Indian Journal of Pharmacy and Pharmacology

Page No. 155-161

Authors: Prabhu M.R, Sahajanandha H, Dwajani S

Bone is a dynamic organ made up of mostly collagen that provides the structure to the skeleton and calcium phosphate that gives strength and hardens the skeleton structure. Bone is constantly renewed by remodeling, a lifelong process consisting of bone resorption (osteoclasts) and formation (osteoblasts) to repair skeletal damage and maintain calcium homeostasis. Several hormones like calcitonin, parathyroid hormone, vitamin D, estrogen, testosterone etc. regulate resorption and formation. Several factors like age, low diet calcium, smoking, certain medications, - glucorticoids, aromatase inhibitors, proton pump inhibitors, immunosuppressant, selective serotonin inhibitors and antiepileptic drugs can influence bone health which are used for long term treatment. Imaging techniques like dual X-ray absorptiometry (DEXA), Quantitative computerized tomography (QCT) are available for exact measurement of bone mineral density which helps identifying the fracture risk. Newly, bone biomarkers are known to increase their demand and play an important role in detection of bone loss at early stage. Recent evidence suggests that these markers may be useful in monitoring the response to anti-resorptive therapy. The potential for these markers used along with imaging techniques helps to diagnose bone loss, possibly prior to overt clinical signs. Hence, the aim of the article was to review the diagnosis of bone loss using specific bone biomarkers which can strongly correlate to these classes of drugs causing bone loss at early stage with possible duration of the treatment.

Page No. 165-168

Authors: Nagesh Raju G., Manjunath S.M., Dharmaraj B

Introduction: Most of the common health ailments are treated by general population themselves without medical supervision, which is termed as self-medication. There are potential risks of self-medications like adverse drug reaction, disease aggravation, drug dependence, drug resistance etc. The undergraduate medical and dental students have easy access to information from various sources to self-diagnose and self-medicate. So, we conducted the study to assess the practice of self-medication among 2nd year medical and dental students studying at Basaveshwara Medical College & S.J.M. Dental College, Chitradurga. Materials: This was an observational, cross-sectional study based on a semi-structured, pre-validated questionnaire. Descriptive statistics was used for analysing the data. The result was analysed using the software Microsoft Excel sheet. Results: The study included 172 students (medical & dental), out of which 57.5% were females and 42.4% were males. 82.5% of participants had practised self-medication at some point in their life. 85% felt that there was no need to consult physician for simple ailments. The source of information for self-medication was pharmacist (61.6%), followed by google & internet (46.5%), senior (32.5%). Most common conditions for which self-medication was practiced included cold (93%), cough (85%), diarrhea (80%). Drugs commonly used for self-medication included Paracetamol (94%), Antacids (59%), Antibiotics (41%). Conclusions: Our study revealed that there is a high prevalence of self-medication among medical and dental students. We as the healthcare professionals need to raise the awareness regarding the ill effects of self-medication among undergraduates and also stress on various measures to curb its growing trend.

Page No. 173-177

Authors: V.M. Motghare, C.S. Bajait, A. Turnakar, S.D. Sontakke, S. Chavan Page No. 173-177

Introduction: Skin diseases are chronic in nature and they require lifetime treatment. Prescription pattern reflects health professional attitude towards the disease and role of drugs in its treatment. The study of prescription pattern is important to make medical care rational and cost effective. Objective: To evaluate drug prescribing pattern and adverse drug reaction profile in Dermatology department of tertiary care hospital. Results: 410 prescriptions were analyzed which include 1696 drugs. Majority of drugs prescribed were antihistaminic (20.99%), antibacterial (16.05%), antifungal (9.08%), and corticosteroids (7.78%). Eighteen patients were reported with ADR. Most of ADRs are reported with Antimicrobials (50%) & common ADR was Maculopapular rash (50%), On severity assessment by modified Hartwig and Siegel’s scale, out of 18 ADRs, 8 (44.44%) were mild, 8 (44.44%) were moderate and 2 (11.11) were severe in nature. Conclusion: The present study showed antihistaminic were commonly prescribed class & antibiotics were responsible from majority of ADR. Maculopapular rash was most common ADR.

Page No. 182-185

Authors: Hemamalini MB, Rekha MB, Basavaraj Bhandare, Adarsh E

Introduction: Acute respiratory infection (ARI) is the largest cause of morbidity across the world in children under five years of age. Antibiotics are the most commonly prescribed medications for Lower respiratory tract infection [LRTI]. Rational use of antibiotic is very necessary to avoid resistance. Objective: To evaluate the pattern of antibiotic use among children under 5yrs of age. Methods: A hospital based, non-interventional, prospective, observational study was carried out between April 2014 to September 2014 in the department of Pediatrics in collaboration with pharmacology department, Rajarajeswari Medical College and Hospital, a tertiary care hospital, Bangalore. The demographic data, diagnosis, type of drug, dosage duration of treatment and hospital stay was collected from inpatients admitted to pediatric ward over a period of 6 months. The descriptive analysis was done and was presented as mean and percentage. Results: A total of 250 in patient case records of children with LRTI were analyzed. In this study less than 1 year children constituted highest percentage (59.2%).56.8%were males and 43.2% were females. A total of 1045 drugs were prescribed in 250 prescriptions (4.18 drugs/ prescription). Brochiolitis (41.6%) was the most common diagnosis followed by Bronchopneumonia(33.6%). 32.77% of patients receive one antibiotic, 39.49% received 2 antibiotics and 27.73% of patients received 3 antibiotics. Most commonly prescribed antibiotic was Amoxcillin+clavulanic acid(58%), followed by Amikacin(57%) and Ceftriaxone(53%). Conclusion: It is evident from the present study that antibiotics were most commonly prescribed for LRTI. Bronchiolitis is most often associated with a viral etiology and use of unnecessary antibiotics for viral LRTI will lead to increased threat of antibiotic resistance.

Page No. 192-196

Authors: Ashutosh Tiwari, Pooja Reddy, Chhaya Goyal

Introduction: Fungal infections are common and treatment imposes economic burden on the patients. The compliance of the patient may be significantly dependent on the cost of the prescribed medicines, especially in developing countries like India. Therefore, this study was conducted to analyze cost variation of drugs used for fungal infections. Aim and Objectives: To evaluate the cost of different brands of anti-fungal drugs available in India, and to analyze the variations in cost of same dosage of different brands of the same active drug. Material and Methods: Cost of a particular drug that is manufactured by different companies, in the same strength, number and dosage forms was obtained from Current Index of Medical Specialties, July-October 2016 and Drug Today, July-September 2016 and were analysed. Cost range, cost ratio and percentage cost variation were calculated. Correlation between percentage cost variation and number of companies manufacturing the drug was analysed by linear regression and Spearman correlation analysis. p < 0.05 was considered statistically significant. Result: The costs of a total of 8 antifungal drugs available in 18 different formulations were analysed and a substantial variation in cost was found. Fourteen drugs had percentage cost variation more than 100%, fluconazole 150 mg (10214%) had maximum percentage cost variation while griseofulvin 500 mg (42%) had minimum percentage cost variation. There was a linear relationship between no. of manufacturing companies and percentage cost variation and Spearman correlation analysis showed a statistically significant positive correlation between these two variables. Conclusion: The present study shows wide variation in the cost of the different brands of the same antifungal drugs manufactured by different companies. This adds to the economic burden for the patients. Ideally, generic drugs should be prescribed to decrease the healthcare cost and to enhance the compliance. Hence, the stakeholders should aim at decreasing the cost variation among different brands while maintaining the therapeutic efficacy.

Page No. 206-209

Authors: P. Chakraborty, NN Bala, S. Das

Acacia nilotica Linn. Subsp. indica (Family- Mimosaceae) bark has many activities like anti-plasmodial, molluscidal, antifungal, anti-microbial activity. The plant has no CNS depressant action found yet, but having such good number of beneficial action to human being has drawn our interest to study the same. The aim of the present study is to investigate the CNS depressant activity of ethanolic extracts A.nilotica bark on mice. The CNS depressant activity was determined by muscle relaxant property, reduction in spontaneous motility. The investigations had brought out that ethanolic extract of Acacia nilotica bark has significant CNS depressant property.

