Pharmacoeconomic comparison of losartan and amlodipine in patients of hypertension in a tertiary care teaching hospital

Background: To conduct a pharmacoeconomic comparison (cost-effectiveness analysis) and to evaluate the overall safety and efficacy of Losartan and Amlodipine in reducing the Mean blood pressure per mm Hg in hypertensive patients.Methods: This was a prospective, randomized, open label, observational analysis of cost-effectiveness; into compare the cost of Losartan 50mg and Amlodipine 5mg in hypertensive patients using either of the two drugs. A total of 80 newly diagnosed drug naïve hypertensive patients were considered for the comparison, of which 40 patients were prescribed Losartan and the other 40 were prescribed Amlodipine as per the recommended dosage. Based on the data, statistical analysis was carried out using SPSS Software Version 21.Results: The two drugs were found to be equi-effective in reducing the blood pressure to the target goal, at their respective equivalent doses Moreover, the cost of reducing 1 mm of Hg mean blood pressure with Losartan was 103.42 INR, whereas that of Amlodipine was 57.11 INR. Hence the cost incurred in treating elevated BP was markedly lower with the Amlodipine group as compared to the Losartan group.Conclusions: This pharmacoeconomic analysis shows that Amlodipine is more cost-effective as compared to Losartan when the cost per mm Hg reduction in mean blood pressure is considered. Hence in India, where the cost of drug is a significant deterrant to patient compliance, cost-effective therapy of chronic disease like hypertension is of prime importance

A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

Background: Incidence of Pulmonary Mycosis is rampantly growing in critically ill patients. This study was designed to comparatively evaluate conventional and molecular method-Polymerase Chain Reaction (PCR) for detecting Candida and Aspergillus species in Brocho-Alveolar Lavage (BAL) samples and secondarily to find out the Cost-Effective treatment for Pulmonary Mycosis.Methods: In this study 100 BAL-specimens were collected from patients suspected of Pulmonary Mycosis. These samples were examined for Aspergillus and Candida species by preparation of wet smear using potassium hydroxide, Gram staining, Culture media and Polymerase Chain Reaction (PCR). For Cost-Effectiveness analysis(CEA), a decision tree model was constructed for Anidulafungin and Fluconazole The probability of treatment success and mortality rate were extracted from published Randomized Control Trials. Incremental Cost Effectiveness Ratio (ICER) was calculated.Results: Out of 100 samples, 22 were found to be positive for mycotic infections, 9 were detected as Candida and 13 as Aspergillus. On comparing with KOH and Culture, it was observed that all KOH positive and all Culture positive fungal infections were PCR positive. In no cases PCR negative was identified either culture or KOH positive. This establishes the superiority of PCR over conventional diagnostic methods. Anidulafungin was associated with an Incremental Cost Effectiveness Ratio (ICER) of INR 1,13,217 per LY saved, which was below the implicit ICER threshold for India.Conclusions: PCR is a novel molecular method for early and definitive diagnosis of fungal infection and Aidulafungin appears to be the cost-effective drug for treatment of Pulmonary Mycosis

Drug utilization audit of antipsychotics using WHO methodology: recommendations for rational prescribing

Background: Utilization pattern of antipsychotics has undergone a major shift as the newly introduced atypical antipsychotics have heralded the market. Hence continuous studies on current prescribing trends are needed to provide most updated, effective and rational treatment of psychoses.Methods: This cross-sectional prospective study was conducted at Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. OPD tickets of the department of psychiatry for the year 2016-2017 were evaluated for a total of 310 cases. These prescriptions were used to determine the drug utilization of antipsychotics and for their appropriateness against the WHO recommended core prescribing indicators.Results: A total of 310 patients satisfied the inclusion criteria and a male predominance was seen (male:female= 1.3:1). The most common psychotic disorder diagnosed was schizophrenia (44%). Majority of the patients (76%) received monotherapy and the prescribing trend showed a higher use of atypical antipsychotics (89%) over typical ones (11%). The most commonly prescribed anti-psychotic drugs were olanzapine (31%), followed by risperidone (26%). On analysing prescriptions according to the WHO core prescribing indicators it was observed that average number of antipsychotics prescribed per prescription was 1.32. 24% of drugs were prescribed by generic name and 5.2% were administered via injectable route. Drugs prescribed from National list of Essential Medicine, 2015 constituted 46%.Conclusions: The high inclination towards the use of atypical antipsychotics observed in our study correlates with the global changing trends in the treatment of schizophrenia. WHO prescribing indicators should be adhered to, to impart rational prescribing

A comparative evaluation of diclofenac and tramadol as post-operative analgesics along with causality and severity assessment of ADRs

Background: Diclofenac and Tramadol are well established analgesics for post-operative pain management, yet some adverse effects are associated with their use which govern their tolerability. The objective of the study was to evaluate the comparative efficacy of the two drugs and to assess the causality and severity of documented Adverse Drug Reactions (ADRs).Methods: An open labelled, prospective, interventional, simple randomized clinical study to compare efficacy and safety of diclofenac and tramadol was conducted by the Department of Pharmacology in collaboration with the Department of Surgery. Post-operative pain intensity was measured on Visual Analogue Scale (VAS). Causality and severity assessment of the recorded ADRs was done using WHO-UMC scale and modified Hartwig and Seigel Scale respectively.Results: A total of 211 patients underwent different surgeries. The most common surgery performed was mesh hernioplasty 78 (36.96%). VAS score was used as data to determine the analgesic efficacy of two drugs. Wilcoxon Signed Rank test showed significant reduction in pain on all days for each group individually while Mann Whitney U test compared both the groups and revealed that both the drugs i.e. diclofenac and tramadol were equally efficacious in reducing post-operative pain. Causality assessment showed that all the documented ADRs fall in POSSIBLE category while severity assessment revealed that all the ADRs were MILD in nature.Conclusions: Diclofenac and tramadol proved to be equi-effective in reducing post-operative pain . The study also emphasized that active surveillance of ADRs can lead to timely intervention and provide maximum benefit to the patient

POSTPARTUM CONTRACEPTIVE USE IN RURAL BAREILLY

Background: Contraception is an important intervention to reduce burden of unwanted pregnancy and promote healthy living among women. Objectives: To find out the postpartum contraceptive usage and identify the different variables which affect the postpartum contraception among the rural females of Bareilly district. Methods: The cross sectional study was carried out in randomly selected villages of Bhojipura Block of Bareilly district, Uttar Pradesh. All women who had delivered within last one year were interviewed by house to house survey to collect data regarding socio-demographic characteristics and contraceptive use by structured questionnaire. A total of 123 women participated in the study. Chi- square test was used to analyze data. Results: Only 13.8% mothers adopted postpartum contraception. Lack of knowledge (32.5%) and young infant being breastfed (28.5%) were the common reasons of not using any contraceptive method. Contraceptive use was higher amongst females aged less than 30 years and those belonging to middle socioeconomic class and nuclear families. The significant influence of the women’ educational status on utilization of family planning methods was observed (p<0.05). Conclusions: Low percent of postpartum contraceptive use indicates the need for improving awareness among the study population

A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

Background: Incidence of Pulmonary Mycosis is rampantly growing in critically ill patients. This study was designed to comparatively evaluate conventional and molecular method-Polymerase Chain Reaction (PCR) for detecting Candida and Aspergillus species in Brocho-Alveolar Lavage (BAL) samples and secondarily to find out the Cost-Effective treatment for Pulmonary Mycosis.Methods: In this study 100 BAL-specimens were collected from patients suspected of Pulmonary Mycosis. These samples were examined for Aspergillus and Candida species by preparation of wet smear using potassium hydroxide, Gram staining, Culture media and Polymerase Chain Reaction (PCR). For Cost-Effectiveness analysis(CEA), a decision tree model was constructed for Anidulafungin and Fluconazole The probability of treatment success and mortality rate were extracted from published Randomized Control Trials. Incremental Cost Effectiveness Ratio (ICER) was calculated.Results: Out of 100 samples, 22 were found to be positive for mycotic infections, 9 were detected as Candida and 13 as Aspergillus. On comparing with KOH and Culture, it was observed that all KOH positive and all Culture positive fungal infections were PCR positive. In no cases PCR negative was identified either culture or KOH positive. This establishes the superiority of PCR over conventional diagnostic methods. Anidulafungin was associated with an Incremental Cost Effectiveness Ratio (ICER) of INR 1,13,217 per LY saved, which was below the implicit ICER threshold for India.Conclusions: PCR is a novel molecular method for early and definitive diagnosis of fungal infection and Aidulafungin appears to be the cost-effective drug for treatment of Pulmonary Mycosis

A comparative study of propranolol versus amitriptyline at a low dose for prophylaxis of episodic migraine at a tertiary care centre

Background: The aim of this study was to assess efficacy and tolerability of propranolol compared to amitriptyline at a low dose in a sample of Indian Population for prophylaxis of episodic migraine. Methods: Episodic migraine patients aged 18 to 55 years, not on any preventive treatment were randomly allocated to receive propranolol (80 mg/day) or amitriptyline (10 mg/day). The primary efficacy outcome was the mean change in migraine attack frequency per month after 3 months of treatment. Multiple secondary efficacy outcomes and adverse events were also assessed. Results: Both study groups showed a reduction of migraine frequency, severity of headache and disability due to migraine at 3 months. Propranolol significantly reduced the frequency of headache (51.6% vs 43.6%, p=0.03) and the number of rescue medications (53.1% vs 43.3%, p=0.01) compared with amitriptyline at 3 months. The responders with ≥50% improvement was significantly more in propranolol group compared to amitriptyline (60% vs 43.3%, p=0.02). There was no significant difference in the incidence of adverse events between the two groups. Conclusions: Propranolol (80 mg/day) was more efficacious than amitriptyline (10 mg/day) in terms of significantly reducing the frequency of headache and the number of rescue medicine at 3 months. Both drugs were comparable in safety profile

Antimicrobial Susceptibility Pattern of E.coli in cases of UTI in a Tertiary Care Teaching Hospital, Bareilly

Background: Urinary tract infections (UTIs) is the most common infections in OPD and even hospitalized patients. Current knowledge on antimicrobial susceptibility pattern for uropathogens is essential to effectively manage UTIs. The development of antimicrobials has changed the scenario of medical science by being able to treat a number of infections but with their development microorganisms have adapted and become resistant to previous antimicrobial agents. Objectives: The present study is aimed at determining antimicrobial susceptibility pattern in E.coli in urine samples. Methods: the samples were collected from Microbiology Department where Ecoli was isolated from urine samples and antibiotic susceptibility testing was done on Mueller-Hinton agar using the disk diffusion (Kirby Bauer’s) technique following the CLSI guidelines.Results: Out of 180 urine samples studied, E. coli was the most dominant with a prevalence of 41.6%. Escherichia coli isolates were highly susceptible to Carbapenem (100%) and nitrofurantoin (100%) but showed high resistance to Amoxicillin-Clavulanic acid (88%) and Fluroquinolones (76%).Conclusion: Escherichia coli, the predominant uropathogen, showed significant multidrug resistance to antibiotics commonly prescribed for the management of UTIs. These findings should form a basis for empirical treatment for UTIs

Role play as a teaching-learning method for communication skills in prescribing medication

Objectives: The purpose of this study was to evaluate role-playing as a teaching-learning method for communication skills in prescribing medication and to analyse the student's responsiveness to the role-play. Materials and Methods: The Pharmacology Department conducted a questionnaire-based observational study for three months in the academic year 2020–2021. Peer-role-play exercises on medication communication were invited for students in the second professional MBBS 4th semester (n = 150). Statistical Analysis: The data was imported into a Microsoft Excel spreadsheet and analysed with SPSS 22. Frequencies and proportions were used to display categorical data. Results: The concept of role-playing was highly received, and it was thought to be an excellent way to learn how to communicate about medications. Many pupils appreciated the organised evaluation from peers and teachers. More than 90% of the students said they were very comfortable presenting therapy information, such as drug names, purposes, mechanisms, dose information, and precautions. The majority said they remembered pharmacological topics better and would like to see more of them. Peer-role-playing is regarded by the vast majority of pupils as an essential strategy for developing successful drug-therapy communication skills. Role-play sessions are justified in the undergraduate medical curriculum because they provide possibilities for experiential learning and because they are easy to execute. It is necessary to investigate peer-role play as a way of teaching undergraduate pharmacology students' medication-communication skills. Students' perceptions of the sessions' positive effects on their ability to acquire communication skills may influence future teaching methods in this area