Drug price control order: the impact on pharmacoeconomics

Background: The objective of the present study was to analyze the prices of metformin, losartan, atorvastatin, paracetamol and aspirin for the doses which are included in the list of Drug Price Control Order (DPCO) 2013.Methods: Current index medical specialties India, 37th year, April-July 2015 issue was used for analysis. The retail prices of the drugs in INR were tabulated in Microsoft Office Excel 2013. The prices of the above listed drugs were compared with prices of DPCO 2013 for the same doses of drugs. The analysis of drugs costing more than the prices listed in the DPCO with the margin of the difference in percentage was carried out.Results: Out of 25 brands of metformin 500 mg tablet, 11 (44%) brands had price higher than listed in DPCO 2013. Similarly, prices for losartan 25 mg and 50 mg tablets, 8 (25%) out of 32 and 11 (31.42%) out of 35 were higher respectively. For atorvastatin 5 mg and 10 mg tablets, 2 (9.52%) out of 21 and 8 (13.55%) out of 59 brands had higher prices. For paracetamol 500 mg tablet, 12 (63.15%) out of 19 brands were priced higher than DPCO list. For aspirin 100 mg tablet and 325 mg tablet, 3 (100%) out of 3 brands and 1 (100%) out of 1 brand had higher prices.Conclusions: Many of the brand formulations have higher prices than the DPCO 2013 issued by government of India. The clinicians prescribing these drugs should be aware of these brand formulations to reduce the cost of the drug therapy

Clinical and epidemiological characterization of severe Plasmodium vivax malaria in Gujarat, India.

The mounting evidence supporting the capacity of Plasmodium vivax to cause severe disease has prompted the need for a better characterization of the resulting clinical complications. India is making progress with reducing malaria, but epidemics of severe vivax malaria in Gujarat, one of the main contributors to the vivax malaria burden in the country, have been reported recently and may be the result of a decrease in transmission and immune development. Over a period of one year, we enrolled severe malaria patients admitted at the Civil Hospital in Ahmedabad, the largest city in Gujarat, to investigate the morbidity of severe vivax malaria compared to severe falciparum malaria. Patients were submitted to standard thorough clinical and laboratory investigations and only PCR-confirmed infections were selected for the present study. Severevivax malaria (30 patients) was more frequent than severe falciparum malaria (8 patients) in our setting, and it predominantly affected adults (median age 32 years, interquartile range 22.5 years). This suggests a potential age shift in anti-malarial immunity, likely to result from the recent decrease in transmission across India. The clinical presentation of severe vivax patients was in line with previous reports, with jaundice as the most common complication. Our findings further support the need for epidemiological studies combining clinical characterization of severe vivax malaria and serological evaluation of exposure markers to monitor the impact of elimination programmes

Prevalence and associated factors of dry eye: Our experience in patients above 40 years of age at a Tertiary Care Center

Context: Dry eye is a very common as well as under-diagnosed ocular disorder. It is not only troublesome in terms of its symptoms but also imposes a great financial burden. Aims: To determine the prevalence of dry eye in ophthalmology out-patients at a Tertiary Care Hospital and its association with various clinico-epidemiological factors. Settings and Design: A hospital-based study at a Tertiary Care Center was conducted including 400 out-patients of age 40 years and above. Materials and Methods: Patients were consecutively selected and underwent a routine ophthalmological examination along with tear film break-up time (TBUT) as a screening tool for detecting the presence of dry eye. Statistical Analysis: We performed a descriptive, univariate and multivariable logistic regression analysis to calculate odds ratios and 95% confidence interval. Results: The mean age of the study population was 58.6 years. The overall prevalence of dry eye was found to be 54.3%. An association was found between dry eye prevalence and outdoor workers, participants working indoor using air conditioners, housewives, diabetics, patients who have undergone previous ocular surgery and those with meibomian gland dysfunction. Conclusions: Dry eye is a very common condition with a high prevalence among the elderly. We recommend the screening of all out-patients by TBUT, which is a simple test to perform and examination of lids for meibomian gland disease, which if present can be treated. Further studies are needed to establish uniform diagnostic criteria for dry eye, which will help to get more concrete prevalence data, as well as its etiological factors

Prevalence and associated factors of dry eye: Our experience in patients above 40 years of age at a Tertiary Care Center

Context: Dry eye is a very common as well as under-diagnosed ocular disorder. It is not only troublesome in terms of its symptoms but also imposes a great financial burden. Aims: To determine the prevalence of dry eye in ophthalmology out-patients at a Tertiary Care Hospital and its association with various clinico-epidemiological factors. Settings and Design: A hospital-based study at a Tertiary Care Center was conducted including 400 out-patients of age 40 years and above. Materials and Methods: Patients were consecutively selected and underwent a routine ophthalmological examination along with tear film break-up time (TBUT) as a screening tool for detecting the presence of dry eye. Statistical Analysis: We performed a descriptive, univariate and multivariable logistic regression analysis to calculate odds ratios and 95% confidence interval. Results: The mean age of the study population was 58.6 years. The overall prevalence of dry eye was found to be 54.3%. An association was found between dry eye prevalence and outdoor workers, participants working indoor using air conditioners, housewives, diabetics, patients who have undergone previous ocular surgery and those with meibomian gland dysfunction. Conclusions: Dry eye is a very common condition with a high prevalence among the elderly. We recommend the screening of all out-patients by TBUT, which is a simple test to perform and examination of lids for meibomian gland disease, which if present can be treated. Further studies are needed to establish uniform diagnostic criteria for dry eye, which will help to get more concrete prevalence data, as well as its etiological factors

