Analysis of fixed dose combinations of expectorants, antitussives, decongestants, antihistamines and mucolytics available in the Indian market for rationality and cost variation

Background: Aim of the current study was to analyze the FDCs of expectorants, antitussives, decongestants, antihistamines and mucolytics available in the Indian market for their rationality, cost, and dosage forms. Methods: FDCs involving expectorants, antitussives, decongestants, antihistamines and mucolytics listed on Drug Today and Jan Aushadhi online portal were analysed for rationality according to the list of banned FDCs by CDSCO published on 01 Jan 2018. The FDCs with EADAM available in Jan Aushadhi online portal are compared with cost of different brands with same composition, strength and dosage form available in the Indian market as per the latest drug today. The cost ratio and percentage cost variation were calculated for each FDC. Results: Out of total 340 oral formulations, 268 were liquid and 72 were solid formulations. 228 were Syrups, 67 were Tablets, 23 were Drops, 17 were Suspension and 5 were Capsules. Out of 47 banned FDCs, branded FDC with Ammonium chloride 50mg, Bromhexine 4mg, Dextromethorphan 5mg and Menthol in syrup form was still available for over-the-counter purchase and for online purchase with prescription. Percentage cost variation between branded and generic FDCs ranged from 99% for Terbutaline 2.5 mg and Bromhexine 8 mg to 1081% for Terbutaline 1.25 mg, Bromhexine 4mg, Guaiphenesin 50 mg and Menthol 2.5 mg. Conclusions: One among 47 Banned FDCs was available at both online apps and drug stores. These irrational FDCs can be risk to human lives. The drug authorities need to tune the price of these FDCs as there is a huge percentage cost variation between generic and branded products

RANDOMIZED, OPEN LABEL, ACTIVE CONTROLLED STUDY TO ASSESS AND COMPARE HEALTH RELATED QUALITY OF LIFE WITH MOMETASONE & FORMOTEROL VERSUS FLUTICASONE & FORMOTEROL DRY POWDER INHALER IN MILD TO MODERATE PERSISTENT ASTHMA

ABSTRACTObjectives: The present study was under taken to assess and compare the improvement in HRQoL among mild to moderate persistent asthmabetween Mometasone & Formoterol versus Fluticasone & Formoterol using dry powder inhaler using Asthma HRQoL questionnaire which is diseasespecific32-item instrument including 4 domains: symptoms, emotions, exposure to environmental stimuli and activity limitations where impairmentsexperienced during the previous 14 days and respond on 7-point scale.Methods: The present study was conducted in Preventive Medicine Unit and Chest & TB diseases OPD, KIMS & RC, Bangalore during March 2011 toFebruary 2012. 60 patients were recruited in each group based on inclusion and exclusion criteria. PFT was done pre and post bronchodilator withSalbutamol nebulization with Spirometry. Study medications were randomized and were given for 12weeks. HRQoL questionnaire was administeredbefore and after the medications and outcome was compared between them. Statistical test used were descriptive statistics, t- test.Results: There was a significant improvement in HRQoL from baseline to the end of 12 weeks in all domains (symptoms, emotional, exposure toenvironmental stimuli and activity limitations) in both the groups. The overall improvement in the HRQoL was better in Mometasone & Formoterolgroup compared to Fluticasone & Formoterol group but this difference was not statistically significant, which revealed both combinations wereequally effective in improving HRQoL in mild to moderate persistent asthma.Conclusion: Both Mometasone & Formoterol and Fluticasone & Formoterol combinations are equally effective in improving HRQoL in mild tomoderate persistent asthma patients.Keywords: Health-related quality of life, Mild to moderate persistent asthma, Dry powder inhaler

FORMULATION AND EVALUATION OF SOLID SELF MICRO EMULSIFYING DISPERSIBLE TABLET OF PIROXICAM

Objective: The aim of this study was to formulate the solid self-micro emulsifying dispersible tablets for promoting the dissolution of Piroxicam. Methods: Solubility study test was performed to know the solubility of various oil phase, surfactants, cosurfactants. Self-emulsifying grading test was done by visual grading system. Ternary phase diagrams and droplet size analysis test were performed to screen and optimize the Piroxicam-self microemulsifying drug delivery system (SMEDS). Then microcrystalline cellulose (KG802) was added as a suitable adsorbent and dispersible tablet were prepared by wet granulation compression method. Results: The final composition of Piroxicam-SMEDS was oil phase (oleic acid, 23%), surfactant (Cremophor R H-40,61%), co-surfactant (PEG-400,16%) based on the result of solubility test, self-emulsifying grading test, droplet size analysis and ternary phase diagrams. Microcrystalline cellulose (KG802) was selected based on dissolution study (98.35%) and added to liquid Piroxicam-Smeds formulation to form dispersible tablets. The in vitro dissolution study showed 98.02 % of drug release from Piroxicam-SMEDS tablets. Conclusion: Piroxicam–Self microemulsifying dispersible tablets have increased the solubility and bioavailability of the Piroxicam to a greater extent. SMEDS formulation can help the solubility of poorly water-soluble drugs

Integrated nutrient management for improving crop yields, soil properties, and reducing greenhouse gas emissions

Recently, most agrarian countries have witnessed either declining or stagnant crop yields. Inadequate soil organic matter (SOM) due to the poor physical, chemical, and biological properties of the soil leads to an overall decline in the productivity of farmlands. Therefore, the adoption of integrated nutrient management (INM) practices is vital to revive sustainable soil health without compromising yield potential. Integrated nutrient management is a modified nutrient management technique with multifarious benefits, wherein a combination of all possible sources of plant nutrients is used in a crop nutrition package. Several studies conducted in various parts of the world have demonstrated the benefits of INM in terms of steep gain in soil health and crop yields and at the same time, reducing greenhouse gas emissions and other related problems. The INM practice in the cropped fields showed a 1,355% reduction in methane over conventional nutrient management. The increase in crop yields due to the adoption of INM over conventional nutrient management was as high as 1.3% to 66.5% across the major cropping systems. Owing to the integration of organic manure and residue retention in INM, there is a possibility of significant improvement in soil aggregates and microbiota. Furthermore, most studies conducted to determine the impact of INM on soil health indicated a significant increase in overall soil health, with lower bulk density, higher porosity, and water-holding capacity. Overall, practicing INM would enhance soil health and crop productivity, in addition to decreasing environmental pollution, greenhouse gas emissions, and production costs

Weight-bearing in ankle fractures: An audit of UK practice.

INTRODUCTION: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. METHODS: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, "early" weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and "delayed" weight-bearing as unrestricted weight-bearing permitted after 3 weeks. RESULTS: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. DISCUSSION: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. CONCLUSION: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible