A study of morbidity and drug utilization pattern in indoor patients of high risk pregnancy at tertiary care hospital

Background: Pregnancy represents a special physiological state during which the use of drug is of growing concern due to risk of teratogenicity. High risk pregnancy is common threat to mother and foetus. Therefore, our aim was to study the drug utilization and morbidity pattern in high risk pregnancy in hospitalized pregnant women. Methods:An observational, prospective study was carried out in 250 patients for 6 months in the tertiary care hospital. Protocol was approved by the Institutional Review Board (IRB). The data were collected in a pre-designed proforma. Data were analysed by using SPSS version 20.0 Software. Results: Among 250 patients, 19 (7.6%), 218 (87.2%) and 13 (5.2%) were of less than 20, 20 to 30 and more than 30 years of age respectively. About 68.8% women had complained of abdominal pain and 67.6% had weakness followed by headache / body ache (47.2%), oedema (26.4%) and vomiting (18.8%). Iron (91.2%) and calcium (84.5%) were the commonest drugs prescribed followed by folic acid (59.6%), protein powder (54.8%), vitamin C (46.8%) and isoxsuprine (26.6%). As per FDA Drug Risk Category, Category-A (82.21%) was most frequently prescribed followed by Category-B (15.64%) and Category-C (2.15%). Percentage of drugs prescribed by generic name and from essential drug list was 62.80% and 80.79%. Conclusion: Iron, Calcium and Folic acid were most commonly prescribed drugs. There is lesser number of drugs prescribed by generic name suggesting need for sincere efforts to improve situation

Drug use in acute otitis media: a prospective study at a tertiary care teaching hospital

Background: Drug use study identifies the problems that arise from prescription and highlights the current approaches to the rational use of drugs. The objective of the study was to assess drug use pattern in patients diagnosed of acute otitis media in tertiary care teaching hospital.Methods: This prospective observational study was carried in the Otorhinolaryngology department of a tertiary care teaching hospital over a period of twelve months. The data collected for patients with acute otitis media included the patient's demographic details and the drugs prescribed. Data were analysed for drug use pattern and cost per prescription and assessment of rationality of prescription.Results: Total 153 patients were analysed, 100 (65.35%) belonged to male patients and 53 (34.65%) belonged to female patients. Children less than 2years age were the most diagnosed with AOM 47.71%, the major diagnostic symptoms were earache (58.16%) and fever (54.90%) and signs were congestion (52.94%) and discharge (43.13%). In a total 153 prescriptions (469 drugs), 33.68% were antimicrobials, followed by mineral supplements (23.67%). Average number of drugs per prescription was found to be 3.0. Most common antibiotic prescribed was amoxicillin (with or without clavulanate) in 142 (92.81%) patients. Paracetamol alone or in fixed dose combination with antihistaminics were prescribed in 131 patients. Average cost per prescription was 87.74(±35.67) Indian rupees. Seventeen (11.11%) prescriptions were rational in all the aspects based on standard guidelines.Conclusions: The present study showed that paracetamol and amoxicillin with or without clavulanate were mostly commonly prescribed in children with AOM. Irrational prescribing was seen in maximum number of cases

Newer approaches in the treatment of asthma

Asthma is a worldwide public health problem. The most effective anti-asthmatic drugs - inhaled β2-agonists and glucocorticoids controls asthma in about 90-95% of patients. However, severe glucocorticoid-dependent and resistant asthma presents a great clinical burden. Therefore, reducing glucocorticoids - related adverse effects using novel steroid-sparing agents is needed. Furthermore, the mechanisms involved in the persistence of inflammation are poorly understood and the reasons why some patients have severe life threatening asthma and others have very mild disease are still unknown. Although glucocorticoids effectively control the inflammatory process in asthma, they have little effect on the lower airway remodeling processes that appear to play a role in the pathophysiology of asthma. Several new drugs developed to target specific components of the inflammatory process in asthma [e.g. anti-IgE antibodies (omalizumab), cytokines and/or chemokines antagonists, immunomodulators, antagonists of adhesion molecules)], have not yet been proven to be particularly effective. Hence, considering the central role of T lymphocytes in the pathogenesis of asthma, drugs targeting disease-inducing Th2 cells are promising future therapeutic strategies. Some of these new anti-asthmatic treatment approaches may in the future not only control symptoms and modify the natural course of asthma, but also potentially prevent or cure the disease. Hence, the development of novel drugs may allow resolution of these changes

Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study

Background: Use of anti-emetic drugs in pediatric population is often warranted, but choice of drug remains questionable within pediatricians. Objective of current study is: to study prescribing pattern and to calculate cost of antiemetic drug therapy in pediatric wards.Methods: A prospective, observational study was conducted in pediatric wards of a tertiary care hospital of over 14 month’s duration. Institutional ethics committee approval was obtained and written informed consent of parents/guardians was taken. Data of any pediatric patient receiving anti-emetic agent were included in the study.Results: A total of 218 prescriptions were collected. Mean age of patients was 4.39±3.16 (range 4 months to 12 years). Gastroenteritis was the most frequently diagnosed disease in 137(63%) patients. Domperidone was prescribed in 52.4% and ondansetron in 47.6% children. Oral liquid dosage formulation was prescribed in 109 (48.4%) followed by solid dosage form 47 (20.9%). Mean cost of domperidone therapy was 25.34±6.55 INR and for ondansetron it was 36.62±17.94 INR.Conclusions: Gastroenteritis was most frequent indication for use of anti-emetics. Domperidone pharmacotherapy was cheaper and most frequently prescribed than ondansetron

Morbidity and drug utilization pattern among admitted pregnant anemic women and to find out rationality of drug by using Indian guidelines

Background: Pregnancy represents a special physiological state during which the use of drug is of growing concern due to risk of teratogenicity. Anemia is common threat to mother. Therefore, our aim was to study the drug utilization, teratogenic risk among patients of anemia in pregnancy and check rationality of prescriptions.Methods: An observational, prospective study was carried out in 150 indoor patients in the tertiary care hospital. Protocol was approved by the Institutional Review Board. The data were collected in a pre-designed proforma. Data were analyzed using SPSS version 20.0 Software.Results: Among 150 patients, 23, 111, and 16 were of <20, 20-30 and more than 30 years of age respectively. Among anemic patients Pregnancy induced hypertension (18.7%), antepartum hemorrhage (12.7%) were common. About 71% women have complaint of weakness, followed by headache. Iron (93.3%) and calcium (86.0%) were the most common drugs prescribed. Iron sucrose and packed cell volume given in severe anemia. Drug risk category, Category A (90.21%) was most frequently prescribed, which is followed by Category B (8.0%) and Category C (1.8%). Percentage of drugs prescribed by generic name and from essential drug list was 70.3 and 89.2. Overall prescribing habit was rational according to Indian guideline.Conclusion: Iron, calcium, and folic acid were most commonly prescribed drugs in anemic patients. No teratogenic risk was found out during drug use. Drug and dose of the drug was rational and appropriate. There is lesser number of drugs prescribed by generic name and hospital supply

Drug utilization pattern in acute coronary syndrome at tertiary care hospital: a prospective cross-sectional observational study

Background: To study the pattern of utilization of drug in the patients of Acute Coronary Syndrome at tertiary care hospital.Methods: Prospective cross-sectional observational drug utilization study was conducted in patients of acute coronary syndrome admitted in ICCU, for the period of two months. Data was collected in preformed Case record form. Analysis was done by using drug use indicators, demographic pattern, morbidity pattern of disease, pattern of drug use. Data analysed using Microsoft Excel SPSS software - version 21.l. Total 71 cases were analysed.Results: In our study we analysed 71 patients out of that 50 were male and 21 were female patients. The mean age of patient was 57.61±11.09 yr; most belonging to age group of 51-60 years (36.62%). Number of patients undergoing thrombolysis were 28(39.43%) and 43(60.57%) underwent percutaneous coronary intervention (PCI). Total 44 different drugs were used and 565 drugs were prescribed in 71 patients. Most frequently prescribed drugs were Clopidogrel and aspirin in 100% encounters, followed by atorvastatin (85%).Average number of drugs per encounter was 7.96. Percentage of drugs prescribed by generic name was 16.28%.Conclusions: The present study provides valuable insight about the overall pattern of drug used in Acute Coronary syndrome. Physician should be encouraged to prescribe drugs with generic name

Study of drug utilization, morbidity pattern and cost of hypolipidemic agents in a tertiary care hospital

Background: Data on the extent of use and costs of lipid-lowering agents are not widely available. Our aim was to study the drug utilization and morbidity pattern, cost of different hypolipidemic drugs along with the risk assessment for coronary heart disease.Methods: After approval of protocol by the Institutional Review Board, an observational, prospective study was carried out in 300 patients using NCEP and ATP III Guidelines-2002 for evaluation of presence or absence of risk factors for coronary heart diseases. Data were analysed using SPSS software version 16.0and WHO Core Drug Prescribing Indicators.Results: Patient’s morbidity pattern revealed that 62%, 49.3%, 28% suffered from ischemic heart disease, hypertension and type 2 diabetes mellitus respectively. On risk assessment, 48%, 13.3% patients had borderline and high level of total cholesterol respectively; 42%, 22.7% had borderline and high triglyceride levels respectively; 71.1% men and 62% women had low HDL cholesterol levels while 17.3%, 6% and 2.7% patients had borderline high, high and very high level of LDL cholesterol levels respectively. Frequency of prescriptions was atorvastatin (82%), rosuvastatin (9.3%) and simvastatin (4.7%) among the most frequently prescribed statins drug group. The mean number of drugs per prescription was 7.34. Drugs prescribed by generic name and from essential drugs list was 24.96% and 71.81% respectively. Mean cost of hypolipidemic agents/prescription/day was 10.74 (±1.96) Indian Rupees with rosuvastatin being the costliest.Conclusion: Rational use of hypolipidemic agents with an increasing trend of statins prescriptions will significantly reduce the morbidity and mortality from coronary heart diseases.

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin