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Background: Behcet's disease (BD) has a heterogeneous and unpredictable phenotype that differs in various geographical areas. Objective: To describe the clinical phenotype & outcome of Behcet's disease(BD) from Karnataka, India and compare them with large cohorts from endemic regions. Methods: Databases of practising rheumatologists from Karnataka were reviewed to retrieve clinical characteristics, course of illness, prescribing information and outcome at last follow-up of patients clinically diagnosed as BD. The classification criteria, namely revised International criteria for Behcet's disease (rICBD) and International study group (ISG) criteria were applied. Outcome was defined as complete or partial remission, persistent disease or relapse. Results: We included 72 patients, equal gender distribution and mean age 37.4 ± 12.8 years from 8 rheumatology centres. Commonest presentations were recurrent oral aphthosis 58(80.6%), genital ulcers 36(50%) and ocular manifestations 40(55.6%). Three-quarters [51/72(70.8%)] fulfilled rICBD criteria whereas only half [36/72(50%)] fulfilled ISG criteria. Apart from glucocorticoids [53/72(73.6%)], frequently prescribed therapies were colchicine 39(54.2%) and azathioprine 35(48.6%). Eleven-patients received biologics(anti-TNF-α) and JAK inhibitors to treat severe organ involvement. HLA-B*51 and pathergy tests were positive in 27/45(60%) and 12/34(35.3%) patients respectively. Outcomes were documented in 94.4%(68/72) patients at median follow-up of 24 (12;36) months. Majority [46/68(67.6%)] had complete remission, 17/68(25%) had partial remission, 4/68(5.9%) had persistent while 1/68(1.5%) had relapsing course. Conclusion: Majority of BD patients had orogenital aphthosis and ocular manifestations and an excellent response to treatment. Key Points • In our region, Behçet's Disease primarily manifests with recurrent oral aphthae and ocular involvement, with comparatively lower incidence of severe genital ulcers and neurological involvement than in endemic regions. • Apart from glucocorticoids, colchicine and azathioprine are the most commonly used agents. Biologics and JAK inhibitors are prescribed infrequently, primarily in cases of severe organ involvement. • A significant proportion of patients achieved either complete or partial remission during follow-up, with no observed mortality suggesting a milder disease course and better outcome compared to endemic regions. • Gender, HLA-B*51 status, and pathergy response did not exert any significant influence on the clinical profile or outcome in BD patients in Karnataka. [ABSTRACT FROM AUTHOR]

Objectives: Current medical management of osteoarthritis (OA) is mostly palliative with non-steroidal anti-inflammatory drugs (NSAIDs) being the mainstay of therapy. NSAIDs are commonly used despite well-known side effect which may lead to various adverse drug reactions and drug toxicity. Therefore, the objectives of the study are to analyse the prescription pattern of NSAIDs in OA patients and to assess appropriateness of the use of NSAIDs in relation to gastrointestinal and cardiovascular risk. Methods: A cross sectional study was carried out among patients attending orthopaedics out- patient department & provisionally diagnosed as OA. Patients who were prescribed any of the following drugs or their combinations were included in the study: NSAIDs, Glucocorticoids, Opioid analgesics and Symptomatic Slow Acting Drugs for OA (SYSADOA). To assess prescription pattern, ‘WHO core prescribing indicators’ were used Analysis of appropriateness of NSAIDs use by the prescribers in relation to GI & CV risks, the recommendations of the ‘First International Working Party Report on Management of Patients on NSAIDs’ were adopted and categorised as appropriate or inappropriate or uncertain. Data were entered in statistical software ‘EpiInfo’. Data were represented by suitable tables & figures and expressed in frequency and percentage. Results: A total 600 OA patients were included in the study. Out of 600 prescriptions, NSAIDs were prescribed in 547 prescriptions. Total 402 prescriptions were analyzed for appropriateness of NSAIDs therapy. Out of total 402 prescriptions, 222 prescriptions were found appropriate, 127 inappropriate and 53 were found as uncertain. Conclusions: The study showed that NSAIDs should be selected more judiciously for OA patients in relation to GI and CV risk in order to reduce untoward adverse effects of these agents. [ABSTRACT FROM AUTHOR]

Aims and Objective: To evaluate the prescription pattern of insulin and oral antidiabetic drugs (OADs) and the trend of glycemic control in people with diabetes (PwD) with type 2 diabetes mellitus attending a tertiary care center in India. Materials and Methods: This retrospective, cross-sectional observational study included clinic records of 647 PwD collected at three different time points (2011, 2015, and 2019). Population characteristics, patterns of glycemic parameters, and trends of antidiabetic medication were analyzed. Results: PwD population was similar in terms of anthropometric and clinical variables. Dysglycemia was observably higher in the 2015 population (mean HbA1C = 8.37 ± 1.8%) compared with the 2011 population (6.4 ± 0.4%) and stabilized in the 2019 population (8.35 ± 1.9%) compared with the 2015 population. This correlated with the trend of increase in basal and bolus insulin prescriptions as more subjects were initiated on insulin to address the higher dysglycemia in 2015 than in 2011 and were later titrated in 2019. The proportion of subjects with uncontrolled diabetes increased marginally in 2015 (50.9%) compared with 2011 (45.6%) and decreased significantly in 2019 (34.1%) compared with 2015. This correlated with the additive increases of premix insulin, sodium-glucose transport protein 2 inhibitors (SGLT2i), and dipeptidyl peptidase 4 inhibitors (DPP4i) prescriptions. Conclusion: We observed a judicious usage of insulin prescriptions correlating with the higher need for PwD to be initiated with basal insulin to counter the increasing trend of dysglycemia, followed by more premix insulin prescriptions to address stabilized dysglycemia. Optimal diabetes control can be partly attributed to dysglycemia stabilization by insulin initiation and usage of newer OADs, such as SGLT2i and DPP4i. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a major public health problem globally and in India. Many studies in the past have documented inadequate glycemic control and complication rates among the Indian diabetic population due to inappropriate or inadequate pharmacological treatment. Studies assessing the prescription pattern are also very Scarce from the country. The present study has been conducted with the objective of assessing the profile of diabetic patients admitted to a tertiary care teaching hospital and the prescription pattern of anti-diabetic medication among them. Aims and Objectives: The study is aimed to analyze the current prescribing patterns for patients with both uncomplicated and complicated Type 2 DM in a tertiary care hospital and to identify the most commonly prescribed antidiabetic medications and their combinations in both uncomplicated and complicated cases. Materials and Methods: The present study was a retrospective case record review of 136 patients with Type 2 DM admitted in the ward of general medicine department of a Tertiary care teaching hospital. Results: The mean age was 54.39 ± 12.46 years and 61.03% of participants were males. Comorbidities such as systemic hypertension were present in 21.32% of participants and hyperlipidemia was present in 11.76% of participants. The proportion of subjects, who had complicated DM, was 52.21%. Among the study population, 77 (56.62%) had oral hypoglycemic agents (OHA) alone, 27 (19.85%) had insulin alone, and 32 (23.53%) had Insulin + OHA. Among the study population, 70 (51.47%) had single OHA, 32 (23.53%) had dual combination of OHA, and 7 (5.15%) had triple combination OHA. The majority (53.70%) people were taking metformin, 20 (14.71%) people were taking glimepiride, 16 (11.76%) people were taking glibenclamide, 13 (9.56%) people were taking gliptins. Among the study population, 34 (25%) people were taking actrapid, 32 (23.53%) people were taking mixtard, and 10 (7.35%) people were taking lup Insulin. Among the study population, 32 (23.53%) had anti-hypertensive drugs, 19 (13.97%) had statins, 14 (10.29%) had antiplatelet, 12 (8.82%) had antibiotics and 4 (8.94%) had diuretics. The mean fasting blood sugar at admission was 178.51 ± 69.56 g/dL and at the discharge was 123.23 ± 24.92 g/dL and the mean difference (55.29) between two groups was statistically significant (P < 0.001). The mean postprandial blood sugars at admission was 228.92 ± 67.03 g/dL and at the discharge was 166.66 ± 30.73 g/dL, and the mean difference (55.29) between two groups was statistically significant (P < 0.001). Conclusion: The treatment intake was inadequate and glycemic control was poor in majority of the diabetic population. There is high reliance on metformin and sulfonylureas and insulin is underutilized even in patients with poor glycemic control. There is strong need to optimize the therapy in diabetic patients. [ABSTRACT FROM AUTHOR]

