An analysis of the pattern and profile of adverse drug reactions reported at a tertiary care teaching hospital in Kerala, India: a retrospective record based observational study

Background: Adverse drug reactions (ADRs) are an important concern in modern therapeutics. Due to limitations in identifying ADRs during research phase, organized post marketing studies are essential. However, there are only few recent studies on this subject available in India. Hence this study was done in a tertiary care hospital in South Kerala to evaluate the profile and causality of ADRs.Methods: The details of patients who developed ADRs during the period from October 2016 to November 2017 were collected. Data collection was done using the suspected drug reactions monitoring form by CDSCO used under PvPI and a retrospective observational cross-sectional analysis was done. The profile and causality of ADRs were evaluated.Results: The total number of ADR events reported was 300. 179 ADRs were hypersensitivity reactions (Aronson Type B) and the remaining 121 reactions were Type A reactions. The individual drug class causing majority of the ADRs was antibiotics (36%). Commonest significant dose related ADR was bleeding (7%) caused by combined use of antiplatelets and anticoagulants. The organ system most affected as per SOC classification was skin and appendages (56%). Causality assessment revealed that majority (76%) belonged to “probable” category, whereas 23.6% were of “possible” type.Conclusions: The development of ADRs can significantly affect treatment course – interruption of drug therapy, use of additional drugs and prolonged hospital stay. Employing monitors dedicated to ADR detection and education of prescribers to closely monitor patients can help manage ADRs effectively

Awareness of pharmacovigilance and adverse drug reactions among second professional MBBS students of a medical college in Kerala, India

Background: Pharmacovigilance is the science and activities related to detection, assessment, understanding and prevention of adverse drug reactions (ADR). The major challenge faced by the pharmacovigilance programme of India is underreporting. It is mainly due to lack of awareness, knowledge, attitude and practice among health care professionals. The main objective of this study was to assess the knowledge, attitude and practices of second professional MBBS students towards ADR reporting and to provide a session on pharmacovigilance as an intervention to increase their awareness since they are the future budding doctors.Methods: This questionnaire based study was conducted among 158 second professional MBBS students of Travancore Medical College, Kollam, Kerala. A pretest was conducted using the questionnaire followed by which a two-hours session on ADR reporting and Pharmacovigilance was given. A posttest was done with the same questionnaire. The response of the KAP questionnaire were analysed separately for pretest and posttest in percentages and based on scores and was compared.Results: Out of the158 students participated all the students successfully completed the questions of both pretest and posttest within stipulated time frame. In pretest 3 (1.9%), 101 (64%), 43 (27.1%) candidates were categorized to excellent, good and poor respectively. In posttest 155 (98.1%), 3 (1.9%) were in excellent and good category respectively. There was not even a single candidate in poor category. There was a marked increase in the knowledge and awareness of the students after the two hours intervention session on ADR reporting and pharmacovigilance which was statistically significant (p= 0.001).Conclusions: This study revealed the awareness of second professional MBBS students towards ADR reporting and Pharmacovigilance in our institution and also clearly showed the importance of early sensitization through educational interventions, which improved the KAP in pharmacovigilance in them. Educating medical students will improve the challenge of underreporting of ADRs and will increase the numbers of ADRs reported in our country

An analysis of seriousness, predictability and preventability of adverse drug reactions reported at a tertiary care teaching hospital in Kerala, India: a retrospective observational record based study

Background: Adverse drug reactions (ADR) are the leading cause of mortality and morbidity in all health care systems. Hospital based ADR monitoring and reporting programmes can throw some light upon the profile of ADRs and ways to prevent them, facilitating rational drug use. An attempt has been made in this study to analyse the seriousness, predictability, preventability, severity and outcome of ADRs occurring in a tertiary care hospital.Methods: This was a retrospective observational study based on the data collected from ADRs reported to an approved ADR monitoring centre (AMC). Data collected was evaluated for seriousness, predictability, preventability, severity and outcome using appropriate scales. Simple descriptive statistics was used for analysis.Results: The total number of ADRs reported was 300. Among this 39% reactions were serious. The commonest reason for considering as serious reaction was prolongation of hospitalization. The overall predictability was 40.4%. Total preventability was found to be 18.3%. Assessment of severity showed 55.3 %, 41.7%, 3% reactions in mild, moderate and severe grades respectively. 64.3% patients had recovered from the reaction and 30% were recovering at the time of reporting ADR. Only 0.3% ADRs caused death.Conclusions: Authors hope this study will foster the culture of reporting and analysing ADRs among health care professionals and students. The findings from the study can create awareness among health care professionals regarding the impact of ADRs on the treatment course

Effect of Different Nitrogen and Potassium Rates on Agronomic Characters of Aloe indica

A field study was conducted to investigate the growth of Aloe indica with different rates of nitrogen and potassium fertilizers at the Germplasm Centre, Department of Horticulture, Bangladesh Agricultural University.  Treatments consisted of 0, 200 and 300 kg nitrogen/ha and 0, 100 and 200 kg potassium/ha. The rates of nitrogen and potassium had significant effect on the leaf production of Aloe indica when compared to control. Leaf yield of Aloe indica was highest at application of nitrogen at rate 200 kg/ha and potassium at rate 100 kg/ha. Leaf protein content was 12.71% higher at 200 kg N/ha and 8.47% higher at 300 kg N/ha compared to control. Potassium application at rate of 100 and 200 kg/ha produced 4.86 % and 8.51% higher leaf protein content than the control, respectively. It is recommended to apply nitrogen at rate 200 kg/ha and potassium at rate 100 kg/ha for leaf production of Aloe indica.   Key words: Aloe indica, chemical fertilizers, leaf nitrogen, protein content, potassium conten

AN ANALYSIS OF THE PREVALENCE OF POLYPHARMACY AMONG INPATIENTS OF A TERTIARY CARE HOSPITAL IN KERALA

Objectives: The aim of the study was to estimate the prevalence of polypharmacy, identify the age groups commonly associated with polypharmacy, study the correlation between duration of hospital stay and polypharmacy, and identify the diseases commonly associated with polypharmacy Methods: Record-based, prospective, and cross-sectional study among 370 inpatients of a tertiary care hospital in Kerala. Prescriptions containing ≥3 drugs were collected from inpatient medical records of patients with at least 3 days hospital stay. The number of drugs ≥5 was considered as polypharmacy in the present study. Results: The prevalence of polypharmacy was 93% and average the number of drugs per prescription was 8.81±3.097. Average number of drugs per prescription was significantly high among patients >60 years. Percentage of prescriptions with polypharmacy among patients with duration of stay 3–5 days, 6–8 days, and ≥ 9 days was found to be 89.4, 98.6, and 100, respectively. There was a significant positive association between duration of hospital stay and percentage of prescriptions with polypharmacy as well as average number of drugs per prescription. Diseases or comorbidities most commonly associated with polypharmacy were hypertension, diabetes mellitus, cerebrovascular accidents, coronary artery disease, and dyslipidemia. Conclusion: The prevalence of polypharmacy was high in the present study (93%) when compared to similar studies. Age >60 years was strongly associated with the prevalence of polypharmacy, but gender was not found to be factor. Duration of hospital stay was an important factor positively associated with percentage of prescriptions with polypharmacy as well as number of drugs per prescription

Multifarious Beneficial Effect of Nonessential Amino Acid, Glycine: A Review

Glycine is most important and simple, nonessential amino acid in humans, animals, and many mammals. Generally, glycine is synthesized from choline, serine, hydroxyproline, and threonine through interorgan metabolism in which kidneys and liver are the primarily involved. Generally in common feeding conditions, glycine is not sufficiently synthesized in humans, animals, and birds. Glycine acts as precursor for several key metabolites of low molecular weight such as creatine, glutathione, haem, purines, and porphyrins. Glycine is very effective in improving the health and supports the growth and well-being of humans and animals. There are overwhelming reports supporting the role of supplementary glycine in prevention of many diseases and disorders including cancer. Dietary supplementation of proper dose of glycine is effectual in treating metabolic disorders in patients with cardiovascular diseases, several inflammatory diseases, obesity, cancers, and diabetes. Glycine also has the property to enhance the quality of sleep and neurological functions. In this review we will focus on the metabolism of glycine in humans and animals and the recent findings and advances about the beneficial effects and protection of glycine in different disease states

A highly efficient activated carbon by chemical activation method for adsorption of paraquat (toxin)

The ambient condition for preparing the highly efficient activated carbon has been investigated in this work. The effects of different activation temperatures on the pore structure and surface morphology of highly efficient activated carbon (AC) derived from waste palm shell by chemical activation method using phosphoric acid as activating agent were studied. For activation, different activation temperatures in the range of 5500C-6500C were carried out. Activated carbon with well developed pore size were produced at activation temperature of 6000C for 2 hours. At this temperature the Brunauer , Emmett and Teller (BET) surface areas are 1287 m2g-1, the total pore volume for adsorption and desorption are 0.65209 cm3 g-1. Scanning Electron Microscope also confirmed the porosity of the highly efficient activated carbon. Finally it was tested in vitro to determine its adsorbing capacity for paraquat as a toxin. For optimum adsorption ability of activated carbon for paraquat, 0.9% NaCl solution is the most suitable solvent. The paraquat preferentially adsorbed onto the activated carbon in NaCl solution. The adsorption ability of the activated carbon (the amount adsorbed) for paraquat observed to be 99.9 mg g-1

LASERS : A BOON IN THE MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS

Temporomandibular disorders have been identified as the most important cause of pain in the facial region. Pain relief and reestablishment of normal masticatory function are the main goals of conservative management of Temporomandibular Disorders (TMD). Laser therapy is a part of the treatment modality that have demonstrated to have an analgesic, anti-inflammatory and biostimulating effect. The LLLT is a non invasive , quick and safe, non pharmacological intervention that may be beneficial for patient with TMDs. This review article projects the use of LLLT for management of temporomandibular disorders ,its mode of action and also gives a review on various studies conducted to assess its efficacy on pain management

Evaluation of Sterculia foetida Gum as Controlled Release Excipient

The purpose of the research was to evaluate Sterculia foetida gum as a hydrophilic matrix polymer for controlled release preparation. For evaluation as a matrix polymer; characterization of Sterculia foetida gum was done. Viscosity, pH, scanning electronmicrographs were determined. Different formulation aspects considered were: gum concentration (10–40%), particle size (75–420 μm) and type of fillers and those for dissolution studies; pH, and stirring speed were considered. Tablets prepared with Sterculia foetida gum were compared with tablets prepared with Hydroxymethylcellulose K15M. The release rate profiles were evaluated through different kinetic equations: zero-order, first-order, Higuchi, Hixon-Crowell and Korsemeyer and Peppas models. The scanning electronmicrographs showed that the gum particles were somewhat triangular. The viscosity of 1% solution was found to be 950 centipoise and pH was in range of 4–5. Suitable matrix release profile could be obtained at 40% gum concentration. Higher sustained release profiles were obtained for Sterculia foetida gum particles in size range of 76–125 μm. Notable influences were obtained for type of fillers. Significant differences were also observed with rotational speed and dissolution media pH. The in vitro release profiles indicated that tablets prepared from Sterculia foetida gum had higher retarding capacity than tablets prepared with Hydroxymethylcellulose K15M prepared tablets. The differential scanning calorimetry results indicated that there are no interactions of Sterculia foetida gum with diltiazem hydrochloride. It was observed that release of the drug followed through surface erosion and anomalous diffusion. Thus, it could be concluded that Sterculia foetida gum could be used a controlled release matrix polymer