A STUDY OF DRUG UTILIZATION IN PATIENTS OF CARCINOMA BREAST RECEIVING SYSTEMIC CHEMOTHERAPY IN TERTIARY CARE HOSPITALS

Objective: The objective of the study is to study drug utilization in patients with breast carcinoma receiving systemic chemotherapy in government as well as private set-up. Methods: This was a record-based, retrospective-prospective study, analyzing the prescription pattern of drugs used for systemic chemotherapy in patients diagnosed with carcinoma breast at government teaching hospital (GTH) and private trust hospital (PTH) for 1 year in 600 patients. Patient’s demographic, clinical, and therapeutic data were collected from the files and personal interviews and analyzed in Microsoft Excel. Results: Diagnosis of breast carcinoma was highest in age bracket of 40–49 years (32.33% GTH and 32.67% PTH), and the most common presenting symptom was painless lump (76.33% GTH and 83% PTH). In GTH, most frequently prescribed regimen was 4AC → 4T → RT (17.33%). In PTH, most commonly prescribed regimen was 6FEC → RT (19.33%). Highest prescribed drugs were A (32.8%), C (29.12%), and F (20.24%) in GTH and A (32.26%), F (31.68%), and E (16.45%) in PTH. Average number of drugs prescribed per prescription was 12.55 and 11.37; percentage of chemotherapeutic agents prescribed by generic name was 100 and 95.02, and from the WHO essential drug list (2015) was 96.43 and 82.77 in GTH and PTH, respectively (A= Cyclophosphamide, C= Doxorubicin, T=Taxanes [Paclitaxel/Docetaxel], F=5-fluorouracil, E=Epirubicin, RT=Radiotherapy, → followed by, the number indicates chemotherapy cycle). Conclusion: The study results can help in generating local data regarding drug use pattern of the systemic chemotherapeutic agents in breast cancer patients and promote rational drug use

An evaluation of Adverse Drug Reactions with Remdesivir in patients of COVID-19 : Adverse drug reactions with remdesivir.

Background: Corona virus disease (COVID-19) is a systemic thrombo-hyperinflammatory vasculitis caused by SARS CoV2 virus, symptoms of which range from pharyngitis to severe acute respiratory illness. Remdesivir, an adenosine triphosphate analogue, was granted USFDA Emergency Use Authorization (EUA) for COVID-19 treatment. Limited data is available regarding its safety profile. This study aims to evaluate the Adverse Drug Reactions (ADRs) following remdesivir therapy in patients of COVID-19infection.   Aim: To evaluate the Adverse Drug Reactions following Remdesivir therapy in patients of COVID-19.   Methodology: All Patients more than 18 years of age of any gender, diagnosed with COVID-19 infection receiving remdesivir therapy and fulfilling the selection criteria were included in the study after informed consent. They were monitored for ADRs till end of treatment and analysed for characteristics of the ADRs: causality, severity and preventability.   Results: Out of 80 patients (mean age of 49.27±16.22 years) enrolled, 51 (63.75%) developed 84 ADRs. Most common ADRs included increased aspartate transaminases (AST),(20.23%), increased bilirubin (19.04%), increased alanine transaminases (ALT) (13.09%), increased creatinine (11.90%) and increased blood urea (9.52%). Causality assessment using WHO-UMC scale showed, 85.71% possible, 13.09% probable and 1% certain causal association of the ADRs with remdesivir. A total 75% ADRs were mild in severity and 45% patients recovered from the event at the end of treatment.   Conclusion: Hepatic and Renal dysfunctions are observed with remdesivir in COVID-19 patients. Intensive monitoring of ADRs with newer drugs with EUA such as remdesivir is warranted to ensure safer use in patients

Rare case of ocular tuberculous noduloulcerative scleritis

Tuberculosis is an endemic disease in developing countries like India. A scleral tuberculoma is a very rare manifestation of this disease. Ocular involvement is usually secondary to pulmonary tuberculosis or in cases of disseminated tuberculosis. A very high index of suspicion is necessary in endemic areas as the condition can be sight threatening. We hereby report a rare case of ocular tuberculosis presenting as a noduloulcerative lesion of the sclera. An otherwise healthy, 26 year old female patient, presented with redness, pain and watering in the right eye since two months. On examination an oval noduloulcerative scleral lesion was noted associated with cells and flare in the anterior chamber. Patient had a normal vision and posterior segment. After ruling out all other causes of ocular inflammation and with a positive Mantoux test, the patient was started on oral antituberculous treatment. The lesion faded and resolved over a period of two weeks. This case emphasises the necessity of ruling out tuberculosis in endemic areas where the clinical manifestations of the disease can be obscure. Early diagnosis and prompt systemic treatment gives a favourable prognosis

Prevalence of glaucoma in pathological myopia

Purpose: To find association of glaucoma in pathological myopia for their early diagnosis and treatment and to prevent patients from glaucoma associated blindness. Settings and design: Cross sectional study. Materials and methods: 102 high myopic patients coming to the outpatient department at Dhiraj hospital, Waghodia, Piparia, Vadodara had undergone complete ophthalmic evaluation along with detailed ocular and medical history followed by examination. Results: A detailed clinical observation was done on 102 eyes with pathological myopia with an average axial length of 28 mm which showed an overall glaucoma prevalence of 25%. The study population was divided into four different groups which showed an increased prevalence of glaucoma up to 10-20% for the first group with an axial length of 26 mm; 30% for the second group with an axial length of >26 mm; 36% for the third group with an axial length >28 mm; and finally, 40% for the fourth group with an axial length of >29 mm. It becomes very important to rule out the co-existence of myopic maculopathy and glaucomatous optic neuropathy (GON) in pathological myopia due to increased prevalence of glaucoma.&nbsp