Efficacy, safety and cost effectiveness of levocetrizine and ebastine in allergic rhinitis: a comparative study

Background: Allergic rhinitis is a ubiquitous aliment affecting a large population of individuals. The mainstay of treatment includes antihistamines and topical steroids. With a large assortment available, the choice of the drugs needs to be non-random and evidenced based. Hence this study was undertaken to compare Levocetrezine and Ebastine in terms of efficacy, safety and cost effectiveness in treatment of allergic rhinitis.Methods: Newly diagnosed patients with allergic rhinitis were categorized into two groups and treated with Levocetrizine 5mg and Ebastine 20mg per day respectively. Severity of the symptoms at the commencement and at the end of second and the fourth weeks of therapy were assessed using a four-point Likert scale and assigning a Total Nasal Symptoms Score (TNSS). The primary efficacy measure was mean change from baseline TNSS at each follow up visit. Change in TNSS was compared using Independent sample test. Adverse effects in both the groups were compared using Chi square test. Cost effectiveness was inferred by calculation of the Average Cost Effectiveness Ratio.Results: A total of 159 patients 84 from Levocetrizine group (L group) and 75 from the Ebastine group (E group) were available for study. At the end of second week, the E group showed a better reduction in TNSS(p-0.04). However, both the groups showed similar reduction in TNSS at the concluding visit (p-value of 0.09). The incidence of adverse effects was significantly higher in the L than in E. Levocetrezine was found to be more cost effective than Ebastine.Conclusions: Levocterezine and Ebastine are equally efficacious in treatment of allergic rhinitis. Hence treatment will have to be personalized to the individual patients based on other factors such as adverse drug effects and cost effectiveness

Drug prescribing pattern in ulcerative colitis in a tertiary care hospital: an observational study

Background: Ulcerative colitis (UC) is an inflammatory disease of colon and rectum of uncertain etiology. The clinical course of UC is marked by exacerbations and remissions. Furthermore there is limited data available on the management of ulcerative colitis from India. Hence, the present study was undertaken to study the drug prescribing pattern in ulcerative colitis.Methods: A retrospective case record based observational study was done at Kasturba Hospital, Manipal, India from 1st January 2009 to 31st December 2010. Patients diagnosed to have UC during our study period based on clinical, endoscopic and histopathological evidence were included in the study. SPSS 17 software package was used for statistical calculations. Descriptive statistics was used to analyze the data.Results: The total number of patients diagnosed to have UC during our study period was 83.The peak incidence of disease was in the age group of 30-39 years and it was more common in males. The prescription rate of aminosalicylates, glucocorticoids and immunosuppressants were 96.3, 54.3, and 18.5% respectively. Mesalamine, prednisolone, and azathioprine were the commonly prescribed drugs in each class. The commonly prescribed treatment regimen was combination of aminosalicylates with glucocorticoids (43.2%).Conclusions: Ulcerative colitis was more common in males. Aminosalicylates were the commonly prescribed drugs and a combination of aminosalicylate and steroid was frequently used regimen in our study

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Evaluation of practice of self-medication among medical students in a teaching hospital

Abstract Objective: Self-medication is common among medical students , this may lead to irrational usage of drugs. The objective of this study was to evaluate prevalence of self -medication among medical undergraduate students. Methods: It was a descriptive cross-sectional questionnaire based study conducted among undergraduate medical students of Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore. Data was analysed using SPSS version 16 and presented as percentages. Results: The prevalence of self-medication was 95.37 % (227) out of 238 students in the last one year. The usual indications for selfmedication were fever followed by common cold; analgesics and antipyretics were commonly used class of drugs. A significant number of students 62.2% opined self-medication as acceptable practice. Conclusion: The present study shows practice of self-medication found to be high among medical students may be due to their exposure on knowledge of drugs and diseases. Hence there is a need to create awareness among students regarding ills of self-medication practice

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology