Genetic Association Between Insulin Resistance And Total Cholesterol In Type 2 Diabetes Mellitus - A Preliminary Observation

We investigated the degree of genetic association between insulin resistance (IR) with type 2 diabetes mellitus (DM) and abnormalities in lipid metabolism in 42 patients. IR was assessed by fasting insulin test (FI), McAuley (McA), HOMA and QUICKI methods. IR was detected in 34 (81%) patients by FI, McA and in 39 (93%) patients by HOMA and QUICKI. 26 (62%) patients had family history of DM and 23 (89%) of them displayed IR by FI & McA. 24 of them (92%) displayed IR by HOMA and QUICKI. Our results suggest that association between the family history of DM and IR were statistically significant by chi-square test (P<0.05). Further, 29 (69%) patients had elevated total cholesterol levels. Association between elevated total cholesterol and IR as assessed by FI test was also statistically significant (x2=4.6; p<0.05). Results of our study indicate the statistically significant genetic association of IR with abnormal cholesterol metabolism and family history of D

Prospective encounter study of the degree of adherence to patient care indicators related to drug dispensing in Health Care facilities: A Sri Lankan perspective

The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT), percentage of drugs actually dispensed (PDAD), percentage of drugs adequately labeled (PDAL) and patient's knowledge on correct dosage (PKCD) were compared in these selected teaching hospitals (TH), general hospitals (GHs) and district hospitals (DHs) in Galle. ADT in DH (1.16 min) and GH (1.07 min) were high when compared with ADT in TH (0.81 min). PDAD was 100% in DH, 97.79% in GH and lowest in TH (94.64%). PDAL was highest (22.66%) in TH, 17.57% in GH and lowest in DH (1.57%). PKCD was 100% in GH and lowest in DH (0%) and only 50% in TH in Galle district. We noted that there was a significant difference in ADT in all three categories (P < 0.05). We noted that dispensers spend only a short dispensing time and showed a tendency for dispensing errors. We found that PDAL was very low in all hospitals but PDAD was significantly high. Even though the ADT was high in DH, PKCD was 0% due to negligence in dispensing practices. We also noted a 100% PKCD only in GH due to the practice of a well-prepared correct labeling system in GH. We noticed that these patients were provided drugs with inadequate labeling and that patients had only a poor knowledge about the drug administration schedule. We conclude that there was a low dispenser–patient ratio in all three hospitals and that there was a need for an implementation plan for proper dispensing techniques by introducing a well-prepared drug labeling system in a printed format

Cost - utility analysis of parenteral antibiotics prescribed in medical wards in a tertiary care health facility in southern province of Sri Lanka

Introduction: Parenteral antibiotic (PA) prescription pattern in a hospital will directly influence the annual budget allocation, development of bacterial resistance and occurrence of unnecessary adverse drug reactions if it is done with poor adherence to the standard guidelines of prescription. As specialist in the field we understand the need of conducting economic studies in relation to the cost and utility of PA prescription pattern. It will be helpful to predict the drug procurement plan for the next year and also to prevent unnecessary complications mentioned above. Objective: Our main objective was to analyze the cost/utility relationship of PA drugs which were used in medical wards in this hospital according to the top ten of the cost (TTTC) and the top ten of the consumption (TTCS). Materials and method : Aggregate data from the pharmacy record books were collected for year 2010 from indoor pharmacy. Unit prize was obtained from medical supplies division. Total quantity consumed by each medical ward was considered for analysis of the cost /utility relationship. Two top ten lists were prepared according to the cost and the consumption respectively for medical wards and the correlation was analyzed using non parametric testing with spearman test. Results: Regarding PA drugs used in this hospital, 7/10 PA drugs in TTTC are not included in the TTCS. Out of the total cost for TTTC, 82.6% of the cost had been spent for the PA drugs which are not in the TTCS and 17.5% of the cost of TTTC was used to purchase only three drugs from the TTCS. But these three drugs had contributed only 28% of top ten consumption. 72% of the PA drugs in TTCS were not costly drugs and highly consumed in medical wards. Correlation was significantly positive between cost and utility of PA drugs. ( r=-0.91,p<0.001) Conclusion: Majority of the consumed PA drugs are non-costly and it indicates the prescriptions had been done according to the rational guidelines including cost, availability and affordability. Correlation further confirms that majority of the PA consumption was low costly drugs. As most of the money had been spent to purchase highly expensive PA drugs for medical wards we suggest to review the clinical indications for these drugs with the microbiological evidence to be compatible with the allocated health budget for the hospital. This further suggests conducting the cost effective economic studies to evaluate the suitable drug alternatives for such indications

A survey: Precepts and practices in drug use indicators at Government Healthcare Facilities: A Hospital-based prospective analysis

Background : We planned to identify the difficulties in practicing the rational use of medicine in health facilities, using drug-use indicators. Materials and Methods : We studied the average consultation time (ACT), average number of drugs per encounter (ANDE), percentage of drugs by generic name (PDPG), percentage of encounters with antibiotics (PAP), percentage of encounters with injection (PIP), percentage of drugs prescribed from the essential drugs list (PEDL), using pretested questionnaires in different hospital types. Results : There was a higher value of ACT in Teachin hospital (TH,2.31 min) and general hospital (GH,2.17 min) compared to district hospital (DH ,0.83 min). ANDE was high in all three categories (3.24, 2.88, and 3.26 in TH, GH, and DH, respectively). There was a significant difference in ANDE in all three categories ( P≤0.05). There was no significant difference in the PDPG among all categories of Hospitals. PAP was highest in DH (80%) and lowest in GH (46%). PIP was highest in DH (6%), 4% in GH, and lowest in TH (3%) in the Galle district. PEDL in TH, GH, and DH were 97, 100, and 99%, respectively. Prescribers use a short consultation time and practice polypharmacy, and the use of generic and essential drug lists is significantly high. Antibiotic usage is high, but usage of injections is low. We further noted prescriptions with absence of the diagnosis, sex, and prescriber′s identity. Conclusion : We conclude that some areas like polypharmacy, high usage of antibiotics, and poor prescription writing practices are high and they can be addressed by in-service awareness programs for noted prescriber errors