QbD Enabled Development of Press Coated Tablet of Nifedipine: Optimization, In-vitro Release and Stability Studies

The study aimed to develop a time-controlled release drug delivery system using the press coating method for chronotherapeutic treatment of hypertension and angina pectoris. The formulation intended to administer the drug at night, with the intention of relieving symptoms in the morning. The research concluded that, the drug's identification test verified it as Nifedipine, demonstrating good flowability. Different polymers, including various viscosity grades of HPC, influenced properties positively. Combining polymers in different ratios yielded distinct release kinetics at specific intervals. Hydrophilic and gellable polymers combined in the outer shell led to productive time release, whereas hydrophilic with erodible polymers extended the release over 6 to 11 hours. Rupturable and gellable polymer combinations achieved release from 6 to 10 hours, while erodible with rupturable polymers ranged from 6 to 8 hours due to composition differences. Excipient concentration impacted release kinetics, with hydrophilic and hydrophobic nature also influencing core tablet release kinetics. pH-independent release demonstrated practicality, especially with non-ionic HPC and EC polymers. The study revealed diverse release kinetics based on polymer and excipient integration in core and outer compositions. Understanding polymeric behaviours improved drug targeting accuracy. Data analysis indicated a mixed release kinetic involving erosion, diffusion, and swelling mechanisms. Overall, the study contributes insights into dosage form behaviour and polymeric influences on drug release

A study of the current prescribing and drug utilization pattern in Ophthalmology Department of a tertiary care teaching hospital

Background: The aim was to study the current prescribing and drug utilization pattern in Ophthalmology Department of a tertiary care teaching hospital. Drug utilization study is a part of pharmaco-epidemiological exercise quantifying the extent, nature and determinants of drug use in a population. Periodic audit of drug usage pattern forms an essential tool to ascertain the role of drug in a society, increase therapeutic efficacy and improve cost effectiveness of the therapy. It is an introspective and critical instrument providing positive impact on health care delivery to the patient. With this background, the present study was carried out to analyze the prescription pattern and drug utilization by measuring the WHO drug use indicators in ophthalmology department of a tertiary care teaching hospital.Methods: The prescriptions of 961 outpatients were included and analyzed using a predesigned case record form OPD prescription of each patient. Patient and prescription related parameters were analyzed.Results: Prescription analysis showed that the average number of drugs per prescription was 1.85. The drugs were prescribed in the form of eye drops (67.42%), followed by ointments (14.37%), capsules (15.45%), and tablets (2.71%). The dosage form and frequency of drug administration was indicated for all of the drugs prescribed, the duration of treatment for 60.97% of the drugs prescribed. Antimicrobial agents and tear substitute together constituted above 50% of all the drugs. Percentage of drugs prescribed by generic name and from NEDL was 31.62% and 37.22%, respectively. Patient’s knowledge of correct dosage was 70.44%.Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions

Study to assess the role of bromocriptine in treatment of diabetes mellitus

Background: Bromocriptine is a dopamine D2 receptor agonist and a sympatholytic agent used very frequently in treatment of hyperprolactinemia, Parkinsonism and acromegaly. Its quick release formulation has been approved for treatment of type 2 diabetes mellitus as an adjunct to diet and exercise. This study evaluated the antihyperglycemic effect of quick release bromocriptine in alloxan induced diabetic rats.Methods: 24 albino rats were taken and divided into four groups of six rats in each group. Diabetes was induced in three groups and one group was kept as a control group. After successful induction of diabetes, in remaining three group, first group was given no treatment second group was treated with bromocriptine and the third group was treated with metformin. Fasting blood sugar of all the groups were measured on day 1, 7, 14 and 28 of treatment.Results: In this study both the treatment groups were found to have significant (P<0.05) antihyperglycemic effect. Further studies are needed to evaluate and compare antihyperglycemic effect and safety profile of bromocriptine with established antidiabetic drugs.Conclusions: From this study, we concluded that individually both metformin and bromocriptine were effective in controlling hyperglycemia but metformin was better in achieving normal mean FBS. Further studies are required to ascertain the consistency in hypoglycemic effect of bromocriptine as well as its effect in lipid profile and cardiovascular outcomes. Study taking different doses of bromocriptine or with increasing the duration of study can elaborate its role in achieving proper glycemic control over time

Learning from error: identification and analysis of causative factors leading to medication error in an inpatient hospital setting

Background: Medication errors are preventable causes of medical error. These errors may happen at various steps of medication process. This study tries to find common errors during four stages i.e. prescribing, transcribing, dispensing and administration.Methods: It was a cross sectional study in a tertiary care teaching hospital in north India. Five hundred patients were randomly selected for the study. Medication error was checked at different level by a medication audit tool. Direct observation, chart reviews and personal communication with patients, nurses and pharmacist were done to complete the details of tool. Root cause analysis was done after discussing with concerned professionals. Severity of the medication errors were assessed using national coordinating council for medication error reporting and prevention (NCCMERP) proposed medication error index.Results: Medication error rate was found to be around 50%. i.e. every one of two patients received some form of error. Prescribing error were most common cause of error followed by administration error and transcription error. Dispensing error was least common. Root cause analysis indicated casual attitude, inadequate knowledge and training as the main causes.Conclusions: This study was an initial step in recognising error prone areas of medication management. It can be used to develop standard procedures and formulating guidelines for prevention of such errors

Study of changes in serum lipid profile and blood sugar level by perindopril and telmisartan during treatment of systemic hypertension

Background: This study was designed to compare adverse effects on serum lipid profile and blood sugar level in the treatment with two commonly used drugs perindopril and telmisartan in cases of hypertension. This was an “observational” and “cross-sectional” study.Methods: A total of 100 patients were included in each, Groups A and B. In both groups, half the patients were given perindopril 4 mg OD and half were given telmisartan 40 mg OD for 24 weeks. Total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), fasting blood sugar (FBS), and postprandial blood sugar (PPBS) level was estimated initially and then at 4th, 12th, and 24th week. Statistical analysis was done using ANOVA.Results: With perindopril initial means of TC, HDL, LDL, TGs, FBS, and PPBS in Groups A and B were 190.32, 49.76, 117.96, 165.04, 84.56, 122.60, and 188.80, 51.64, 118.52, 159.12, 93.92, 133.60, respectively. After 24 weeks, these values were 190.84, 50.68, 118.60, 163.84, 83.48, 120.20, and 190.96, 52.04, 118.28, 157.56, 93.96, 133.68, respectively (p > 0.05). With telmisartan, initial means of TC, HDL, LDL, TG, FBS, and PPBS in both groups were 188.08, 49.76, 118.84, 167.20, 83.72, 120.68, and 188.08, 46.88, 121.96, 167.84, 91.44, 131.72, respectively. After 24 weeks, these values in both groups were 189.36, 49.80, 120.04, 165.96, 82.60, 118.36 and 186.12, 45.28, 121.08, 167.72, 92.76, 129.56 respectively (p > 0.05).Conclusions: It concluded that both perindopril and telmisartan had not any significant adverse effects on plasma lipid profile and blood sugar level in both groups

Diabetes – A Historical review

Diabetes has been known for last 3500 years. Different cultures and systems of medicine describe this disease in their own way. This article gives an overview regarding historical aspects of diabetes mellitus. This article also compiles the development in the field of diabetes mellitus in chronological order

BROMOCRIPTINE - A NOVEL APPROACH FOR MANAGEMENT OF TYPE 2 DIABETES MELLITUS

Quick release formulation of  Bromocriptine mesylate is recently been approved by FDA (Food and Drug Administration) for the treatment of type 2 diabetes mellitus. Early morning dose of bromocriptine mesylate reduces the plasma prolactin level and increases the hypothalamic dopaminergic drive thereby reducing postprandial plasma glucose, triglyceride, and free fatty acid concentrations. Conventional preparation of bromocriptine are available in 2.5 mg or 5 mg tablets used for hyperprolactinemia and suppression of lactation. Studies have shown that quick release bromocriptine given in dose of 0.8-4.8 mg per day for a period of 6 month have successfully achieved target blood sugar. So the drug is well tolerated in antidiabetic dosage with mild side effects like nausea vomiting and fatigue. The central mechanism of action , good side effect profile and its effects to reduce adverse cardiovascular outcomes make it an attractive option for treatment of type 2 diabetes.   Key words : Bromociptine, diabetes, insulin resistance, quick release formulation, prolacti

Prescription pattern of fixed dose drug combination in cardiology department in a tertiary care hospital

Background: A cardiovascular disease (CVD) is one of the most common causes of mortality and morbidity globally. The drastic change in the lifestyle of population during 21st century has had a great impact on health especially cardiovascular diseases. Objective of this study was to assess the prescription pattern of fixed dose drug combinations (FDCs) in the department of cardiology in a tertiary care hospital.Methods: The prescriptions of 210 patients suffered by cardiovascular disorders who attended the department of cardiology were analysed and following data were collected - patient demographics, diagnosis, dosage form, therapeutic category, cost of FDCs compared to individual drugs, duration of therapy, the total number of drugs per prescription and FDCs prescribed, composition of the FDC, whether FDC prescribed is approved by WHO list of essential medicine. A descriptive analysis of data was done.Results: 15 types of FDCs prescribed were received by 92(43.80%) individuals among 210 patients who attended the cardiology OPD. Prescription of FDCs was most common 28 (30.43%) in patients age group 51-60 years. The commonly prescribed FDC was aspirin with atorvastatin followed by telmisartan with hydrochlorothiazide.Conclusions: The results suggested that FDCs for cardiovascular disorders are frequently prescribed by cardiologist. However all are not approved by WHO list of essential medicine. This study was focused on rational use of FDCs for prescribers for cardiovascular morbidities and mortality

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Long- and short-range correlations and their event-scale dependence in high-multiplicity pp collisions at 1as = 13 TeV

Two-particle angular correlations are measured in high-multiplicity proton-proton collisions at s = 13 TeV by the ALICE Collaboration. The yields of particle pairs at short-( 06\u3b7 3c 0) and long-range (1.6 < | 06\u3b7| < 1.8) in pseudorapidity are extracted on the near-side ( 06\u3c6 3c 0). They are reported as a function of transverse momentum (pT) in the range 1 < pT< 4 GeV/c. Furthermore, the event-scale dependence is studied for the first time by requiring the presence of high-pT leading particles or jets for varying pT thresholds. The results demonstrate that the long-range \u201cridge\u201d yield, possibly related to the collective behavior of the system, is present in events with high-pT processes as well. The magnitudes of the short- and long-range yields are found to grow with the event scale. The results are compared to EPOS LHC and PYTHIA 8 calculations, with and without string-shoving interactions. It is found that while both models describe the qualitative trends in the data, calculations from EPOS LHC show a better quantitative agreement for the pT dependency, while overestimating the event-scale dependency. [Figure not available: see fulltext.