Indian Journal of Pharmacy and Pharmacology

37-41

Authors: Ashok Kumar*,Vasant R.Chavan,Mohammaed Arshad,Raghunanadan M,Mohammed Fayazuddin

Introduction: Osteoarthritis (OA) is a major cause of chronic pain and lower extremity disability among the elderly due to its predilection for lower extremity joints such as the knee and hip. The treatment of pain and inflammation is an important area of therapeutics. Over the past two decades, non steroidal anti-inflammatory drugs (NSAIDs) have played a central role in these indications. NSAIDs constitute the largest single group of drugs used worldwide, constituting more than 20% of all drug prescriptions. In India over 400 formulations of NSAIDs are marketed, resulting in wide spread exposure of patients to this class of drugs and its adverse effects, For all these reasons, studies that evaluate the pattern, extent and frequency of NSAID prescriptions are valuable. Periodic evaluation of drug utilization studies provides the information for suitable modifications in the prescription of drugs in order to increase the therapeutic benefit and decrease the adverse effect associated with drug. Materials and Methods: A prospective, observational study was conducted on newly diagnosed as well as old treated patients with osteoarthritis from orthopaedic outpatient department in a tertiary care teaching hospital. A total of 428 were enrolled after screened for the inclusion and exclusion criteria. Data was recorded in a specially designed proforma which include information regarding the demographic profile of the patients and about the pattern of drugs prescribed. Results: Four hundred and twenty-eight patients with the diagnosis of Osteoarthritis visited the orthopedic outpatient department during the period of six months in which the data was collected. Prescriptions of all 428 patients were analyzed. Osteoarthritis was found to be more common in males (56.07%) compared to that of females (43.92%). Results also revealed that, OA was more prevalent in middle age group of 51-65 years (45.32%),with knee joint (66.58%) being most commonly effected, majority of patient were treated with Combination therapy (80.80%) over Monotherapy (19.19%). Most of patients were treated as first line with NSAIDS (79.75%) and Paracetamol (20.10%), was under prescribed. Aceclofenac (32.85%) was the most common NSAID used followed by Diclofenac sodium (25.49%). Gastroprotective agents were used in 12.28% along with Non-selective NSAIDS to prevent gastrointestinal adverse effects, out of which Ranitidine (53.47%) was most preferred, followed by Pantoprazole (16.66%), Various other drugs were also used as adjunct therapies that includes, Calcium and Vitamin D3, symptomatic slow acting drugs for OA (SYSADOA) which included diacerin and glucosamine sulfate as combination in (10.15%) of patients. Conclusions: Our study showed Osteoarthritis most common among males affecting knee joint in middle age group, Paracetamol and SYSADOA being under prescribed and NSAIDS are the most frequently used drugs in OA. National drug policy is needed to rationalize the drug use and bring awareness among the prescribing doctors.

45-51

Authors: Rhythm ,Nirav Asarawala,Barna Ganguly*

Context: Long term use of anti-hormonal therapy in breast cancers is effective for extending long term survival rates but simultaneously can lead to various side effects affecting quality of life. Aims: Aim of this study was to assess the utilization of hormonal treatment in patients suffering from breast cancer with specific objective of reviewing their quality of life with relation to side effects. Settings and Design: This was an OPD based cross sectional study, conducted in Shree Krishna Hospital, Karamsad. Methods and Materials: Prior permission from institutional ethics committee was taken. Utilization part of the study was a record based study, from the case files available in record section of cancer OPD. For quality of life part of the study, written informed consent was taken from the participants and were interviewed according to quality of life questionnaires. Statistical Analysis Used: Data were analyzed as per descriptive statistics and results were presented in form of percentage and range. Mean scores for various quality of life subscales were calculated using EORTC scoring manual. Results: Out of total 38 patients of breast cancer, 26(68.42%) patients were on treatment with letrozole, 12(31.57%) were on tamoxifen. We found better role functioning and cognitive functioning subscales in breast cancer patients of tamoxifen group as reflected in the highest mean score of 93.74 in functional scale. Mean sexual functioning scores in both letrozole and tamoxifen groups were on lower side. Percentage of patients experiencing systemic therapy side effect (dry mouth, hot flushes, hair loss, headache, dysgeusia) were found to be more in tamoxifen group. Conclusions: Overall, the parameters of quality of life in breast cancer patients on hormonal therapy, were found to be in better side, except for sexual functioning scores which were on lower side.

56-59

Authors: Roshi*,Vishal R. Tandon,Annil Mahajan

Menopause is an important physiological process in a female's life. It is not free from different variety of symptoms affecting day to day life. With increasing life expectancy, female spends many years with menopausal symptoms. Having knowledge about these symptoms provides us a guide about treatment for various symptoms to be introduced into postmenopausal health guidelines. Materials and Methods: The present study was undertaken in Medicine OPD of Govt. Medical College Jammu. Total 60 patients were divided into two groups and were given tab gabapentin and nortryptiline. The readings were taken at 0 week, 4 weeks and 8 weeks after noting the demographic profile. Results: Most of the females in both the groups were from rural areas, housewives and with natural menopause. Both the study drug were effective in decreasing the postmenopausal symptoms were none was better than the other. Conclusion: both nortryptiline and gabapentin have potential to be used as drugs in postmenopausal symptoms besides other treatment options.

65-72

Authors: Pradeep Javedar,Shrinivas R Raikar*,Prashant Dass

Introduction: Mental disorders form an important public health priority. Less work has been carried out in India on the economic burden of mental illness. Policy makers are increasingly dependent on clinical data to formulate and implement guidelines on Psychotropic drug use. This study aims to further the database of knowledge regarding Psychotropic drugs and their utilisation in mental health disorders in this region. Materials and Methods: After institutional ethics committee approval, a prospective drug utilisation study of 100 out patient prescriptions was undertaken. Preparation of the protocol and conduct of the study was as per the WHO – DUS and the STROBE guidelines. Results: 100 prescriptions were analysed containing 207 drugs, 174 of these were psychotropic drugs. Utilisation from National Medicines List and WHO Essential Medicines List was 54.54% and 45.45% respectively. Average psychotropic drugs per prescription were 1.74±0.066 (SD). 30% prescriptions contained fixed dose combinations. Only 0.48% drugs were prescribed by generic name. Drug utilisation pattern: Commonly prescribed drugs were Haloperidol, Valproate, Dosulepin, and Clonazepam. The PDD/DDD ratio of three drugs – Risperidone, Lorazepam and Amisulpride – was equal to one. The average cost borne by the patient was 385.2 rupees per month. Conclusion: Overall the principles of rational prescribing were followed. Hospital schedule needs to add more SSRIs. Practice of using typical anti–psychotics as first line was as per recommendations. More drugs need to be prescribed by generic name to reduce the economic burden. Use of drugs from essential medicine lists needs to be increased in order to have more rational prescribing.

06-10

Authors: Archanabahen Archanabahen,Jitendra R. Zaveri*

Introduction: The cost of drug play important role in practice of medicine and disease outcome. In Indian market numerous brand available of generic drug. Tuberculosis is curable disease but if proper treatment not taken by patients then lead to development of drug resistance or pulmonary disability. AKT drugs used for the management of tuberculosis. Objective: To compare and analysed cost variation in AKT drugs with different brand name for same dosage form & same active compound. Materials and Methods: The price of the drug with same formulation and same strength (Dosage) was review from Indian drug review issue 3, 2017 (IDR) & CIMS (Apr- Jul 2017). Percentage of cost price variation and Cost ratio is analysed. Result: High percentage of cost variation among first line AKT drugs seen with Ethambutol (474.51%) followed by Isoniazid (432.60%). Least percentage of cost variation seen with streptomycin (1.01%) followed by rifampicin (1.33%). Maximum cost ratio of first line drugs seen with Ethambutol (5.74). Among 2nd line AKT drug Maximum and least percentage of cost variation are seen with levofloxacin 500 mg tablet formulations (1550.84%) and Ofloxacin 400 mg sustained Releases - tablet (1.57%) respectively. Higher percentage of cost variation seen with more manufacture company/ no. of brand. Conclusion: The wide percentage of cost variation is seen with AKT drugs available in Indian market. Regulation of drug price by concerned agencies and by government is needed. Rational drug prescription with low cost is important for treatment adherence and disease outcome.

14-17

Authors: Padmavathi Vutukuru,Kranti Tekulapally*

Introduction: Hyperlipidemias are recognized as one of the major risk factors for the development of Coronary Artery Disease (CAD). Statins are the most potent lipid lowering agents currently available that significantly lower the morbidity and mortality associated with CAD. Aim: To compare the cost of various statins of different brands by calculating the percentage variation of cost. Materials and Methods: Prices of different statin preparations per 10 tablets/ capsules in rupees were reviewed from Drug today April-June 2018 issue and www.drugsupdate.com for analysis. Maximum and minimum price difference of the same drug manufactured by different pharmaceutical companies was calculated. Percentage variation was calculated as per the following formula Drug formulations manufactured by only one company and those whose price could not be obtained from the sources were excluded from analysis. Results: Maximum companies are manufacturing single drug atorvastatin 10mg (192) and atorvastatin 5 mg + ezetimibe 10mg (40). Highest percentage variation in cost is found with atorvastatin 5 mg (900%) and in atorvastatin 10mg + amlodipine 5 mg (1488%). Conclusion: There is wide variation in the cost of various statins available in India, which increases the economic burden on patients. Government of India should take more consumer friendly steps to control the cost of drugs. Physicians should maintain a P-drug list and prescribe low cost and effective drugs to improve compliance to drug therapy and ensure effective treatment of the disease.

22-27

Authors: Bajaj V A,Turankar AV*,Thakre M,Tiple PG,V M. Motghare

Introduction: Psychomotor performance results from the coordination of sensory and motor system through the integrative and organizational process of brain and central nervous system. Psychotropic drugs may adversely affect work performance which depends on psychomotor activities. Both valproate and flunarizine are widely used drugs in prophylaxis of migraine and they are known to have effect on psychomotor performance. Hence this study was carried out to evaluate the effect of valproate & flunarizine on psychomotor performance in patients of migraine with the help of battery of subjective & objective psychomotor tests over a period of 8 weeks. Materials and Methods: Patients were allocated to one of the two groups on first day of examination. Baseline psychomotor tests were measured using battery of tests including critical flicker fusion test (CFFT), hand steadiness test (HST), arithmetic ability test & reaction time monitoring. At the end of 4 weeks & 8 weeks, again tests using same methods employed previously were performed. Efficacy was calculated by using Migraine dairy template (0, 4, 8 weeks) & CGI Scale (end). A total of 44 patients were recruited with 22 patients in each arm. Results: Flunarizine (n=20) & valproate (n=20) significantly increased CFFT, AAT scores at the end of 8 weeks compared to baseline and significantly reduced HST, RT, Frequency, Duration and severity at the end of 8 weeks compared to baseline. When flunarizine was compared to valproate no statistical significance was found in scores of CFFT, AAT, HST, RT, Frequency, duration, severity, global improvement and efficacy index. Conclusion: Flunarizine & Valproate were found to be equally efficacious to improve psychomotor performance.

159-163

Authors: Palvi Kudyar*,Shivani Rani,Pavan Malhotra

Introduction: Self-medication the use of medication by a patient on his own initiative is increasing widely due to easy accessibility and availability of vast knowledge as a source of information about various drugs more so in the youth. This practice is larger in healthcare students and if used irrationally can lead to various adversities including resistance for drugs. Objective: Aim of the study is to assess the prevalence, knowledge, attitudes & practices towards self medication among nursing students in Acharya shri Chander College of medical sciences, Jammu. Materials and Methods: A cross sectional study was conducted among first year, second & third year nursing students using a 16 questions questionnaire comprising of knowledge, attitude & practice related queries. The responses were recorded and assessment was made based on them. Results: The prevalence of self-medication was high in the study population, with most people relying on previous prescriptions as drug source, using self medications for quick relief with risk of ADR being the most common cause of avoidance. Antipyretics were most rampantly used as self medication but there is lack of sufficient knowledge about the same. Though, the responders exhibit positive attitude and yearn to bring about change in the scenario with alteration of certain policies & regulations. Conclusion: There is a rise in the practice of self-medication among nursing students with lack of knowledge but positive attitude towards the same.

170-175

Authors: Nazima Yunus Mirza*,Barna Ganguly

Self-medication is widely practiced everywhere in the world. The drug for self medication has proven efficacy and safety for short-term use in minor illnesses but there is the potential for misuse and abuse of them. A cross sectional survey was conducted by visiting 800 houses of Anand district of Gujarat. The details regarding self medication were inquired which include the medical conditions for which they used, availability of Fixed Dose Combinations (FDCs), previously prescribed medicines taken as self medication, sources, reference & reasons for self medication. The Knowledge of the study participants regarding Self medication was inquired by revealing the history of illness in past six months. Ethics Committee approval was taken prior to the study. A total of 501 without prescription medicine formulations were found in 245 (30.63%) houses, more in the urban area (38.25%) than the rural (23%). The common conditions for self medication were body ache, arthritis and fever (36.53%). The commonest source was pharmacy stores whereas family, friends or relatives were commonest sources of information for self medication. The Self decision was taken for 32.93% of medicines. Total 43 medicines prescribed earlier were used as self medication for other family member including 12 preparations for pediatric use. Only 126 participants had 222 illness episodes in past six month. Of them 18 study respondents self medicated. Half of the respondents were having the knowledge regarding medicine. There is a need of emphasizing on proper awareness and education related to self-medication.

179-186

Authors: Bhavani V,Nagabushan H*,Bhagyavathi H. D

Objectives: To compare the effectiveness and tolerability of flunarizine and amitriptyline in migraine prophylaxis. Also to assess the disability associated with migraine using Migraine Disability Assessment Test (MIDAS) and Headache Impact Test-6 (HIT-6) questionnaires. Materials and Methods: The study was a prospective observational, open-label, comparative study, conducted for six months among migraine patients attending Tertiary Care Hospital, Mandya. Patients were prescribed either Amitriptyline 25 mg or flunarizine 10 mg OD for three months. Effectiveness was assessed by the number of episodes of migraine attacks, pain severity score on Visual Analogue Scale (VAS), tolerability of adverse reactions reported and disability assessed using MIDAS and HIT-6 questionnaires. Results: Out of 103 patients, 55 were prescribed Amitriptyline and 48 patients flunarizine. 49.5% of patients were between 18 to 30 years of age. At the end of three months of treatment, the frequency and severity of headaches decreased from baseline in both the groups. The overall percentage of responders with >50% reduction from baseline in number of migraine episodes and pain severity together were 67.3% and 50% in amitriptyline and flunarizine groups respectively. There was reduction in MIDAS and HIT-6 scores in both groups, without significant difference between the groups. Both the drugs were well tolerated, with most common adverse effects being dry mouth, somnolence, and constipation. Conclusion: Both amitriptyline and flunarizine are effective in prophylaxis of migraine, with significant reduction in number of episodes and severity of headache from baseline to end of treatment. However, Amitriptyline had a higher overall responder rate when compared to Flunarizine, with similar tolerability profile.

191-194

Authors: Naresh Naresh,Dinesh Dinesh*,Anjna Sharma

Introduction: Pain and inflammation are a day to day affliction for all living beings. Mankind has for years been trying to relieve the agony of pain & inflammation through various means with a large amount of success. Still we have not been able to produce the ideal analgesic or the ideal anti-inflammatory drug. The objective of this study was to evaluate a saponin, albichinoside, with respect to its ability to relieve pain and /or show anti-inflammatory activity. Materials and Methods: The study was conducted on rats. The saponin was evaluated for its effects on acute, sub-acute, chronic and immunological inflammation by using standard anti-inflammatory study protocols. Results: The test substance showed significant inhibition of acute, sub-acute and chronic inflammation produced by immunological and non-immunological methods in rats. These activities were qualitatively less as compared to indomethacin. This activity was like that of non-steroidal anti-inflammatory agents. Conclusion: The test substance has moderate anti-inflammatory activity which could be by means of inhibition of prostaglandin synthesis and the complement.

198-201

Authors: Shikha Jaiswal,Tikam Singh Dhruw*,Rajesh Hishikar,Raka Sheohare,Ajay Halwai

Objective: Pharmaceutical promotional activities create potential for inappropriate prescribing practices without necessarily benefiting the patients but contributes to increased health care costs if prescriber is not aware of WHO criteria for ethical medical drug promotion 1988.So this study was conducted with objective to assess the knowledge of medical post graduate students about WHO criteria for promotional drug literature. Materials and Methods: This observational study was conducted in the various departments of Pt. J. N. M. Medical College & associated Dr. B.R. Ambedkar Memorial Hospital Raipur (C.G.). 100 medical post graduate students were given a promotional drug literature & were asked to evaluate it according to WHO Criteria on prescribed proforma. Results: 33% Medical Post Graduate students were aware of WHO criteria. 14% students evaluated importance of reference of scientific literature. 29% evaluated importance of name and address of manufacturer or distributor. 33% evaluated necessity of dosage form or regimen. 70% evaluated the importance of active ingredients. 76% students evaluated the importance of other ingredients or adjuvant known to cause problem. 80% students evaluated the importance of major drug interactions. 95% students evaluated the importance of the amount of active ingredients per dosage form. 96% students evaluated importance of drug related precautions, contraindications and warnings. 98% evaluated the importance of side effects and major adverse drug reactions. 100% students evaluated the importance of brand name and approved therapeutic uses. Conclusion: The study showed that medical post graduate students have little knowledge about WHO Criteria of promotional drug literature. They require constant education regarding WHO guidelines as these brochures often influence prescribing behaviours of physicians.

207-210

Authors: Galanki Vasantha,A Venkatesham*,CH Dayakar

Lannea coromandelica Houtt have multiple pharmacological activities including anti-inflammatory, aphrodisiac hypotensive, anti microbial, ulcerative stomatitis, wound healing, leprosy, gout, elephantiasis and cholera. Therefore, the present study is taken up to evaluate the hypolipidemic activity of ethanolic leaf extract of L.coromandelica. The ethanolic leaf extract was evaluated for its acute toxicity (2000mg/kg) and for hypolipidemic activity (100 and 200 mg/kg) in Triton X-100 (100mg/kg, i.p) induced model for 7 days. However, the obtained statistical data indicated a significant decrease in the total cholesterol, triglycerides, LDL cholesterol, VLDL cholesterol and increase in the HDL cholesterol, with reference to the standard drug Atorvastatin (10mg/kg,p.o). These results revealed that L. coromandelica has beneficial effect in reducing the blood lipid levels indicating its efficient hypolipidemic activity.

105-109

Authors: Satyendra Sharad,Dinesh Kansal*,Vipin Sharma,Parveen Sharma

Introduction: Diacerein and oxaceprol are frequently used for the treatment of Grade-I & II osteoarthritis of knees. Diacerein acts by blocking the action of interleukin-1 whereas oxaceprol prevents leukocyte infiltration in the synovial joints. Both the drugs are effective. But there are few comparative studies regarding safety and efficacy of these two drugs. Hence we planned this study. Materials and Methods: An open label randomized comparative study was conducted by the departments of Pharmacology and Orthopedics at Dr RPGMC, Tanda, H.P, after taking permission from the IEC. Patients were diagnosed clinically as per American College of Rheumatology (ACR) guidelines and graded radiologically as Grade I & II osteoarthritis of the knee joint based on Kellgren and Lawrence classification. Then considering exclusion criteria, patients were enrolled after taking written informed consent. 31 and 29 patients were enrolled in diacerein and oxaceprol groups respectively. Tab diacerein 50 mg and oxaceprol 200 mg were prescribed twice daily for three months in respective groups. One patient dropped out in each group, who opted for operative intervention after a few days of enrolment. Efficacy was assessed clinically by WOMAC scale during their follow up at three months. Safety was evaluated clinically considering adverse effects and by complete haemogram & blood biochemistry. Results: In diacerein-group, WOMAC score (mean ± S.D.) improved from 48.77± 18.17 to 29.40 ± 19.94 (p-value = 0.00001) and in oxaceprol group from 42.59 ± 19.49 to 26.58 ± 16.83 (p-value = 0.00001). No adverse effect was reported in any group. Conclusion: Both medicines are almost similar in safety and efficacy.

116-120

Authors: Sumit Patel*,Akanksha Prajapati

Introduction: Pediatric age group comprises about 40% of total population of India. Many medications are available to children and the safety of paediatric medications is an important public health issue. The challenge all the paediatricians are facing is the calculation of appropriate dose of drugs prescribed. A patient’s weight is often used to calculate the appropriate medication dose. When medication errors arise due to inaccurate or unknown patients’ weights, the dose of a prescribed medication could be significantly different from what is appropriate. Therefore the study was undertaken to compare the prescribed dose with standard dose of the drugs by using Clark’s formula. Materials and Methods: Study was an open label cross-sectional. Children admitted to ICUs were included. Data of total 400 patients were collected, 200 from PICU and NICU each. Analysis of NICU and PICU was done separately. Comparison of prescribed total daily dose of each drug with the standard total daily dose was done. Results: Total 712 and 437 drugs were prescribed in PICU and NICU. Antibiotics were the major group of drugs prescribed in both PICU and NICU. In comparison of prescribed and standard total daily dose of drugs, statistically significant difference was observed with antimicrobials, Antiepileptic, NSAIDs and antihistaminic. Conclusions: There was significant difference in means of prescribed and standard doses of drugs in various groups, which was higher in PICU as compared to NICU. E-prescriptions can reduce Perhaps dosing error and will reduce drug induced adverse drug reactions in children.

124-128

Authors: Smita Sontakke,Vijay Motghare*,Ritu Budaniya,Kundan Niwangune,Avinash Turankar

Objective: To estimate plasma olanzapine concentration (POC) using liquid chromatography-mass spectrometry (LCMS) and identify factors that contributes to pharmacokinetic variability of olanzapine. Materials and Methods: This was a prospective, observational study initiated after approval of institutional ethics committee. Stable patients of schizophrenia on olanzapine, above 18 years of age, of either gender, on olanzapine therapy for at least 12 weeks with no change in dose for at least one week were included. Plasma levels of olanzapine were assessed using HPLC based kit on LCMS. To assess response to treatment patients were subjected to Brief Psychiatric Rating Scale (BPRS) in which lower score indicates better response. Adherence to therapy was assessed by using Morisky 8-Item Medication Adherence Questionnaire in which lower score indicates better adherence. Graph pad prism version 6.0 was used for statistical analysis. Results: POC was higher in women compared to men. No correlation was observed between POC and age (r = 0.01343, p= 0.9470) or daily dose of olanzapine(r= -0.2765, P = 0.1626). Patients having POC more than 20 ng/ml had better adherence (Morisky’s score 1 or 2) to medication compared to those having POC less than 20 ng/ml. Significant correlation was observed between POC and clinical response(r = -0.4371, p=0.0226). Conclusion: TDM of olanzapine is important considering large interpatient variability in POCs at the same dosages. It can also help in improving efficacy, particularly when patients do not respond to therapeutic doses or when they develop adverse effects. Cost of the procedure is a major concern which needs to be considered before this can be established in routine practice.

135-140

Authors: Karunakar Hegde*,Fathima Jazeela M A,Vijetha Poojary K,Satish S

In the present study the ethanolic extract of Aquilaria malaccensis (Agar wood) leaves before inoculation (BF) and after inoculation (AF)) was evaluated for its anticancer potentials. The leaf extracts (BF and AF) was subjected to in-vitro cytotoxicity studies on EAC cells, normal spleen cells and DLA cells. The leaf extracts showed dose dependent cytotoxicity with increase in dose. The IC50 value for BF and the AF leaf extract was 79.09?g/ml and 79.20?g/ml respectively. The effect on primary spleen cells was observed to be more than 100?g/ml. The study concluded that the extract of the said plant leaves has significant potential anti-cancer activity. All these results clearly indicate that the crude extract has a remarkable capacity to inhibit the growth of Ascites tumor induced by EAC cell line in animals.

146-152

Authors: Ajay Kumar Halwai,Vinod Koshley*,Rajesh Hishikar,Basant Maheshwari,Usha Joshi

Objectives: To evaluate the potential association between antipsychotics (Olanzapine, Risperidone and Haloperidol), serum glucose level and serum cholesterol level in schizophrenic patients. Introduction: Schizophrenia is quite prevalent and has high rate of chronicity and morbidity. Newer atypical antipsychotic drugs were developed in response to limitations such as lack of efficacy and side effects associated with older (conventional) agents. However, significant hyperglycemia, dyslipidemia and weight gain have been reported with the use of newer atypical antipsychotics. Materials and Methods: This was an observational prospective study. Total 75 schizophrenic patients were divided in three groups according to treatment allocated (group I- olanzapine, group II- risperidone, group III haloperidol) comprising of 25 patients in each group. Blood sample was collected when patient came to hospital for the first time before starting the treatment and 6 weeks after treatment, then again 6 months after treatment, fasting serum glucose and cholesterol levels were estimated by enzymatic procedure. Simultaneously body weight was also measured. Results: In this study majority of patients were male-73.33% with mean age of 30.76 years. There were significant increase in serum glucose levels and serum cholesterol level, after 6 weeks and 6 months of treatment (t=3.11 p<0 xss=removed xss=removed> t=3.65 p < 0 t=3.11,> Conclusion: Olanzapine was associated with increased risk of glucose intolerance, dyslipidemia and weight gain.

48-59

Authors: Sheshaprasad R., Anuradha Pai

Introduction: Recurrent aphthous ulcer (RAU) is a common oral disease characterized by ulcers with an erythematous halo, affecting 5–25% of the general population. The underlying etiology is not clear, but several factors are believed to be responsible for the pathogenesis of the disease including stress, hormones, genetic factors etc. Behcet'ssyndrome is a multisystem disorder involving vasculitis of small and medium-sized vessels and inflammation of the epithelium, characterized by recurring oral and genital ulcers with eye lesions. Aim:The objectives of this paper were to compare different treatment options available for the patients suffering from RAU and major refractory oral aphthae without any systemic disease or any syndromes except Bechet’s, associated with RAU published in the review of RAU, point out drugs and therapies along with their dosages that may be used in the first line of treatment (topical) and second line of treatment (systemic). Materials and Methods: Pub Med search (full text and abstracts) with drugs belonging to several categories like anesthetics; antibiotics and antiseptics, corticosteroids, anti-inflammatory and antiallergic drugs hemorrheologic agents, zinc substitutes, immunomodulatory agents and chemical cauterizing agents was done. Pub Med search term “Behcet's trial oral” was used and only those publications that described clinical trial with drugs on patients with Behcet’s disease involving oral lesions were selected. Result:Total 62 articles were analyzed to extract the data regarding different therapeutic agents used in the treatment of Recurrent aphthous ulcer and oral ulcers in Bechet’s syndrome. The drugs most commonly used were lidocaine, benzocaine, tetracycline, chlorehexidine amlexenox and dexamethasone topically and prednisolone, levamisole and thalidomide systemically as a single therapy or in combination. The impact of immunomodulators and LASER in comparison with topical drugs also was assessed. Conclusion:Novel research strategies should be designed to clinically test combination therapies in the treatment of aphthous ulcers.

62-65

Authors: Sonia Dhiman, Rekha Bansal, Dinesh Kansal, Parveen K. Sharma

Objectives: Assessment of Health Related Quality of Life (HRQoL) of drug resistant tuberculosis patients at the start of treatment under PMDT regime. Materials and Methods: This observational study was conducted on a cohort of 172 drug resistant tuberculosis (DR-TB) patients at the time of registration under PMDT regime. Patients who started their treatment between January 2016 and December 2016 were included in the study after approval from IEC. A validated WHOQOL-BREF questionnaire was used for interviewing the patients. This questionnaire assesses HRQoL on 0-100 transforming scale in four domains – Physical, Psychological, Social relationship and Environmental. Results: Out of 172 participants, 50 (29.1%) were females and 122(70.9%) were males. Their mean age±SD was 40.23±15.77 years. 77.9% participants were married. 97.7% of them were residing in rural areas. Most of the participants were from district Mandi (33.1%) and Kangra (20.9%). Scores of Physical domain were 39.76±13.88; Psychological domain were 37.23±14.89; Social relationship domain were 43.28±13.48 and Environment domain were 50.66±9.13. Overall HRQoL scores were 42.73±10.11. Conclusion: Chronic diseases like tuberculosis affect all domains of HRQoL and there is need to consider HRQoL domains of patients of DR-TB along with smear positivity and mortality to evaluate the success of any national heath programme.

71-74

Authors: Tamilisetti Vidya Sagar, Sanjay Kumar, Pramila Nayak

Introduction: To know adverse drug reactions when Aspirin is prescribed with Antihypertensive medications. Materials and Methods:Prospective observational study conducted in a tertiary care hospital, total 60 patients of age Casuality assessment of all ADRs was done by Naranjo ADR scalegroup 18 to 65 years were included in the study, It is a 12 week study, clinical examination done at enrollment and with subsequent follow up at 4,8 and 12 weeks,Base line investigations done at enrollment and at 12 weeks ,ADR monitoring done at each follow up Results:Out of 45 patients who experienced adverse effects, causality assessment shows that Aspirin is responsible for producing ADRs in 15 patients and in Betablocker therapy and 26% in Aspirin with thiazide diuretics and 16% in aspirin with ACE inhibitors or Calcium channel blockersremaining 30 patients, Aspirin interaction is likely cause for ADRs, Incidence of adverse effects is 40% in Aspirin with concomitant Conclusion: This study shows Betablockers and Thiazide diuretics in treatment of hypertension,Incidence of ADRs is high in elderly patients,increased incidence of Adverse drug reactions (though these are mild ADRs) when Aspirin is added to Betablockers and Thiazide diuretics in treatment of hypertension,Incidence of ADRs is high in elderly patients.

82-85

Authors: Arvind Kumar Yadav, Meenu Pichholiya, Jitendra Jeenger

Introduction: Drug utilization studies can identify the problems and provide feedback to prescribers so as to create awareness about irrational use of drugs. This study was conducted to find out the prescribing pattern in out-patient department (OPD) of Psychiatry. Materials and Methods:This prospective observational study was carried out in a tertiary care teaching hospital of southern Rajasthan. The data was collected in a case record form from patients of all age irrespective of gender who attended the psychiatry OPD. Assessment of prescription patterns was done as per the selected WHO-INRUD (World Health Organization-Indicators for rational use of drugs) drug use indicators. Results:Depression (34%) was the most common diagnosis followed by schizophrenia (13.5%) and bipolar affective disorder (12%). Overall predominance of psychiatric disorders was found between 36-40 years age group with 20 male and 16 female patients. Mean age of depression patients was found 41.35 years and 37.07 for schizophrenia patients. Escitalopram (18.27%) was the maximally prescribed drug followed by Clonazepam (10.44%), Olanzapine (9.13%), Amitryptaline (7.83%). The average drug per prescription was 1.915 out of the total 383 drugs. 7.30% drugs were included in WHO Model list/National list of Essential Medicine. 0.78% drugs were prescribed by generic name. Not a single drug was given by injectable form and no antibiotic was prescribed to any patient. Conclusion:Escitalopram was the most commonly prescribed drug as depression was found most common disorder. Drugs were less prescribed by generic names and less percentage of essential drugs in prescriptions but there was no polypharmacy in our study.

93-96

Authors: Siddharth Athawale, M. D. Kulkarni, S. M. Doifode

Introduction: Acute poisoning is a very common & life threatening crisis and leads to serious conditions and even death of patients. Poisoning may be due to self consumption or accidental of various chemical compounds, medications and poisonous animals. The various drugs used in poisoning and there clinical outcome with different poisoning substances was investigated in this study Material and Methods: The patients which have been diagnosed with acute poisoning in Medical intensive care unit from January 2017 to July 2017 are included in this study. Results: During 7 months of study total 154 patients of acute poisoning were included in this study. Male patients were 111 (72%) while female patients were 43 (28%). Mean age of patients was 34.97 +14.46 years. The commonest cause of poisoning was by use of pesticides followed by venomous snake bite. Drugs prescribed to patients were mainly symptomatic like H2 blockers (99.3%), antiemetics (97.4%), and antimicrobials (90.2%). Specific antidotes prescribed were Atropine (92.8%), pralidoxime (79.8%) and anti-snake venom (17.5%) Conclusions:Organophosphorus compounds were the most common among poisons, followed by Snake bite. Gastroprotective and antiemetic drugs are most commonly prescribed drugs.