Use of complementary and alternative medicines by patients with orthopaedic disorders in western part of India: a cross sectional study

Background: Complementary and alternative medicines (CAM) are consumed all over the world for variety of health problems. This study was aimed at assessing the prevalence and pattern of CAM in patients with orthopaedic disorders.Methods: This cross sectional study was carried out at outpatient department of Orthopaedics at a tertiary care teaching hospital. Data was collected with help of questionnaire which contained sociodemographic details and details of use of CAM if any by the attending patients. Data was analysed for sociodemographic and clinical characters, pattern of use of CAM, source of information and reasons for using CAM.Results: Out of 500 participants 196 (39.2 %) reported use of CAM. Mean age of participants was 42.6±19.8 (mean±SD) years and 130 (66.3%) users were women. Illiterate patients (57%) were the most frequent users of CAM. About 77% of patients aged 60 years and above used CAM. Fibromyalgia (48%) was the commonest condition for CAM use. Folk medicines (46%) and ayurvedic medicines (45%) were most commonly used CAM. Advice from friends/relatives was the commonest source of information. None of the respondents had knowledge of adverse effects of CAM used by them and about 70% did not inform their doctor about use of CAM.Conclusions: Use of CAM is highly prevalent in patients with orthopaedic disorders, women, illiterate and elderly being the more likely users. Concurrent use of folk remedies with allopathic medicines has potential for interactions between the two. History of use of CAM should be obtained as a routine from patients with musculoskeletal complaints

Interaction of two memory enhancing herbal drugs memory plus and mentat with morphine and imipramine in mice

Background: The non-medical self-administration of memory enhancing drugs is a common practice. Present study was designed to evaluate interactions of two such herbal drugs- Memory plus (MP) and Mentat, with other central nervous system active drugs.Methods: Two activities-analgesic activity and antidepressant activity were performed using adult albino mice of both sexes weighing 25-30g to observe the interactions of the herbal drugs with morphine and imipramine respectively. For each activity animals were divided into seven groups of six mice each. Group-I was control group receiving 0.2ml of 1% Tween 80 ip/ 0.2 ml saline p.o, Group II, III and IV acute treatment groups; received single dose of herbal (2mg/kg ip MP or 200mg/kg po Mentat) CNS active drugs alone in subeffective doses. Group II received morphine 2mg/kg ip, group III imipramine 2mg/kg ip and group IV-received MP/Mentat+ morphine or imipramine respectively. Groups V, VI and VII were subchronic treatment groups, received drugs once daily for eight days in same dose as acute treatment groups II, III and IV respectively. Analgesic activity was measured as prolongation of reaction time by hot plate method and antidepressant activity by reduction in despair time using Porsolt’s forced swimming test.Results: When administered for 8 days, both MP and Mentat potentiated the effect of morphine preventing the development of tolerance to analgesic effect (P< 0.05). However the antidepressant effect of imipramine was not modified by any in subchronic treatment groups.Conclusions: Two herbal memory enhancing preparations Memory plus and Mentat potentiate analgesic effect of morphine but not the antidepressant action of imipramine in mice

Prescribing quality in patients with chronic diseases at primary and secondary health care facilities using prescription quality index tool

Background: Prescribing quality is a matter of major concern worldwide. This study was carried out to determine the quality of prescribing in chronic diseases at primary health care (PHC) and secondary health care (SHC) settings using the new prescription quality index (PQI) tool.Methods: A cross-sectional observational study was carried out at four PHC and two SHC facilities in Anand district of India. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33), and high quality (score 34-43) based on PQI total score. The internal consistency of PQI was measured using item total correlation and Cronbach’s α so as to validate it in our settings. Data were analyzed using Statistical Package for Social Science 20.Results: A total of 134 prescriptions were collected and evaluated for quality of prescribing. Mean age of patients was 60.6 ± 13.5 years. Mean PQI score was 23.60 ± 9.3 with 71.6% prescriptions being of poor quality. Quality of prescribing did not differ at PHC and SHC (P>0.05). Of 22 criteria, PQI score was strongly correlated with drug indication, drug effectiveness, evidence-based prescribing, unnecessary duplication, duration of therapy, and cost (P<0.01). PQI total score was negatively correlated to the number of drugs per prescription. Cronbach’s α for the entire 22 criteria were 0.90.Conclusion: PQI was found to be a reliable tool for assessment of prescribing quality in chronic diseases

A study of morbidity and drug utilization pattern in indoor patients of high risk pregnancy at tertiary care hospital

Background: Pregnancy represents a special physiological state during which the use of drug is of growing concern due to risk of teratogenicity. High risk pregnancy is common threat to mother and foetus. Therefore, our aim was to study the drug utilization and morbidity pattern in high risk pregnancy in hospitalized pregnant women. Methods:An observational, prospective study was carried out in 250 patients for 6 months in the tertiary care hospital. Protocol was approved by the Institutional Review Board (IRB). The data were collected in a pre-designed proforma. Data were analysed by using SPSS version 20.0 Software. Results: Among 250 patients, 19 (7.6%), 218 (87.2%) and 13 (5.2%) were of less than 20, 20 to 30 and more than 30 years of age respectively. About 68.8% women had complained of abdominal pain and 67.6% had weakness followed by headache / body ache (47.2%), oedema (26.4%) and vomiting (18.8%). Iron (91.2%) and calcium (84.5%) were the commonest drugs prescribed followed by folic acid (59.6%), protein powder (54.8%), vitamin C (46.8%) and isoxsuprine (26.6%). As per FDA Drug Risk Category, Category-A (82.21%) was most frequently prescribed followed by Category-B (15.64%) and Category-C (2.15%). Percentage of drugs prescribed by generic name and from essential drug list was 62.80% and 80.79%. Conclusion: Iron, Calcium and Folic acid were most commonly prescribed drugs. There is lesser number of drugs prescribed by generic name suggesting need for sincere efforts to improve situation

Drug use in acute otitis media: a prospective study at a tertiary care teaching hospital

Background: Drug use study identifies the problems that arise from prescription and highlights the current approaches to the rational use of drugs. The objective of the study was to assess drug use pattern in patients diagnosed of acute otitis media in tertiary care teaching hospital.Methods: This prospective observational study was carried in the Otorhinolaryngology department of a tertiary care teaching hospital over a period of twelve months. The data collected for patients with acute otitis media included the patient's demographic details and the drugs prescribed. Data were analysed for drug use pattern and cost per prescription and assessment of rationality of prescription.Results: Total 153 patients were analysed, 100 (65.35%) belonged to male patients and 53 (34.65%) belonged to female patients. Children less than 2years age were the most diagnosed with AOM 47.71%, the major diagnostic symptoms were earache (58.16%) and fever (54.90%) and signs were congestion (52.94%) and discharge (43.13%). In a total 153 prescriptions (469 drugs), 33.68% were antimicrobials, followed by mineral supplements (23.67%). Average number of drugs per prescription was found to be 3.0. Most common antibiotic prescribed was amoxicillin (with or without clavulanate) in 142 (92.81%) patients. Paracetamol alone or in fixed dose combination with antihistaminics were prescribed in 131 patients. Average cost per prescription was 87.74(±35.67) Indian rupees. Seventeen (11.11%) prescriptions were rational in all the aspects based on standard guidelines.Conclusions: The present study showed that paracetamol and amoxicillin with or without clavulanate were mostly commonly prescribed in children with AOM. Irrational prescribing was seen in maximum number of cases

Newer approaches in the treatment of asthma

Asthma is a worldwide public health problem. The most effective anti-asthmatic drugs - inhaled β2-agonists and glucocorticoids controls asthma in about 90-95% of patients. However, severe glucocorticoid-dependent and resistant asthma presents a great clinical burden. Therefore, reducing glucocorticoids - related adverse effects using novel steroid-sparing agents is needed. Furthermore, the mechanisms involved in the persistence of inflammation are poorly understood and the reasons why some patients have severe life threatening asthma and others have very mild disease are still unknown. Although glucocorticoids effectively control the inflammatory process in asthma, they have little effect on the lower airway remodeling processes that appear to play a role in the pathophysiology of asthma. Several new drugs developed to target specific components of the inflammatory process in asthma [e.g. anti-IgE antibodies (omalizumab), cytokines and/or chemokines antagonists, immunomodulators, antagonists of adhesion molecules)], have not yet been proven to be particularly effective. Hence, considering the central role of T lymphocytes in the pathogenesis of asthma, drugs targeting disease-inducing Th2 cells are promising future therapeutic strategies. Some of these new anti-asthmatic treatment approaches may in the future not only control symptoms and modify the natural course of asthma, but also potentially prevent or cure the disease. Hence, the development of novel drugs may allow resolution of these changes

Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study

Background: Use of anti-emetic drugs in pediatric population is often warranted, but choice of drug remains questionable within pediatricians. Objective of current study is: to study prescribing pattern and to calculate cost of antiemetic drug therapy in pediatric wards.Methods: A prospective, observational study was conducted in pediatric wards of a tertiary care hospital of over 14 month’s duration. Institutional ethics committee approval was obtained and written informed consent of parents/guardians was taken. Data of any pediatric patient receiving anti-emetic agent were included in the study.Results: A total of 218 prescriptions were collected. Mean age of patients was 4.39±3.16 (range 4 months to 12 years). Gastroenteritis was the most frequently diagnosed disease in 137(63%) patients. Domperidone was prescribed in 52.4% and ondansetron in 47.6% children. Oral liquid dosage formulation was prescribed in 109 (48.4%) followed by solid dosage form 47 (20.9%). Mean cost of domperidone therapy was 25.34±6.55 INR and for ondansetron it was 36.62±17.94 INR.Conclusions: Gastroenteritis was most frequent indication for use of anti-emetics. Domperidone pharmacotherapy was cheaper and most frequently prescribed than ondansetron

Effect of diuretics on sodium, potassium and chloride levels- a cross sectional study

Background: Diuretics are one of the widely used class of drugs used in various cardiovascular and other disorders. However, they can cause various metabolic adverse effects, electrolyte imbalance being among important changes.Methods: A cross sectional study was conducted in which patients diagnosed with hypertension for at least one month were included. Over a period of 6 months patients were enrolled irrespective of whether they were taking diuretics or not. Demographic details, drug therapy and electrolyte levels were recorded in a proforma. Data was analyzed for difference in serum electrolyte levels between diuretic and nondiuretic groups as well as between different diuretic groups.Results: Out of total 177 participants, 71 were on diuretic therapy. There was significant difference in mean serum sodium (S. Na), potassium (S. K) and chlorine (S. Cl) levels between diuretic and nondiuretic groups (P<0.05). Hyponatremia, hypokalemia and hyperkalemia were observed. Thiazide diuretic group showed significantly greater hyponatremia compared to other diuretics (P=0.028). Hyperkalemia was observed in participants receiving K sparing diuretic or combination of loop and K sparing diuretics. Old age and number of comorbidities showed negative association with S. Na. Females had significantly more hyponatremia than male participants.Conclusions: The study confirms that diuretics cause various abnormalities in electrolytes namely Na and K levels. Old age, comorbidities and female sex are risk factors for hyponatremia

Pattern of antidiabetic drugs use in type-2 diabetic patients in a medicine outpatient clinic of a tertiary care teaching hospital

Background: Diabetes mellitus (DM) is an important public health problem in developing countries. Drug utilisation study of antidiabetic agents is of paramount importance to promote rational drug use in diabetics and make available valuable information for the healthcare team. The aim of study was to investigate the drug utilization pattern in type-2 diabetic patients.Methods: A prospective, cross-sectional study was carried out in medicine outpatient clinic of tertiary care hospital, Ahmedabad for eight weeks. Patients with type-2 diabetes and on drug therapy for at least one month were included. Patients’ socio-demographic and clinical data were noted in a pre-designed proforma. Data was analysed by using SPSS version 20 and Excel 2007.Results: Total 114 patients were enrolled with mean (± standard deviation) age and duration of diabetes of 56.8 ± 10.5 and 8.3 ± 9.4 years respectively. Male: Female ratio was 0.72:1. Mean fasting and postprandial blood glucose levels were 147.5 ± 73.1 and 215.6 ± 97.3 mg/dl respectively. Most common symptom was weakness/fatigue (77.2%). Hypertension (70.2%) was most common co-morbid illness. Mean number of drugs prescribed were 7.8 ± 2.5. Total numbers of patients receiving more than five drugs were 89.5%. Most commonly used drug group was biguanides (87.7%) followed by sulphonylureas (68.4%).Conclusion: Metformin (biguanide) was the most utilized (87.7%) antidiabetic drug for type-2 diabetes. This study revealed that the pattern of antidiabetic prescription was rational and largely compliant with NICE (National Institute for Health and Clinical Excellence) guidelines

Prevalence and pattern of self-medication in elderly individuals

Background: Self-medication that is taking medicines without prescription by the doctor is highly prevalence in the community. Elderly population is more likely to self-medicate due to multiple morbidities. This study was undertaken to evaluate the prevalence and pattern of use of self-medication among elderly individuals.Methods: Study was carried out at tertiary care hospital. The questionnaire which was used in our earlier studies regarding self-medication was utilized. After obtaining consent, the elderly individuals (≥60 years) reporting for health check-up were requested to fill up the questionnaire themselves or were asked to respond to questions verbally in the case of illiterate. Questionnaire mainly contained demographic and clinical data and self-medication details - frequency, symptoms/disease for self-medication, drugs, reasons for self-medication, sources of information, awareness regarding the risk of self-medication.Results: Out of 200 elderly included in the study, 177(88.5%) reported self-medication in 6-month recall period. About 60% were male and mean age - 69.64±6.21 (60-85) years. About 21% reported frequent self-medication. Abdominal pain (16%) and headache (14%) were the most common symptoms, and diabetes (7%) was the most common disease for self-medication. Allopathic medicines (55%) mainly paracetamol (13.5%) were most frequently used followed by home remedies (23%) and ayurvedic (17%). Previous experience with the drug (50%) followed by advertisements (23.2%) were common source of information. Most common reasons for self-medication were convenience (69.5%) and cost (56%). None of respondents were aware of risks of self-medicationConclusion: Self-medication is highly prevalent in elderly people who are unaware of risks involved