Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra

Background: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra. Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages. Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination. Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs

Current pattern of adverse drug reactions to anti-retroviral therapy in an antiretroviral therapy centre attached to a government medical college of Maharashtra, India: a retrospective study

Background: Antiretroviral drug therapy (ART) has brought a ray of hope to people living with HIV/AIDS. Adverse drug reactions (ADRs) can often cause significant morbidity among individuals on ART, occasionally leading to mortality. The present study was conducted to assess the nature, causality, severity of ADRs to ART, and to identify risk factors for ADRs in HIV-positive patients receiving ART in India.Methods: A total of 109 patients reported with ADRs to ART during July 2015-December 2015 were randomly included in a retrospective observational study conducted at an ART center attached to a government medical college of Maharashtra. Causality and severity assessment of ADRs was done by using Naranjo’s ADR Causality scale and Modified Hartwig and Siegel scale respectively. The data was computed using MS Excel and descriptive results were expressed as counts and percentages. The study was approved by Institutional Ethics Committee.Results: Among 109 patients, females (60.55%) had higher prevalence of ADRs than males (39.45%). A total of 132 ADRs were reported. Anemia (76.52%) was the commonest ADR reported followed by skin rash (11.36%) and raised renal function tests (6.06%). Zidovudine + Lamivudine + Nevirapine (ZLN) were the commonest ART regimen causing anemia as ADR.Conclusions: Reporting of ADRs is a very inefficient system in detecting drug-related conditions, leading to underestimation of the burden due to ADRs in India. A well-structured, efficient pharmacovigilance systems, which assesses and monitor safety profile and impact of antiretroviral medicines is very much needed at present in India

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

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

Current pattern of adverse drug reactions to anti-retroviral therapy in an antiretroviral therapy centre attached to a government medical college of Maharashtra, India: a retrospective study

Background: Antiretroviral drug therapy (ART) has brought a ray of hope to people living with HIV/AIDS. Adverse drug reactions (ADRs) can often cause significant morbidity among individuals on ART, occasionally leading to mortality. The present study was conducted to assess the nature, causality, severity of ADRs to ART, and to identify risk factors for ADRs in HIV-positive patients receiving ART in India.Methods: A total of 109 patients reported with ADRs to ART during July 2015-December 2015 were randomly included in a retrospective observational study conducted at an ART center attached to a government medical college of Maharashtra. Causality and severity assessment of ADRs was done by using Naranjo’s ADR Causality scale and Modified Hartwig and Siegel scale respectively. The data was computed using MS Excel and descriptive results were expressed as counts and percentages. The study was approved by Institutional Ethics Committee.Results: Among 109 patients, females (60.55%) had higher prevalence of ADRs than males (39.45%). A total of 132 ADRs were reported. Anemia (76.52%) was the commonest ADR reported followed by skin rash (11.36%) and raised renal function tests (6.06%). Zidovudine + Lamivudine + Nevirapine (ZLN) were the commonest ART regimen causing anemia as ADR.Conclusions: Reporting of ADRs is a very inefficient system in detecting drug-related conditions, leading to underestimation of the burden due to ADRs in India. A well-structured, efficient pharmacovigilance systems, which assesses and monitor safety profile and impact of antiretroviral medicines is very much needed at present in India

Estimation of changes in C-reactive protein level and pregnancy outcome after nonsurgical supportive periodontal therapy in women affected with periodontitis in a rural set up of India

Aims and Objectives: Estimation of changes in C-reactive protein (CRP) level and pregnancy outcome after nonsurgical supportive periodontal therapy in pregnant women affected with Periodontitis. Materials and Methods: A total of 100 pregnant females with periodontitis were assigned to treatment and control groups. All the details about previous and current pregnancies were obtained. Full-mouth periodontal examination was done at baseline, which included oral hygiene index simplified plaque index, gingival index, and clinical attachment loss. CRP level was also measured from collected blood sample initially at baseline and later after the delivery in both the group. Subjects in the treatment group received nonsurgical periodontal treatment during the second trimester of gestational period, and those in the control group did not receive any periodontal therapy during this period. Periodontal therapy included mechanical plaque control instructions and scaling and root planning. Outcome measures assessed were changes in CRP levels, gestational age, and birth weight of the infants. When delivery occurred at 0.05). Conclusion: Nonsurgical supportive periodontal therapy may lower the risk of preterm delivery in females affected with periodontitis by reducing CRP level

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN