AN OVERVIEW OF RATIONAL PRESCRIBING PATTERN IN HYPERTENSIVE PATIENTS IN TERTIARY CARE HOSPITAL

Objective: To study the prescribing patterns of antihypertensive (AHT) drugs in hypertensive (HTN) patients and hypertension with diabetes mellitus (HTN with DM) patients in tertiary care hospital, to assess the rationality of prescribing patterns, to compare the hypertension management with Joint National Committee-7 guidelines (JNC-7).Methods: A prospective study was conducted over a period of 6 mo in the medicine department of Bharati Hospital and Research Centre, Pune. HTN and (HTN with DM patients. Who met the study criteria were enrolled in the study. The pattern of antihypertensive medications prescribed was studied and analyzed using Microsoft excel 2010 and Statistical. The rational prescribing pattern was assessed by using JNC 7 guidelines and World Health Organization (WHO) indicators.Results: Total of 60 patients included in this study, 43 (71.7 %) were HTN patients, and 17 (28.3 %) were HTN with DM patients. There were 29 (48.33 %) males and 31 (51.66 %) female patients were involved. 45 % of patients had pre-hypertension, 33.33 % had stage-1 hypertension, 8.4 % had stage-2 hypertension other 13.33 % patients are on Antihypertensive medications and whose Blood Pressure (BP) were normal according to JNC-7. In hypertensive 47.05 % patient had prescribed Calcium Channel Blockers (CCBs) as monotherapy along with 87.5 % Angiotensin Receptor Blockers (ARBs) with diuretics as combination therapy. In HTN with DM 46.15 % patients had prescribed Angiotensin Converting Enzymes (ACEs) as monotherapy along with 62.5 % CCBs with BBs were prescribed according to JNC-7. As per WHO indicators, average no. of medicines prescribed per prescription was 2.91 and all antihypertensive medicines in the study population were prescribed rationally.Conclusion: The present study represents the current prescribing trend for antihypertensive agents. It implies that. In hypertensive patients ARBs are the leading group of antihypertensive agents as monotherapy and ARBs with diuretics as a combination therapy according to JNC 7.Keywords: Joint National Committee (JNC-7), World Health Organization (WHO), Hypertension (HTN), Diabetes mellitus (DM

ASSESSMENT OF THE POSSIBLE CAUSES OF DIABETES MELLITUS DEVELOPED IN PATIENTS POST COVID-19 TREATMENT IN A TERTIARY CARE HOSPITAL

Objective: Novel COVID-19 virus is extensively being studied for its long-term effects. A predominant trend of development of Diabetes Mellitus (DM) in Covid-19 patients is being observed, and hence further relation is explored in this study. Methods: This is an observational inductive retrospective study conducted for four months in a tertiary care hospital. The study included subjects who recovered from COVID-19 and were treated post-COVID-19 in the hospital. The subjects who had stable glucose counts were excluded. The data obtained from the medical record department encompassed demographic details and clinical data of the patient. The data were tabulated, and observations were reported using descriptive analysis. Results: Among 5632 admitted patients for COVID-19, 694 came for follow-up. 105 patients were re-admitted, but 11 had newly developed DM, and 14 observed uncontrolled DM managed by medical attention. The reported incidence rate in Newly-Diagnosed DM was 0.195%, and the person above 41 y was at greater risk. Similarly, the incidence rate in Uncontrolled-DM was 13.33%, and persons above 47 y were at greater risk. It was found that both these categories of patients had comorbidities, and the development of this was seen between the 25th-40th day. In both cases, males were more prone than females. Conclusion: The study reports a bi-directional relationship between Covid-19 and DM. The use of steroids may have stepped-up this relationship. Cautious use of steroids, changes in the hospital formulary, and further quantitative clinical investigations are primary recommendations that may prevent such episodes

ASSESSMENT OF QUALITY OF LIFE, COMPLICATIONS AND POST-TRANSFUSION ADVERSE REACTIONS IN THALASSEMIA PEDIATRIC IN TERTIARY CARE HOSPITAL

Objective: To assess the quality of life, investigate complications and adverse transfusion reactions post blood transfusion in thalassemia pediatric.Methods: A prospective, observational study was conducted over a period of six months in the pediatric department of Bharati hospital and research center, Pune. Thalassemia patient profile form was used for collecting demographic details, to record adverse transfusion reactions and complications. Using PedsQLâ„¢ (Pediatric Quality of Life Inventory) questionnaire thalassemia patients, and the control group was interviewed to assess their quality of life.Results: Out of 39 patients who were enrolled, 28 patients were above the age of 3 y; their overall quality of life score was significantly lower in thalassemia pediatric than healthy control. School function was a most affected domain. 53.84% had post-transfusion fever, 5.1% of respiratory distress while 41.06% had myalgia, swelling at IV site, headache, and vomiting. Out of 39 patients, 24 patients examined for complications; 33.34% had hepatosplenomegaly, 25% had infections, 16.66% had splenomegaly, 13.88% had cardiac complications, 8.34% had bone deformity, and 2.78% had growth failure.Conclusion: It was found that there was a significant decrease in the quality of life domains in thalassemia pediatric compared to control group. School domain was most affected. Hepatosplenomegaly is one of the leading complications observed in this study. Most common transfusion-related reaction was post-transfusion fever. Public awareness and preventive measures such as pre-marital and prenatal testing should be done to eliminate this fatal disease.Keywords: Thalassemia, Quality of life, PedsQLâ„¢, Adverse transfusion reactions, Complication in Thalassemia

Leptin in non PCOS and PCOS women: a comparative study

Background: Leptin, a hormone secreted by adipose tissues, controls body weight through regulation of appetite and thermogenesis.  The present study was aimed to observe role of leptin in healthy and polycystic ovary syndrome (PCOS) women.Methods: Correlation between serum leptin and anthropometric, endocrine and metabolic profile was studied in 30 apparently healthy women (control group) and 38 PCOS women (PCOS group). Each group was stratified based on body mass Index (BMI), as normal weight (BMI<23) and overweight/obese (BMI>23).Results Leptin level was high in 30% control group and in 65.79% PCOS group. Mean leptin (ng/ml) in PCOS group was higher compared to control group (18±1.9 v/s 12±1.7, p<0.05). Mean leptin levels were higher in overweight/obese subgroup as compared to normal weight subgroup in both Control (p<0.05) and PCOS groups (p=<0.05). In control group, leptin showed positive correlation with waist circumference (WC) (r=-0.49, p<0.01) and negative correlation with Cholesterol: HDL ratio (p<0.05). In PCOS group, leptin showed positive correlation with BMI (r=0.377,p<0.05) and Triglyceride (r=0.34,<0.05) and negative correlation with Fasting Blood Glucose( FBG)(r=-0.33,p<0.05). In normal weight subgroup among control group (n=25), leptin showed positive correlation with LDL (r=0.49, p<0.05). In control overweight/obese subgroup (n=5), leptin showed positive correlation with Follicle Stimulating Hormone (FSH) (r=+1.0, p<0.05) and inverse correlation with testosterone(r=-1.0,p<0.05). In normal weight subgroup among PCOS group, leptin had a positive correlation with LDL: HDL ratio (r=0.488, p<0.05). Conclusions: Hyperleptinemia is common in obesity. Leptin controls glycemic status in patients with IR. Correlation of leptin with FSH and testosterone is influenced by obesity and PCOS.  Leptin regulation of lipid homeostasis is influenced by obesity or PCOS

High sensitivity C - reactive protein (hs-CRP) and clinical characteristics, endocrine, metabolic profile in Indian women with PCOS: a correlation

Background: Role of hs-CRP was studied in PCOS women.Methods: Correlation between serum hs-CRP and endocrine, metabolic profile was studied in 30 healthy women and 88 PCOS women. In PCOS women correlation between hs-CRP and clinical characteristics viz obesity, infertility, acne, hirsutism, acanthosis nigricans (AN) was also studied. Serum levels of hs-CRP, Luteinizing hormone (LH), Follicle stimulating hormone (FSH), LH:FSH ratio, Testosterone (Testo), fasting insulin, fasting blood glucose (FBG), total cholesterol (TC), triglyceride (Tg), low density lipoprotein (LDL), high density lipoprotein (HDL) and Homeostasis Model Assessment (HOMA) were estimated.Results: Mean serum hs-CRP in PCOS women was higher than that in control women (6.9 ± SE 0.84 v/s 2.0 ± SE 0.19mg/L, P=0.005).  In PCOS group overweight/obese had higher hs-CRP as compared to normal weight women (P=0.0051). In control group hs-CRP was positively correlated with age (r=0.385 p=0.035) and LDL (r=0.38 P=0.036). PCOS women showed positive correlation between hs-CRP and cholesterol, LDL, fasting insulin, HOMA. PCOS women showed a significant negative correlation between hs-CRP and LH. AN positive PCOS women showed higher serum hs-CRP levels as compared to AN negative PCOS women (11 ± SE 0.7 v/s 5.5 ± SE 2.3, P=0.0439).Conclusions: Serum hs-CRP is raised in Indian PCOS women reflecting association of low grade chronic inflammation. A positive correlation is present between hs-CRP and AN, insulin in PCOS women and obesity may aggravate this association. A positive correlation between hs-CRP and TC, LDL in the background of normal lipid profile is suggestive of precedence of chronic inflammation over dyslipidemia in PCOS

FOXO3 gene hypermethylation and its marked downregulation in breast cancer cases: A study on female patients

BackgroundFOXO3, a member of the FOX transcription factor family, is frequently described as being deregulated in cancer. Additionally, notable role of FOXO3 can be easily recognized in the process of ageing and survival. Even though various studies have been done to acknowledge the tumour-suppressive or oncogenic role of FOXO3 in cancer, still there exist a lack of understanding in terms of cancer prognosis and treatment. Therefore, to provide better insight, our study aims to evaluate the role and function of FOXO3 in breast cancer in Indian female patients. We examined the FOXO3 expression levels in breast cancer samples by analyzing mRNA and protein expression along with its clinicopathological parameters.ResultsA total of 127 cases of breast cancer with equal normal cases (n=127) were assessed with methylation (MS-PCR), Immunohistochemistry (IHC), mRNA expression using Real-time PCR was analysed and 66.14% cases at mRNA level were found to be downregulated, while 81.10% of cases had little or very little protein expression. Our data state, the promoter hypermethylation of the FOXO3 gene and the downregulated protein expression are significantly correlated (p=0.0004). Additionally, we found a significant correlation between the level of FOXO3 mRNA with ER (p=0.04) and status of lymph node (p=0.01) along with this.ConclusionData suggests the prognostic significance and the tumour-suppressive role of FOXO3 in breast cancer cases studied in India. However, there is a need for the extended research targeting FOXO3 to measure its clinical potential and develop well-defined therapeutic strategies

Evaluation of antibiotic prescribing pattern in pediatrics in a tertiary care hospital

Background: The irrational use of antibiotics is a global issue and it can lead to morbidity, mortality, and increased health care costs. Hence, proper use of antibiotics is imperative and should be included in the pharmaceutical care plan. Objective: The objective of this study was to evaluate the prescribing pattern of antibiotics for children using WHO core prescribing indicators. Materials and Methods: A prospective, observational study was carried for 6 months in the pediatric department at a tertiary care hospital, Pune. The WHO prescribing indicators were used to evaluate the prescriptions, and the ideal WHO range was considered as a determining factor for rational prescription. Results: A total of 302 patients were included in the study, with a mean patient age of 4.92 ± 4 years. The average number of drugs per encounter was 6.12 (WHO standard is less than 2). The percentage of antibiotics prescribed was 26.3% with an average of 1.63 antibiotics per prescription. Of the 493 antibiotics, 85.59% were injectable which is higher than the WHO standard of 13.4–24.1%. A near-optimal value of 99.59% antibiotics was prescribed from the hospital formulary which is similar to WHO standards, and the antibiotics prescribed with generic names were 25.76%. The most common class of antibiotics prescribed were cephalosporins and penicillins. Conclusion: Polypharmacy, high injectable use, and non-adherence to generic prescription were common in our tertiary care center. Continuous audits, training, and new treatment protocols are recommended

TO STUDY THE THERAPEUTIC MANAGEMENT, DRUG RELATED PROBLEMS AND CONCOMITANT USE OF DRUGSIN PATIENTS WITH CANCER

Objective: To study the prescribing patterns of chemotherapeutic drugs, concomitant drugs and to determine the drug-related problems in cancer patients.Methods: A prospective and retrospective observational study was conducted over a period of 6 mo in a tertiary care teaching hospital, Pune after ethical approval and informed consent. Patients were then interviewed for patient information like demographics, treatment, and associated drug related problems using specially designed proforma and then required data was introduced in Microsoft excel spreadsheets.Results: Out of 60 patients 50 were enrolled in this study during which 9 different sites of cancer were examined. The maximum number of patients with cancer resides in the age group of 51-60 y (32%) and more common in females in 27 (54%). The most prevalent risk factor and co-morbidity encountered were tobacco chewing 13 (26%) and hypertension 8 (16%), respectively. On the further evaluation of data, the findings suggested that the majority of patients were prescribed with an alkylating group of anti-neoplastic agents, paclitaxel+platinum-based compound regimen, and the drug paclitaxel. On screening, 167 drug interactions were observed, of these most of the interactions were in the moderate category. The most common organ system affected was gastrointestinal system 135 (30.80%) whereas the prevalent toxicity was hyperuricemia. Polypharmacy was not observed, whereas antacid (ranitidine) was frequently prescribed during hospitalisation and discharge.Conclusion: This study has highlighted certain facts and drawbacks in medication-related care which can be addressed by conducting future studies in cancer care in order to provide patient-specific outcomes