Page No. 214-220

Authors: Manju Agrawal, Toshanlal Todar, Rajesh Hishikar, Usha Joshi, Preeti Singh

Objective: The aim of the study was to evaluate the medical student’s knowledge and attitude towards generic drugs and categorize if a drug is generic or branded from the drug label. Method: A prospective cross sectional survey was undertaken among 90 final year medical students.17 item questionnaire was developed, validated and administered to assess their knowledge and attitude on generic vs. branded drugs. Results: In our survey 71% students knew that generic drugs are bioequivalent to branded drugs but only 17.77% knew that generic are manufactured after expiry of patent. 73.33% students were aware that Medical Council of India has made generic prescription mandatory. 88% students were sensitive to the difference in generic vs. branded pricing. However 47% students felt that incentives will increase generic prescription. 50% of the students did not categorize the given sample of drugs either as branded or generic. 100% stressed the need of sensitization programmes at undergraduate level to update them on drug prescription patterns. Conclusion: Good percentage of students had knowledge about generic medicines. They showed positive attitude towards generic prescription in their future practice and were ready to consume generic drugs themselves when required. Inspite of this fact patients and practitioners still favour branded drugs.

Page No. 225-226

Authors: Chhaya Goyal, Mohammad Rafi, Ghazala Khan

Anaphylaxis is a rare condition during ante natal care since most of the drugs except nutraceuticals are avoided in pregnancy unless essentially required to prevent developing foetus from any teratogenic effects. An anaphylactic reaction follows idiosyncrasy that may occur with any drug or food to which an individual is previously known or unknown to be allergic. Antibiotics and NSAIDs are the most common class of drugs known to cause allergic reactions. Maternal anaphylaxis has the potential to cause foetal defects (morbidity) and in rare cases foetal death (mortality), latter possibly due to hypoxia. The authors here report a similar case of maternal anaphylaxis to ciprofloxacin infusion during third trimester in which maternal outcome was positive but 8 months foetus died within an hour of reaction. Iron sucrose infusion was also administered to the mother prior to ciprofloxacin in a community clinic.

103-107

Authors: Avanthi E, Pradeep Kumar L, Lokesh BN, Yadavalli Guruprasad

Background: The objective was to evaluate and compare the effect of extract of essential oil of clove with the standard sodium valproate on MES model. Methods: A total of thirty mice were taken, they were given an electroconvulsive shock. Thirty mice were divided into five groups of six animals each, the control group received distilled water 5ml/kg i.p, standard received Inj. Sodium valproate 200 mg/kg i.p. another group received Sesame oil – 10ml/kg i.p(control), test groups received Clove oil- 0.075 ml/kg i.p., Clove oil- 0.1ml/kg i.p respectively. All the injections were given 30 minutes before the test. Results: Clove oil produced significant antiepileptic effect at all the doses. Conclusion: Clove oil has shown significant antiepileptic activity in mice

115-120

Authors: Shanta Das Sutradhar, Sushil Kumar Varma

Background: Urticaria is a very common skin condition characterized by recurrent, pruritic (itchy), pink-to-red edematous (swollen) lesions that often have pale centers (wheals). Histamine is the main mediator of urticaria and H1 antihistamines represent the initial and mainstay treatment of urticaria. The newer second generation H1 antihistamines are preferred over the older first generation H1 antihistamines as the initial choice of therapy due to its less sedating and less cholinergic side effects. Although numerous treatments are available for urticaria, there is little information about the prescription pattern for the treatment of urticaria. Hence this study was conducted. Methods: This was a cross-sectional study conducted on 100 newly diagnosed and untreated patients of urticaria who attended Dermatology and Venereology outpatient department of a rural tertiary care teaching hospital. The prescriptions were collected for the duration of 18 months and details of prescription (particulars of the patient, diagnosis, name of the drugs, dose, route of administration, total duration etc.) were collected in case record forms. Results: Majority of the patients (34) belonged to the age group of 21-35years. The mean age of the patients was 34.35±15.26 years. Most of the patients were treated with oral antihistamines. Among oral antihistamines, most of the patients received 2nd generation antihistamines either as monotherapy or in combination with 1st generation antihistamines and H2 blockers. Among 2 nd generation antihistamines, fexofenadine was prescribed highest either as monotherapy or in combination with levocetirizine and cetirizine. Patients with more severe form of disease were treated with combination of oral and parenteral therapy. Further long term study is required for proper assessment of prescription pattern in urticaria patients. Conclusion: Most of the patients with urticaria can be effectively treated with Oral antihistaminic medication, and additional parenteral therapy may be required only for severe cases of acute on chronic urticaria.

127-134

Authors: Tesfaye Wolde, Behailu Bizuayehu, Tesfaye Hailemariam, Kassahun Tiruha

Introduction: Ethiopian communities highly depend on local plants to safe and sound their survival and health. Local trees are subjugated and used intensively for medicinal uses. Objective: The aim of the present study was too carried out phytochemical analysis of organic extract of Hagenia abyssinica and to find out antihelmentic property of Hagenia abyssinica. Methods: Hagenia abyssinica female flower extracts was used for plant component analysis and for determination of antihelmentic activity. Earth worm (Pheretima posthuma) strains were used for experimental purpose. Disc diffusion method was used to assess the antibacterial effect of the extracts on micro-organisms. Results: The phytochemical screening indicated the presence of flavonoids, tannins, steroid, alkaloid, saponins in all extracts. Antibacterial and antihelmentic activity of Ethanolic, Methanolic, Hexane and Petroleum Ether extract of Hagenia abyssinica female flowers was highly active against Adult earthworm (Pheritima posthuma) and active against Staphyloccoccus aureus and showed less activity against Salmonella typhi. Conclusion: The present study finally demonstrates that Hagenia abyssinica is a good source of various phytochemical such as Saponins, Phlobathanins, Flavonoids, Anthraquinones, Phenols, Terpenoids, Alkaloids, Steroids, Glycosides, Tannins. The antibacterial activity Hagenia abyssinica was clearly shown by the present study against bacteria. All these preliminary reports affirm an in depth analysis of the usefulness of Hagenia abyssinica as miracle drug against various ailments.

139-145

Authors: Girish C. Soni, PD Chaudhary, PK Sharma

Solid dispersion was aim for increasing solubility and bioavailability of poorly aqueous soluble drug aceclofenac (ACE). Solid dispersion of drug aceclofenac (NSAID) was prepared by using different polymers i.e. Polaxomer 188, PVP k30, PEG 6000, in different ratios 1:1, 1:2, 1:3, by different methods of solid dispersion preparation i.e. Physical method, solvent evaporation method, melt method. The prepared formulations was characterised by Differential scanning calorimetry (DSC), Scanning electron microscopy (SEM), X-ray diffraction (XRD), In vitro dissolution studies, drug content estimation, saturation solubility. It was concluded that there is change in the crystalline form of drug into amorphous state during formation of solid dispersion. Polaxomer 188 in ratio 1:3 through melt method, it shows maximum drug release which is 99.04% in 40 minutes. It was concluded that solid dispersion formation of aceclofenac drug by using polaxomer 188 is promising approach in enhancement of its absorption rate increase bioavailability and minimising its side effects

44-48

Authors: Anshu Gupta

Communication skill is one of the six required competencies by the Accreditation Council for Graduate Medical Education (ACGME). They can have a better outcome if practiced than just preached. Role plays are widely used as an educational method of learning communication skills in medical students. This paper studies the student’s perspective of role-plays as a teachinglearning strategy and how role-plays helpful in developing communication skills. Methodology: Fourth semester undergraduate medical students participated in a role-play sessions in endocrine pharmacology classes. Before and after the session, students completed questionnaires. In the pre-session questionnaire, students were asked about their previous experiences of role-play as teaching learning tool. Immediately after the session, students provided reflections and answered questions in relation to the role-play activity as a teaching learning method and development of communication skills. Descriptive statistics were used to analyze data. Results: 127 students completed pre evaluation forms and 124 completed the post evaluation forms. Most students (n = 112; 90.3%) supported role plays to be conducted in class. Students considered role-plays as a feasible way of learning (81.2%). Ninety one(73.4%) agreed that they helped in improving the communication skills. Improvement in communication with the teacher and the peers was identified as an advantage of role-plays by 66 of the participants (53.2%). Students were of the view that the communication skill development should be started in early years of MBBS. Conclusion: Role-play was valued by students in the acquisition of communication skills during pharmacology classes which will be of help in real settings.

52-58

Authors: Bhanu Prakash Kolasani, Divyashanthi CM, Raghunatha Rao Ponnaluri, Prasanand Sasidharan, Sri Venkate

Background: The trends of prescribing drugs in patients of psoriasis with an emphasis on WHO core prescribing indicators have never been studied previously in India. Hence the present study was planned to analyse the prescribing pattern of drugs and WHO core prescribing indicators among inpatients of psoriasis in dermatology department of our institute. Methods: An observational prospective study was conducted in 75 inpatients of psoriasis pregnant women for a period one year. Each prescription was analyzed for patient’s demographic variables, type of psoriasis, total number of drugs prescribed, various categories of drugs prescribed, percentage of individual drugs in each class, World Health Organization (WHO) core prescribing indicators and percentage of drugs prescribed by their dosage forms. Statistical analysis was primarily descriptive with values mainly expressed as percentages and absolute numbers. Result: Majority of the patients belonged to 30-40 age group and the most common type was plaque psoriasis (57.33%). Overall 317 medications were prescribed to a total of 75 patients among which antioxidant, vitamin and mineral preparations (32.40%) were the most commonly prescribed category followed by antihistamines (13.13%) and topical corticosteroids (12.57%). Methotrexate (4.19%) was the only immunosuppressant drug prescribed. Average number of drugs per prescription was 4.23%. Percentage of drugs prescribed by generic name was 36.91%. Percentage of encounters with antibiotic prescribed was 6.31% whereas injection prescribed was 1.89%. Percentage of drugs prescribed from National list of essential medicines (NLEM) was 59.10%. Tablet (57.14%) was the most commonly prescribed dosage form. Conclusion: The study reveals inappropriately higher usage of multivitamin preparations, higher prevalence of polypharmacy and relatively under usage of topical antibiotics and emollient preparations. Measures to facilitate and encourage rational prescribing of drugs in psoriasis among the students and prescribers must be undertaken in order to derive the optimum benefit with least adverse effects.

63-68

Authors: Mounika K, Lakshmana Rao A

A simple, rapid, accurate and precise isocratic reversed phase high performance liquid chromatographic method has been developed and validated for simultaneous estimation of Bromhexine and Erythromycin in tablet dosage forms. The chromatographic separation was carried out on Hypersil BDS C18 column (150 mm x 4.6 mm I.D., 5 µm particle size) with a mixture of 0.01N phosphate buffer and acetonitrile in the ratio of 35:65 v/v as a mobile phase at a flow rate of 1.0 mL/min. UV detection was performed at 224 nm. The retention times were 4.619 minutes and 2.329 minutes for Bromhexine and Erythromycin respectively. Calibration plots were linear (r2=0.999 for both Bromhexine and Erythromycin respectively) over the concentration range of 2-12 µg/mL for Bromhexine and 62.5-375 µg/mL for Erythromycin. The method was validated for linearity, precision, accuracy and robustness. The proposed method was successfully used for simultaneous estimation of Bromhexine and Erythromycin in tablet dosage forms. Validation studies revealed that the proposed method is specific, rapid, reliable and reproducible. The high % recovery and low % RSD values confirm the suitability of the proposed method for routine quality control analysis of Bromhexine and Erythromycin in bulk and tablet dosage forms.

73-74

Authors: Avanthi E, Pradeep Kumar L, Lokesh BN, Yadavalli Guruprasad

Objective: To evaluate the antidepressant activity of Rosuvastatin in male albino mice. Method: Thirty male swiss albino mice were selected for forced swim test model. There were five groups and each group had six animals. The control group received Normal saline (10ml/kg I.P), the standard Imipramine (10mg/kg I.P), the 3 test group received Rosuvastatin (10mg/kg, 15mg/kg, 20mg/kg I.P) respectively. The test was conducted 30mins after injecting the drugs by forced swim test model. Duration of immobility was noted. Statistical analysis was performed using Mean +/- SEM. One way ANOVA followed by Tukey’s post hoc test was done P<0.05 was considered statistically significant. Results: Rosuvastatin produced significant antidepressant effect at all the doses, as indicated by reduction in the duration of immobility compared to the control and standard with significant p value of <0.0001. Conclusion: The results of the present study indicates the antidepressant like activity of Rosuvastatin in male albino mice.

79-83

Authors: Seema Rani, Sanjeev Kumar, Joyti, Prem Kumar Vaerma, Dharvin Lamba, Rahul Saini

Background & Objectives: Eperisone hydrochloride is a new drug came in market with centrally acting muscle relaxant, having additional vasodilator effect and used for treatment of backache associated with muscle stiffness like thiocolchicoside but supposed to be slightly better in efficacy and adverse effect profile. The aim of this study was to compare the efficacy and safety of eperisone with thiocolchicoside in patients with acute lower backache associated with muscle spasm. Methods: 100 eligible subjects were taken and assessment of severity of pain and muscle spasm was done by using Visual Analogue Scale, finger-to-floor distance (FFD), Lasegue’s maneuver and modified Schober’s test. Results: No statistically significant difference in pain relief and muscle spasm among both the treatment groups but clinically pain relief is slightly better in eperisone group. The adverse drug reactions occurring during study showed a slightly better safety profile in patients on eperisone than on thiocolchicoside. Conclusion: These findings confirm that eperisone represents a valuable and safer alternative to thiocolchicoside for treatment of low back pain associated with muscle spasm

88-94

Authors: Shabbir Rafik Pendhari, Kedar Shashikant Joshi, Ramchandra Prabhakar Limaye

Background: In 2006 PPI was the third most frequently prescribed drug in Australia. In United States, UK and New Zealand similar trends were observed. Utilization of proton pump inhibitors is increasing continuously. Differential drug utilization of PPIs are observed along with NSAIDs with antibiotics, Utilization of PPI alone is less, and some newer adverse drugs reactions are being reported, so we planned a study to find out the actual burden of PPI in our area. Methods: 50 registered pharmacies were selected. Then data collection was done after consent of patient or relative having PPI containing prescription and photos of prescription were taken, without any personally identifiable information of patient or physician. Results: 1466 prescription containing PPI were obtained during study. (69.85%) prescriptions were containing NSAIDs along with the PPI. while 55% AMA were used by the physician during the study period. PPI is preferred and prescribed as gastroprotective agents alone or along with antimicrobials and NSAIDs, thus they will reduce the gastrointestinal adverse effects, of concomitant drugs. Conclusion: 45.05% burden of PPI is there in study area observed. PPI are mostly used along with NSAIDs and/or AMA, for their ability to produce gastro protective effect. But their contribution towards adverse effect is to be evaluated.

7-12

Authors: Vani K, Malathi Priyanka M, Durga Srinivas P, Naveen Kumar U, Kalyani Y, Aminabee SK, Lakshmana Rao

Objective: The aim of the present study was to evaluate preliminary phytochemicals and in-vitro evaluation of antioxidant activity of Sesamum indicum leaves. Methods: Antioxidant activity was evaluated by using in-vitro antioxidant assay models like hydrogen peroxide scavenging activity, reducing power assay and phosphomolybdenum method. All the antioxidant activities were compared with standard antioxidant such as ascorbic acid. Results: The ethanolic extract of Sesamum indicum leaves was found to contain flavonoids. Additionally, the capacity to scavenge hydrogen peroxide, the reducing power (capacity to reduce Fe3+ to Fe2+) and formation of phosphomolybdenum complex were evaluated. From this study it was concluded that the extract exhibited a concentration dependent scavenging activity.

17-23

Authors: Anisha Prasad

Diabetes Mellitus is a complex disease where the carbohydrate, protein and fat metabolism is deranged and co-exists with insulin resistance. The defect is either in the secretion of insulin, in the insulin receptors or post receptor events1. It manifests as hyperglycemic state with dyslipidemia and other metabolic defects. Insulin promotes glucose uptake through its receptor located in the cell surface by generating signal that results in the translocation of glucose transporter (GLUT) to cell surface. Thereafter, glucose is transported to the cytoplasm through these receptors by facilitated diffusion in the muscle cell and the adipose tissues. In type 2 DM, the muscle cells and adipose tissues are resistant to this signaling pathway2-7. Trivalent chromium (Cr) vital micronutrient obtained from diet which serves to potentiate insulin action and maintenance of normal glucose tolerance. Studies suggest, chromium is an essential cofactor that is required for optimum insulin activity9-11. Cr increases insulin receptor numbers8 on cell surface of the target cells hence facilitates more insulin-receptor binding. Trivalent Cr, especially Cr tri-picolinate and chromium histidinate are effective in insulin resistance. Chromium replacement is essential in deficient conditions and this fact has been well established, the aim of this review is to assess the role of chromium in the pathology of diabetes.

29-32

Authors: Akshay Sadhotra, Anshu Gupta, Rani Walia, Nidhi Sharma

Adverse Drug Reactions are very common cause of hospital morbidity.