Study of various intrauterine pathologies by hysteroscopy leading to various gynaecological problems

Background: This study was to diagnose different types of intrauterine pathologies, their locations and relations with clinical presentations (like abnormal uterine bleeding (AUB), recurrent abortions, unexplained infertility and secondary dysmenorrhoea) by hysteroscopy. To know the prevalence and identification of the demographic relations of different intrauterine pathologies and clinical symptoms were observed. This study also aimed in selecting OPD or indoor operative procedure.Methods: Data collection of 144 cases was done with suspicion of intrauterine pathology on the basis of history and clinical examination. They were screened by per abdomen, per speculum, pelvic examination. USG and HSG in cases of infertility were used. Further intrauterine pathologies were explored by hysteroscopyResults: On hysteroscopy no abnormality was detected in 80/144 (55.6%) cases which was the maximum finding observed. AUB 96 (66.7%) was the most common presenting complaint followed by infertility 39 (27.1%). In 96 cases there was no organic pathology. Thickened endometrium was the commonest 17/144 (11.8%) pathology observed by hysteroscopy followed by endometrial polyp 14/144 (9.7%).Conclusions: With increasing demands for one-stop clinics where diagnosis and treatment are offered in same sitting. Diagnostic hysteroscopy by virtue of its diagnostic and therapeutic capabilities can become the procedure of first choice in evaluation of gynaecological problems

Cost variation analysis of oral anti-diabetic drugs

Background: Diabetes Mellitus is a chronic metabolic disorder, one of the major causes of morbidity, mortality and needs lifelong treatment. There are large numbers of oral anti-diabetic drugs available for the treatment of type 2 diabetes mellitus. There are numerous brands available for each of the individual oral anti-diabetic drug. Thus, a study was planned to find out cost variation among different brands of same active oral anti-diabetic drug.Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from the price list provided by the pharmaceutical companies in Current Index of Medical Specialities (CIMS) (October 2017- January 2018). The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was analyzed.Results: Percentage cost variation of the commonly used drugs found was seen highest with Sulfonylureas (Glimepiride - 562%) followed by Metformin (492%) which was followed by Pioglitazone (488%), DPP-4 inhibitor Teneligliptin (231%), α- glucosidase inhibitors (Voglibose 284%), Meglitinides (Repaglinide 0.5mg 154%) and lowest was seen with Repaglinide 2mg (15%).Conclusions: There is very wide cost variation among different brands of the same oral anti-diabetic drugs manufactured in India. The average percentage cost variation of different brands of the same oral anti diabetic drugs manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences

An introspection of quality of novel drug approvals by United States Food and Drug Administration

Background: United States Food and Drug Administration (FDA) is the fastest drug review agency in the world. FDA is responsible for protection of the public health by assuring that foods are safe, wholesome, sanitary and properly labelled. Approved Novel drugs are often innovative products that serve unmet medical needs or otherwise help to advance patient care.Methods: FDA novel drug approvals were analysed from calendar year (CY) 2012 to 2016 on the basis of three criteria i.e., impact, access and predictability. Impact measured on the basis of: percentage of novel drug approvals (a) first in class (b) for rare diseases. Access measured on the basis of: percentage of novel drug approvals (a) first cycle approval (b) approval in the U.S. before other countries and (c) percentage of priority reviews. Predictability measured by: the percentage of novel drug approvals that met the PDUFA goal dates for the application review.Results: Total number of novel drugs approved from CY 2012 to 2016 was 176 (average 35 novel drugs/ year). Impact of novel drug approvals: 40% were first in class and 39% were for rare diseases. Access of novel drug approvals: 84% were first cycle approval, 60% were approval in US before other countries, 51% priority reviews among novel drug approvals. Predictability of novel drug approvals: 97% approvals able to meet PDUFA goal dates for application review.Conclusions: Novel drug approvals during CY 2012-2016 had a high quality which is very much evident by their high impact, good access and high predictability

Cost analysis of antiepileptic drugs available in India

Background: Epilepsy is one of the major causes of morbidity, mortality and needs long-term treatment. There is a wide range of variation in the prices of drugs marketed in India. Thus, a study was planned to analyse out cost variations of antiepileptic drugs available in Indian market.Methods: Minimum and maximum costs in rupees (INR) of antiepileptic agents manufactured by different companies, in the same strength and dosage forms were obtained from “current index of medical specialties” January ‑ April 2016. The cost ratio and percentage cost variation were calculated for each generic antiepileptic agent.Results: There is a wide variation in the prices of different brands of same antiepileptic agent in Indian market. The highest cost ratio and percent cost variation was found for divalproex 500 mg [(1:3.17) and 216.7], followed by lamotrigine 25 mg [(1:2.5) and 150], clobazam 10 mg [(1:2.47) and 147.3] and clonazepam 0.5 mg [(1:2.46) and 145.9].Conclusions: The average percentage price variation of different brands of the same oral antiepileptic drugs in Indian market is very wide. Treatment of epilepsy has a long course with compliance being a key factor for successful treatment. Improved adherence to the treatment can be ensured by decreasing the cost of therapy, by changes in the government policies and regulations and creating awareness among treating physicians for switching to cost effective therapy

A Study of Obesity and Sleep Disordered Breathing

Introduction: Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality and various Cardiovascular risk factors. Obesity is strongly linked with respiratory symptoms and diseases like dyspnea on exertion, obstructive sleep apnea syndrome (OSAS). This study has been undertaken to analyze the severity of hypertension in obese patients, sleep-disordered breathing (SDB) in obese patients, to analyze whether SDB is a risk factor for hypertension in obese individuals and to correlate how many obese hypertensives have correctable SDB. Methods: A total of 200 obese patients were randomly selected from the outpatient department. Berlin's questionnaire and the Epworth sleepiness scale score (ESSS) were used to assess sleep-disordered breathing (SDB). Asian classification of obesity suggested by the World Health Organization was used for the assessment of BMI. All statistical analysis was carried out using the SPSS version20, and Appropriate Statistical tools were applied wherever required, like a test of proportion, Chi-square test etc. Results: Out of 200 subjects, 116 were male, and 84 were female. The majority of the study population (70.0%) had suffered from obstructive sleep apnea, while the rest (30.0%) had mixed sleep apnea. The mean spread of age for total selected subjects (N=200) was 45.64±12.75 years. The body mass index (BMI) between 40 and 50 kg/m2 in 49.0% obese patient. Systemic hypertension prevailed more in male (81.0%) obese subjects than female (77.4%) obese subjects. The most significant risk factor for predicting hypertension was moderate type sleep apnea (p<0.005) followed by the age of the (p<0.007) obese patients that were confirmed strongly significant on the statistical ground. Conclusion: Obesity has a very high and proportionate correlation between sleeping disordered breathing. Obstructive sleep apnea is the predominant sleep-disordered breathing in our study population. Sleep-disordered breathing is very much correctable in the obese hypertensive population by weight reduction and risk factor control

Analytical survey of scenario for permanent method of contraception

Background: This study has analysed the average completed family size with relation to parity, average age of both partners accepting permanent contraception, the percentage of women who finished their family with only female children and comparison of practice observed in rural and urban population.Methods: A retrospective analytical study was conducted at RKDF medical college and research centre Bhopal M.P. from 1 January 2017 to 31 August 2020 (3 Years 7 months) on 286 patients. Data of the patients who had undergone tubal ligation after normal vaginal delivery, caesarean section, with medical termination of pregnancy and interval tubectomy was collected at RKDF medical college and research centre Bhopal M.P.Results: Parity wise maximum number of cases completed their family with two issues i.e. (51%). Permanent sterilisation was done in even one issue in (0.6%) minimum number of cases were observed in 9 issues (0.34%). Rural versus urban distribution was 25 and 75% respectively. Maximum age observed was 47 years of husband and 42 years of wife.Conclusions: For the desire of male child, number of female children increased thereby increasing the family size

To evaluate the analgesic activity of resveratrol in different doses in animal model

Background: Pain is a complex unpleasant phenomenon composed of sensory experiences originating from damaged tissue or abnormal physiological condition. The objective of this study was to evaluate the analgesic activity of resveratrol in different doses in animal model.Methods: Albino mice of either sex weighing 20-30 gms were selected for the study. Mice were divided into 4 groups of 6 animals each. The control group received 0.9% normal saline (10 ml/kg), standard group received indomethacin (10 mg/kg) and test groups received resveratrol (50 mg/kg and 100 mg/kg). The drugs were given orally 1 hour prior to the tests. The animals were tested for analgesia activity 30, 60, 90, 120 minutes after drug administration using tail flick method and 1% acetic acid was given intraperitoneally to induce writhing in the other method. Delay in the reaction time in tail flick method and decrease in total number of writhes in acetic acid induced writhing model denoted analgesic activity. Data analysis was done using one way ANOVA followed by Tukey’s HSD test. P<0.05 was considered as statistically significant.Results: Resveratrol showed significant increase in reaction time at various time periods in tail flick method and showed significant decrease in the number of writhes in acetic acid induced writhing method.Conclusions: In the study, resveratrol exhibited analgesic activity in both thermal and chemical pain models in both the doses, and analgesic activity in higher dose (100 mg/kg) was comparable to standard drug

Anxiolytic potential of astaxanthin on experimental animal model

Background: Astaxanthin is a naturally occurring carotenoid found in nature primarily in marine organisms. Carotenoids are well known for their therapeutic benefits in the aging process and various diseases, because of their antioxidant properties. Additionally, astaxanthin has well-documented anti-inflammatory and immune-stimulating effects. It is a known fact that oxidative stress is associated with depression, anxiety, and related psychiatric disorders. Astaxanthin may also reduce oxidative stress in the nervous system, reducing the risk of neurodegenerative diseases. Although astaxanthin has the ability to cross the blood–brain barrier and has a beneficial effect on the CNS, the effects of astaxanthin on anxiety and depression have not been reported.Methods: In this study, to investigate the effects of astaxanthin on anxiety, we performed some behavioural tests including elevated plus maze test, hole-board test, light/dark exploration test.Results: In elevated plus maze test the time spent in the closed arm by astaxanthin treated rats was significantly (P <0.05) decreased as compared to control. The number of readings in both the arms was significantly (P <0.05) increased in astaxanthin treated rats as compared to control. In hole board apparatus, it showed anxiolytic response by significantly reduced the number of head poking. Increased number of entries in the bright side and decrease of time spent by the animal in dark side were observed in the light/dark exploration test.Conclusions: The present study indicates that Astaxanthin produces anxiolytic response at the dose of 3 mg/kg on experimental animal model

Evolocumab: rising momentum as novel antidyslipidemic drug

Increased levels of low density lipoprotein cholesterol are responsible for the major cardiovascular events. Low density lipoprotein cholesterol reduction has proved to be highly effective in reducing the risk of major cardiovascular (CV) events in various trials. ACC/AHA guidelines recommend lipid-lowering therapy for patients with known cardiovascular diseases (CVD). Statins are the gold standard treatment for all types hypercholeterolemia but still there is need of some other lipid-lowering therapies especially in patients with statin intolerance and in patients responding inadequately to statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) was discovered in 2003 and subsequently emerged as a novel target for LDLC-lowering therapy. Evolocumab is a fully human monoclonal immunoglobulin G2 (IgG2) directed against human PCSK9. Evolocumab binds to PCSK9 enzyme rendering it unable to bind to the LDLR. More LDLR are available to bind to LDLC. Evolocumab increase the density of LDLR on the surface of hepatocytes, thereby increasing the uptake of LDL particles and decreasing the LDLC in the blood. Evolocumab has proved its efficacy with LDLC reduction from 53% to 75% and associated with minor side effects. Evolocumab has corroborated its effectiveness in reduction in the levels of LDLC. This drug has shown efficacy in heterozygous and homozygous subtypes of familial hypercholesterolemia. Statin intolerance seen in about 15% of all patients restricts the use of first line drug for dyslipidemia. Evolocumab can be a useful option in statin intolerant patients and in patients responding inadequately to statins

A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open angle glaucoma

Background: The purpose of this study was to compare and evaluate the clinical efficacy of topically applied travoprost 0.004% eye drops versus brimonidine/timolol fixed combination eye drops in the management of primary open-angle glaucoma.Methods: In this prospective, randomized study, 65 patients received either travoprost eye drops once daily in the morning (n=33) or brimonidine/timolol fixed combination eye drops twice daily (n=32). Intra ocular pressure (IOP) was assessed at 2, 4, 8, and 12 weeks. The primary outcome measure was mean reduction in IOP.Results: Thebaseline mean IOP values were similar between two groups. Mean reduction of IOP in the right eye for brimonidine/timolol fixed combination group was 9±2.9 mmHg, whereas in the left eye it was 10.9±2.8 mmHg. In the travoprost group, the reduction in IOP of the right eye was 7.8±2.9 mmHg (p=0.0002) and 7.5±3.4 mmHg (p=0.0001) in the left eye. The mean reduction of IOP for the brimonidine/timolol group was 9.95 mmHg and for the travoprost group it was 7.6 mmHg (p<0.0001) in both the eyes.Conclusions: The fixed combination brimonidine/timolol twice daily demonstrated superior mean IOP lowering efficacy compared to travoprost 0.004% in patients with open-angle glaucoma