Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity.

OBJECTIVE: The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS: Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS: Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION: Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Comparison of body weight and adipose tissue in male C57Bl/6J mice fed diets with and without trans fatty acids.

The effect of a diet containing trans-fatty acids (tFA) on the fatty acid composition and fat accumulation in adipose tissue was investigated in mice. Male C57Bl/6J mice were fed Control or Trans Diets that were similar, except that 50% of the 18:1, which was all cis in the Control Diet, was replaced by tFA in the Trans Diet. At selected ages, body weight, epididymal fat pad weight, perirenal fat yield, adipose tissue cellularity and fatty acid composition were examined. Over the time period studied (2-24 mon), the proportion of 18:0 and 16:0 tended to decrease while cis-18:1 levels increased. Compared to the Control Diet, the Trans Diet resulted in adipose tissue lipids with higher percentages of 14:0 and 18:2n-6 and lower percentages of cis-18:1 and 20:4n-6. In polar lipids, tFA replaced saturated fatty acids, whereas tFA replaced cis-18:1 in the nonpolar lipids. Body weights at 16 and 24 mon of age and epididymal fat pad weights at 8-24 mon of age were lower in mice fed the Trans Diet as compared to those fed the Control Diet. At the ages studied, the Trans Diet also resulted in lower values for perirenal fat weights, triacylglycerol to polar lipid ratios, and adipose cell size. The data suggest that chronic consumption of tFA affects lipid metabolism and results in decreased fat accumulation in murine adipose tissue.

Comparison of body weight and adipose tissue in male C57BI/6J mice fed diets with and withouttrans fatty acids.

The effect of a diet containingtrans-fatty acids (tFA) on the fatty acid composition and fat accumulation in adipose tissue was investigated in mice. Male C57BI/6J mice were fed Control or Trans Diets that were similar, except that 50% of the 18∶1, which was allcis in the Control Diet, was replaced bytFA in the Trans Diet. At selected ages, body weight, epididymal fat pad weight, perirenal fat yield, adipose tissue cellularity and fatty acid composition were examined. Over the time period studied (2-24 mon), the proportion of 18∶0 and 16∶0 tended to decrease whilecis-18∶1 levels increased. Compared to the Control Diet, the Trans Diet resulted in adipose tissue lipids with higher percentages of 14∶0 and 18∶2n-6 and lower percentages ofcis-18∶1 and 20∶4n-6. In polar lipids,tFA replaced saturated fatty acids, whereastFA replacedcis-18∶1 in the nonpolar lipids. Body weights at 16 and 24 mon of age and epididymal fat pad weights at 8-24 mon of age were lower in mice fed the Trans Diet as compared to those fed the Control Diet. At the ages studied, the Trans Diet also resulted in lower values for perirenal fat weights, triacylglycerol to polar lipid ratios, and adipose cell size. The data suggest that chronic consumption oftFA affects lipid metabolism and results in decreased fat accumulation in murine adipose tissue.

Isomeric trans fatty acids in the U.S. diet.

Since actual consumption data for trans fatty acid (FA) intakes for the U.S. population do not exist, estimates of trans fatty acids (FAs) available in the U.S. food supply have been calculated from U.S. Department of Agriculture-Economic Research Service (USDA-ERS) fats and oils production figures and food disappearance data for fats and oils. Based on weighted averages for the trans levels in each fats and oils category, these estimates of trans FAs available in the U.S. food supply range from 12.5 to 15.2 g/person/day (average 13.3 +/- 1.1 g/person/day). Estimates of trans FA consumption have been calculated; these estimates predict a wide range from 1.6 to 38.7 g/person/day. These calculations are based on published estimates of trans FAs available in the total fat of 5-15%, and the total fat intake (range 31-258 g/person/day) of a representative sample of adults (ages 20-59) as determined by the Lipid Research Clinics (LRC). Using an equation based on a relationship between trans FAs in adipose tissue and dietary fat, an intake range of 0.7-28.7 g/person/day trans FAs for the same LRC fat consumption data can be predicted. Adipose tissue isomer profiles that indicate 90-95% of the trans FAs in the tissues comes from partially hydrogenated vegetable fats and oils allow us to predict a dietary intake range from 11.1 to 27.6 g/person/day trans FAs. The significance of these estimates to nutrition policy is discussed.