Health related quality of life in hypertensive patients in a tertiary care teaching hospital.

BACKGROUND: Quality of life (QOL) evaluation has emerged as an important outcome measure for chronic diseases like hypertension. AIMS: To determine QOL in patients suffering from hypertension using MINICHAL and WHOQOL-BREF tools. METHODS AND MATERIAL: The study was carried out for eight weeks in medicine outpatient department of a tertiary care hospital. All patients diagnosed with essential hypertension and on drug therapy for at least one month were included. Their socio-demographic and clinical data were noted. Patients were interviewed for QOL using two questionnaires - WHOQOL-BREF and MINICHAL scale. RESULTS: Total 269 patients had mean age and duration of hypertension 58.25 ± 10.35 and 7.65 ± 8.00 years respectively. Age, duration of illness, number of symptoms, systolic blood pressure and number of drugs prescribed showed statistically significant (P < 0.05) negative correlation with WHOQOL-BREF score while number of symptoms, systolic blood pressure and duration of illness showed statistically significant positive correlation with MINICHAL scale (P < 0.05). MINICHAL scale and WHOQOL-BREF were significantly correlated with each other (P < 0.01). Women had significantly poorer QOL compared to men. CONCLUSIONS: Age, female gender, duration, number of symptoms, systolic blood pressure and number of medications may be important predictors of QOL in hypertensive patients.

Evaluation of rationality in prescribing, adherence to treatment guidelines, and direct cost of treatment in intensive cardiac care unit: A prospective observational study.

BACKGROUND: Cardiovascular diseases (CVDs) remain the most common cause of sudden death. Hence, appropriate drug therapy in intensive cardiac care unit (ICCU) is crucial in managing cardiovascular emergencies and to decrease morbidity and mortality. OBJECTIVE: To evaluate prescribing pattern of drugs and direct cost of therapy in patients admitted in ICCU. MATERIALS AND METHODS: Patients admitted in ICCU of a tertiary care teaching hospital were enrolled. Demographic data, clinical history, and complete drug therapy received during their stay in ICCU were noted. Data were analyzed for drug utilization pattern and direct cost of treatment calculated using patient's hospital and pharmacy bills. Rationality of therapy was evaluated based on American College of Cardiology/American Heart Association (ACC/AHA) guidelines. RESULT: Data of 170 patients were collected over 2 months. Mean age of patients was 54.67 ± 13.42 years. Male to female ratio was 2.33:1. Most common comorbid condition was hypertension 76 (44.7%). Most common diagnosis was acute coronary syndrome (ACS) 49.4%. Mean stay in ICCU was 4.42 ± 1.9 days. Mean number of drugs prescribed per patient was 11.43 ± 2.85. Antiplatelet drugs were the most frequently prescribed drug group (86.5%). Mean cost of pharmacotherapy per patient was '2701.24 ± 3111.94. Mean direct cost of treatment per patient was '10564.74 ± 14968.70. Parenteral drugs constituted 42% of total drugs and 90% of total cost of pharmacotherapy. Cost of pharmacotherapy was positively correlated with number of drugs (P = 0.000) and duration of stay (P = 0.027). CONCLUSION: Antiplatelet drugs were the most frequently prescribed drug group. Mean number of drugs per encounter were high, which contributed to the higher cost of pharmacotherapy. ACC/AHA guidelines were followed in majority of the cases.

Students' perceptions on feedback module in pharmacology.

CONTEXT: Feedback is an integral part of formative assessment though underutilized in medical education. The objective of this study was to review our feedback module through students' perceptions. METHODOLOGY: We have developed a feedback module which is practiced by us for last 10 years for term ending examination that gives collective feedback to the whole class, followed by individual student-teacher interactions. Students were also exposed to 6-7 multiple choice questions (MCQs) based assessment during the course of pharmacology. Immediately after each MCQ test the answer keys is displayed along with an explanation. Two classes of students were requested to give their perceptions about the feedback by responding on Likert scale for the statements in the questionnaire. All the 206 students who volunteered for the study were enrolled in the study. Mann-Whitney test was used to calculate the difference in perceptions. RESULTS: Of 278 students of two classes, 206 responded (74%). Students' agreement varied from 93% to 98% for 5 items in the questionnaire for the feedback after term ending examinations. Perception of students attending one or more than one feedback session did not differ significantly. For MCQs, tests agreement was 91% to 98% for the 4 items. There was no significant difference between two classes in their perceptions regarding feedback practices (P < 0.05). CONCLUSION: Students gave a favorable opinion for our feedback module. In the medical colleges with a large number of students, this module is feasible for feedback in formative assessment in the form of written tests.

Assessment of quality of prescribing in patients of hypertension at primary and secondary health care facilities using the Prescription Quality Index (PQI) tool.

OBJECTIVE: To determine the quality of prescribing in hypertension in primary and secondary health care settings using the Prescription Quality Index (PQI) tool and to assess the reliability of this tool. MATERIALS AND METHODS: An observational cross-sectional study was carried out for 6 months in order to assess quality of prescribing of antihypertensive drugs using Prescription Quality Index (PQI) at four primary (PHC) and two secondary (SHC) health care facilities. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33) and high quality (score 34-43) based on PQI total score. Psychometric analysis using factor analysis was carried out to assess reliability and validity. RESULTS: Total 73 hypertensive patients were included. Mean age was 61.2 ± 11 years with 35 (48%) patients above 65 years of age. Total PQI score was 26 ± 11. There was a significant difference in PQI score between PHC and SHC (P < 0.05) Out of 73 prescriptions, 43 (59%) were of poor quality with PQI score <31. The value of Cronbach's α for the entire 22 criteria of PQI was 0.71 suggesting good reliability of PQI tool in our setting. CONCLUSIONS: Based on PQI scores, quality of prescribing in hypertensive patients was poor, somewhat better in primary as compared to secondary health care facility. PQI is reliable for measuring prescribing quality in hypertension in Indian set up.

Quality of prescribing for hypertension and bronchial asthma at a tertiary health care facility, India using Prescription Quality Index tool.

OBJECTIVE: Several tools have been introduced to evaluate the quality of prescribing. The aim of this study was to determine the quality of prescribing in hypertension and bronchial asthma in tertiary health care (THC) setting using the new Prescription Quality Index (PQI) tool and to assess the reliability of this tool. METHODS: A prospective cross-sectional study was carried out for 2 months in order to assess the quality of prescribing of antihypertensive and antiasthmatic drugs using recently described PQI at THC facility. Patients with hypertension and bronchial asthma, attending out-patient departments of internal medicine and pulmonary medicine respectively for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor, medium and high quality based on total PQI scores. RESULTS: A total of 222 patients were included. Mean age was 56 ± 15.1 years (range 4-87 years) with 67 (30.2%) patients above 65 years of age. Mean total PQI score was 32.1 ± 5.1. Of 222 prescriptions, 103 (46.4%) prescriptions were of high quality with PQI score ≥34. Quality of prescribing did not differ between hypertension and bronchial asthma (P > 0.05). The value of Cronbach's α for the entire 22 criteria of PQI was 0.71. CONCLUSION: As evaluated by PQI tool, the quality of prescribing for hypertension and bronchial asthma is good in about 47% of prescriptions at THC facility. PQI is valid for measuring prescribing quality in these chronic diseases in Indian setting.

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.

A study of potential adverse drug-drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital.

OBJECTIVE: To evaluate prevalence, types, and severity of potential adverse drug-drug interaction in medicine out-patient department. MATERIALS AND METHODS: A single-point, prospective, and observational study was carried out in medicine OPD. Study began after obtaining approval Institutional Ethics Committee. Data were collected and potential drug-drug interactions (pDDIs) were identified using medscape drug interaction checker and were analyzed. RESULT: A total of 350 prescriptions with mean age 52.45 ± 14.49 years were collected over a period of 5 months. A total of 2066 pDDIs were recorded with mean of 5.90 ± 6.0. The prevalence of pDDI was 83.42%. Aspirin was most frequently prescribed drug in 185 (10.15%) out of total of 1821 drugs It was also the most frequent drug implicated in pDDI i.e. in 48.16%. The most common pDDI identified was metoprolol with aspirin in 126 (6.09%). Mechanism of interactions was pharmacokinetic in 553 (26.76%), pharmacodynamic in 1424 (68.92%) and 89 (4.30%) having an unknown mechanism. Out of all interactions, 76 (3.67%) were serious, 1516 (73.37%) significant, and 474 (22.94%) were minor interaction. Age of the patients (r = 0.327, P = 0.0001) and number of drugs prescribed (r = 0.714, P = 0.0001) are significantly correlated with drug interactions. CONCLUSION: Aspirin being the most common drug interacting. The use of electronic decision support tools, continuing education and vigilance on the part of prescribers toward drug selection may decrease the problem of pDDIs.

Drug utilization in pediatric neurology outpatient department: A prospective study at a tertiary care teaching hospital.

BACKGROUND: Neurological disorders are a significant cause of morbidity, mortality and adversely affect quality of life among pediatric patients. In India, more than 30% population is under 20 years of age, many of whom present late during the course of illness. Several drugs prescribed to pediatric population suffering from neurological disorders may be off label or unlicensed. AIMS AND OBJECTIVES: To study drug use pattern, identify off-label/unlicensed drug use and to check potential for drug-drug interactions in patients attending outpatient department of pediatric neurology at a tertiary care teaching hospital. METHODOLOGY: Prescriptions of patients attending pediatric neurology outpatient department were collected prospectively for 8 weeks. They were analyzed for prescribing pattern, WHO core prescribing indicators, off-label/unlicensed drug use and potential for drug-drug interactions. RESULT: A total of 140 prescriptions were collected, male female ratio being 2:1. Epilepsy was the most common diagnosis (73.57%) followed by breath holding spells, migraine and developmental disorders. Partial seizure was the most common type of epilepsy (52.42%). Average number of drugs prescribed per patient was 1.56. Most commonly prescribed drug was sodium valproate (25.11%) followed by phenytoin (11.41%). About 16% of the prescriptions contained newer antiepileptic drugs. More than 60% of the drugs were prescribed from WHO essential drug list. In 8.57% of cases drugs were prescribed in off-label/unlicensed manner. Twenty-six percent prescriptions showed potential for drug interactions. CONCLUSION: Epilepsy is the most common neurological disease among children and adolescents. Sodium valproate is the most commonly prescribed drug. A few prescriptions contained off-label/unlicensed drugs.

Objective structured practical examination as a tool for the formative assessment of practical skills of undergraduate students in pharmacology.

INTRODUCTION: Assessment for practical skills in medical education needs improvement from subjective methods to objective ones. An Objective Structured Practical Examination (OSPE) has been considered as one such method. This study is an attempt to evaluate the feasibility of using OSPE as a tool for the formative assessment of undergraduate medical education in pharmacology. MATERIALS AND METHODS: Students of second year MBBS, at the end of the first term, were assessed by both the conventional practical examination and the Objective Structured Practical Examination (OSPE). A five-station OSPE was conducted one week after the conventional examination. The scores obtained in both were compared and a Bland Altman plot was also used for comparison of the two methods. Perceptions of students regarding the new method were obtained using a questionnaire. RESULTS: There was no significant difference in the mean scores between the two methods (P = 0.44) using the unpaired t test. The Bland Altman plot comparing the CPE (conventional practical examination) with the OSPE showed that 96% of the differences in the scores between OSPE and CPE were within the acceptable limit of 1.96 SD. Regarding the students' perceptions of OSPE compared to CPE, 73% responded that OSPE could partially or completely replace CPE. OSPE was judged as an objective and unbiased test as compared to CPE, by 66.4% of the students. CONCLUSION: Use of OSPE is feasible for formative assessment in the undergraduate pharmacology curriculum.

Drug utilization in emergency medicine department at a tertiary care teaching hospital: A prospective study.

BACKGROUND AND OBJECTIVES: The practice of emergency medicine has the primary mission of evaluating, managing and providing treatment to those patients with unexpected injury or illness. Instituting appropriate therapy is necessary for safety of the patients and to decrease mortality and morbidity. The objectives were to study the drug utilization pattern and direct cost of therapy in emergency medicine department of a tertiary care teaching hospital. MATERIALS AND METHODS: Data of the patients admitted to emergency medicine department was collected prospectively for 48 h from the time of admission over 2 months. The prescriptions were analyzed for drug use pattern and direct cost of therapy was calculated. RESULTS: A total of 156 patients received 1635 drugs with the mean of 9.99 ± 2.55 drugs/patient. Most common diagnosis was acute coronary syndrome 35 (21.79%). Ondansetron 135 (86.53%) was most frequently prescribed drug followed by pantoprazole 133 (85.25%) and furosemide 68 (43.58%). Amongst antimicrobials ceftriaxone 51 (32.69%) was the most commonly prescribed drug. Direct cost of treatment per patient for the first 48 h was र 4051 ± 1641. CONCLUSION: Ondansetron and pantoprazole were the most commonly prescribed drugs in the emergency department. However, their use in all patients was not justified. Polypharmacy was prevalent. A closer look at the rationality of therapy would help in highlighting issues involved and would be helpful to authorities in deciding prescribing policies.

Use of potentially inappropriate medications in hospitalized elderly at a teaching hospital: a comparison between Beers 2003 and 2012 criteria.

OBJECTIVES: To detect the prevalence and pattern of use of Potentially inappropriate medications (PIMs) in hospitalized elderly patients of a tertiary care teaching hospital using Beers 2012 criteria and to compare the same with Beers 2003 criteria. MATERIALS AND METHODS: Prescriptions of the elderly patients aged 65 years and above were collected from the medicine ward and analyzed. PIMs were identified with help of Beers 2003 and Beers 2012 criteria and comparison was made between the two criteria. Predictors associated with use of PIM were identified using bivariate and multivariate logistic regression analysis. RESULTS: A total of 210 patients received 2,267 drugs. According to Beers 2003 criteria, 60 (28.57%) elderly patients received at least one PIM and 2.9% drugs were prescribed inappropriately. According to Beers 2012 criteria, 84 (40%) elderly received at least one PIM while 22 (10.47%) received multiple PIMs and about 5% drugs were prescribed inappropriately. The most commonly prescribed PIM was mineral oil-liquid paraffin (30, 14.3%) followed by spironolactone (25, 11.9%), digoxin (19, 9%), and benzodiazepines (14, 6.7%). There was a significant association between the number of patients receiving more than six drugs and the use of PIMs (P < 0.01). Use of more than 10 drugs was a significant predictor for use of PIMs in the elderly. CONCLUSION: The study shows high prevalence of prescribing PIMs in hospitalized elderly patients. Beers 2012 criteria are more effective in identifying PIMs than Beers 2003 criteria.

Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies.

BACKGROUND: Ivermectin has opened a new era in the management of scabies as orally effective drug. However, topical route has been little explored for ivermectin. AIMS: To compare the efficacy and safety of topical permethrin, oral ivermectin, and topical ivermectin in the treatment of uncomplicated scabies. METHODS: This was an open-label, randomized, comparative, parallel clinical trial conducted in 315 patients, randomly allocated to 3 groups. First group received permethrin 5% cream as single application, second group received tablet ivermectin 200 mcg/kg as single dose, and third group received ivermectin 1% lotion as single application. All the patients received anti-histaminic for pruritus. The patients were followed up at intervals of 1, 2, 3, and 4 weeks. If there were no signs of cure, the same intervention was repeated at each follow up. Primary efficacy variable was clinical cure of lesions. Statistical analysis was done by chi square test and one way ANOVA test using SPSS version 12. RESULTS: At the end of first week, cure rate was 74.8% in permethrin group, 30% in oral ivermectin group, and 69.3% in topical ivermectin group (P < 0.05). At the end of second week, cure rate was 99% in permethrin group, 63% in oral ivermectin group, and 100% in topical ivermectin group (P < 0.05). At the end of third week, 100% cure rate was observed in permethrin and topical ivermectin group while 99% in oral ivermectin group (P = 0.367). No serious adverse events were observed. CONCLUSIONS: Permethrin and topical ivermectin were equally effective against scabies while oral ivermectin was significantly less effective up to 2 weeks. Topical ivermectin can be used as an alternative to permethrin.

Interaction of two memory enhancing herbal drugs Memory Plus and Mentat with diazepam and phenytoin sodium in mice.

Background: The non-medical self-administration of memory enhancing drugs is a common practice. Present study was designed to evaluate interactions of two such herbal drugs Memory Plus (MP) and Mentat, with other central nervous system (CNS) active drugs. Methods: Two activities - pentobarbitone sleeping time (PST) and maximal electroshock seizures (MES) were performed using adult albino mice weighing 25-30 g to observe the interactions of the herbal drugs with diazepam and phenytoin sodium, respectively. For each activity, animals were divided into seven groups of six mice each. Group I was a control group receiving 0.2 ml of 1% Tween 80 i.p/0.2 ml saline p.o, Group II, III and IV acute treatment groups; received single dose of herbal (2 mg/kg i.p MP or 200 mg/kg p.o Mentat) CNS-active drugs alone in subeffective doses group II - diazepam 5 mg/kg i.p, Group III PS 15 mg/kg i.p and Group IV - MP/Mentat+diazepam or PS, respectively. Groups V, VI, and VII were subchronic treatment groups, received drugs once daily for 8 days same as acute treatment groups. Sleeping time was measured as the interval between the loss and recovery of righting refl ex and anticonvulsant activity by giving supra maximal shock via ear electrodes using a techno electro convulsiometer. Results: Both MP and Mentat showed potentiation of effect of diazepam and PS in subchronic treatment groups by signifi cantly prolonging PST (p<0.05) and by showing signifi cant percentage protection in MES method (p<0.05) compared to control group. Conclusion: Subchronic administration of MP and Mentat shows significant interaction with diazepam and PS. Further human studies are warranted to confi rm these fi ndings.

Prescribing quality in patients with chronic diseases at primary and secondary health care facilities using prescription quality index tool.

Background: Prescribing quality is a matter of major concern worldwide. This study was carried out to determine the quality of prescribing in chronic diseases at primary health care (PHC) and secondary health care (SHC) settings using the new prescription quality index (PQI) tool. Methods: A cross-sectional observational study was carried out at four PHC and two SHC facilities in Anand district of India. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33), and high quality (score 34-43) based on PQI total score. The internal consistency of PQI was measured using item total correlation and Cronbach’s α so as to validate it in our settings. Data were analyzed using Statistical Package for Social Science 20. Results: A total of 134 prescriptions were collected and evaluated for quality of prescribing. Mean age of patients was 60.6 ± 13.5 years. Mean PQI score was 23.60 ± 9.3 with 71.6% prescriptions being of poor quality. Quality of prescribing did not differ at PHC and SHC (P>0.05). Of 22 criteria, PQI score was strongly correlated with drug indication, drug effectiveness, evidence-based prescribing, unnecessary duplication, duration of therapy, and cost (P<0.01). PQI total score was negatively correlated to the number of drugs per prescription. Cronbach’s α for the entire 22 criteria were 0.90. Conclusion: PQI was found to be a reliable tool for assessment of prescribing quality in chronic diseases.

Study of potential drug-drug interactions between benzodiazepines and four commonly used antiepileptic drugs in mice.

Background: Benzodiazepines (BZD) is one of the commonly used drug groups for certain neurological diseases. As sometimes, the anti-epileptic drugs (AEDs) may be used concomitantly with BZD there is a potential for drug-drug interactions. Study aimed to study potential drug-drug interactions between four commonly used AEDs (phenytoin, carbamazepine (CBZ), phenobarbitone, sodium valproate) and BZD (diazepam, clonazepam) in mice using maximal electroshock seizure (MES) method and pentylenetetrazole (PTZ) method. Methods: Adult male albino mice were divided into four different groups of six animals each and anti-epileptic activity was assessed using MES method and PTZ method. Group I acted as a control, Group II received any one of the four AEDs (phenytoin, CBZ, phenobarbitone or sodium valproate) in sub-effective doses, Group III received diazepam or clonazepam alone, Group IV received a combination of diazepam or clonazepam with any one of the AEDs. Results: In MES method, the groups receiving combination of diazepam with phenytoin and CBZ showed significant protection compared to the control group (p<0.01 and p<0.02), respectively. However, diazepam in combination with sodium valproate and phenobarbitone did not show any significant protection compared to the control group and individual antiepileptic group. All the four antiepileptic showed significant protection against MES seizure in combination with clonazepam when compared to control group. In PTZ method, combination of sodium valproate with clonazepam showed significant protection compared to control group (p<0.02). However, this was not observed with diazepam-valproate combination. Conclusion: Clonazepam potentiates the action of all the four anti-epileptics while diazepam potentiates only phenytoin and CBZ against MES seizures. Clonazepam but not diazepam potentiates the action of sodium valproate against PTZ seizures.

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.

A Patient with Tracheal Leiomyoma and Meningioma: A Case Report.

Most of the tumors that form in the trachea and bronchi in adults are malignant but a few are benign. Common benign tumors of the trachea are squamous cell papilloma, fibroma, hemangioma and leiomyoma. Leiomyoma of trachea constitute only 1% of the common benign tumors of the trachea and hence few cases are reported in the literature. Meningiomas are a diverse set of tumors arising from the meninges, majority of these tumors are usually benign and only 8% are either atypical or malignant, which could recur after treatment or removal. Presence of both this uncommon tumors in a single patient is quite rare. We present a case of a woman with both the tumors.

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.

Comparison of analgesic, anti-inflammatory and anti-pyretic efficacy of diclofenac, paracetamol and their combination in experimental animals.

Background: Various combinations of analgesics antipyretic drugs are available in the market for treatment of various musculoskeletal disorders and pain relief. Diclofenac and paracetamol combination is most commonly used combination and its rationality is questionable. The objective of this study was to compare the analgesic, anti-inflammatory and anti-pyretic activities of diclofenac, paracetamol and their combination. Methods: Experimental animals were divided into 4 different groups – control, diclofenac, paracetamol and their combination. Analgesic activity was compared by using tail-clip method in rats and writhing test in mice, anti-inflammatory activity was compared by carrageenan paw edema method using plethysmometer and anti-pyretic action was compared using TAB vaccine induced pyrexia and measuring the rectal temperature. Different doses of diclofenac (1mg/kg and 2mg/kg) and paracetamol (10mg/kg and 20mg/kg) used and same doses were used in combination group. Results: Diclofenac sodium (1mg/kg) showed significantly higher analgesic activity using tail-clip and writhing method compared to paracetamol (10mg/kg) (p<0.0001) and the combination group (p<0.05). Diclofenac sodium (2mg/kg) showed significantly higher analgesic activity using tail-clip and writhing method compared to paracetamol (20mg/kg) (p<0.0001) and the combination group (p<0.1). Diclofenac has no significant difference in anti-inflammatory activity using carrageenan induced paw edema when compared to the combination group (p<0.1) for both doses. But diclofenac when compared to paracetamol for anti-inflammatory effect, it was highly significant (p<0.0001 and p<0.0004) for both doses at 1st and 3rd hour. Paracetamol 20mg/kg was superior antipyretic (p<0.05,0.01 and 0.01 ) when compared to the combination group at 1hr, 2hr and 3hr duration after injecting TAB vaccine. Conclusion: Diclofenac and paracetamol combination was either equal or inferior in all three activities studied as compared to the individual drugs.