A cross sectional observational study to find the difference in occurrence of muscle related adverse effects of statins among geriatric and non-geriatric patients

Background: Statins are effectively used for the treatment of dyslipidemias in geriatric patients. The geriatric patients are more vulnerable to experience consequences of drug intensification leading to the manifestation of adverse effects, such as muscle related adverse effects (MRAE) with statins use. The main objective was to find the difference in the occurrence of MRAE of statins among geriatric and non-geriatric users.Methods: This was a cross-sectional, observational comparative study in which MRAE associated with statins and relevant patient information was noted. Creatine phosphokinase (CPK) levels which are considered as a marker for statin induced muscle damage were obtained for all patients. The different parameters were compared among geriatric and non-geriatric statin users.Results: Sixty one patients, 28 geriatric (≥60 years) and 33 non-geriatric (<60 years) statin users were enrolled in this study. Ten (38%) geriatric statin users as compared to 6 (20%) non-geriatric statin users were found to have MRAE (P = 0.207). No significant difference in the occurrence of MRAE among geriatric and non-geriatric statin users was found.Conclusions: The results obtained from the present study suggest that statins are relatively safe, even in older people. There was no evidence to suggest an increased risk of MRAE in geriatric patients receiving statin therapy as compared to non- geriatric patients

Appropriateness of Proton Pump Inhibitor Use in Hospitalized Patients: A Cross Sectional Study in a Tertiary Care Hospital in North India

Background: Proton Pump Inhibitors (PPIs) are often prescribed inappropriately among hospitalized patients and same is often continued even after their discharge from the hospital. The inappropriate use of PPIs leads to an increased risk of adverse effects, drug interaction, and unnecessary hospital expenditure for such patients. Aim of this study was to determine the appropriateness of PPIs use among hospitalized patients. Methods: A cross sectional observational study was conducted on hospitalized patients in a tertiary care hospital in Northern India. The clinical records of adult patients hospitalized during April- May 2022 were assessed for the prescribing pattern and appropriateness of PPI use as per the National Institute of Health and Care Excellence (NICE) guidelines. Results: A total of 192 patient’s records were included in this study with the mean age 57 years and 61% of the study participants were males. Overall, 72% (138) of the study participants were prescribed PPIs by intravenous route and only in 28% (54) cases an oral route was preferred. Pantoprazole was the most commonly prescribed PPI in 112 (58%) patients and it was administered by intravenous route among 87 patients (78%) and by oral route in 25 (22%) patients. PPI use was appropriate in 54% of the cases and they were most commonly prescribed for ulcer prophylaxis. This study identified higher use of PPIs was seen in low risk patients for longer duration than indicated. Conclusion: PPIs are being prescribed inappropriately among hospitalized patient unrelated to their widely accepted clinical indications and are often continued unnecessarily once patient is discharged. These results suggest the need of regular audits on use of PPIs clubbed with educational initiatives to promote rational use of PPIs among hospitalized patients

Stroke outcome after domiciliary use of opioids in the peri-stroke period

Background: Stroke affects large number of people worldwide resulting in disability. The people in the northern region of India follow some domiciliary practices, which include administration of opioids at the onset of stroke to retard its progression. Aim: To study the effect of opioids on the outcome and severity of stroke when used as domiciliary treatment in peri-stroke period. Materials and Methods: A prospective, observational study on stroke patients was carried out in Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India from March 2012 to March 2013. Data were collected in a semi-structured proforma. The variables which were studied included socio-demographic characteristics such as age, gender, religion, socio-economic status, and place of inhabitation. The time of opioid administration, approximate amount administered, frequency of administration, duration of hospital stay, risk factors and co-morbid conditions were also studied. The stroke severity was analyzed by comparing National Institutes of Health Stroke Scale (NIHSS) score and outcome by comparing Modified Rankin Scale (MRS) score in both the groups at the time of admission and at the time of discharge. Results: Out of n = 100 recruited patients, n = 44 (Group A) reported opioid intake in the peri-stroke period and n = 56 (Group B) did not. Proportions of patients from rural areas were 61.4% in Group A and 37.5% in Group B. Mean age in groups A and B was 63 ± 9.15 and 59.8 ± 13.87 years, respectively; in these groups male proportions were 70.5% and 60.7%, respectively. At admission, mean NIHSS scores in Groups A and B were 10.0 ± 4.48 and 10.8 ± 4.51, respectively; on discharge, these scores were 6.3 ± 3.83 and 7.7 ± 3.79, respectively. At admission, mean MRS scores in Groups A and B were 3.7 ± 1.14 and 3.8 ± 1.32, respectively; upon discharge, these scores were 2.8 ± 1.18, 3.1 ± 1.23 respectively. Conclusion: In this cohort, we found that the domiciliary practice of opioids administration in the peri-stroke period is more common among the elderly and in the rural areas. There was no statistically significant difference in the mean NIHSS and MRS scores at admission as well as discharge implying that the opioid administration did not improve outcome or decrease the severity of the stroke. Our findings are robust enough to propose a larger sample size and follow-up in future studies to definitively ascertain the effect of opioids as pretreatment in stroke patients