Pattern of anti-diabetic drugs prescribed for type 2 diabetes mellitus patients in a tertiary care hospital of India: an observational study

Background: Type 2 diabetes mellitus (T2DM) is a leading cause of significant morbidity and mortality in developing countries. Evaluation of anti-diabetic drug use pattern guides the healthcare professionals to identify early signals of irrational prescribing and to plan interventions to optimize the benefits of pharmacotherapy.Methods: Observational descriptive study was conducted on 500 prescriptions of T2DM patients collected from Outpatient department of a tertiary care hospital. Prescriptions were analysed for type, number, generic/brand names, fixed dose combinations (FDCs) of anti-diabetic drugs and anti-diabetic drugs prescribed from within National List of Essential Medicines (NLEM) 2015.Results: Average number of anti-diabetic drugs per prescription was 2.5. Of these 49% were from within NLEM and only 39% were prescribed by their generic names. Among all the anti-diabetic groups of drugs used, biguanide (32.85%) was the most frequently prescribed followed by insulins (25.4%) and DPP-4 inhibitors (13.75%). Combined drug therapy was more prevalent than monotherapy (70% versus 30%). Metformin+sitagliptin and metformin+linagliptin were most commonly prescribed fixed dose combinations.Conclusions: Recent trend of anti-diabetic drug use included newer anti-diabetic drugs in combination with metformin to achieve better euglycemia and to minimize complications of T2DM

Pupils Need To Know More About Use of Medicines and self-care

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EVALUATION OF DRUG ADVERTISEMENTS IN A MEDICAL JOURNALThough ideally the scientific information provided by pharmaceutical companies in drug advertisements should be for promotion of rational use of drugs, this objective is rarely achieved, as often the d

Though ideally the scientific information provided by pharmaceutical companies in drug advertisements should be for promotion of rational use of drugs, this objective is rarely achieved, as often the data is incomplete and biased. Analytical studies with the help of standard indicators on this aspect of drug advertisements are very few from developing countries. We analyzed all medical drug advertisements in eleven consecutive issues of Journal of Nepal Medical Association published between 1993 and 1996 with a special emphasis on their conformity with WHO guidelines and International Federation of Pharmaceutical Manufacturers Association (IFPMA) code for drug advertisement. The 78 advertisements in the Journal of Nepal Medical Association constituted 7.7% pages of the eleven issues. Of the 38 products advertised, 30 (79%) were manufactured outside Nepal. Antimicrobial agents were the most frequently advertised group of drugs (47.4%). While generic name was not mentioned in 16.7% of the advertisements, the information on indications, adverse effects and contra-indications was lacking in 37%, 88.4% and 87.1% of the advertisements respectively. Only 11.5% of advertisements provided information on generic name, indications, dosage, adverse effects and contra indications. However, none of the advertisement was "complete" on the basis of the indicators of WHO guidelines and IFPMA codes. Key Words: Medical drug advertisement, drug information, WHO guidelines, IFPMA code

Correlation of compliance to statin therapy with lipid profile and serum HMGCoA reductase levels in dyslipidemic patients

Background: The efficacy of statin therapy may be lost or vary with reduction in compliance and intensity of statin therapy. Objective: To study and correlate the quantitative effect of compliance on lipid profile and 3-hydroxyl-3-methylglutaryl coenzyme A reductase (HMGCoA-R) levels in dyslipidemic patients. Methods: Compliance to different intensity of statin therapy assessed by pill count was correlated with serum levels of total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides (TG), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and HMGCoA-R. Results: Out of 200 patients, 160 received moderate intensity statin therapy whereas 40 were on high intensity statin therapy. The overall mean compliance of patients was 56.7%. The compliance of patients on moderate intensity statin therapy was higher (56.8%) than those on high intensity (56.4%) (p = 0.92). There was significant inverse correlation (p < 0.05) between compliance and TC, TG, LDL-C and HMGCoA-R levels and positive correlation (p < 0.05) with HDL-C levels. The mean serum HMGCoA-R levels did not fall below 9–10 ng/mL when compliance to either moderate or high intensity statin therapy was increased above 60%. Conclusions: It is appropriate to improve the compliance to existing statin therapy than switching over to higher intensity statin therapy. Estimation of HMGCoA-R levels may be explored as a surrogate marker to monitor and assess the compliance of patients to statin therapy

Assessment of anti-CarP antibodies, disease activity and quality of life in rheumatoid arthritis patients on conventional and biological disease-modifying antirheumatic drugs

Tunable optical phased arrays and metasurfaces play an important role in a diverse range of applications from imaging and remote sensing to communications and displays. However, as the number of tunable elements grows, the required control architecture becomes insurmountably complex. Here, we discuss the concept of perimeter-controlled tuning to shape far-zone radiation. We discuss applications of our approach to beam forming, holography, and image projection. We show that, with a proper design, the complexity of a control architecture may be dramatically simplified. We further discuss the use of our method to time-sharing image projection and holography. Our concept is applicable to a variety of systems, including phased array optical antennas and metasurfaces

Randomized controlled trial comparing the efficacy of daily and every other day atorvastatin therapy and its correlation with serum hydroxymethylglutaryl-CoA reductase enzyme levels in naïve dyslipidemic patients

Objective: Data regarding efficacy comparison of daily regimen (DR) versus every other day regimen (EODR) atorvastatin therapy is not validated by estimation of serum hydroxymethylglutaryl-CoA reductase (HMGCR) levels and HMGCR correlation with lipid indices. Methods: In this randomized controlled trial, we compared the efficacy of DR versus EODR by measuring lipid indices and serum HMGCR levels at baseline and after 12 weeks of 10 mg atorvastatin therapy. Primary endpoint was comparison of mean change in serum HMGCR levels and lipid indices of both groups and their correlation with each other. Secondary endpoints were assessed by estimating serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase MM (CK-MM) levels and adverse drug reactions (ADRs). Results: A total of 61 patients were enrolled of which 46 completed the study (24 in DR vs 22 in EODR group). The mean reduction in total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) and non-high density lipoprotein-cholesterol (HDL-C) was significantly higher in DR group, whereas mean reduction in triglycerides (TG) and increase in HDL-C was similar in both the groups. Reduction in serum HMGCR levels was comparable in both the groups (31.17% vs 28.19%). Change in serum HMGCR levels correlated more with change in lipid indices of DR group. Also, safety parameters were similar between the two groups. Conclusion: Both the regimens achieved therapeutic goals, however DR was found to be superior as it achieved greater reduction in TC and LDL-C. Further, these findings are substantiated by correlation of lipid indices with serum HMGCR levels. Keywords: Atorvastatin, Every other day atorvastatin, Dyslipidemia, Hydroxymethylglutaryl-CoA reductase enzym