Cost variation analysis of oral anti-diabetic agents available in drug store of the tertiary care hospital and in Indian market

Background: Diabetes, a chronic disorder and requires life-long treatment. Cost of drug treatment is a major hurdle related to medication compliance in Type 2 Diabetes Mellitus. The objective of the study was to find out the cost of antidiabetic drugs available in the drug store of a tertiary care hospital and compare it with the different brands of the same drugs available in Indian market. To evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost.Methods: Cost of single compound and combination compound oral antidiabetic drugs available in drug store and those same drugs in Indian market manufactured by different companies, in the same strength, number and dosage form. The percentage price variation between minimum and maximum cost of drugs were calculated. The percentage difference in cost of antidiabetic drugs available in drug store and in the Indian market was calculated.Results: The percentage price variation of oral antidiabetic drugs available in drug store was found to be as follows. In sulfonylureas, it was highest in Glimepiride (2mg) 1962, 96%, among biguindes, Metformin (500mg) 3012.5%, among alpha glucosidase inhibitors Voglibose (0.2mg) 387.17%. Voglibose (0.3mg) 361.30%. Among combination therapy Voglibose (0.3mg) + Metformin (500mg) 2809% showed maximum price variation.Conclusions: The average percentage price variation of different brands of the same drug is very wide and hence the physician must keep this in mind while prescribing since the drug treatment of type II diabetes mellitus is usually lifelong. Hence, manufacturing companies should aim to decrease the price variation while maintaining the therapeutic efficacy. Drug store of tertiary care hospital should try to provide the oral antidiabetic drug with least cost and sell the generic drugs

IMPACT OF STRESS ON TYPE 2 DIABETES MELLITUS MANAGEMENT

Background: Type 2 diabetes mellitus (T2DM) is one among the major health and socioeconomic problems worldwide. It is, however, not a somatic illness for which just symptomatic treatment will suffice. Stress is an important factor in not only causing diabetes onset or exacerbation, but also in hampering proper treatment by interfering with the treatment adherence of patients. Hence, it becomes important for physicians to acquaint themselves with the effects of stress on T2DM in order to ensure proper treatment of the latter. Objective: Documentation of effect of stress on the management of T2DM. Subjects and methods: The research was a cross-sectional study on the patients attending Sri Muthukumaran Medical College, Hospital and Research Institute, Mangadu. A total of 400 people, who werepre-established diabetic patients of the hospital of age greater than 30 years, were chosen for the study. The stress levels of the patients were assessed with the Perceived Stress Scale (PSS) and treatment adherence using a questionnaire prepared exclusively for the study. Based on the data, a statistical relationship was framed between the degree of control (treatment adherence) and the stress levels of the patients. Results: - The FBS levels were a direct reflection of the stress levels (P<0.05). - Stress had a major impact on treatment adherence among the diabetic subjects: Increased levels of stress decreased the adherence (P<0.001). - The glycemic index (HbA1C level) was found to be linked to both treatment adherence and stress. Increased adherence kept it at bay (P<0.05) while stress proved abysmal to glycemic control. Conclusion: T2DM is the result of an interplay between various factors; environmental, psychiatric and somatic. Hence, a holistic treatment approach is required, one that involves stress management, education and mental health awareness along with pharmacological treatment, to fully control the disease

Pharmacoeconomic assessment and comparing efficacy between cetirizine, levocetirizine, loratadine and fexofenadine in allergic rhinitis patients

Background: A successful treatment of allergic rhinitis is considered not only as relief from sneezing, itching, rhinorrhoea, congestion but also as the functional impact on the patient’s daily life. The cost of treating allergic rhinitis and indirect costs related to loss of workplace productivity are substantial.Methods: The present study was single centered, open label, randomized, four Arm, parallel-group, comparative clinical study between orally administered Cetirizine, Levocetirizine, Loratadine and Fexofenatidine in patients with allergic rhinitis conducted at MIMER Medical college and Dr. Bhausaheb Sardesai hospital in rural Maval Taluka in Pune district of Maharashtra State.Results: Total Nasal Symptom Score differs significantly for all the treatment groups. Subsequent pairwise contrasts using a Bonferroni adjustment reveals maximum reduction of symptoms in Levocetirizine group. Cost effectiveness ratio was effective for Levocetirizine followed by Cetirizine, Loratadine, and Fexofenadine.Conclusions: From the analysis of results, the study shows that both Levocetirizine and Cetirizine control the symptoms of allergic rhinitis better as compared to Loratadine and Fexofenadine but Levocetirizine was a better choice in comparison to others due to its cost effectiveness

Visual analogue scale: a simple tool in rural region for physician’s global evaluation and patient’s self-evaluation in allergic rhinitis

Background: The study was done with the objective to study whether the physician’s global evaluation of the consultation corelates with patient’s self-evaluation to patient outcome concerning symptom relief of nasal congestion by using visual analogue scale.Methods: A total of 52 patients completed a visual analogue score questionnaire presented at the consultation. 52 patients were reached in a seven days follow-up after the consultation. Patient’s outcome measures conducted at MIMER Medical College and Dr. Bhausaheb Sardesai Hospital in rural Maval Taluka in Pune district of Maharashtra state.Results: Physician’s self-evaluation of the consultation was much more strongly associated with outcome than the patient’s evaluation.Conclusions: The difference between the physician’s and patient’s evaluation of the consultation to predict patient outcomes indicates that the physician’s self-evaluation of the consultation is of importance

Assessment of cost effectiveness of antihistaminics in allergic rhinitis patients in rural region by Nasal cytology: a simple and inexpensive tool

Background: This study was to assess the usefulness of nasal smear as a quick, easy and inexpensive diagnostic method for allergic rhinitis and for assessment of the cost effectiveness of antihistaminics.Methods: This study was conducted in rural setting of tertiary care hospital. Nasal smears were taken from 52 patients with a clinical history of nasal allergy having nasal congestion score of at least 3 or more. Nasal smears were stained with Hematoxilin-Eosin and examined by pathologists.Results: A total of 52 patients 13 in each groups of the age group 18 to 65 years (Mean age, 33.73±10.23 years); 48.08% are Female and 51.92% are Male were randomized and received either Cetirizine, Levocetirizine, Loratadine, or Fexofenadine over a period of one week. The association of eosinophil before and after the treatment was obtained using logistic regression analysis for each treatment separately. Eosinophil is marginally associated with Cetirizine before and after treatment.Conclusions: Evaluation of eosinophils in nasal smear is an insensitive but cheaper test for the diagnosis of allergic rhinitis and use as a simple tool for comparison of cost effectiveness among commonly used oral antihistaminics. pharmacoeconomic analysis of present comparative clinical study shows that cetirizine is a better choice in comparison with levocetrizine, loratidine and fexofenadine due to its cost effectiveness

Neuroinflammation and Oxidative Stress in Diabetic Neuropathy: Futuristic Strategies Based on These Targets

In Diabetes, the chronic hyperglycemia and associated complications affecting peripheral nerves are one of the most commonly occurring microvascular complications with an overall prevalence of 50–60%. Among the vascular complications of diabetes, diabetic neuropathy is the most painful and disabling, fatal complication affecting the quality of life in patients. Several theories of etiologies surfaced down the lane, amongst which the oxidative stress mediated damage in neurons and surrounding glial cell has gained attention as one of the vital mechanisms in the pathogenesis of neuropathy. Mitochondria induced ROS and other oxidants are responsible for altering the balance between oxidants and innate antioxidant defence of the body. Oxidative-nitrosative stress not only activates the major pathways namely, polyol pathway flux, advanced glycation end products formation, activation of protein kinase C, and overactivity of the hexosamine pathway, but also initiates and amplifies neuroinflammation. The cross talk between oxidative stress and inflammation is due to the activation of NF-κB and AP-1 and inhibition of Nrf2, peroxynitrite mediate endothelial dysfunction, altered NO levels, and macrophage migration. These all culminate in the production of proinflammatory cytokines which are responsible for nerve tissue damage and debilitating neuropathies. This review focuses on the relationship between oxidative stress and neuroinflammation in the development and progression of diabetic neuropathy

Dielectric properties of electron irradiated PbZrO<SUB>3</SUB> thin films

The present paper deals with the study of the effects of electron (8 MeV) irradiation on the dielectric and ferroelectric properties of PbZrO3 thin films grown by sol-gel technique. The films were (0.62 &#181;m thick) subjected to electron irradiation using Microtron accelerator (delivered dose 80, 100, 120 kGy). The films were well crystallized prior to and after electron irradiation. However, local amorphization was observed after irradiation. There is an appreciable change in the dielectric constant after irradiation with different delivered doses. The dielectric loss showed significant frequency dispersion for both unirradiated and electron irradiated films. Tc was found to shift towards higher temperature with increasing delivered dose. The effect of radiation induced increase of &#949;'(T) is related to an internal bias field, which is caused by radiation induced charges trapped at grain boundaries. The double butterfly loop is retained even after electron irradiation to the different delivered doses. The broader hysteresis loop seems to be related to radiation induced charges causing an enhanced space charge polarization. Radiation-induced oxygen vacancies do not change the general shape of the AFE hysteresis loop but they increase Ps of the hysteresis at the electric field forced AFE to FE phase transition. We attribute the changes in the dielectric properties to the structural defects such as oxygen vacancies and radiation induced charges. The shift in TC, increase in dielectric constant, broader hysteresis loop, and increase in Pr can be related to radiation induced charges causing space charge polarization. Double butterfly and hysteresis loops were retained indicative of AFE nature of the films

PCR diagnosis of tick-borne pathogens in Maharashtra state, India indicates fitness cost associated with carrier infections is greater for crossbreed than native cattle breeds

Tick-borne pathogens (TBP) are responsible for significant economic losses to cattle production, globally. This is particularly true in countries like India where TBP constrain rearing of high yielding Bos taurus, as they show susceptibility to acute tick borne disease (TBD), most notably tropical theileriosis caused by Theileria annulata. This has led to a programme of cross breeding Bos taurus (Holstein-Friesian or Jersey) with native Bos indicus (numerous) breeds to generate cattle that are more resistant to disease. However, the cost to fitness of subclinical carrier infection in crossbreeds relative to native breeds is unknown, but could represent a significant hidden economic cost. In this study, a total of 1052 bovine blood samples, together with associated data on host type, sex and body score, were collected from apparently healthy animals in four different agro-climatic zones of Maharashtra state. Samples were screened by PCR for detection of five major TBPs: T. annulata, T. orientalis, B. bigemina, B. bovis and Anaplasma spp.. The results demonstrated that single and co-infection with TBP are common, and although differences in pathogen spp. prevalence across the climatic zones were detected, simplistic regression models predicted that host type, sex and location are all likely to impact on prevalence of TBP. In order to remove issues with autocorrelation between variables, a subset of the dataset was modelled to assess any impact of TBP infection on body score of crossbreed versus native breed cattle (breed type). The model showed significant association between infection with TBP (particularly apicomplexan parasites) and poorer body condition for crossbreed animals. These findings indicate potential cost of TBP carrier infection on crossbreed productivity. Thus, there is a case for development of strategies for targeted breeding to combine productivity traits with disease resistance, or to prevent transmission of TBP in India for economic benefit

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries