG2 34GA genotype was associated with impaired triglyceride levels with marginal significance and showed an increased risk for the development of dyslipidemia (P = 0.07, OR = 2.76). The expression level of MTP gene was 1.22-fold decreased in patients without HIVLD compared with that in patients with HIVLD. ABCG2 gene was upregulated 2.16-fold in patients with HIVLD than in patients without HIVLD. In conclusion, MTP -493C/T polymorphism influences the expression level of MTP in patients without HIVLD. Individuals without HIVLD having ABCG2 34GA genotype with impaired triglyceride levels may facilitate dyslipidemia risk