Background: The most common superficial fungal infections are tinea corporis, tinea cruris, tinea capitis, tinea pedis, tinea unguium, and tinea facie and cutaneous Candida albicans infections such as oral thrush, oropharyngeal candidiasis, vaginal candidiasis, and onychomycosis. Aims and Objectives: (i) Analysis of prescription pattern of antifungal drugs and (ii) to study common adverse effects. Materials and Methods: A retrospective, observational study conducted in B. K. L. Walawalkar Hospital, Sawarde, Ratnagiri. A total of 993 case papers were analyzed after getting approval from the institutional ethics committee and permission from dermatology department. The frequency with percentage was used for the analysis of data. Results: In 993 patients with superficial fungal infections, 523 (52.7%) were males and 470 (47.3%) were females. Majority of patients were belonged to 21-40-year age group, i.e., 439 (44.2%) followed by 41-60 years, i.e., 244 (24.6%). Our study shows that the most common superficial fungal infections with single lesion were tinea corporis (22.3%), tinea cruris (14.6%), and pityriasis versicolor (13.9%). In Candida albicans, the most common infection was onychomycosis 14 (1.4%). The most common antifungal prescribed was luliconazole (20.84%) followed by itraconazole (20.58%). The most common route was topical route (68.26%). Combination of drugs was not prescribed. Different prescription indicators were that the average number of drugs prescribed per encounter was 3.4 and average number of drugs prescribed per encounter was 2.7. Conclusion: Most commonly prescribed newer antifungal was luliconazole. Next most commonly prescribed by oral route was itraconazole. In our study prescription pattern were rational approach in two points, they are no use of combination of drugs and many drugs were selected from essential medicinal list. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is a severe psychiatric condition that affects approximately 24 million people worldwide. The complex pathophysiology of schizophrenia presents various challenges for researchers and doctors. Therefore, it is crucial to curate robust pharmacotherapy for patients with schizophrenia to ease their symptoms. Establishing proper standards for patient care requires an ammunition of research studies done on the disease and its therapy, upon which health-care practitioners can rely for future patient care. Unfortunately, there is a void of adequate research studies done on understanding the prescription patterns of schizophrenia in India, especially in rural areas. To improve patient outcomes, there is a need for increased research on this particular subject. Aim: The aim of this study was to assess the prescription pattern of antipsychotics in patients with schizophrenia at a tertiary care hospital in rural Karnataka. Setting and Design: This is an observational study carried out in MVJ Medical College and Research Hospital, Bengaluru, India. Materials and Methods: The study included a total of 139 inpatients, regardless of their age and sex, who had been diagnosed with schizophrenia. The study was conducted for a period of 6 months, from February 2022 to July 2022. Data collection involved a case record form (CRF) designed for assessing treatment patterns. An investigator was assigned to the Department of Psychiatry, where patients with schizophrenia were discovered and after reviewing their medication chart, necessary data were filled into the CRF. The obtained data were then compiled and assessed. Results: Paranoid schizophrenia was the major subclass (90.0%). The prescription pattern showed that second-generation antipsychotics (SGAs) were prescribed more than first-generation antipsychotics (FGAs), 112 (81.29%) and 41 (29.5%) prescriptions, respectively. In SGAs, tablet olanzapine received the most prescriptions which was 42 (30.22%). Tablet haloperidol was the major FGA to be prescribed receiving 18 prescriptions (12.95%). This study also included the assessment of combination drugs which showed that tablet risperidone + tablet trihexyphenidyl was the most prescribed combination drug 118 (78.43%). Conclusion: Our study showed that our findings aligned with several similar studies and also differed from a few, underscoring the need for further research and individualized treatment approaches to manage this complex psychiatric disorder.

Aims and Objective: To evaluate the prescription pattern of insulin and oral antidiabetic drugs (OADs) and the trend of glycemic control in people with diabetes (PwD) with type 2 diabetes mellitus attending a tertiary care center in India. Materials and Methods: This retrospective, cross-sectional observational study included clinic records of 647 PwD collected at three different time points (2011, 2015, and 2019). Population characteristics, patterns of glycemic parameters, and trends of antidiabetic medication were analyzed. Results: PwD population was similar in terms of anthropometric and clinical variables. Dysglycemia was observably higher in the 2015 population (mean HbA1C = 8.37 ± 1.8%) compared with the 2011 population (6.4 ± 0.4%) and stabilized in the 2019 population (8.35 ± 1.9%) compared with the 2015 population. This correlated with the trend of increase in basal and bolus insulin prescriptions as more subjects were initiated on insulin to address the higher dysglycemia in 2015 than in 2011 and were later titrated in 2019. The proportion of subjects with uncontrolled diabetes increased marginally in 2015 (50.9%) compared with 2011 (45.6%) and decreased significantly in 2019 (34.1%) compared with 2015. This correlated with the additive increases of premix insulin, sodium-glucose transport protein 2 inhibitors (SGLT2i), and dipeptidyl peptidase 4 inhibitors (DPP4i) prescriptions. Conclusion: We observed a judicious usage of insulin prescriptions correlating with the higher need for PwD to be initiated with basal insulin to counter the increasing trend of dysglycemia, followed by more premix insulin prescriptions to address stabilized dysglycemia. Optimal diabetes control can be partly attributed to dysglycemia stabilization by insulin initiation and usage of newer OADs, such as SGLT2i and DPP4i.

Background Rational use of medicine in a teaching hospital is critical for effective and efficient patient care. This study assessed prescription, dispensing, and rational medicine in a Nigerian tertiary care facility. Materials and Method This was an analytic cross-sectional study with data collected using validated tools underpinned by the World Health Organisation (WHO) and the International Network for the Rational Use of Drugs (INRUD) core indicators for prescription, patient care, and facility. A cluster sample of 10 specialist clinics and servicing pharmacies were selected. Simple random sampling was deployed to retrieve 600 medicine prescriptions in the pharmacies over a six-month period (June 1, 2021–November 30, 2021). Patient care indicators were assessed using 330 patient encounters, and 48 prescribers across the 10 clinics were randomly selected for assessing factors influencing prescribing practices. Exploratory and confirmatory analyses were conducted with SPSS version 25, and findings were compared with WHO/INRUD recommendations. Results The mean medicine count per visit was 3.4 ± 1.9 with 40.2% and 24.8% of prescriptions containing antibiotics and injections, respectively. Nonproprietary prescriptions were 43.6% and 97.1% of medicines prescribed were contained the essential medicines list (EML). The mean times spent were 17.5 ± 8.0 and 7.7 ± 3.8 min with prescribers and dispensers, respectively. Most (99.8%) of the dispensed medicines were labeled properly while 82% of patients knew the regimen. Most (93.3%) tracer medicines were in the pharmacies, but no clinic had copies of the EML. Significant differences in prescription and patient care indicators were reported across specialty units. Conclusion Gaps exist in medicine prescription and dispensing. The preponderance of brand prescription, polypharmacy, and antibiotic prescription calls for implementation of extant policies and guidelines on the use of medicines as well as training and monitoring on rational medicine use among prescribers and dispensers in the teaching hospital.

Drug use during pregnancy should be evidence-based and favor the safest and most appropriate prescription. The Italian Medicines Agency (AIFA) coordinates a network focusing on monitoring medication use in pregnancy. Hypertensive disorders are common medical complication of pregnancy and antihypertensive therapy is prescribed to reduce the risk of adverse feto-maternal complications. The objective of this study is to highlight the prescription pattern of antihypertensive drugs before pregnancy, during pregnancy and in the postpartum period in Italy and to evaluate their use with a specific attention to the prescription pattern of drugs considered safe during pregnancy. A multidatabase cross-sectional population study using a Common Data Model (CDM) was performed. We selected all women aged 15-49 years living in eight Italian regions who gave birth in hospital between 1 April 2016 and 31 March 2018. In a cohort of 449.012 women, corresponding to 59% of Italian deliveries occurred in the study period, the prevalence of prescription of antihypertensive drugs in the pre-conceptional period was 1.2%, in pregnancy 2.0% and in the postpartum period 2.9%. Beta-blockers were the most prescribed drugs before pregnancy (0.28%-0.30%). Calcium channel blockers were the most prescribed drugs during pregnancy, with a prevalence of 0.23%, 0.33%, 0.75% in each trimester. Alfa-2-adrenergic receptor agonists were the second most prescribed during pregnancy with a prevalence of 0.16%, 0.26% and 0.55% in each trimester. The prescription of drugs contraindicated during pregnancy was below 0.5%. Only a small percentage of women switched from a contraindicated drug to a drug compatible with pregnancy. The analysis showed little variability between the different Italian regions. In general, the prescription of antihypertensive drugs in the Italian Mom-Network is coherent with the drugs compatible with pregnancy. [ABSTRACT FROM AUTHOR]

Background: One of the cases of accidental injuries is burns. Globally, every year estimated 180,000 mortalities occur due to burns, and most of the deaths are seen in the lower or poor socioeconomic class of developing countries. Due to predominantly poor and low socioeconomic status, overpopulation, poor education, and unreachability to advanced burn care in certain parts of the country - the incidence, complications, and deaths have continued to rise in developing countries. About 75% of the deaths associated with burn injuries are related to wound infection, especially in developing countries. The present study was undertaken to study the microflora of burn wounds as well as drug utilization in the management of burn patients in a tertiary care teaching hospital. Aims and objectives: Assessment of antimicrobial susceptibility and resistant pattern and drug utilization in burns patients. Materials and Methods: This observational cross-sectional descriptive study was performed on 130 hospitalized burn patients over 12 months (from November 2020 to November 2021). All burn patients who were admitted in the hospital and received at least 1 day of treatment were included in the study. All required information, including demographic data, prescribed medication, microbial culture sensitivity report, and treatment outcome were recorded in the case record form. Descriptive statistics using Microsoft Excel version 2019. Results: Of a total of 130 burn patients, 52% were females. The most common type of burn was flame in 69% of patients. The mean length of hospital stay was 9 days and it ranged from 1 to 40 days. Culture from burns wound revealed Pseudomonas aeruginosa (47.6%) as the most common organism isolated followed by Klebsiella pneumoniae (45.2%), Acinetobacter baumannii (14.2%), Proteus mirabilis (14.2%), Staphylococcus aureus (9.5%), and Escherichia coli (4.7%). Among the isolated microorganisms, most of them showed sensitivity to beta-lactam, aminoglycoside, and tetracyclines. Sulphonamide was dominant among the topically applied antibiotics, whereas cephalosporins were dominant among the systemically administered antibiotics. The average number of drugs per-prescription ranges from 6.5 to 8.5. Conclusion: The present study results are helpful in understanding the pattern of burns wound sepsis, the dominant bacterial organism, the antimicrobial susceptibility/resistance, and the drug utilization pattern in burns patients. [ABSTRACT FROM AUTHOR]

Background: When considering changing hypnotic pharmacotherapy, lemborexant has attracted attention as a candidate due to its effectiveness and safety profile. However, few studies have investigated switching patterns in clinical practice. Research design and methods: We conducted a retrospective cohort study using a nationwide claims database. Patients prescribed a single hypnotic who either subsequently switched to (switching cohort) or were additionally prescribed (add-on cohort) lemborexant between July 2020 and December 2021 were identified. Proportion of successful switching was defined as remaining on lemborexant alone or without any hypnotic at 6 months after lemborexant initiation. Results: The success proportion was 70.1% in the switching cohort (n = 4,861) and 38.6% in the add-on cohort (n = 9,423). In the add-on cohort, the success proportion was lower in patients with a hypnotic history of ≥180 days (31.4%) and in patients whose prescribed hypnotic was a benzodiazepine or non-benzodiazepine (31.5% and 37.6%, respectively). Conclusion: The proportion of successful switching was higher in patients who switched to lemborexant than in those who added lemborexant as a concomitant treatment. The lower success proportion in the add-on cohort might be related to clinically more severe insomnia, and/or a concomitant prescription of benzodiazepine or non-benzodiazepine, from which discontinuation may be challenging. [ABSTRACT FROM AUTHOR]

Background: Prescription pattern studies are a tool for assessing the prescribing, dispensing and distribution of medicines. Diabetes mellitus (DM) is a spectrum of metabolic disorders as a consequence of different pathogenic mechanisms resulting in hyperglycemia. A genetic predisposition to develop β-cell dysfunction synergizes with insulin resistance to lead to type 2 DM. Adequate management of type 2 DM requires institution of non-pharmacological management followed by pharmacological management. Currently trending anti diabetic drugs, Teneligliptin a magic drug which is recently developed oral dipeptidyl-peptidase-4 inhibitor indicated for the management of uncontrolled type 2 diabetes mellitus (T2DM) in adults along with diet and exercise. Methods: This cross-sectional study was conducted in the Department of Pharmacology in collaboration with Department of General Medicine. A total of 518 patients were enrolled in study based on inclusion and exclusion criteria after taking written informed consent. A structured case recording form was used to record demographic details and prescription details. The rationality of prescriptions was assessed using American Diabetes Association guidelines (ADA) 2015. Results: Majority of the patients were prescribed combination therapy (54%) followed by monotherapy (46%). Oral anti-diabetic agents used as monotherapy other than metformin were appropriate. Among the patients receiving combination therapy majority were receiving a fixed dose combination which were appropriate. Among the recent anti-diabetic drug Teneligliptin was the most commonly prescribed drug and Teneligliptin has been found to be well accepted and tolerated, and the safety profile is similar to other dipeptidyl peptidase-4 inhibitors. Teneligliptin was used as monotherapy, add-on to metformin or add-on to metformin plus sulfonylureas combination for better glycaemic control. Conclusion: Upon overall analysis this study indicates that rational prescribing of drugs in tertiary care hospital has to be improved by prescribing current trends, Prescribing drugs from Essential drug list (EDL) and the use of combination therapy was significant. The study of drug prescribing pattern showed that antidiabetic drugs were prescribed according to American Diabetes Association guidelines. The trends in prescribing newer anti diabetic drugs shows the acceptance of teneligliptin and updated skills in physicians to promote better glycaemic control. [ABSTRACT FROM AUTHOR]

Objectives: Adherence to antiparkinsonian medications (APMs) may significantly influence Parkinson's disease (PD) outcome. The present study assesses the role of motor and non-motor features, and prescription patterns on adherence. Materials and Methods: This observational and cross-sectional study included 50 PD patients taking APMs for =24 months. Demographic data, PD characteristics, treatment, and follow-up history were collected. Patients following up at least once in six months were considered as regular, else were labeled irregular. Montreal cognitive assessment, patient health questionnaire-4, Pittsburgh sleep quality (SQ) index, Epworth sleepiness scale, global quality of life (GQOL) scale, and Morisky Green Levine medication adherence scale (MGL-MAS) were used to evaluate cognition, depressive and anxiety features, SQ, excessive daytime sleepiness (EDS), quality of life (QOL), and APMs adherence, respectively. Results: Nearly half (46%) of the PD patients reported high adherence (MGL-MAS = 0). Most of the clinical characteristics were comparable between those with medium/low and high adherence, except for a larger proportion of patients in the medium/low adherence group belonging to Hoehn-Yahr stage >2 (P = 0.02). A comparable proportion of patients in both groups reported poor SQ (P = 0.52) and EDS (P = 0.32). In comparison to the high adherence group, a significantly lower median GQOL score was observed in the medium/low adherence group (median [interquartile range] = 65 [50-70] vs. 80 [70-85]; P < 0.001). The APMs prescription and follow-up patterns were comparable between both groups. Conclusion: More than half the PD patients reported medium-to-low adherence. While motor severity and depressive symptoms were associated with medium-to-low adherence, poor SQ was comparable in both groups. Those with medium-to-low adherence reported poor QOL. [ABSTRACT FROM AUTHOR]

Objective(s): Drug prescription is one of the strategic issues in the field of health. Rational prescription of medicine and efforts towards appropriate, safe and efficient use of medicine are one of the main missions of health policy makers in the country. This study was conducted with the aim of reviewing the studies was done in the country in the field of drug prescription pattern. Methods: The present research was a scoping review using the Arsky and O'Malley protocol. The English and Persian databases examined in this study were Scopus, Web of Science, PubMed, Magiran and SID. Searched keywords were Prescription, Rational Use, Rational Utilization, Rational Consumption, Overconsumption, Overutilization, Utilization Management, Inappropriate Utilization, and Iran in English and Persian. Original research articles published in journals in English or Persian that estimated WHO prescribing indicators were included to the review. Studies published in other languages, books, theses, conference papers, review studies, articles whose full text was not available and articles published before 2010 were excluded from the study. Results: In the first stage 2846 citations were retrieved. After considering all inclusion and exclusion criteria 22 full articles were reviewed. About 70% of articles were published in English. 74% of studies focused on the prescription of a specific group of providers and 13% focused on drug administration in elderlies. The average number of drugs per prescription varied from 2 to 4.5 items in different studies. The percentage of prescriptions included antibiotics reported between 8.8 for elderlies’ home health care to 97.6 for dentists’ prescriptions. The prescriptions included injections also varied from 9.3 to 58.9 in medical interns and general practitioners in Kerman. Conclusion: The trend of drug prescription reflects the success of the country's policies toward rational use of drugs. However, to achievement the global standards, the implementation of policies to improve the prescription pattern in the country should be a priorities of health system.

Abstract Cerebral infarction (CI) is a common cerebrovascular disease worldwide, and the burden caused by the sequelae of CI has increased significantly. However, current treatment guidelines lack standardized recommendations for pharmacotherapy of sequelae of CI. This retrospective study collected and analyzed 1.98 million prescriptions concerning sequelae of CI from patients admitted to Zhiyun Health Internet Hospital in 2022. The mean age of patients was 66.2 ± 11.4 years, and 52.40% were male. 79.73% had one or more comorbidities. For treatment, the prescriptions of 1-, 2- and ≥ 3-drug accounted for 64.55%, 23.77% and 11.68% respectively. Chinese patent medicine (CPM) prescriptions, western medicine (WM) prescriptions, and CPM and WM combined (CPM + WM) prescriptions accounted for 53.81%, 27.33%, and 18.86% respectively. In CPM prescriptions, the most frequently prescribed medications were Salvia miltiorrhiza (34.81%), Ginkgo biloba (24.96%), Panax notoginseng (20.67%), Gastrodia (7.15%) and Ligusticum Wallichii (4.90%). For WM prescriptions, the most commonly prescribed agents were anti-hypertensive (32.82%), anti-thrombotic (16.06%), vasodilator (15.70%), anti-dementia (10.88%), and lipid-lowering (9.58%) drugs. Among CPM + WM prescriptions, 72.61% had CPM/WM = 1, 21.20% had CPM/WM 1. This research utilized real-world data extracted from internet hospitals in China to present valuable evidence of online prescription patterns among patients experiencing sequelae of CI.

Cerebral infarction (CI) is a common cerebrovascular disease worldwide, and the burden caused by the sequelae of CI has increased significantly. However, current treatment guidelines lack standardized recommendations for pharmacotherapy of sequelae of CI. This retrospective study collected and analyzed 1.98 million prescriptions concerning sequelae of CI from patients admitted to Zhiyun Health Internet Hospital in 2022. The mean age of patients was 66.2 ± 11.4 years, and 52.40% were male. 79.73% had one or more comorbidities. For treatment, the prescriptions of 1-, 2- and ≥ 3-drug accounted for 64.55%, 23.77% and 11.68% respectively. Chinese patent medicine (CPM) prescriptions, western medicine (WM) prescriptions, and CPM and WM combined (CPM + WM) prescriptions accounted for 53.81%, 27.33%, and 18.86% respectively. In CPM prescriptions, the most frequently prescribed medications were Salvia miltiorrhiza (34.81%), Ginkgo biloba (24.96%), Panax notoginseng (20.67%), Gastrodia (7.15%) and Ligusticum Wallichii (4.90%). For WM prescriptions, the most commonly prescribed agents were anti-hypertensive (32.82%), anti-thrombotic (16.06%), vasodilator (15.70%), anti-dementia (10.88%), and lipid-lowering (9.58%) drugs. Among CPM + WM prescriptions, 72.61% had CPM/WM = 1, 21.20% had CPM/WM < 1, and 6.19% had CPM/WM > 1. This research utilized real-world data extracted from internet hospitals in China to present valuable evidence of online prescription patterns among patients experiencing sequelae of CI. [ABSTRACT FROM AUTHOR]

Objective(s): Drug prescription is one of the strategic issues in the field of health. Rational prescription of medicine and efforts towards appropriate, safe and efficient use of medicine are one of the main missions of health policy makers in the country. This study was conducted with the aim of reviewing the studies was done in the country in the field of drug prescription pattern. Methods: The present research was a scoping review using the Arsky and O'Malley protocol. The English and Persian databases examined in this study were Scopus, Web of Science, PubMed, Magiran and SID. Searched keywords were Prescription, Rational Use, Rational Utilization, Rational Consumption, Overconsumption, Overutilization, Utilization Management, Inappropriate Utilization, and Iran in English and Persian. Original research articles published in journals in English or Persian that estimated WHO prescribing indicators were included to the review. Studies published in other languages, books, theses, conference papers, review studies, articles whose full text was not available and articles published before 2010 were excluded from the study. Results: In the first stage 2846 citations were retrieved. After considering all inclusion and exclusion criteria 22 full articles were reviewed. About 70% of articles were published in English. 74% of studies focused on the prescription of a specific group of providers and 13% focused on drug administration in elderlies. The average number of drugs per prescription varied from 2 to 4.5 items in different studies. The percentage of prescriptions included antibiotics reported between 8.8 for elder lies' home health care to 97.6 for dentists' prescriptions. The prescriptions included injections also varied from 9.3 to 58.9 in medical interns and general practitioners in Kerman. Conclusion: The trend of drug prescription reflects the success of the country's policies toward rational use of drugs. However, to achievement the global standards, the implementation of policies to improve the prescription pattern in the country should be a priorities of health system. [ABSTRACT FROM AUTHOR]

Drug use during pregnancy should be evidence-based and favor the safest and most appropriate prescription. The Italian Medicines Agency (AIFA) coordinates a network focusing on monitoring medication use in pregnancy. Hypertensive disorders are common medical complication of pregnancy and antihypertensive therapy is prescribed to reduce the risk of adverse feto-maternal complications. The objective of this study is to highlight the prescription pattern of antihypertensive drugs before pregnancy, during pregnancy and in the postpartum period in Italy and to evaluate their use with a specific attention to the prescription pattern of drugs considered safe during pregnancy. A multi-database cross-sectional population study using a Common Data Model (CDM) was performed. We selected all women aged 15–49 years living in eight Italian regions who gave birth in hospital between 1 April 2016 and 31 March 2018. In a cohort of 449.012 women, corresponding to 59% of Italian deliveries occurred in the study period, the prevalence of prescription of antihypertensive drugs in the pre-conceptional period was 1.2%, in pregnancy 2.0% and in the postpartum period 2.9%. Beta-blockers were the most prescribed drugs before pregnancy (0.28%–0.30%). Calcium channel blockers were the most prescribed drugs during pregnancy, with a prevalence of 0.23%, 0.33%, 0.75% in each trimester. Alfa-2-adrenergic receptor agonists were the second most prescribed during pregnancy with a prevalence of 0.16%, 0.26% and 0.55% in each trimester. The prescription of drugs contraindicated during pregnancy was below 0.5%. Only a small percentage of women switched from a contraindicated drug to a drug compatible with pregnancy. The analysis showed little variability between the different Italian regions. In general, the prescription of antihypertensive drugs in the Italian Mom-Network is coherent with the drugs compatible with pregnancy.

The imprudent use of antibiotics increases the environmental microflora's resistance to various drugs, particularly antibiotics. Prescription data is crucial for understanding antibiotic usage frequency and dosage. This health-focused study aims to analyze antibiotic prescription patterns in human and veterinary practices to identify emerging trends in environmental antibiotic resistance.For this survey, A total of 6550 prescriptions were randomly collected from hospitals and pharmacies in Mymensingh sadar upazila, Bangladesh, between August and October 2022. Of these, 5123 (78 %) were for human cases and 1427 (22 %) for veterinary purposes. Photos of the prescriptions were taken and analyzed to understand prescribing habits. Additionally, 30 water samples from rivers, ponds, sewage, and households in Mymensingh City Corporation were collected to assess environmental antibiotic levels and resistance patterns of microorganisms.The analysis showed that Cephalosporins were the most prescribed antibiotics, found in 570 (56.27 %) of human prescriptions and 230 (42.99 %) of veterinary prescriptions. Aminoglycosides had the lowest frequency, with 13 (1.2 %) for humans and 46 (8.6 %) for animals. Macrolides (12.24 %), carboxylic acids (1.87 %), and rifamycins (1.28 %) were only found in human prescriptions, while sulfa drugs (10.84 %), tetracyclines (5.42 %), and combinations of antibiotics (14.77 %) were only in animal prescriptions. Quinolones were prescribed 4.06 times more for humans, while aminoglycosides were used 3.54 times more for animals. Environmental samples showed E. coli had the highest resistance (MAR Value: 0.625) against eight antibiotics.This study illuminates the human-animal prescription patterns that are influenced by environmental factors which drive antibiotic stewardship in Bangladesh. It is imperative for practitioners to exercise caution and adhere to guidelines when prescribing antibiotics, both in human and veterinary practices, given the alarming trend of antibiotic resistance. Additionally, measures must be taken to restrict the influx of antibiotics residue into the environment.

Exotic companion animals have had an important role in our society since ancient times. Preserving animal health is necessary to do a responsible use of veterinary medicines. This study aimed to describe the prescription patterns of drugs in exotic pets and wildlife animals attending the Veterinary Teaching Hospital of the University of León (HVULE). A retrospective study was carried out between 2018 and 2022. Birds were the largest group of exotic animals attending the HVULE. Visits were related to emergency reasons and for musculoskeletal disorders. One-third of the animals were eventually euthanised. Regarding pharmacological treatments, the most frequently active ingredients used were pentobarbital, isoflurane, meloxicam, and within antibiotics, marbofloxacin (category B in the classification of European Medicines Agency). [ABSTRACT FROM AUTHOR]

Aim of the study: determine the pattern of prescription of Anti Diabetic Drugs in a cohort of patients at a tertiary care centre of East Nimar region of Central India. Methods: The study was a Prospective observational study and was conducted in the Outpatient department of Medicine conducted for a period of 6 Months. Demographic and clinical data of total 82 patients were collected and Prescription of these Diabetic patients were analysed. Result: Out of Total 82 Patients, the maximum percentage of Diabetic patients, including both males and females belonged to the age group of 51 to 60 years (36.58%). Majority of Patients received Two Drug Anti-diabetic Drug combination (i.e. Metformin and Glimepiride combination) which were the most prescribed drugs (65.85%, 54 Patients out of total 82 Patients) followed by Mono-therapy with Metformin (13.41%, 11 Patients out of total 82 Patients). Among the three drugs combination therapy prescribed in 15 patients (18.29%), often Metformin + Glimepiride + Pioglitazone combination were prescribed (6 patients, 7.31%), followed by Metformin + Glimepiride+ Vildagliptin/Tenegliptin/Sitagliptin (DPPIV Inhibitors) (5 patients, 6.09 %). As far as comorbid conditions are concerned 62 Patients (75.60 %) had no comorbid disease along with Diabetes, 20 patients (24.39 %) had Hypertension and 3 patients (3.65 %) had Hyperlipidaemia along with Hypertension and Diabetes and received concomitant medications for the same. Conclusions: The present study represents the current prescribing pattern of Anti-Diabetic Drugs in our Hospital. Our findings showed that Metformin and Glimepiride combination dominated thescenario followed by Monotherapy with Metformin among the elderly populations of Diabetes. The use of Anti-Diabetic drugs largely confirms the guidelines as most of the patients belonged to the category of elderly populations, but still there is a significant room of improvement in terms of rational prescribing. [ABSTRACT FROM AUTHOR]

Background. Schizophrenia is a public health burden and a severe type of mental disorder that has a significant distress to the individual and the society. Pharmacotherapy is the mainstay of the treatment, and the rational prescription is guided by World Health Organization (WHO) prescribing indicators developed to assess pharmaceutical prescribing practices by health providers. This study evaluated the pattern of health providers’ prescription of psychotropic drugs for schizophrenia patients from a tertiary mental health facility in Anambra State, southeastern part of Nigeria. Methodology. This was a one-year retrospective, descriptive, cross-sectional study of psychotropic medicines prescriptions for adult schizophrenia patients who were at least 18 years old, to assess the average number of drugs prescribed per encounter, the percentage of encounters with injection prescribed, the percentage of drugs prescribed by generic name, and the percentage of drugs prescribed from the Essential Medicines List. Results. A total of 338 encounters were assessed after random sampling, and the results show that the average number of prescriptions per encounter was 3.23, while 95.97% of the total number of drugs were prescribed by generic names, in 26.9% of the total number of encounters there were prescribed injections, while 100% of the prescribed drugs were from the Essential Medicines List. Other indicators reveal that fluphenazine was the most prescribed antipsychotic injection, while haloperidol and olanzapine were the most prescribed typical and atypical antipsychotics, respectively. Conclusions. There were issues of polypharmacy, some reluctance in prescribing drugs with generic names, and overuse of injections [ABSTRACT FROM AUTHOR]

Chung-Chih Liao,1,2 Chi-Hsien Chien,1 Teng-Shun Yu,3 Jung-Miao Li4,5 1Department of Post-Baccalaureate Veterinary Medicine, College of Medical and Health Science, Asia University, Taichung, 41354, Taiwan; 2Chuyuan Chinese Medicine Clinic, Taichung, 40455, Taiwan; 3Management Office for Health Data, China Medical University Hospital, Taichung, 40459, Taiwan; 4School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; 5Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, TaiwanCorrespondence: Jung-Miao Li, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Tel +886– 4-22053366 ext.3139, Email jmli@mail.cmu.edu.twBackground: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Chinese herbal medicine (CHM), a major branch of traditional Chinese medicine, has been reported to exert beneficial effects on PCOS symptoms. However, the relationship between CHM use and the risk of coronary heart disease (CHD) in patients with PCOS remains unclear. The study aimed to investigate the potential protective role of CHM on CHD incidence in patients with PCOS and to understand CHM prescription patterns for PCOS treatment.Methods: This retrospective cohort study was performed using data from Taiwan’s Longitudinal Health Insurance Database 2000 (LHID2000). Patients with PCOS were identified, and data on their demographic characteristics, comorbidities, and medication use were extracted. The patients were then divided into CHM and non-CHM users.Results: Propensity score matching yielded two balanced cohorts of 2913 individuals each. CHM users demonstrated a 94% reduced risk of CHD compared to non-CHM users (adjusted hazard ratio, 0.06; 95% confidence interval, 0.04– 0.1) during the 19-year follow-up period. Stratified analysis confirmed the benefits of CHM treatment on the incidence of CHD across various subgroups. The key elements identified in the CHM prescription patterns associated with reduced CHD risk were Xiang Fu, Yi Mu Cao, Jia Wei Xiao Yao San, and Gui Zhi Fu Ling Wan.Conclusion: This study provides evidence that CHM may protect against CHD development in patients with PCOS. It is also highlight the most frequently prescribed CHM for mitigating CHD risk among patients with PCOS. These findings lay the groundwork for future studies to confirm and elucidate CHM’s therapeutic mechanisms in PCOS-related CHD prevention, offering a significant contribution to the field.Keywords: polycystic ovary syndrome, coronary heart disease, Chinese herbal medicine, retrospective cohort study, prescription pattern

Background: Prescription audit can be described as a tool to evaluate the quality of medical treatment which is being offered to the patients in any health care facility. It can prove to be helpful in devising any effective changes that would improve quality of care to the patients. Aims and Objective: The study was conducted to carry out prescription audit among the psychiatric patients seeking consultation in a tertiary care centre. Materials and Methods: This prospective observational study was conducted on 500 prescriptions for a time period of six months in the outpatient department of Institute of Mental Health and Neurosciences (MHANS). During the study all the prescriptions were collected and evaluated based on WHO prescribing indicators. Data was entered and analyzed using SPSS software version 16.0. Results: Five hundred prescriptions comprising of 1,260 drugs were analyzed. The average number of drugs per prescription was 2.8. There were 52.7% males and 47.3% females. Most patients (49%) were from the age group of 21-40 years. In majority of the cases (90.9%) more than one drug was prescribed and 4.6% (20) of medications were prescribed by generic names. The study revealed that Major Depression Disorder (MDD) was the most common psychiatric morbidity (40%). Clonazepam was the most common drug (19.6%) that was prescribed for the patients irrespective of the diagnosis. Conclusion: Prescription audit can be helpful to evaluate the existing prescription pattern of any health care facility and ensure the rational drug therapy as per WHO prescription parameters.

Abstract Background Patients with Type 2 Diabetes Mellitus (T2DM) are at a higher risk of polypharmacy and more susceptible to irrational prescriptions; therefore, pharmacological therapy patterns are important to be monitored. The primary objective of this study was to highlight current prescription patterns in T2DM patients and compare them with existing Standards of Medical Care in Diabetes. The second objective was to analyze whether age and gender affect prescription patterns. Method This cross-sectional study was conducted using the Iran Health Insurance Organization (IHIO) prescription database. It was mined by an Association Rule Mining (ARM) technique, FP-Growth, in order to find co-prescribed drugs with anti-diabetic medications. The algorithm was implemented at different levels of the Anatomical Therapeutic Chemical (ATC) classification system, which assigns different codes to drugs based on their anatomy, pharmacological, therapeutic, and chemical properties to provide an in-depth analysis of co-prescription patterns. Results Altogether, the prescriptions of 914,652 patients were analyzed, of whom 91,505 were found to have diabetes. According to our results, prescribing Lipid Modifying Agents (C10) (56.3%), Agents Acting on The Renin-Angiotensin System (C09) (48.9%), Antithrombotic Agents (B01) (35.7%), and Beta Blocking Agents (C07) (30.1%) were meaningfully associated with the prescription of Drugs Used in Diabetes. Our study also revealed that female diabetic patients have a higher lift for taking Thyroid Preparations, and the older the patients were, the more they were prone to take neuropathy-related medications. Additionally, the results suggest that there are gender differences in the association between aspirin and diabetes drugs, with the differences becoming less pronounced in old age. Conclusions Almost all of the association rules found in this research were clinically meaningful, proving the potential of ARM for co-prescription pattern discovery. Moreover, implementing level-based ARM was effective in detecting difficult-to-spot rules. Additionally, the majority of drugs prescribed by physicians were consistent with the Standards of Medical Care in Diabetes.

Exotic companion animals have had an important role in our society since ancient times. Preserving animal health is necessary to do a responsible use of veterinary medicines. This study aimed to describe the prescription patterns of drugs in exotic pets and wildlife animals attending the Veterinary Teaching Hospital of the University of León (HVULE). A retrospective study was carried out between 2018 and 2022. Birds were the largest group of exotic animals attending the HVULE. Visits were related to emergency reasons and for musculoskeletal disorders. One-third of the animals were eventually euthanised. Regarding pharmacological treatments, the most frequently active ingredients used were pentobarbital, isoflurane, meloxicam, and within antibiotics, marbofloxacin (category B in the classification of European Medicines Agency).

Background: Levodopa (LD) is the most effective drug to treat Parkinson's disease (PD). The recently concluded multinational Parkinson's Real-World Impact Assessment (PRISM) trial revealed highly variable prescription patterns of LD monotherapy across six European countries. The reasons remain unclear. Methods: In this post hoc analysis of PRISM trial data, we used multivariate logistic regression analysis to identify socio-economic factors affecting prescription practice. We applied receiver-operated characteristics and split sample validation to test model accuracy to predict treatment class (LD monotherapy vs. all other treatments). Results: Subject age, disease duration, and country of residence were significant predictors of treatment class. The chance of receiving LD monotherapy increased by 6.9% per year of age. In contrast, longer disease duration reduced the likelihood of receiving LD monotherapy by 9.7% per year. Compared to the other countries, PD patients in Germany were 67.1% less likely and their counterparts in the UK 86.8% more likely to receive an LD monotherapy. The model classification accuracy of treatment class assignment was 80.1%. The area under the curve to predict treatment condition was 0.758 (95% CI [0.715, 0.802]). Split sample validation revealed poor sensitivity (36.6%), but excellent specificity (92.7%) to predict treatment class. Conclusion: The relative lack of socio-economic variables affecting prescription practice in the study sample and limited model accuracy to predict treatment class suggest the presence of additional, country-specific factors affecting prescription patterns that were not assessed in the PRISM trial. Our findings indicate that physicians still avoid prescribing LD monotherapy to younger PD patients. [ABSTRACT FROM AUTHOR]

Background: Prescription audit can be described as a tool to evaluate the quality of medical treatment which is being offered to the patients in any health care facility. It can prove to be helpful in devising any effective changes that would improve quality of care to the patients. Aims and Objective: The study was conducted to carry out prescription audit among the psychiatric patients seeking consultation in a tertiary care centre. Materials and Methods: This prospective observational study was conducted on 500 prescriptions for a time period of six months in the outpatient department of Institute of Mental Health and Neurosciences (MHANS). During the study all the prescriptions were collected and evaluated based on WHO prescribing indicators. Data was entered and analyzed using SPSS software version 16.0. Results: Five hundred prescriptions comprising of 1,260 drugs were analyzed. The average number of drugs per prescription was 2.8. There were 52.7% males and 47.3% females. Most patients (49%) were from the age group of 21-40 years. In majority of the cases (90.9%) more than one drug was prescribed and 4.6% (20) of medications were prescribed by generic names. The study revealed that Major Depression Disorder (MDD) was the most common psychiatric morbidity (40%). Clonazepam was the most common drug (19.6%) that was prescribed for the patients irrespective of the diagnosis. Conclusion: Prescription audit can be helpful to evaluate the existing prescription pattern of any health care facility and ensure the rational drug therapy as per WHO prescription parameters. [ABSTRACT FROM AUTHOR]

Objectives. Descriptive statistics were employed to determine the frequency and prevalence, and the results were presented using tables and figures.Results and Discussion: The average number of medications prescribed per encounter was 2.64, which is above the WHO standard. The percentage of encounters in which antibiotics and injections were prescribed was 80.20% and 99.2%, which exceeds the upper limit of WHO standard range (20– 26.8%) and (13.4– 24.1%), respectively. All medications were prescribed using generic names and were included in Eka Kotebe General Hospital's essential drug list, which is in line with WHO standards.Conclusion: The degree of polypharmacy and the prescription practices for antibiotics and injections at Eka Kotebe General Hospital deviated from the World Health Organization's standards. As a result, there is a need to enhance medical education programs to rationalize the prescription of antibiotics and injection use. [ABSTRACT FROM AUTHOR]

Background and Aims: To reduce death rates for critical patients hospitalized in intensive care units (ICUs), coronavirus (COVID‐19) lacks proven and efficient treatment methods. This cross‐sectional study aims to evaluate how physicians treat severe and suspected COVID‐19 patients in the ICU department in the absence of an established approach, as well as assess the rational use of the medication in the ICU department. Methods: Between June 16, 2021, and December 10, 2022, a total of 428 prescriptions were randomly gathered, including both suspected (yellow zone) and confirmed (red zone) COVID‐19 patients. For data management, Microsoft Excel 2021 was utilized, while STATA 17 provided statistical analysis. To find associations between patients' admission status and demographic details, exploratory and bivariate analyses were conducted. Results: Of the 428 patients admitted to the ICU, 228 (53.27%) were in the yellow zone and 200 (46.73%) were in the verified COVID‐19 red zone. The majority of patients were male (54.44%), and the age range from 41 to 60 was the most common (41.82%). No significant deviation was detected to the yellow and red groups' prescription patterns. A total of 4001 medicines (mean 9.35/patient) were prescribed. Antiulcerants, antibiotics, respiratory, analgesics, anticoagulants, vitamins and minerals, steroids, cardiovascular, antidiabetic drugs, antivirals, antihistamines, muscle relaxants, and antifungal treatments were widely prescribed drugs. Enoxaparin (67.06%) appeared as the most prescribed medicine, followed by montelukast (60.51%), paracetamol (58.41%), and dexamethasone (51.64%). Conclusion: The prescription patterns for the yellow and red groups were comparable and mostly included symptomatic treatment. Respiratory drugs constituted the most frequent therapeutic class. Polypharmacy should be taken under considerations. In ICU settings, the outcomes emphasize the need of correct diagnosis, cautious antibiotic usage, suitable therapy, and attentive monitoring. [ABSTRACT FROM AUTHOR]

Background: Patients with Type 2 Diabetes Mellitus (T2DM) are at a higher risk of polypharmacy and more susceptible to irrational prescriptions; therefore, pharmacological therapy patterns are important to be monitored. The primary objective of this study was to highlight current prescription patterns in T2DM patients and compare them with existing Standards of Medical Care in Diabetes. The second objective was to analyze whether age and gender affect prescription patterns. Method: This cross-sectional study was conducted using the Iran Health Insurance Organization (IHIO) prescription database. It was mined by an Association Rule Mining (ARM) technique, FP-Growth, in order to find co-prescribed drugs with anti-diabetic medications. The algorithm was implemented at different levels of the Anatomical Therapeutic Chemical (ATC) classification system, which assigns different codes to drugs based on their anatomy, pharmacological, therapeutic, and chemical properties to provide an in-depth analysis of co-prescription patterns. Results: Altogether, the prescriptions of 914,652 patients were analyzed, of whom 91,505 were found to have diabetes. According to our results, prescribing Lipid Modifying Agents (C10) (56.3%), Agents Acting on The Renin-Angiotensin System (C09) (48.9%), Antithrombotic Agents (B01) (35.7%), and Beta Blocking Agents (C07) (30.1%) were meaningfully associated with the prescription of Drugs Used in Diabetes. Our study also revealed that female diabetic patients have a higher lift for taking Thyroid Preparations, and the older the patients were, the more they were prone to take neuropathy-related medications. Additionally, the results suggest that there are gender differences in the association between aspirin and diabetes drugs, with the differences becoming less pronounced in old age. Conclusions: Almost all of the association rules found in this research were clinically meaningful, proving the potential of ARM for co-prescription pattern discovery. Moreover, implementing level-based ARM was effective in detecting difficult-to-spot rules. Additionally, the majority of drugs prescribed by physicians were consistent with the Standards of Medical Care in Diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Urolithiasis is a hard deposit of minerals and salts that form inside the kidney, ureter, and bladder in the urinary system. Kidney stones are a common disease of the urinary tract. Prevention of stones mainly depends on the mechanisms of the stone formation, daily water intake, and food habits. Aim and Objectives: A prospective observational study was conducted on risk factors, and prescription patterns in urolithiasis patients. Materials and Methods: The study was conducted from August 2022 to February 2023 in Khammam, Telangana. Men and women were included as a sample of subjects aged 18-60 years. The total number of samples was 200. Results: Urolithiasis was more commonly observed in males than females aged 18-60. Urolithiasis developed in individuals who consumed less water, frequently ate non-veg, and had a family history of calculi. Out of 200 patients, only 27 patients had complications like AKI, and abdominal pain and painful incomplete urination was the most reported symptoms. Conclusion: The prevalence, risk factors, and prescription pattern of urolithiasis were observed in this study. The Formation of Kidney stones may be due to diet, age progression, gender, obesity, genetics, and lifestyle factors. A better understanding of the epidemiology of urolithiasis is further essential to plan effective treatment and preventive strategies. [ABSTRACT FROM AUTHOR]

This study documented the prescribing patterns of methylphenidate and atomoxetine among patients aged 3 to 18 in Taiwan diagnosed with attention deficit hyperactivity disorder (ADHD) between 2004 and 2017. Initial treatment for ADHD, the time between the first diagnosis and the first prescription, and medication-switching patterns were investigated. The final cohort consisted of 256,882 patients, and 147,210 (57.3%) of them received medication treatment. Most of the patients (98.2%) received methylphenidate. Atomoxetine use increased from 0.1% in 2007 to 5.5% in 2017. The median time between the ADHD diagnosis and the first prescription was 21 days (IQR: 0–212 days). In patients who initiated methylphenidate, 12,406 (8.4%) patients switched to atomoxetine; 850 (31.3%) of the children began with atomoxetine and switched to methylphenidate. In conclusion, methylphenidate was the predominant treatment for ADHD in 2004–2017. However, the prevalence of pharmacotherapy for ADHD was relatively low. Further investigation on the reasons behind this pattern is recommended.

This article examines the prescription patterns of anti-asthmatic drugs for adults in an outpatient department of a tertiary care hospital in India. The study analyzed 500 prescriptions and found that the majority of patients were men (67%) and received combination therapy (85%) rather than monotherapy (15%). Beta 2 agonists, such as salbutamol, were the most commonly prescribed anti-asthmatic drugs (68%), followed by steroids (47%). The study also found that oral tablets were more commonly prescribed (76%) than inhalers (24%). The findings suggest a preference for beta 2 agonists over steroids and a higher use of oral administration, which may increase the risk of adverse drug reactions. [Extracted from the article]

Abstract Background and Aims To reduce death rates for critical patients hospitalized in intensive care units (ICUs), coronavirus (COVID‐19) lacks proven and efficient treatment methods. This cross‐sectional study aims to evaluate how physicians treat severe and suspected COVID‐19 patients in the ICU department in the absence of an established approach, as well as assess the rational use of the medication in the ICU department. Methods Between June 16, 2021, and December 10, 2022, a total of 428 prescriptions were randomly gathered, including both suspected (yellow zone) and confirmed (red zone) COVID‐19 patients. For data management, Microsoft Excel 2021 was utilized, while STATA 17 provided statistical analysis. To find associations between patients' admission status and demographic details, exploratory and bivariate analyses were conducted. Results Of the 428 patients admitted to the ICU, 228 (53.27%) were in the yellow zone and 200 (46.73%) were in the verified COVID‐19 red zone. The majority of patients were male (54.44%), and the age range from 41 to 60 was the most common (41.82%). No significant deviation was detected to the yellow and red groups' prescription patterns. A total of 4001 medicines (mean 9.35/patient) were prescribed. Antiulcerants, antibiotics, respiratory, analgesics, anticoagulants, vitamins and minerals, steroids, cardiovascular, antidiabetic drugs, antivirals, antihistamines, muscle relaxants, and antifungal treatments were widely prescribed drugs. Enoxaparin (67.06%) appeared as the most prescribed medicine, followed by montelukast (60.51%), paracetamol (58.41%), and dexamethasone (51.64%). Conclusion The prescription patterns for the yellow and red groups were comparable and mostly included symptomatic treatment. Respiratory drugs constituted the most frequent therapeutic class. Polypharmacy should be taken under considerations. In ICU settings, the outcomes emphasize the need of correct diagnosis, cautious antibiotic usage, suitable therapy, and attentive monitoring.

BackgroundsNon-vitamin K antagonist oral anticoagulants (NOACs) have been recommended as the first choice over warfarin for non-valvular atrial fibrillation (AF). However, there is limited data about their usage in mainland China.MethodsPrescriptions of patients diagnosed with AF and containing OACs were extracted from Hospital Prescription Cooperation Project from January 2016 to March 2021. The primary outcome was the changing percentage of different OACs. The secondary outcomes were frequencies as well as factors with the choice of different OACs and dosage of NOACs. Univariate and Multivariate logistic regressions were conducted to explore possible factors. All statistical analyses were performed using SAS software (Version 9.4).ResultsAmong the 220,083 distinct prescriptions diagnosed with AF and prescribed with OACs, the percentage of NOACs increased over years, exceeding warfarin in 2018. Until March 2021, 83.53% of included patients were prescribed with NOACs. Rivaroxaban (62.25%) and dabigatran (37.65%) were the most commonly prescribed NOACs. Low dosage was common for NOACs (44.54%), this was mainly driven by rivaroxaban, 67.98% of which were low dosage. Multivariate logistic regression indicated that several factors were positively associated with the preference of low dosage, including outpatients (OR 1.32, 95% CI 1.26–1.39), patients with hypertension (OR 1.49, 95% CI 1.40–1.58), acute coronary syndrome (OR 1.17, 95% CI 1.12–1.22), stroke (OR 1.42, 95% CI 1.33–1.52), and kidney disease (OR 1.63, 95% CI 1.34–1.97), as well as concomitantly using antiplatelet agents (OR 1.52, 95% CI 1.40–1.66), and steroids (OR 1.76, 95% CI 1.50–2.07). On the contrary, they were less common in health insurance holder (OR 0.79, 95% CI 0.75–0.84), patients taking apixaban (vs. rivaroxaban, OR 0.39, 95% CI 0.18–0.81), dabigatran (vs. rivaroxaban, OR 0.01, 95% CI 0.01–0.01), edoxaban (vs. rivaroxaban, OR 0.36, 95% CI 0.23–0.55), diagnosed with heart failure (OR 0.87, 95% CI 0.81–0.93), deep vein thrombosis (OR 0.36, 95% CI 0.29–0.46), pulmonary embolism (OR 0.35, 95% CI 0.28–0.43), and peripheral artery disease (OR 0.68, 95% CI 0.55–0.85).ConclusionThe usage of OACs for AF was overall complying with updated guidelines. Low dosage was common for NOACs, further studies were warranted to verify its effectiveness and explore the underlying mechanism.

Background: The COVID-19 pandemic, caused by the novel coronavirus 2 (SARS-CoV-2), has been associated with an increased risk of secondary bacterial infections. Numerous studies have reported a surge in antibiotic usage during the COVID-19 pandemic. This study aims to examine the impact of the COVID-19 pandemic on the frequency and patterns of antibiotic prescriptions at Primary Health Care Centers (PHCC) in Qatar, comparing the period before and during the pandemic. Methods: This population-based, cross-sectional study analyzed all antibiotic prescriptions issued in two-month intervals before COVID-19 (November and December 2019) and during the initial wave (June and July 2020) of COVID-19. The study included 27 PHCCs in Qatar. Results: Prior to the COVID-19 outbreak, the PHCCs dispensed a total of 74,909 antibiotic prescriptions in November and December. During the first wave of COVID-19, the number decreased to 29,273 prescriptions in June and July 2020. Antibiotics were most commonly prescribed for adults and least commonly for the elderly, both before and during the COVID-19 period. In the pre-COVID-19 period, Betalactams and macrolides accounted for the majority (73%) of all antibiotic prescriptions across all age groups. However, during the COVID-19 period, Betalactams and other antibiotics such as Nitrofurantoin and Metronidazole (73%) were the most frequently prescribed. Conclusion: The rate of antibiotic prescriptions during the first wave of COVID-19 was lower compared to the two months preceding the pandemic at the PHCC in Qatar. [ABSTRACT FROM AUTHOR]

Abstract Background Irrational prescription has a lion share for uncontrolled blood pressure. There is no study assessing prescription pattern among hypertensive patients at the study sites. Therefore, the objective of the current study was to evaluate prescription patterns for hypertension and blood pressure (BP) control at randomly selected hospitals of South Gondar Zone. Methods A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021. Hypertensive patients were selected by systematic random sampling proportionally from study hospitals. Structured questionnaires were used to collect socio-demographic chacteristics and adherence. Data abstraction form was used to collect prescription patterns, BP level and other necessary information. The association of prescription patterns and other variables with blood pressure control was determined by using binary logistic regression. Results All recruited 423 patients were included in data analysis. Among prescriptions for hypertension, on average 93.5% were found to be in line with WHO guideline. About 53% of prescriptions for hypertension were monotherapies. Patient level low medication regimen complexity, and monotherapy were associated with blood pressure control (Ajusted Odds Ratio [AOR] = 2.04, [1.07–3.91]; AOR = 3.83 [1.42–10.35], respectively). Patients with inappropriate drug selection, and non-adherence were less likely to have controlled BP (AOR = 0.47 [0.26–0.85]; AOR = 0.52 [0.34–0.85], respectively). Moreover, patients who didn’t have health insurance and follow regular aerobic exercise were less likely to have controlled BP (AOR = 0.42 [0.26–0.68]; AOR = 0.53 [0.32–0.88], respectively). Conclusion Diuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Patient level low medication regimen complexity and monotherapy were positively associated with BP control whereas, non-adherence, inappropriate drug selection, having no health insurance, and didn’t follow regular aerobic exercise were negatively associated with BP control. Clinicians should be adherent to treatment guidelines and focus on modifiable factors to improve BP control.

Aim: To evaluate treatment patterns of novel therapies (inotuzumab ozogamicin (inotuzumab), blinatumomab, and tisagenlecleucel) in patients with acute lymphoblastic leukemia (ALL) in a Japanese real-world setting. Patients & Methods: Patients with ALL diagnoses from a Japanese claims database were examined. Results: We included 194 patients (97 patients were prescribed inotuzumab; 97 patients were prescribed blinatumomab; and no patient was prescribed tisagenlecleucel); 81.4% in the inotuzumab group and 78.4% in the blinatumomab group were prescribed chemotherapy prior to the initiation of those drugs. Most patients were prescribed subsequent treatment (60.8 and 58.8%, respectively). A small number of patients were prescribed sequential treatment of inotuzumab-to-blinatumomab or blinatumomab-to-inotuzumab (20.3 and 10.5%, respectively). Conclusion: This study revealed inotuzumab and blinatumomab treatment features in Japan. In acute lymphoblastic leukemia (ALL), the increase in leukemic cells prevents the production of normal blood cells. As a result, people with ALL become more susceptible to anemia, fatigue, infections, fever, bruising and bleeding easily. ALL progresses rapidly without treatment. In recent years, new therapeutic drugs, including inotuzumab and blinatumomab, have become available; however, it remains unclear how they have been used in clinical practice. In this report, we assess how they are used in clinical practice using a large database to collect the clinical data of ALL patients. To see the treatment pattern, we found that most of the patients (81.4% of patients who received inotuzumab and 78.4% of those who received blinatumomab) had received chemotherapy before starting treatment with inotuzumab or blinatumomab. After patients ended treatment with inotuzumab or blinatumomab, 60.8% of patients who received inotuzumab and 58.8% of those who received blinatumomab received the next therapies, including chemotherapy. However, a small number of patients had received inotuzumab-to-blinatumomab or blinatumomab-to-inotuzumab (20.3 and 10.5%, respectively). These findings show the real-world treatment patterns of inotuzumab and blinatumomab; that is, both inotuzumab and blinatumomab are more likely to be prescribed to patients who might not have enough efficacy from prior chemotherapy or might have had to stop chemotherapy early due to side effects. Overall, there is clinical meaningful information from our findings of how inotuzumab and blinatumomab have been used for treatment of ALL and this information could improve the clinical practice of ALL in Japan. [ABSTRACT FROM AUTHOR]

This study documented the prescribing patterns of methylphenidate and atomoxetine among patients aged 3 to 18 in Taiwan diagnosed with attention deficit hyperactivity disorder (ADHD) between 2004 and 2017. Initial treatment for ADHD, the time between the first diagnosis and the first prescription, and medication-switching patterns were investigated. The final cohort consisted of 256,882 patients, and 147,210 (57.3%) of them received medication treatment. Most of the patients (98.2%) received methylphenidate. Atomoxetine use increased from 0.1% in 2007 to 5.5% in 2017. The median time between the ADHD diagnosis and the first prescription was 21 days (IQR: 0–212 days). In patients who initiated methylphenidate, 12,406 (8.4%) patients switched to atomoxetine; 850 (31.3%) of the children began with atomoxetine and switched to methylphenidate. In conclusion, methylphenidate was the predominant treatment for ADHD in 2004–2017. However, the prevalence of pharmacotherapy for ADHD was relatively low. Further investigation on the reasons behind this pattern is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Acetylcholinesterase inhibitors (AChEIs) and memantine are currently the only anti-dementia drugs (ADDs) approved for treating Alzheimer's disease (AD) in Italy. This nationwide study aims to characterize dementia drug utilization in a population > 65 years, during 2018–2020. Methods: Different administrative healthcare databases were queried to collect both aggregate and individual data. Results: ADD consumption remained stable throughout the study period (~ 9 DDD/1000 inhabitants per day). AChEI consumption was over 5 DDD/1000 inhabitants per day. Memantine consumption was nearly 4 DDD/1000 inhabitants per day, representing 40% of ADD consumption. The prevalence of use of memantine represented nearly half of ADD consumption, substantially unchanged over the 3 years. Comparing the AD prevalence with the prevalence of ADDs use, the gap becomes wider as age increases. In 2019, the proportion of private purchases of ADDs was 38%, mostly represented by donepezil and rivastigmine. In 2020, memantine was the only ADD with an increase in consumption (Δ% 19–20, 1.3%). Discussion: To our knowledge, this study represents the first attempt to investigate the ADD prescription pattern in Italy with a Public Health approach. In 2019, the proportion of ADD private purchases point out several issues concerning the reimbursability of ADDs. From a regulatory perspective, ADDs can be reimbursed by the National Health System only to patients diagnosed with AD; therefore, the off-label use of ADDs in patients with mild cognitive impairment may partially explain this phenomenon. The study extends knowledge on the use of ADDs, providing comparisons with studies from other countries that investigate the prescription pattern of ADDs. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease that affect patients' social, emotional, and physical well-being. In most Western countries, the prevalence of RA is approximately 0.5- 1%, affecting more females than males, the prevalence of RA in India is approximately 0.75% and increasing trend has been noticed. Aims and Objectives : This observational cross-sectional study was designed to study the prescription patterns in Rheumatoid arthritis patients in Indian adult population in orthopeadic outpatient department in a tertiary care teaching hospital. Materials and Methods: This study was conducted over the span of 1 year,where 100 patients were enrolled in study following the inclusion and exclusion criteria after taking informed consent. All the demographic data and complete prescription of rheumatoid arthritis were collected on predesigned semi structured proforma to evaluate the prescription pattern . The collected prescriptions were analyzed by using WHO drug use indicators. Results: Total of 100 prescriptions was analyzed. 77 (77%) were females and 23(23%) were males. Most commonly presenting age group was 31-45 years 46 (46%). Family history and RA factor was positive in 25 (25%) and 80 (80%) patients respectively. Anti-ccp was raised in 87 (87%) patients. The comorbid conditions were OA 13(13%) type-2 diabetes mellitus 8 (8%), hypertension 8 (8%), GERD 9 (9%) . Total of 446 drugs were prescribed during the study period. The prescribed drugs were disease modifying anti-rheumatic drugs (DMARDs) 145 (32.51%), vitamin-D3 and calcium supplements 104 (23.32%), analgesics 56 (12.56%), antacids 58 (13%), others 69(15.47%). Monotherapy with one DMARD 55 (37.9%) or as dual drug therapy i.e two DMARDS therapy 45(31.03%) was prescribed in prescriptions. 4.46 drugs per prescription, 422 (94.62%) drugs by generic names and 88.79% drugs were prescribed from the National List of Essential Medicine (NLEM) 2022. Conclusions: There is a requirement for data, which can help implement better strategy for regulation of the prescription of DMARDs at all levels. More studies will help articulate guidelines for prescribing this group of drugs for rationally usage. [ABSTRACT FROM AUTHOR]

Antibiotics are choice of drugs in patients with respiratory infections. Irrational use of antibiotics is an important public health issue faced on daily basis by the community and the individual. Keeping this in consideration, the current study investigates the prescription pattern of antibiotics in lower respiratory tract infection in general population.The objectives of the study include prescription pattern analysis of antibiotics for LRTIs in general population and to evaluate adherence to antibiotic treatment. This was a hospital based prospective observational study conducted between November 2021 to April 2022 in the department of general medicine and pediatrics. Compliance to various antibiotics was scrutinized by using MMAS 4 scale. Patient demographics, laboratory details, prescribed antibiotics, duration of hospital stay were gathered over a period of 6 months.A total of 200 patients were involved in the study, out of which 53% were males and 47% were females. A total of 2127 drugs were prescribed in 200 patients (10.6 drugs/prescription). Ceftriaxone was the most commonly used antibiotic followed by azithromycin and piperacillin/tazobactam. The most frequently diagnosed disease was Bronchopneumonia (41%) followed by A/E COPD (28%). Evaluation of medication adherence resulted in 58% high and 11% poor adherence. The number of antibiotics prescribed was found to be rational but prevalence of polypharmacy should be prevented. Medication adherence decreases as the frequency of antibiotic increases, so it is recommended to lower the frequency of drugs as possible to enhance the compliance.

Aims And Objectives: To assess the completeness and rationality of prescriptions in District General Hospital, Botad using WHO core prescribing indicators and other parameters. Materials And Methods: An analysis of 145 prescriptions from Botad District General Hospital in Gujarat (June-August 2023) explored drug count, brand name usage, Fixed Dose Combinations (FDCs), drug sourcing, adherence to the National List of Essential Medicines (NLEM), antimicrobial prescriptions, injectable drugs usage, vitamins, iron supplements, and prescription completeness mainly using WHO's prescribing indicators. Results: The analysis revealed several key findings, including a high prevalence of polytherapy (95.86%), brand name usage (73.79%), and the use of Fixed Dose Combinations (44.9%), of which 90% were rational. Hospital supplies accounted for a significant portion of drug sourcing (98.15%). Antimicrobial prescriptions were frequent (39.31%), and injectable medications were prescribed judiciously (4.14%). Vitamins and iron supplements were commonly included (34.48%). Alarmingly, 84.14% of prescriptions lacked a formal diagnosis, and none were considered complete. Conclusions: Optimizing prescription practices, promoting generic prescriptions, evidence based antimicrobial usage, and accurate diagnosis documentation are essential for better healthcare delivery in this healthcare setting. [ABSTRACT FROM AUTHOR]

Background: Psychiatric morbidity is on the rise in the developing economy India. Little data is available for policy makers to develop guidelines for rational and cost effective prescription of psychotropic drugs. Aims and Objectives: The present study aims to analyze the prescription pattern of psychotropic drugs in a psychiatric Out Patient Department. Materials and Methods: This was a Hospital based prospective analysis of 100 Psychiatric OPD prescriptions. Consent was obtained prior enrollment. Pharmacological data along with clinical and demographical profile was collected and analyzed. Data was collected in MS Excel and presented as numbers and percentages in the form of tables and figures. Results: There was an equal gender distribution. Most of the patients belonged to the age group of 20-40 years(55%). Depression(38%) was the most common diagnosis among all the prescriptions evaluated. The most commonly prescribed drugs were antidepressants(38%) followed by anxiolytics, antipsychotics and mood stabilizers. Conclusion: Prescribing pattern was in accordance with standard guidelines. This data gives a brief overview of the psychotropics prescription pattern in our demographic region. [ABSTRACT FROM AUTHOR]