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Introduction: An arsenal of Antiepileptic Drugs (AED) is used in the management of childhood seizure disorders. Most of them are taken long-term. These drugs have the potential to cause hyperlipidemia by inducing the P450 enzyme system. The alteration in lipid profile caused by long-term use of antiepileptic drugs in children needs to be studied to reduce the risk of future atherosclerosis. Aim: To analyse the effect of antiepileptic drugs on serum lipid profile in children with epilepsy in a tertiary care. Materials and Methods: This prospective descriptive study was conducted in the Outpatient and Inpatient Wards of the Department of Paediatrics and Neurology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, from February 2017 to September 2017. The study involved a total of 155 children, who were on monotherapy antiepileptic drugs for at least 6 months (33 on phenytoin, 42 on phenobarbitone, 20 on levetiracetam, 20 on carbamazepine, 40 on sodium valproate). A corresponding numbers of children, who attended the General Outpatient Department for acute upper respiratory tract and were otherwise healthy, were included as controls. A blood sample (3 mL) was drawn after an overnight fast for serum glucose, liver enzymes, total cholesterol, High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), Very Low Density Lipoprotein (VLDL) cholesterol and Triglycerides (TG) measurement. Chi-square test was performed to find out the significance of association and independent t-test was used to compare the mean between various groups. Results: Cytochrome P450 (CYP) enzyme inducers like carbamazepine, phenytoin and phenobarbitone significantly modified serum lipids in epileptic children when compared to healthy controls. In children on long-term phenytoin monotherapy, mean cholesterol levels were significantly higher in the cases compared to controls (156.73±31.93 mg/dL vs 105.03±8.60 mg/dL, p-value <0.0001), significantly elevated triglycerides (123.48±25.99 mg/dL vs 87.88±12.16 mg/dL, p-value <0.0001), and HDL-C level was significantly lower (44.52±10.14 mg/ dL vs 56.73±12.56 mg/dL, p-value <0.0001) than in controls. Phenobarbitone use was associated with significantly higher levels of cholesterol (164.97±34.41 mg/dL vs 107.76±9.28 mg/dL, p-value <0.0001), LDL (155.27±28.55 mg/dL vs 93.36±6.81 mg/ dL, p-value <0.0001), and triglycerides (125.55±42.19 mg/dL vs 86.30±8.12 mg/dL, p-value <0.001) and lower HDL (46.30±9.47 mg/dL vs 57.73±14.41 mg/dL, p-value <0.0001). Levetiracetam was not associated in significant alteration in both liver enzymes and lipid profile (p-value >0.05). Carbamazepine monotherapy was associated with higher levels of cholesterol (180.50±28.06 mg/dL vs 112.15±13.55 mg/dL, p-value <0.0001), LDL (138.85±22.55 mg/dL vs 82.45±12.12 mg/dL, p-value<0.0001) and triglycerides (142.80±9.48 mg/dL vs 85.40±6.29 mg/dL, p-value <0.0001) when compared to healthy controls. There was no alteration in lipid profile in valproate monotherapy. Valproate monotherapy was associated with significant increase in levels of SGOT and SGPT when compared to mean levels (40.35±11.208 (IU/L), and 40.70±8.809 (IU/L), respectively) observed in other AEDs and significant increase in SGPT levels when compared to healthy controls (36.50±10.61(IU/L) in cases vs 40.70±8.81 (IU/L) in controls). Conclusion: Levetiracetam did not produce significant changes in the serum lipid profile and liver enzymes and appears to be safe to use in children for long-term epilepsy management especially in children with baseline deranged lipid profile. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The present study aimed to determine the pattern of prescription of antiepileptic drugs (AEDs) in a cohort of patients with epilepsy (PWE) attending a tertiary care center of North India. MATERIALS AND METHODS: Demographic variables including age, gender, age at onset, type and frequency of seizures, and prescription of all AEDs (dose and duration) were noted. Descriptive analysis of the use of AEDs was done, and their different combinations were studied. RESULTS: A total of 1187 prescriptions were evaluated. Demography showed 65.7% of males; mean age of 21.9 years (range: 2–77 years), generalized seizures (53%), and focal seizures (47%). Only 21.8% of the patients were seizure free with no seizure in 1 year of treatment. The five most frequently prescribed AEDs out of 12 AEDs were sodium valproate (VPA) (49.6%), clobazam (CLB) (39.3%), levetiracetam (LEV) (28.4%), carbamazepine (CBZ) (27.3%), and phenytoin (PHT) (26.5%). Monotherapy was effective in 36.6% of the patients. Sodium VPA (39.4%), PHT (25.6%), and CBZ (20.1%) were commonly used as monotherapy. Polytherapy was required in 63.4% of the patients, and most commonly prescribed combinations were PHT + CLB (n = 53), sodium VPA + CLB (n = 62), CBZ + CLB (n = 45), PHT + sodium VPA + CLB (n = 28), and CBZ + sodium VPA + CLB (n = 31). CONCLUSIONS: Polytherapy is a very common practice in our tertiary care center. Sodium VPA, a highly prescribed AED, results in good control of generalized seizures, whereas focal seizures are well controlled by CBZ alone as well as in combination. The present study highlights the commonly prescribed combinations of AEDs resulting in control of different types of seizures. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the utilization pattern of anti‐epileptic drugs (AEDs) in Indian paediatric patients and compare it with the global usage data. Methods: Paediatric patients (≤18 years) with a confirmed diagnosis of epilepsy and prescribed with at least one AED were included in the study from a child neurology clinic in Pune, Maharashtra, India. The data pertaining to the type of epilepsy, and drug therapy was obtained retrospectively. The prescribing pattern of AEDs was identified and compared with the drug utilization pattern of the Asian and European countries from a systemic literature review. Key findings: Out of the 343 paediatric patients enrolled in the study, 55.6% were males. Thirty‐four per cent of the patients were under the age group of 2–6 years. More than half (60.5%) of the patients were diagnosed with generalized seizures, with tonic–clonic seizures (48%) being the most common among them. Out of the 37.9% of patients diagnosed with partial epilepsy, simple partial seizure was the most common type. The most commonly prescribed drug was sodium valproate for both generalized and partial seizures. Levetiracetam was found to be the preferred newer AED for management of generalized epilepsy. Similar prescribing pattern was seen in Asian countries where sodium valproate was the most preferred AED followed by levetiracetam and oxcarbazepine. Sodium valproate was also highly prescribed in European countries while levetiracetam and oxcarbazepine were underused. Two hundred and seven patients (60%) were managed on monotherapy. Conclusions: Older generation AEDs are still used in majority of patients as mono and dual therapy. Among the newer generation AEDs, there is an increase in the utilization of levetiracetam. Prescription of AEDs in our study goes in line with Asian countries but differs with the European counterparts due to various reasons. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is a chronic disorder requiring life-long treatment to maintain the blood glucose levels. The total economic cost of diabetes was $245 billion in 2012. In India, one spends approximately 20% of their income for the treatment of diabetes per year which affects the patients' compliance and there is also a huge discrepancy in the cost of drugs. Aim: To study the pattern of oral hypoglycaemic agents' usage among Type-2 diabetic patients and also compare their costanalyses, to determine the percentage cost variation and to arrive at the economical oral hypoglycaemic drugs. Materials and Methods: This observational cross-sectional study was conducted among Type-2 diabetic patients attending the diabetology department over a period of three months in a tertiary care teaching hospital. Three hundred prescriptions (both old and new cases) were used to extract information like number of oral hypoglycaemic agents prescribed, their strength, duration, price, generic or branded and manufacturer's details. The percentage cost variation was calculated using the cost difference between the highest and lowest priced brand. Data were analysed using chi-square test (to elicit the association between duration of treatment and mono/combination therapy) using SPSS Software 20.0 version. Results: Majority of the patients (59.3%) were above 50 years of age with female preponderance (54%). Branded drugs were prescribed to 87.7% of patients. 85.3% received combination therapy (Metformin, Glimepiride, Gliptins) and 14.7% received monotherapy (Metformin, Teneligliptin). Commonly used monotherapy was metformin with cost of about 2.75 INR/day and the combination therapy was teneligliptin and metformin with a minimum cost of 13.31 INR/day. The most economical combination therapy was found to be of glimepiride and metformin with cost of 8.25 INR/day. Percentage cost variation of different brands ranged from 5.88% to 177.57%. There was a significant association between combination therapy and disease duration greater than five years (p<0.01). Conclusion: It was observed from this study that there is a wide variation in cost of different drugs. Hence, it is necessary for regulatory authorities to regulate the wide variation that exists among the drug cost. This study will be useful to the clinicians to choose most economic drugs without change in quality of treatment in diabetic patients. Metformin is the most commonly used economic monotherapy and combination therapy was Glimepiride+Metformin. [ABSTRACT FROM AUTHOR]

Objectives To assess the cost-effectiveness of current monotherapies and prospective combinations for treating visceral leishmaniasis (VL) in Bihar, India in terms of years of life lost (YLL) averted as well as deaths averted. Methods We employed two methods to estimate the number of avertable deaths in our analysis: one using estimated mortality, the other using direct incidence estimates for VL. Costs of care are based on an average private hospital in Bihar, and data on drug costs were obtained both locally and from the World Health Organization. Results The cost of monotherapies per averted YLL ranged from US$2 for paromomycin in an outpatient setting to US$20–22 for AmBisome® at 20 mg/kg. The corresponding costs per death averted ranged from US$53–54 to US$523–527. Combinations ranged US$5–8 per YLL averted and US$124–213 per death averted. Conclusion The available treatments for VL are cost-effective, and our mortality and incidence-based methods produce consistent estimates. The combinations considered here were more cost-effective than most monotherapies. Having multiple treatment options and combining drugs are also likely to reduce drug pressure and prolong the drugs’ life-span of effective use. [ABSTRACT FROM AUTHOR]

Brachytherapy is one of the curative treatment for early stage prostate cancer.HDR BT has normally been used in combination with external beam radiotherapy. There has been considerable interest in the recent years in HDR BT as monotherapy. HDR BT was started at Apollo Speciality Hospital, Chennai in April 2006. This article briefly describes and compares the treatment alternatives of surgery, external beam radiation, and brachytherapy for prostate cancer and highlights the advantages of HDR brachytherapy [Copyright &y& Elsevier]

Objective: The primary objective of this study was to assess the use of moxonidine, a centrally acting anti-hypertensive agent in real world practice. Material and Methods: Patients who attended out-patients clinic with diagnosis of hypertension were enrolled in the study. Demographics with co-morbid illnesses of all patients were recorded. Patient's prescriptions were recorded and antihypertensive medications were also analysed. Results: A total of 990 patients were eligible during the study period. Moxonidine was used in 4.54% of patients. Two groups could be identified in moxonidine users - one Group with resistant hypertension (30 patients, 3.03% of total, 66.66% of moxonidine users) on multiple drugs to control BP and another Group with intolerance to conventional, first line drugs (15 patients 1.51% of total, 33.33% of moxonidine users). Moxonidine was not used in newly diagnosed hypertension cases. Resistant hypertension and renal failure predicted the use of moxonidine. Majority of drug used was as per current guidelines. Conclusions: Our study results reflected real world practice of current anti-hypertensive therapy. Patients generally receive medications in accordance with current recommendations and guidelines. Small but significant proportion of patients may require use of drugs like moxonidine to control high BP. Guidelines need to incorporate these real world practices. [ABSTRACT FROM AUTHOR]

Purpose: The public health burden of infections caused by Neisseria gonorrhoeae is magnified due to high rates of resistance to traditional antimicrobials. The aim of this study was to evaluate the in vitro efficacy of an alternative dual therapy comprising gentamicin and azithromycin., Methodology: The E-test method was used to determine the minimum inhibitory concentrations (MICs) of gentamicin and azithromycin individually prior to testing in combination using the cross or 90 o angle formation method. A total of 70 clinical isolates of N.gonorrhoeae displaying varying ceftriaxone MICs along with 2 reference strains (WHO K and P) and 1 ceftriaxone-resistant QA isolate were examined. The fractional inhibitory concentration index (FICI) was calculated and the results were interpreted using the following criteria: synergy, FICI ≤0.5; indifference or additive, FICI >0.5 to ≤4.0; and antagonism, FICI >4.0., Results: A total of 54 (77.1 %) isolates displayed indifference, while 16 (22.9 %) demonstrated synergy. When azithromycin was tested alone, the MICs ranged from 0.016 to 2 µg ml -1 . However, in combination with gentamicin, the mean MIC value of all isolates decreased from 0.275 µg ml -1 to 0.090 µg ml -1 (P=0.05).When gentamicin was tested alone, the MICs ranged from 0.25 to 8 µg ml -1 , with a mean MIC of 4.342 µg ml -1 , whereas in combination with azithromycin it decreased significantly to 2.042 µg ml -1 (P=0.04)., Conclusion: No antagonism was observed in this combination, suggesting that it could be a future treatment option as we prepare for a post-cephalosporin era. However, comprehensive in vivo evaluations are warranted and recommendations should be made based on clinical trials.