Analysis of cost of medical therapy in patients of metabolic syndrome: an observational study

Background: The objective of the study was to analyze cost of medical therapy in patients of Metabolic syndrome.Methods: This was an observational study. The study was conducted by enrolling patients of the outpatient department of Medicine of Rajindra Hospital, Government Medical College, Patiala, Punjab. A total of 100 patients diagnosed with Metabolic syndrome were enrolled in the study. The total daily cost of the therapy was calculated by adding the direct cost of individual drugs taking in consideration the frequency of the drug. The daily cost of therapy was then extrapolated to calculate the monthly as well as annual cost of therapy.Results: The mean age of patients was 58.27±10.32 years. Out of a total of 100 patients, there were 57 female and 43 male patients, indicating a female preponderance of the disease. The average individual daily cost of medical therapy is INR 44.56 which upon extrapolation gives monthly and annual cost of INR 1336.90 and INR 16264.40 respectively. The cost of treatment in males is costlier than females (INR 50.09 in males versus INR 40.22 in females). The cost of treatment of age 31-40 years is INR 27.90 while it INR 36.97, 48.16 and 50.75 for age groups 41-50, 51-60 and 61-70 years. The various components of metabolic syndrome viz. diabetes mellitus, hypertension and dyslipidemia contribute differently to the cost of therapy. Daily cost of medical therapy for diabetes mellitus is INR 18.57 while for hypertension and dyslipidemia are INR 10.25 and INR 6.13 respectively.Conclusions: Chronic diseases like metabolic syndrome have a huge share of the healthcare budget. Given the fact that it is a lifestyle disease, its prevalence is likely to swell in the coming decades. Hence, formulation of preventive and innovative treatment guidelines is of utmost importance

A study to evaluate compliance in patients of diabetes mellitus in a North-Indian tertiary care hospital

Background: The objective of the study was to determine level of adherence and recognize various causative factors which can affect the compliance in the diabetic patients.Methods: This was an observational study. The study was conducted by enrolling patients of the outpatient department of Medicine of Rajindra Hospital, Government Medical College, Patiala, Punjab. To assess adherence, a questionnaire was administered to the patients - Morisky Medication Adherence Scale (MMAS) -8 item questionnaire. The various factors affecting compliance was determined by a researcher made questionnaire.Results: Out of a total of 100 subjects, age range extended from 18 years to 80 years. The mean age was 57.52±12.33years. 51% of patients were females and 49% was males. Analysis of MMAS- 8 item scores of patients showed that 52% of patients had low adherence, 29% had medium while 19% had high adherence to the treatment. Only 30% patients were compliant i.e. with HbA1C value of 7 or less while 70% patients were non-compliant i.e. with HbA1C value of more than 7.Conclusions: Compliance to medical treatment is influenced by a myriad of factors. In order to promote compliance, it is necessary to increase awareness about the disease, possible complications and treatment guidelines among patients as well as their family members.

Effect of benzalkonium chloride-preserved latanoprost and benzalkonium chloride-free latanoprost on intraocular pressure in patients of primary open angle glaucoma

Background: To evaluate the change in mean IOP with BKC-preserved latanoprost versus BKC-free latanoprost in patients of primary open angle glaucoma (POAG).Methods: This was an open-label, randomized, interventional, switch trial. Thirty patients of primary open angle glaucoma (POAG) who were already on benzalkonium chloride (BKC)-preserved latanoprost for a minimum of three months were recruited. Their intraocular pressure (IOP) was recorded at the baseline. Then, they were switched over to benzalkonium chloride (BKC)-free latanoprost for another three months. Their intraocular pressure (IOP) was recorded at both 6 and 12 weeks of follow-up.Results: IOP decreased from 15.57±0.85mm Hg at baseline to 15.40±0.89mm Hg at 6 weeks to 15.30±0.70mm Hg at 12 weeks. p value was found to be 0.209 and 0.115 at 6 and 12 weeks respectively. No statistically significant change was observed between mean IOP at both 6 and 12 weeks as compared to the baseline.Conclusions: BKC-free medications have equal IOP lowering effect as BKC-preserved medications in glaucoma patients

Obstetric use of nitroglycerin: Anesthetic implications

Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min) used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration