A survey of prescription pattern of anti-diabetic drugs on diabetic patients with cardiovascular complications within Dhaka metropolis

Background: This survey study was designed to analyze the current prescription pattern of anti-diabetic drugs that used in diabetic patients with cardiovascular complications within Dhaka metropolis.Methods: The present study has been conducted by out-patient department in a number of well-known general and specialized government and private hospitals in Dhaka, Bangladesh for 5 months. 1200 prescriptions and questionnaire were randomly evaluated for this present survey. A standard questionnaire was prepared, containing 17 different questions, to conduct the survey based on patient’s demographic data such as which type of diabetes they have contained, age, gender, education and their self-assessment of health, disease history and medication.Results: Among the patients involved in this study, there were 46% (550) male and 54% (650) female between the ages of 30 and 75 years. Between 46 and 70 years, 19% male and 31% female were found to be diabetic indicating that in this age group female are mostly affected by diabetes. About 2020 antidiabetic drugs were prescribed by the physicians in which 30.43% contained single, 54.16% contained two and 15% contained more than two anti-diabetic drugs. Amongst antidiabetic medications, metformin was the most commonly prescribed drug which was given in 30.69% patients followed by glimepride 10.9%, 5.45% had glipizide, 1% pioglitazone and other drugs. A total of 7.43% drug was prescribed by fixed dose combinations. Highest percentage of male diabetic patients with hypertension (86%), dyslipidemia (100%) and other complications (57%) was found at 75 years of age while no female patients were found under the same condition at the same age.Conclusions: The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing & marketing any new drug. Therefore it is necessary to create better awareness among people, focus on rational use of anti-diabetic drugs and also motivate our physicians to prescribe the generic drugs

Analysis of prescription pattern of antibiotic drugs on patients suffering from ENT infection within Dhaka Metropolis, Bangladesh

Background: This survey was designed to assess and evaluate the prescription pattern of antibiotic drugs on patients suffering from ENT infection within Dhaka Metropolis, Bangladesh.Methods: A cross sectional, observational and prospective study was conducted from January to June 2015 in the out-patients (OPD) and in-patients (IPD) of ENT department at different general and specialized government and private hospitals (Dhaka Medical College and Hospital, Sir Solimullah Medical College Mitford Hospital, Holy Family Red Crescent Medical College and Hospital, Dhaka Community Medical College and Hospital) within Dhaka city.300 prescriptions were collected and randomly evaluated for this present study.Results: Out of 300 patients, 220 (73.33%) were male and 80 (26.67%) were female (including children and adults) where most of the patients were outpatients 262 (87.33%). In the patients information section it was observed that approximately 93.33%  prescription contained antibiotic drugs and almost all prescription (100%) contained antibiotic drugs along with other drugs such as 80.67% PPI (proton pump inhibitors), 76.67% analgesic and 51.33% vitamin/ iron supplements. From this analysis we found that 19.33% prescription contained single antibiotic drug, 80.67% contained two antibiotic drugs and no prescription contained more than two antibiotic drugs. Most of the prescribed drugs were administered orally (12% capsule, 80% tablet form). Out of 473 prescribed antibiotic drugs majority of them lie underβ-Lactam (54%) class followed by cephalosporin (46.33%) class in which maximum drugs (92%) were prescribed by their brand names.Conclusions: Prescribing more than one antibiotics was commonly encountered in this study indicating the occurrence of polypharmacy. Interventions to rectify over prescription of antibiotics, use of brand names, inadequate labelling of drugs is necessary to improve rational drug use. Standard treatment guidelines, hospital formulary, and educational intervention become essential to modify this behaviour to benefit the patient

Wound healing effect of Euphorbia hirta linn. (Euphorbiaceae) in alloxan induced diabetic rats

Abstract Background Euphorbia hirta linn., is a species of Euphorbiaceae family. They are known as asthma plant, barokhervi. The plant E. hirta is famous for its medicinal importance among the tribal population. It is a common practice to use the whole to heal wounds. Several pharmacological properties including antiseptic, anti-inflammatory, antidibetic, antispasmodic, antibacterial, antiviral, antifungal, anticonvulsant, nootropic, antifertility and aphrodisiac properties have already been reported for this plant. The aim of present work was to evaluate the wound healing property in diabetic animals by oral and topical administration of ethanolic extract of E. hirta whole plant. Methods The ethanolic extract of E. hirta was subjected to determine the total phenolic content and total flavonoid content using galic acid and quercetin, respectively as standard. A single injection of alloxan monohydrate (120 mg/kg, i.p.) prepared in normal saline was administered to produce diabetes in rats, after overnight fasting. For analyzing the rate of contraction of wound, excision wounds sized 4.90cm2 and of 2 mm depth were used. Oral (100, 200 and 400 mg/kg/day; p.o.) and topical treatment with the extract (5% and 10% ointment 50 mg/kg/day) and standard (5% povidone iodine ointment 50 mg/kg/day) was started on the day of induction of wound and continued up to 16 days. The means of wound area measurement between groups at different time intervals were compared using ANOVA and Dunnet’s test. The diabetic wound healing mechanism was studied by measuring the plasma level of glucose, malondialdehyde (MDA) and nitric oxide (NO) in both control and treated groups. For the confirmation of activity, histopathology of the wounds tissues from excision wound model was performed. Results Phytochemical investigations showed the presence of various phytoconstituents (carbohydrates, saponins, alkaloids, glycosides, steroids, flavonoids, tannins). In the ethanolic extract of E. hirta the total phenol content was 285 ± 3.22 mg/g whereas the total flavonoid content was 118.46 ± 1.85 mg/g. In the present study, E. hirta caused significant wound closer both orally (35.92%, 44.69% and 61.42% at the doses of 100, 200 and 400, respectively) and topically (32.86% and 36.32% at the doses of 5% and 10%) treated groups as compared to diabetic control. However, the orally treated groups showed more significant effect than the topically treated groups. Moreover, oral administration of E. hirta ethanolic extract significantly reduced the blood glucose levels in diabetic wound rats (p  0.05). It also demonstrated a significant decrease in the plasma levels of lipid malondialdehyde and nitric oxide. The results of biochemical parameters were further supported by the histopathological changes of different organs (liver, pancrease, kidney, heart and skin from wound area) which were evidenced through a decrease in inflammatory cell infiltration. Conclusion The present study demonstrates that E. hirta whole plant extract promotes healing of wounds more significantly as compared to diabetic control rats, where healing is otherwise delayed

Effects of Alcoholic Extracts of Bangladeshi Mangrove Acanthus ilicifolius Linn. (Acanthaceae) Leaf and Stem on Atherogenic Model of Wistar Albino Rats

Acanthus ilicifolius Linn. (Acanthaceae) is a popular mangrove ethnomedicinal plant that cures several ailments, including asthma, diabetes, cancer, and many others. Our experiment was aimed at evaluating the anti-atherogenic effect of A. ilicifolius (leaf and stem) on a high-fat diet-induced atherogenic rat model. Atherosclerosis was developed in 12 weeks. Treatment with the standard drug (3 mg/kg b.w./day, p.o. of Simvastatin), separate doses of methanolic and ethanolic extracts of A. ilicifolius leaf (250 and 500 mg/kg b.w./day, p.o.), and stem (200 and 400 mg/kg b.w./day, p.o.) was subsequently conducted for additional 15 days. The anti-atherogenic effect was evaluated by estimating the change in body weight, systolic blood pressure, and lipid profile. Histopathology of aorta, liver, and kidney of atherogenic models was done for further evaluation. The antioxidant effect of different extracts was performed via DPPH (2,2-diphenyl-1-picrylhydrazyl) assay using ascorbic acid as standard. The anticoagulant effect was determined after 15 days of treatment with the same doses of the plant extracts and the standard Warfarin (2 mg/kg b.w./day, p.o.). When compared with atherogenic control, treatment with A. ilicifolius significantly reduced (p < 0.01) body weight, systolic blood pressure, and serum lipid levels while it elevated HDL (high-density lipoprotein) level in a dose-dependent manner. Moreover, bleeding and clotting time was significantly decreased (p < 0.01) under the treatment of plant extracts. The histopathological data showed considerable improvement in tissue morphology after treatment. Our study evidenced that the alcoholic extracts of A. ilicifolius leaf and stem have anti-atherogenic properties and may be recommended as a potential herbal remedy for preventing cardiovascular diseases

A survey of prescription pattern of anti-diabetic drugs on diabetic patients with cardiovascular complications within Dhaka metropolis

Background: This survey study was designed to analyze the current prescription pattern of anti-diabetic drugs that used in diabetic patients with cardiovascular complications within Dhaka metropolis.Methods: The present study has been conducted by out-patient department in a number of well-known general and specialized government and private hospitals in Dhaka, Bangladesh for 5 months. 1200 prescriptions and questionnaire were randomly evaluated for this present survey. A standard questionnaire was prepared, containing 17 different questions, to conduct the survey based on patient’s demographic data such as which type of diabetes they have contained, age, gender, education and their self-assessment of health, disease history and medication.Results: Among the patients involved in this study, there were 46% (550) male and 54% (650) female between the ages of 30 and 75 years. Between 46 and 70 years, 19% male and 31% female were found to be diabetic indicating that in this age group female are mostly affected by diabetes. About 2020 antidiabetic drugs were prescribed by the physicians in which 30.43% contained single, 54.16% contained two and 15% contained more than two anti-diabetic drugs. Amongst antidiabetic medications, metformin was the most commonly prescribed drug which was given in 30.69% patients followed by glimepride 10.9%, 5.45% had glipizide, 1% pioglitazone and other drugs. A total of 7.43% drug was prescribed by fixed dose combinations. Highest percentage of male diabetic patients with hypertension (86%), dyslipidemia (100%) and other complications (57%) was found at 75 years of age while no female patients were found under the same condition at the same age.Conclusions: The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing &amp; marketing any new drug. Therefore it is necessary to create better awareness among people, focus on rational use of anti-diabetic drugs and also motivate our physicians to prescribe the generic drugs

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population