Role of vitamin D supplementation as adjunctive therapy to escitalopram in patients of major depressive disorder: a 8 week prospective, randomized, interventional, clinical study

Background: Depression is a major public health problem and occurs in persons of all ages, and is associated with increased morbidity, soaring costs for treatment and reduced productivity and quality of life. Vitamin D is involved in numerous brain processes including neuroimmunomodulation, neuroprotection, neuroplasticity, regulation of neurotrophic factors, and making it biologically plausible to be associated with depression. Aim of the present study is to compare the therapeutic effects of vitamin D given along with escitalopram versus escitalopram given alone in patients with major depressive disorder.  Methods: In this prospective, randomized, interventional clinical study, 60 patients with a diagnosis of major depressive disorder based on ICD-10 criteria were randomly assigned into two groups, one group received 60000IU vitamin D3 weekly plus 10 mg escitalopram OD daily while the other group received escitalopram10 mg OD daily alone for 8 weeks. Depression severity was assessed at 2-week intervals using the 24-item Hamilton Depression Rating Scale (HDRS). Serum 25(OH) vitamin D levels were measured in all the patients at baseline and after intervention.Result: Fifty nine patients completed the trial. Depression severity based on HDRS decreased significantly after intervention, with a significant difference between the two groups. The vitamin D3+escitalopram combination was significantly better than escitalopram alone from the fourth week of treatment. Conclusion: Role of vitamin D in mood disorder and its dietary supplementation is effective as an adjuvant treatment along with SSRIs in depressive disorders, especially in vitamin D deficient patients

Metabolic effects of Olanzapine versus Iloperidone: A 24 weeks randomized, prospective, interventional study

Atypical antipsychotics have become the mainstay of therapy for psychosis. Though extrapyramidal side effects have been reduced with atypical antipsychotics, yet there are increased concerns over metabolic effects. The present study is aimed to comparatively evaluate the metabolic profile of olanzapine and iloperidone in cases of psychosis. A prospective, randomized, open label, observational study of 6 months duration was conducted in the Department of Pharmacology and Department of Psychiatry, Rohilkhand Medical College and Hospital, Bareilly. A total of 62 patients of both sexes newly diagnosed with psychosis (ICD-10, F20- F29) were included in the study, 31 each in olanzapine and iloperidone groups. Demographic parameters were recorded, following which the patient’s body weight, BMI, fasting blood sugar and lipid profile were estimated at baseline. Follow-up of the patients was done periodically after one month, three months and six months. Olanzapine treated patients showed markedly significant rise in body weight up to 7 kg at the endpoint (p<0.0001) at each follow-up, with a significant increase in BMI. Rise in fasting blood sugar (FBS), total cholesterol (TC), triglycerides (TG) and low-density lipoprotein (LDL) levels werealso statistically significant. At the same time, significant decrease in HDL levels was also observed. Iloperidone treated patients showed statistically significant less rise in body weight (upto 1kg, p<0.05) and BMI. No significant changes in fasting blood sugar, total cholesterol, LDL and HDL levels were noted, while TG levels were significantly reduced. Iloperidone caused numerically less rise in bodyweight and BMI, and fewer metabolic adverse effects as compared to olanzapine, and hence should be preferred.Keywords: Atypical antipsychotics; Weight gain; Blood sugar level; Dyslipidemi

An open-label prospective observational study to evaluate the efficacy and safety of alternate day versus daily dosing of atorvastatin in patients of dyslipidemia

Background: Hypercholesterolemia is a main driver of atherosclerosis. Cholesterol-containing lipoproteins induce endothelial dysfunction and macrophage activation. Foam cell formation results from the uptake of cholesterol-containing lipoproteins by macrophages, it is an essential step in the initiation and progression of atherosclerosis. Aims and Objectives: To evaluate the efficacy and safety of alternate day versus daily dosing of atorvastatin in patients with dyslipidemia. Materials and Methods: This open-label, prospective, observational study was conducted on dyslipidemic patients who came into the medicine Outpatient Department of Dhanalakshmi Srinivasan Medical College and Hospital, Tamil Nadu. Approval for the study was taken from the Institutional Ethical Committee. The duration of the study was 3 months. The efficacy of atorvastatin was checked by noting their blood lipid profile status. Results: Out of 100 patients included in the study 79 completed the study whereas 21 patients were lost in follow-up, 42 patients were analyzed in daily dose (Group A), and 37 patients in alternate dose (Group B) of atorvastatin (20 mg). There was no statistically significant difference based on triglyceride, total cholesterol, low-density lipoprotein, and high-density lipoprotein levels both prior and post-treatment in both the groups. Adverse drug reactions (ADR) profile showed a statistically significant difference between both the groups after treatment by atorvastatin (P=0.0001), with more ADRs noted in a daily dosing group. Conclusion: The results of this study show that alternate dosing of atorvastatin was better tolerated than daily dosing hence physicians can consider choosing an alternate day therapy to reduce pill burden on patients

Analysis of the prevalence and pattern of polypharmacy among elderly patients admitted in general medicine department of a rural tertiary care hospital in South India

Background: Quality and safety of prescribing drugs in older people remain a global healthcare concern. Inappropriate prescribing pattern in the elderly population is now considered as a major public health issue and polypharmacy is one of the common problems among the elderly patients. Aims and Objectives: The aims of this study were (1) to analyze the prevalence, pattern of polypharmacy with respect to age, and gender among the elderly patients and (2) to evaluate the most frequently prescribed drugs in the geriatric population. Materials and Methods: This prospective, cross-sectional, and observational study was conducted among the elderly patients admitted in the Department of General Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu. The duration of research project was 12 months from May 2018 to April 2019; approval for the study was taken from the Institutional Ethical Committee. Data on total number of prescribed drugs and main and adjuvant drugs prescribed to patients during treatment were collected and analyzed. Results: A total of 289 patients, that is, 167 male and 122 female were included in the study. The prevalence of minor polypharmacy (2–4 drugs) accounted for 15.22%, major polypharmacy (≥5 drugs) for 81.35%, and hyper polypharmacy (≥10 drugs) for 3.46%. Most commonly prescribed drugs were vitamins, proton-pump inhibitors, antipyretic agents, and H2 receptor blockers. They accounted for 21.70%, 5.78%, 5.42%, and 4.94%, respectively. Conclusion: Polypharmacy is a preventable and can be rectified by prescribing appropriate medications. In future, a multidisciplinary approach which will be involving doctors, nurses, and pharmacists, shall be implemented for rational use of drugs in elderly patients