Assessment of antimicrobial prescribing and rationality of drug usage in general practitioners in Pune city, India

Background: Most of the common ailments are managed by general practitioners (GPs). GPs prescribe major bulk of the drugs sold in the market. Naturally, irrational use of drugs at this level could lead to disastrous consequences. So this study was undertaken to determine prescribing pattern of Antimicrobials (AMA) and the rationality of drug usage by GPs in Pune city.Methods: It was a cross-sectional study. Pune city was divided into 5 zones. MBBS, BAMS and BHMS GPs doing Allopathic practice were selected randomly. 2 GPs of each specialty per zone were selected; this gave us 10 GPs of each degree – so total 30 GPs.30 Prescriptions at each GP were collected – total 900 prescriptions. The following parameters were studied- Diagnosis of patient, Average no. of drugs/prescription Percentage of AMAs prescribed, Rationality of AMA, Selection of AMAs diagnosis wise, Rationality of Prescription.Results: More than 75% patients coming to GPs were suffering from communicable diseases. Average no. of drugs / prescription and percentage of prescription with AMAs was high in all GPs. Macrolides was the most common group of AMA used by MBBS whereas Cephalosporins was used by BAMS and BHMS. Irrational use of AMAs was high in BHMS GPs. Use of irrational FDCs, banned drugs, steroids was high in BAMS GPs.Conclusions: There are deficiencies in prescription practices among all GPs. Not only are GPs prescribing the highest number of  AMAs  per prescription anywhere, their prescription practices for common health problems are highly inappropriate. High level of irrational use of drugs by BAMS and BHMS GPs are cause of concern

Safety evaluation of directly observed treatment short course (DOTS) regimen in a tertiary care hospital, Pune

Background: Directly observed treatment short course (DOTS) is a cornerstone of Revised National Tuberculosis Control Program of India. Adverse drug reactions (ADRs) induced by this therapy is common and it causes significant morbidity and mortality. Hence, the present study was undertaken to determine the incidence and pattern of ADRs and to assess causality and severity.Methods: We conducted prospective, observational study at DOTS center of tertiary care hospital, Pune. 150 pulmonary tuberculosis patients undergoing DOTS therapy were enrolled. They were monitored weekly in an intensive phase and monthly in the continuation phase. The suspected ADRs were recorded and assessed for causality and severity by standard algorithms.Results: Incidence of ADRs due to DOTS was 19.33% & total 35 ADRs had occurred in our study. Gastrointestinal intolerance, arthralgia & itching with or without rashes were most common ADRs (incidence rates: 12.67%, 2.67% and 2.67%, respectively). On evaluation of causality by Naranjo algorithm, majority of ADRs 91.43% were “possible.” As per WHO- Uppsala Monitoring Center scale, majority of ADRs 91.43% were “possible.” As per Modified Hartwig and Siegel scale, majority of ADRs were “moderate” (48.57%) but 8.57% were “severe.” Female gender was found to be a significant risk factor for developing ADRs (odds ratio: 3.08, 95% confidence interval: 1.33-7.12. 3.33%). ADRs & hepatotoxicity was major reason for defaulting from DOTS (60%).Conclusion: ADRs induced by DOTS are common and there is need of incorporating pharmacovigilance system for this vital public health program. Counseling of patients for timely prevention, detection, and management of ADRs will help in minimizing the further occurrence of ADRs

Role of piracetam on cognitive function in epilepsy and with antiepileptics in rats

Background: To study extent of cognitive impairment by epilepsy & antiepileptic treatment and evaluate the role of piracetam on it.Methods: 48 animals were divided into 6 groups: I-Control, II- Topiramate, III-Topiramate+Piracetam, IV-Valproate, V-Valproate+Piracetam, VI-Piracetam. Baseline cognitive functions were measured using Cook’s pole climbing apparatus (CPCA) and Elevated plus maze (EPM). In CPCA, on completion of training, number of avoidances (NOA) out of 10 trials were noted while in EPM, transfer latency (TL) was measured. Kindling was induced by 30mg/kg Pentylenetetrazol (PTZ), i.p. to all groups (except Group I) on alternate days till seizures developed. Groups were treated with respective drugs orally for 21 days and cognitive functions measured again.Results: Significant decrease in NOA & increase in TL was observed after PTZ kindling. Topiramate further significantly impaired NOA and TL whereas Valproate significantly reduced NOA in CPCA but increase in TL was not significant. Treatment with Piracetam significantly increased Topiramate, Valproate and PTZ kindling induced decrease in NOA as also significantly reduced Topiramate and PTZ kindling induced increase in TL.Conclusion: Seizures are associated with cognitive impairment. Cognitive impairment caused by Sodium valproate differs from Topiramate. Piracetam, a known nootropic can be used in alleviating cognitive impairment associated with epilepsy & chronic antiepileptic therapy

Role of trimetazidine in carbon tetrachloride induced liver damage in rats

Background: Hepatotoxicity by chemicals and drugs is a common clinical problem. Presently very few drugs are showing effectiveness in prevention and treatment of hepatic damage. So in this study, we evaluated the role of trimetazidine in carbon tetrachloride (CCl4) induced liver damage in rats. Objective of current study is to evaluate effects of prophylactic trimetazidine against carbon tetrachloride induced liver damage in rats.Methods: Liver damage was induced in 30 albino rats by CCl4 (0.5 ml/kg, i.p.) once daily for 7 days. Extent of damage was studied by assessing biochemical parameters (SGOT, SGPT, ALP, proteins and bilirubin). These biochemical observations were supplemented by pentobarbitone Sleeping Time and Histological Examination of liver. The effect of co-administration of trimetazidine (doses 5 and 10 mg/kg p. o.) on the above parameters was investigated. Liv.52® was used as Positive Control. Data was analyzed by one way ANOVA, followed by Dunnett's test.Results: Trimetazidine significantly prevented CCl4 induced elevation of serum SGOT, SGPT, ALP and bilirubin (total and direct), and reduction in protein level. Pentobarbitone sleeping time and histological examination of the liver showed consistent results. The results were comparable to that of Liv.52®.Conclusions: Trimetazidine, when administered prophylactically, shows hepatoprotective effect against CCl4 induced liver damage

Effect of pretreatment with coenzyme Q10 on isoproterenol-induced cardiotoxicity and cardiac hypertrophy in rats

AbstractBackground: Coenzyme Q10 (CoQ10) is a lipid-soluble, vitamin-like substance found in the hydrophobic interior of the phospholipid bilayer of most cellular membranes. It appears to be involved in the coordinated regulation between oxidative stress and antioxidant capacity of heart tissue when the heart is subjected to oxidative stress in various pathogenic conditions.Objective: The objective of the present study was to investigate the effect of pretreatment with CoQ10 (100 mg/kg) on isoproterenol (ISO)-induced cardiotoxicity and cardiac hypertrophy in rats.Methods: Albino male Wistar rats (250–300 g) were evenly divided by lottery method into 1 of the following 3 groups: the ISO group (olive oil 2 mL/kg orally for 18 days and ISO 1 mg/kg IP from days 9–18); the CoQ10 + ISO group (CoQ10 100 mg/kg orally for 18 days and ISO 1 mg/kg IP from days 9–18); and the control group (olive oil 2 mL/kg orally for 18 days and water IP from days 9–18). Twenty-four hours after the last dose of water or ISO, the rats were anesthetized and an ECG was recorded. Blood was withdrawn by retro-orbital puncture for estimation of serum creatine kinase-MB (CK-MB) isoenzyme levels, lactate dehydrogenase (LDH) levels, and aspartate aminotransferase activities. The animals were euthanized using an overdose of ether. The hearts of 6 animals from each group were used for estimation of superoxide dismutase (SOD) activity, reduced glutathione (GSH) concentration, lipid peroxidation (LPO), malondialdehyde (MDA), and total protein concentration. Histopathology of the 2 remaining hearts in each group was carried out by a blinded technician.Results: A total of 24 rats (8 in each group) were used in this study; all rats survived to study end. Compared with the control group, the ISO-treated rats had a significant change in heart to body weight ratio (P < 0.001); significant changes in the endogenous antioxidants (ie, significantly higher myocardial MDA concentration [P < 0.001]; significantly lower myocardial GSH concentration [P < 0.001] and SOD activity [P < 0.01]); and significantly higher serum activities of marker enzymes (eg, CK-MB [P < 0.001] and LDH [P < 0.001]). Compared with the ISO group, the CoQ10 + ISO group had a significant change in heart to body weight ratio (P < 0.001); significant changes in the endogenous antioxidants (ie, significantly lower MDA concentration [P < 0.05]; significantly higher myocardial GSH concentration [P < 0.001] and SOD activity [P < 0.05]); and significantly lower serum activities of marker enzymes (eg, CK-MB [P < 0.05] and LDH [P < 0.01]).Conclusion: Pretreatment with CoQ10 (100 mg/kg) for 18 days was associated with moderate protection against ISO-induced cardiotoxicity and cardiac hypertrophy, and with lower myocardial injury by preserving endogenous antioxidants and reducing LPO in rat heart

EVALUATION OF ACUTE AND SUB-ACUTE TOXICITY OF A STANDARDIZED POLYHERBAL FORMULATION (HC9): AN IN VIVO STUDY

Objective: In the present study, we have performed the acute and sub-acute toxicity of a standardized polyherbal formulation (HC9) in Swiss albino mice. Methods: In acute toxicity study, the mice were orally administered with different doses (1750 and 2000 mg/kg) of HC9 and monitored for 14 d. In the sub-acute toxicity study, animals received HC9 extract by oral gavage at the doses of 250, 500 and 1000 mg/kg/day (????=5/group/sex) for 28 d. At the end of the study, the animals were sacrificed and evaluated for effect of HC9 on biochemical, hematological and histopathological parameters. Results: HC9 did not produce any adverse effects in biochemical, hematological, urine and histopathological parameters in mice. HC9 did not induce any adverse effects in terms of mortality and clinical signs in the acute toxicity study. It was well-tolerated by mice up to 2000 mg/kg/body weight. In sub-acute toxicity study, no treatment-related adverse effects were found in the mice upto 1000 mg/kg/day dose. No significant changes were observed in biochemical and hematological parameters as well as histopathology of tissues (liver, kidney, spleen, heart, lung, thymus, adrenal gland, epididymis and testis/ovary) among mice of either sex. Conclusion: Our results showed that HC9 did not induce any acute and sub-acute toxicity in male and female mice, thereby, suggesting its safety for future clinical application

Correlations of Social Support, Religiosity, Spirituality and Life Satisfaction in Indian Geriatrics

ABSTRACT Ageing is a nerve-racking phenomenon in a developing country like India with approximately 7% elderly population. Thus, stress management is a very important aspect of caring in the old age. Various studies have shown that practice of spirituality and religiosity as well as supportive social resources reduces stress. In India, most persons are brought up with divine ideology and religious practices. With this background, we thought, it would be interesting to study the effect of spirituality and religiosity on Life Satisfaction (L.S.) 120 subjects of either sex, above 60 years from middle class families were included in the present study. A standardized questionnaire was prepared and translated into the vernacular language; Marathi. Field work was done by trained interviewers and collected data were analyzed using SPSS. Initially internal consistency of spiritual scale of BMMRS (Brief Multidimensional Measurement of Religiosity and Spirituality) and RFQ (Royal Free Questionnaire) were checked. It was observed that no significant inconsistency was seen with the reported data. A moderate correlation was found between RFQ and BMMRS. There appears to be little effect of age and sex on L.S. Using multiple regression analyses with L.S. and well-being as separate dependent variables, the predictive value of different domains was evaluated. Besides, the influence of social support resources on L.S. was also analyzed. This study underscores that the religious values, daily spiritual experiences and social support resources were found to positively intervene with life satisfaction of elderly

Antimicrobial prescribing pattern in a tertiary care teaching hospital: a pilot study

Background: The emergence of antimicrobial resistance is a worldwide challenge threatening to negate the gains made by discovery of antimicrobial agents (AMAs).  Antimicrobial Stewardship Program (ASP) is an important strategy for ensuring appropriate use of AMAs and controlling emergence of antibiotic resistance. Implementation of ASP must start with assessment of the current state of antimicrobial use. This study was therefore conducted to assess the prevalent prescribing patterns in a tertiary care hospital and identify gaps which warrant corrective intervention.Methods: This prospective pilot study presents analysis of the first 30 Patients from the medicine ward prescribed at least one antimicrobial agent during the two months of study period. Relevant data was collected in AMA record form. Appropriateness of AMAs was analyzed regarding selection as well as administration protocol as per the hospital antibiotic policy.Results: Out of the 60 AMAs prescribed to these patients, most commonly prescribed were cephalosporins (63.3%), anti-amoebics (26.6%) and macrolides (23.3%). Common diseases involved were urinary tract infection, acute gastroenteritis, sepsis and lower respiratory tract infections.  Use of AMAs was found to be appropriate for the indication in 42 %, dose in 97%, duration 60 %, route 93% and frequency 90 %.Conclusions: This gap between the appropriate and the actual practice use of AMAs indicates an urgent need of rigorous implementation of ASP in order to avoid emergence of resistance and to conserve the sensitivity to the available AMAs