Drug utilization study in dengue infection in a tertiary care hospital

Background: Dengue fever (DF) is a serious public health problem, gaining global attention because of its morbidity and mortality. Less studies on Drug utilization pattern of DF in India. The present study was undertaken to analyze Drug utilization pattern of dengue infection in a tertiary care hospital.Methods: A prospective cross-sectional study was conducted for a period of 2 months in a tertiary care hospital and the data was analyzed by using various drug use indicators.Results: A total of 52 prescriptions were analyzed. Male and female were (46.16%, 53.84%), A total of 330 drugs were prescribed. 86 (26.06%) antibiotics, 70 (21.21%) antipyretics, 51 (15.46%) antacids, 19 (5.76%) multivitamins, 52 (15.76%) anti-emetics and 52 (15.76%) papaya leaf extract was prescribed. 84 (25.46%) oral and 246 (74.54%) injectable drugs. IV-fluids given to all patients. 10 (19.24%) were given blood transfusion. 6.17 drugs per prescription. 96% drugs were prescribed by brand names. High DDD for drugs like diclofenac (184), doxycycline (115), metronidazole (2.5), pantoprazole (161.5), rabeprazole (34.6), ondansetron (200) was observed.Conclusions: Most commonly used drugs are antipyretics, antibiotics, antacids, antiemetic, papaya leaf extract. As the incidence of DF is increasing with epidemics, demand for specific treatment guidelines is in great need. Early recognition of the disease, with a rational approach in case management leads good clinical outcome

A case report of life threatening Dapsone Hypersensitivity Syndrome

Dapsone is widely used for a variety of infections, immune and hypersensitivity disorders. However, the use of Dapsone may be associated with a plethora of adverse effects, the most serious being Dapsone Hypersensitivity Syndrome (DHS) wherein the patient typically presents with a triad of fever, skin eruption and internal organ involvement, that occurs during first 2 to 8 weeks of initiating the treatment. The incidence of DHS ranges from 0.5% to 3%.  Here we report a case of severe life threatening Dapsone induced hypersensitivity reaction in a 21year old female who presented with high grade fever, generalized lymphadenopathy, skin rash and hepato-splenomegaly. This condition is best approached with immediate discontinuation of offending drug and prompt administration of oral or IV glucocorticoids. The case is being reported to emphasize the need for timely diagnosis and prompt treatment for successful outcome as it can cause irreversible organ damage or death if untreated early

EFFECT OF LEKHANA BASTI IN THE MANAGEMENT OF DYSLIPIDEMIA: A CLINICAL STUDY

Dyslipidemia one of the life style disorder due to the todays faulty life style. It may be manifested by elevation of the total cholesterol the bad low density lipoprotein (LDL) cholesterol and the triglyceride concentrations and a decrease in the good high density lipoprotein (HDL) cholesterol concentration in the blood. Dyslipidemia is widely regarded as a major risk factor for coronary heart disease (CHD) and atherosclerotic cardiovascular disease (ASCVD). Every 1% increase in cholesterol level there is 1-2% increase in the incidence of Coronary Heart Disease. Lipids can be correlated to that of Medo Dhatu. According to the scattered references Dyslipidemia can be correlated to Medo Dosha and subsequently as Medoroga. The treatment principles mainly includes Samshodhana Chikitsa (Bio cleansing), where as in modern statins are first choice of drug. Looking into the adverse reactions and the limitations in the modern medication clinical trial was carried out in 30 patients having Dyslipidaemia. Lekhana Basti was administered and the effect of treatment on the complete lipid profile i.e., Serum cholesterol, Triglycerides, HDL, S.LDL, VLDL was assessed after the treatment and follow up. As Basti Karma is best treatment for correction of Vata Dosha, which are the basic factors involved in the pathogenesis of Medoroga. Statistical analysis using ANOVA and paired t test showed highly significant result in the lipid profile after the treatment and follow up

An evaluation of knowledge, attitude and perception about adverse drug reactions and pharmacovigilance among intern doctors in a medical college teaching hospital of Sangli

Background: Underreporting of various adverse drug reactions (ADRs) by consultants is a common incurable problem. National pharmacovigilance program is one of the ongoing programs to monitor the adverse drug reactions & reporting at the earliest to the nearby AMCs. As medical interns are budding doctors, the focus of this study was to evaluate the knowledge, attitude and perception about ADRs and pharmacovigilance in them.Methods: A cross section questionnaire-based study was conducted after approval by our institutional ethics committee pretested and validated questions consisting of 20 questions (knowledge, attitude, perception) were administrated to medical interns. The filled questionnaires were collected and analysed.Results: In our study, medical interns have fair enough idea about ADR and pharmacovigilance. In knowledge domain they were aware of term ADRs (100%), pharmacovigilance (72.6%). In attitude domain majority of interns (80.6%) known availability of ADR forms, compulsory of pharmacovigilance unit (90.3%). In perception domain very poor response from interns, not even a single intern had reported any ADR filled form and they don’t know meaning of re-challenge and de-challenge, very few interns (9.7%) know how to manage the ADRs in emergency conditions.Conclusions: Under reporting problem can be improved by doing more teaching activities at undergraduate level and intern’s level including various workshops, CMEs, problem-based teaching of adverse reactions in their curriculum. These exercises will improve their reporting frequency and sensitize the interns from the undergraduate days itself in their upcoming clinical practice in community

Preclinical study comparing the antidotal effect of clonidine with atropine for the treatment of acute malathion poisoning in the albino rats

Background: In developing countries 2–3 million people are acutely poisoned by organophosphorus (OP) pesticides every year. There is a pressing need for new affordable antidotes and in this context clonidine which has central effect (α2 agonist) has been evaluated in the albino rats presenting with signs or symptoms of acute malathion poisoning. And compared with atropine for the acte malathion poisoning in albino rats.Methods: This was a preclinical study conducted on albino rats of either sex weighing 100-150 grams were randomly divided into 4 groups (6/group). Malathion was given at the lethal dose of 54 mg/kg body weight (BW) by gavage to each group. Group 1: normal saline intraperioneal (i.p). Group 2: Post treated with atropine 1.5 mg/kg BW (i.p). Group 3: Pre treated with clonidine 1mg/ kg BW (i.p), 10 minutes priore malathion. Group 4: Pre treated with clonidine and post treated with atropine. The above groups were observed for straub tail, muscle fasciculation, piloerection, lacrimation, defecation/ urination; salivation, tremors, gasping and convulsion and were recorded at time 0, 15, 30, 45 and 60 minutes after poisoning. The latency of onset of tremors, loss of righting reflex and tremors were recorded. Results were presented as percentage occurrence and Mean ± SEM. Repeated measure one way ANOVA and Fisher’s Least Significant Difference post hoc test for comparison between groups. P-value of 0.05 or less was considered for statistical significance.Results: The central effects namely straubs tail and whole body tremors are significantly improved compared to control and atropine with clonidine group (p<0.05). However convulsion shows improve in atropine alone and atropine with clonidine groups. The overall survival time has significantly increased compared to control and atropine and atropine with clonidine (P<0.05).Clonidine has not shown any effect on survival time.Conclusions: Clonidine has some central protective effect in malathion poisoning. And it has not shown any effect on survival time. This issue needs further controlled studies

Prospective observational study of drug utilization in neonatal seizure at a tertiary care hospital with Pharmacoeconomics

Background: Seizures are the most common indicator of significant neurologic dysfunction in neonatal period with incidence of 11.7/1000 live births. Phenobarbitone is used as first line of treatment since 1900s. Newer anti-epileptic drugs (AED) available are Levetiracetam, Topiramate etc. Present study focused on utilization pattern of AED, treatment outcomes and to study economic burden of disease.Methods: An observational study was done on 100 neonates admitted to Neonatal Intensive Care Unit in Basaveshwara hospital, Kalaburagi (June 2016-May 2017). Prescription data was entered into specially designed proforma, WHO core indicators were determined. The data was analyzed using descriptive statistics and presented as means and percentages.Results: Majority of neonates were male (58%) and 63% were diagnosed with subtle seizure. Out of 458 drugs prescribed, 201 were antiepileptics. 41% cases were successfully managed by monotherapy. Most commonly used drug was phenobarbitone (82%) and phenytoin (31%). Leviteracetam, newer AED was used in 3 refractory cases. The major combination of drugs used was Phenobarbitone-Phenytoin (24%). AED were rationally prescribed, but antibiotic was over-utilized(68%). 31% cases had adverse drug reaction. On average per prescription, number of drugs used were 4.6 and drug cost was Rs.3803/-. The total cost of illness per patient was Rs.16363/-.Conclusions: AED utilization in neonatal seizures was in accordance to guidelines, with phenobarbitone being extensively used despite its potential neurotoxicity. The utilization of newer AED would increase if clinicians are supported with the safety and efficacy data. Although monotherapy was preferred with respect to AED, antibiotics were highly prescribed; hence awareness is needed to curb this practice

SYNTHESIS, ANTIMICROBIAL, ANTITUBERCULAR AND CHEMINFORMATIC STUDIES OF 2-(1-BENZOFURAN-2-YL)-N'-[(3Z)-2-OXO-1, 2-DIHYDRO-3H-INDOL-3-YLIDENE] QUINOLINE-4-CARBOHYDRAZIDE AND ITS DERIVATIVES

Objective: Synthesis of novel 2-(1-benzofuran-2-yl)-N'-[(3Z)-2-oxo-1, 2-dihydro-3H-indol-3-ylidene] quinoline-4-carbohydrazide and its derivatives for antimicrobial and antitubercular activity.Methods: Synthesis was carried out using the general method and the structures were confirmed by IR, 1H-NMR, [13]C-NMR and mass spectral analysis. The antibacterial activity was carried by agar well diffusion method, antifungal activity was performed by poison food technique and antitubercular activity was carried out by Microplate Alamar Blue Assay (MABA) method with the help of H37Rv. In silico absorption, distribution, metabolism, excretion, toxicity (ADMET) study of the drug, likeliness was carried out in ACD/lab-2.Results: The results revealed that at 25 mg/ml concentration, compounds 3a and 5a showed good antibacterial activity at 3.5±0.1, 3.8±0.3, 3.6±0.2 respectively against E. coli, K. pneumonia and S. typhimurium, when compared with drug streptomycin with similar concentration. The percentage of inhibition found at 50 µg/ml concentration, compounds 2b and 6a exhibited good antifungal activity at 53±1.15, 57±1.52 against A. flavus and C. neoformans, compared with standard drug fluconazole. The increase in activity was found to be dose dependent. The analogue 2a showed good antitubercular activity at 12.5±0.5 µg/ml, compounds 2b, 3a, 4a-b, 5a-b and 6a-b exhibited significant activity at 25±0.57 µg/ml and compound 3b showed moderate activity at 50±0.57 µg/ml. The mean value of P&lt;0.05 were considered to be statistically significant. The absorption, distribution, metabolism, excretion and toxicity studies of the entitled molecules were analyzed and found to be in acceptable range.Conclusion: The study reveals that compounds containing benzofuran coupled nitrogen heterocycles are essential for activity as they possess excellent drug-like characteristics, suggesting to be potentially best inhibitor of H37Rv strain. The in silico ADME analysis also revealed that all the compounds were in acceptable range to obey the pharmacokinetic parameters

Management of Spondylosis Induced Sciatica through Panchakarma w.s.r. to Vata Kaphaja Gridhrasi - A Case Study

Introduction: Low backache alone or along with radiating pain in the lower limb is a common entity encountered in daily clinical practice. Lumbar spondylosis is a major cause of lower back pain and also important clinical, social, economic and public health problem affecting the world wide population. Degeneration of the disc that affects the lumbar spine can cause low back pain (referred to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg (sciatica). So Lumbar spondylosis induced sciatica can be compared with Gridhrasi in Ayurveda on the basis of sign and symptoms described in Ayurvedic classics. Material and Methods: Presented case was 59-year-old male patient having the symptoms of Vata- Kaphaj Gridhrasi in bilateral leg (left&gt;right). Panchakarma treatment such as Valuka Swedana (sand fomentation), Abhyanga (oil massage), Vashpa Swedana (steam bath), Erandamooladi Niruha Basti (herbal medicated enema) and Kati Basti (oil application on Lumbar region) along with oral Ayurvedic medicines were used. Discussion: Assessments were made using VAS (Visual Analogue scale) Pain score, SLR (Straight leg raise) test and Finger to floor test (FTF). At the end of the treatment, there was significant improvement in sign and symptoms of sciatica and overall improvement in quality of life of the patient

MANAGEMENT OF ASTHI-MAJJAGATA VATA W.S.R. TO AVASCULAR NECROSIS (AVN) OF FEMORAL HEAD STAGE 3 BY PANCHAKARMA - A CASE STUDY

Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that occurs when there is loss of&nbsp;blood supply to the bone, an interruption to the blood supply causes bone to die. If not stopped this process eventually cause the bone to collapse. It is the most challenging condition of the present era in orthopedics. In Ayurveda it can be co-related with the Asthi Majja Gata Vata due to similar sign and symptoms of Avascular necrosis of neck of femur. Aim and objectives: To assess the efficacy of Manjisthadi Kshara Basti, Rooksha Choorna Pinda Swedana, Pizhichil and Shastikashali Pinda Swedana in the management of AVN. Objective was to stop the further deterioration of the hip joint and to reduce the chances of surgical intervention in managing AVN. Materials and methods: A diagnosed and non operated case of Avascular necrosis of stage 3 with complaints of pain of bilateral hip joint, restricted movements and limping gait approached the out-patient division of the hospital and was managed by Rooksha Choorna Pinda Swedana, Manjisthadi Kshara Basti, Pizhichil and Shastikashali Pinda Swedana. Observation and Result: Significant improvement was noticed after the treatment. Pain was reduced significantly with improvement in range of movement. Patient was able to walk and climb stairs after the treatment without pain and stiffness. There was reduction in VAS scale, marked improvement was noticed in Harris Hip Score

MANAGEMENT OF IRRITABLE BOWEL SYNDROME THROUGH AYURVEDA: A CASE STUDY

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by altered bowel habits and abdominal pain in the absence of detectable structural abnormalities. The pathogenesis of IBS is poorly understood, although roles for abnormal gut motor and sensory activity, central neural dysfunction, psychological disturbances, stress, and luminal factors have been proposed. About 10-15% of the population is affected at some time but only 10% of these consult their doctor because of symptoms. In Ayurveda, IBS can be correlated to Grahani Roga due to similarity in their clinical presentation. In this case an effort was made to treat a 32 years old male patient having symptoms of Muhurbaddha Muhurshithil (episode of constipated and loose stools), Apakwa Malapravritti (Stool with mucus), Udarshool (abdominal pain). Patient treated with various Panchakarma (five Bio-cleaning Ayurvedic therapies) procedures like Basti (herbal medicated enema), Takra Dhara (pouring Herbal medicated butter milk on head) and oral medications. At the end of 60 days of treatment patient got significant improvement in episode of constipated and loose stools (75%), distension of abdomen (75%), anorexia (100%) and stool with mucus (100%)