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Background: Inhaled medications form the cornerstone for the management of Asthma and related diseases. Proper technique of pressurized metered dose Inhalers (pMDIs) has proven to be associated with higher level of control of these conditions. Medical personnel who are responsible for training patients must themselves be proficient with usage of pMDI. This study evaluated the outcome of different educational interventions regarding the correct usage of pMDI. Methods: An interventional study was carried out with 60 second year medical students in department of pharmacology, HIMS, Hassan from June to August 2015. Pre and post intervention (after one week and one month) was evaluated based on National Asthma Education and Prevention Program (NAEPP) criteria for the use of pMDI by written and demonstration methods. The interventions included a video clip, an information leaflet and demonstration by a trained faculty. Results: Overall mean scores in pre-test for written knowledge and skill demonstration are 2.13±1.49 and 3.78±1.06 .There was substantial improvement in post intervention scores 7.15±1.41 and 7.37±1.67 (p

Background: Chronic wounds are responsible for increase in burden to healthcare systems. The evidence concerning effectiveness of antibiotic therapy or optimal regimens is insufficient. Patients with chronic wounds receive significantly more systemic and topical antibiotics. Current guidelines for antibiotic prescribing for such wounds are often based on expert opinion rather than scientific fact. As there is increasing prevalence of antibiotic resistance, the relationships between antibiotic resistance and rationales for antibiotic therapy have to be determined. Current practice of antibiotic usage for chronic wounds and postoperative wounds in a tertiary care setting should be studied.Methods: Retrospective study was conducted from February 2017 to February 2018 using medical records of patients with wound admitted in surgical departments in HIMS, Hassan, Karnataka. The inpatient records were analysed, which includes duration of stay in the hospital, number of drugs/products per person, percentage of antibiotics prescribed, percentage of antibiotic injection prescribed, and other modalities used to treat wounds.Results: In present study, amongst 100 antimicrobial prescriptions, 26 females and 74 males. The most commonly prescribed parenteral antibiotic was ceftriaxone (58%), followed by metronidazole (56%). The average number of antibiotics per prescription was 2.8. The mean duration parenteral antibiotics given was 4.26 days during their hospital stay oral antibiotics were 5.18 days after the discharge from the hospital.Conclusions: The information generated shall be used to decide the policies to govern the prescription of antibiotics in the management of chronic wounds and post-operative wounds.

Background: Migraine is the most common headache, having at least five attacks that last 4–72 h, that are unilateral, pulsating, moderate or severe in intensity and aggravated by or cause avoidance of routine physical activity and are also accompanied by nausea/vomiting, photophobia. Treatment of headaches can be either abortive or prophylactic. Here meaning of prophylactic treatment is to reduce the frequency or severity of headaches. Very few studies have been done regarding the safety and efficacy of lisinopril in migraine prophylaxis so we focus on prophylactic therapy for migraine. Aim and Objective: The aim of the study was (i) to compare the effect of propranolol and lisinopril in migraine as prophylaxis and (ii) to assess the adverse drug reaction of lisinopril. Materials and Methods: Sixty out patients diagnosed with Migraine in medicine department, HIMS Hassan, and willing to give consent are included for 3 months. Thirty Patients/group, Group1 – Lisinopril 5 mg/day od and Group2 – Propranolol 20 mg tid given regular treatment. All the patients were provided with a migraine diary and advised to record the number of attacks of migraine. Patients were followed-up at the end of 1st and 3rd months. The change in the migraine frequency and pain intensity was checked (Visual Analog Scale) and also adverse drug reaction. Results: Migraine episodes and headache severity index were reduced by 84% and 43%, with lisinopril compared with propranolol. Days with migraine were reduced in 11 participants for lisinopril. Eight patients reported an adverse effect like cough during lisinopril therapy. Conclusion: Lisinopril has better prophylactic therapy in migraine.

Cancer persists to be a major cause of hospitalization and death every year. With the passage of time, new formulations of anticancer drugs are being introduced to the market and are drawing the concern of healthcare professionals in terms of the superiority, toxicology, and cost-effectiveness of the new formulations in comparison to the conventional formulation of the same drugs. Doxorubicin, a highly potent chemotherapeutic agent, it comes with three formulations (pegylated liposomal, nonpegylated liposomal and non-liposomal conventional formulations). English-language literature of the three formulations of Doxorubicin has been reviewed to inform the healthcare professionals regarding the differences between these formulations. Liposomal Doxorubicin promotes better toxicology profile than non-liposomal conventional Doxorubicin with an increased cost. Due to very limited studies, the cost-effectiveness of liposomal Doxorubicin is not well defined. Apart from that, this review highlights the inter patient variability in regard to the clearance and volume of distribution following the administration of liposomal Doxorubicin. In conclusion, further studies regarding the superiority of liposomal formulation of Doxorubicin , efficacy and dose standardization of liposomal Doxorubicin should be sought in the near future in a more better way.

Background: Drug utilization research is a part of Pharmacoepidemiology defined by the WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. Conducting periodic studies of pattern of drug use in our hospital setting is essential to critically analyse the current hospital drug policies and to make recommendations based on various guidelines to improve upon the current drug usage pattern. Aims and objectives of the study was to generate data on the drug utilization pattern in Medical ICU and to monitor antimicrobial usage in MICU.Methods: Patients who were admitted in medical ICU of Hassan institute of Medical Sciences were recruited based on inclusion-exclusion criteria. The study was conducted over a period of 3 months from April 2018 to June 2018. The demographic and clinical treatment data of patients were collected. The prescriptions were assessed as per the WHO indicators.Results: Common causes of admission were suicidal poisoning, snake bite, viral thrombocytopenia, myocardial infarction and stroke. The average duration of stay was 5.74 days and average number of drugs/patient was 5.26. Pantoprazole, Ranitidine, Ceftriaxone, Atropine, Pralidoxime, ASV, Ondansetron, and N-acetylcysteine were commonly prescribed drugs. 42.4% of drugs were prescribed by generic names and 84.2% of the drugs were prescribed from Essential Medicine List.Conclusions: This study will provide database to address prescription protocols and guide appropriate use of drugs in the ICU setting.

Background: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. The beginning of dialysis treatment causes subtle changes in the life of CKD patients, mainly in the physical and social spheres. It affects the self-care of these patients which lead to poor adherence to dialysis. Hence, the present study was conducted to screen for depression.Methods: This was an observational study among 100 patients undergoing haemodialysis at HIMS, HASSAN. After taking informed consent, subjects were requested to complete Beck, depression Inventory, a 21-question multiple-choice self-report inventory for measuring the severity of depression. Descriptive statistics was applied to infer the findings.Results: The study population showed depression of mild (31%), borderline (10%), moderate (17%), severe (7%) and extreme (3%) grade and the remaining subjects did not show depressive symptoms (32%).Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status of the patients, low literacy rate, gender and those started on dialysis recently.

Background: There is much debate regarding the importance of promoting the use of cheaper generic alternatives over brand-name drugs. While generic drugs have been noted to be comparable to brand-name drugs in their ability to treat conditions, significant debate surrounding their bioavailability or the concentration of the drug that reaches its site of action has arisen. Many experts continue to believe that generic and brand-name drugs are bioequivalent and equally viable options for effective drug treatment, as assumed in this review.Methods: Prices of commonly used branded and generic medicines in same concentration, dosage form and combination were compared with the help of Indian Drug Review, brochures of pharmaceuticals and pharmacies and Jan Aushadhi price list 2017. Mean of all the prices available of branded and generic medicine were calculated and the percentage difference in the mean costs of generic and branded medicines were calculated.Results: The mean cost of 47 branded medicines out of the selected 50 medicines was higher than their generic versions. Mean cost of 3 generic medicines was higher than branded ones. Percentage difference in the mean costs of branded and generic medicines varied from 70%.Conclusions: This study has shown a very noteworthy difference of prices between branded and generic drugs. Efforts should be taken to promote the generic medication. Misconception about low efficacy with generic drugs should be erased.

Background: Chronic Kidney Disease (CKD) is a silent disease that is frequently diagnosed in advanced stages. The prevalence and incidence of chronic kidney disease (end-stage renal disease) are continuously increasing, particularly in elderly patients. Poor adherence to complex multimodal therapies is a widely recognized problem in the daily care of dialysis patients, contributing to excess morbidity and mortality of this population. Aims and objectives was to assess the adherence to medications among patients undergoing haemodialysis and to explore the factors affecting non adherence.Methods: After obtaining approval from Institutional Ethics Committee, a prospective observational study was carried out among 150 patients, who were on dialysis in a tertiary care hospital, Hassan. An eight item Morisky Medication adherence questionnaire was used to assess medication adherence. Chi-square test applied to assess statistics.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non-adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to Dialysis. Other reasons contributing to non-adherence to treatment were forget fullness (86.66%), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11%) and lack of assistance (48.88%).Conclusions: In this study patient showed moderate adherence. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence.

Background: Different medications are used to reduce pain and inflammation after cataract surgery. Hence this study was taken up to compare the efficacy and safety of topical bromfenac 0.09% over topical flurbiprofen 0.03% in reducing anterior chamber inflammation and pain after cataract surgery.Methods: Total of 100 patients who underwent uneventful cataract surgery with posterior chamber intra ocular lens (IOL) implantation were randomly allocated to receive bromfenac 0.09% and flurbiprofen 0.03% topically from first post-operative day onwards for 6 weeks. Assessment of anterior chamber inflammation and pain was done by slit lamp and visual analogue scale respectively on each follow up days. Analysis was done by unpaired t test and Fischer’s exact test.Results: The response to treatment was earlier in bromfenac group for all the inflammatory changes (significant difference was found on day 7, p

Introduction Metronomic chemotherapy is an emerging method of chemotherapy. Metronomic 'lowdose' chemotherapy regimen induces tumour dormancy and reduces cancer resistance against anticancer drugs. It tends to improve overall success rate of cancer chemotherapy than conventional cyclical regimen. Aim The aim of this systemic review was to provide comprehensive data of metronomic chemotherapy trials, regimens used and it's outcome in cancer therapeutics. Materials and methods Fifty chemotherapy trial data were searched sequentially from web. The main sources were official website of Clinical trial forum, USA and Clinical Trial Registry India (CTRI). Evidence on efficacy and safety of such metronomic chemotherapy trials was gathered from various data published in Medline, New England Journal of Medicine (NEJM), Lancet Oncology and other journals with high credentials. As a result of our search, out of 50 trials including breast -15(30%), colon-, 5(10%) ovarian -5(10%), prostate-5(10%) and others including haematologic, soft tissue and nervous system malignancies -20 (50%). Twenty seven trials showed favourable, 20 trials showed equivocal outcome and 3 trials reported unfavourable outcome. Overall comparison showed definitive statistical significance for using metronomic regimen (p-0.05). Conclusion It can be concluded that metronomic chemotherapy regimen seems convincing beneficial to induce tumour remission and survival at a higher than conventional regimen. More metanalyses are needed to frame common metronomic chemotherapeutic regimen.

Background: Adverse drug reactions (ADR) - one of the global problems of major concern leading to morbidity and mortality. Spontaneous reporting of ADR is the cornerstone of Pharmacovigilance (PV) programme and it is important to reduce the risk of drug related harm to the patient. The active participation of healthcare professionals (Doctors, Nurses, Pharmacist) play a major role in the success of Pharmacovigilance. The objective of the study was to assess the knowledge, attitude, practice of Staff Nurses about Pharmacovigilance in a tertiary care hospital.Methods: A Cross sectional, Observational questionnaire based study was carried out using a pre designed KAP questionnaire. Study included 100 staff nurses who were working in Hassan institute of medical sciences (HIMS). The results were analyzed using descriptive statisticsResults: In our study 65% participants knows the correct definition and 48.8% knows the important purpose of Pharmacovigilance and 77.5% aware of existence of ADR reporting system in India. There was huge gap between ADR experienced (53.8%) and ADR reported (21.3%). The determinants of under reporting from our study include Lack of time / overburdened (33.7%) and lack of knowledge about ADR (31.25%).Conclusions: This study showed that majority of participants understand the need for reporting of ADR. In spite of that the reporting rate of ADRs by them is very low. Hence, there is a need to create awareness about the importance of reporting ADR by conducting many Pharmacovigilance programme.

Background: In population with advancing age, the prevalence of medical co-morbid conditions is high and they are prone for complications. Hence the apprehension of using multiple drugs is more. Using more than 5 drugs per day is referred to as Polyphrmacy. Sometimes treatment causes more harm than the disease proper. So, optimizing drug therapy in these aging population is a challenging task for physician. Polypharmacy can also lead to increase in drug interactions, adverse drug reactions and medication errors. Hence the present study was taken up to study drug utilization pattern and factors leading to polypharmacy in geriatrics. The objectives of the study were to study the number and type of drug use and to know the different factors leading to polypharmacy.Methods: Cross sectional study was carried out among 60 geriatric persons ≥60 years of age present in old age home in Hassan. The study was done after taking the consent. All the prescriptions and medications being used along with history were collected and documented. The total number of drugs being used and names of all drugs were noted down and analysed. Results were analysed using descriptive statistics.Results: Among 60 geriatrics 38% males and 62% females age ranges from 60- 87 years. Average number of drugs used per day per person is 5.03 (Males 6.2 and Females 3.8) in 58.03% of individuals. Most common group of drug used is Gastro intestinal system (78.3%) and most common drug being used is Tab. Ranitidine 140mg (50%). Next group is NSAIDs (68.33%) and most common drug being used is Tab. Diclofenac (46.7%). Antihypertensive drugs were prescribed in 53.3% of geriatrics, most commonly prescribed drug is Tab. Amlodipine (5mg). Self medication was found in 100%. Most common group of drugs used as self medication are GIT drugs, supplements and NSAIDs. In supplements (used in 63.3%), Cap. B Complex is widely used (50%).Conclusions: Polypharmacy was found in 58.3% of individuals and highest in age group between 71-75 years and self medication was found to be the most important factor leading to polypharmacy. To counteract the problems associated with Polypharmacy, interventional studies are needed to improve the quality of life of geriatrics patients.

Background: In the present day world the expenditure on medicines is very high. Most of the people in developing countries find it difficult to afford expensive medicines. One of the measures to cut down the expenditure on medicines is to use generic drugs. Hence the study was taken up to know the awareness, attitude and preference for generic drugs among medical and non medical persons.Methods: The study was done on 290 participants. 60 medical interns, 30 doctors, 50 nurses, 50 non medical staff (clerks and attenders) and 100 patients were included. They were given a questionnaire to know the awareness and knowledge on generic drugs, willingness to prescribe (among doctors) and use it (non medical staff and patients).Results: This study showed that all medical persons- doctors, interns and nurses knew about generic drugs whereas 60% of non medical staff and 95% of the patients were not aware about it. All doctors had good knowledge about generic drugs and 80% prescribed it always. 70% of the patients depended on what doctors prescribed for them and never asked for generic/ branded drugs in particular. 70% non medical staff preferred it only sometimes.Conclusions: The awareness among non medical persons is poor than medical persons among the surveyed population. Hence adequate measures should be taken to increase awareness and knowledge among public so that they become imperative enough to ask their doctors to prescribe generic drugs.

Background: Diabetes mellitus (DM) is the most common endocrine disorder and major global public health problem. Lack of adherence to antidiabetic medication has lead to suboptimal blood sugar control, treatment failure, accelerated development of complications and increased mortality, thus medication adherence plays an important role in disease control. Hence present study was taken to evaluate the treatment adherence and factors affecting non adherence among Type 2 diabetes mellitus patients.Methods: A cross sectional study carried out by Department of Pharmacology and Medicine, Hassan Institute of Medical Sciences, Hassan. Total 150 patients of type 2 diabetes were recruited after taking their informed consent. Adherence to treatment and factors associated with non adherence has been assessed during a personal interview with each patient using standardized questionnaire.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to anti diabetic treatment. Other reasons contributing to non-adherence to treatment were forget fullness (86.66 %), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11 %) and lack of assistance (48.88 %).Conclusions: Results showed that patients in the area of study were moderately adherent to anti-diabetic medications. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence.