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Introduction: Renal impairment is characterized by a progressive decline in glomerular filtration rate, a significant public health issue worldwide associated with high morbidity and mortality. In most cases, renal impairment is associated with comorbidities such as hypertension and diabetes, which require multiple drug therapy during a course of treatment, leading to polypharmacy. Objective: The objective of this study was to assess the prescribing pattern of drugs in renal-impaired patients at Dhiraj General Hospital. Materials and Methods: A total of 150 patients with renal impairment were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study conducted over 6 months in a tertiary care teaching hospital, directorate general of hydrocarbons. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Of the total 150 patients, 94 (63%) were male and 56 (37%) female. The highest numbers of patients were in the age group >60 years (59 patients, 39.3%). Anemia was the most common comorbidity (143 patients, 95%) observed, followed by hypertension (129 patients, 86%) and diabetes mellitus (64 patients, 43%). A total of 1693 drugs were prescribed to 150 renal-impaired patients. Each patient received an average of 11.19 ± 3.51 (8%) drugs. Polypharmacy was seen in all patients. Drugs acting on the cardiovascular system constituted the bulk of the prescriptions (25.87%), followed by gastrointestinal (GI) drugs (18.72%), vitamins and minerals (14.94%), and antibiotics (8.33%). Conclusion: There is polypharmacy in patients with renal impairment due to associated comorbidities. The prevalence of polypharmacy was high in patients with chronic kidney disease (CKD). Antihypertensive drugs, drugs used for the GI system, antibiotics, and antidiabetic drugs were frequently used in CKD patients.

Background: Chronic kidney disease (CKD), also known as chronic renal insufficiency, progressive kidney deterioration, or nephropathy, is an illness, in which the kidneys fail to function properly. When prescription and over-the-counter medications are combined, the risk of adverse drug reactions and interactions increases, which are the main causes of hospitalizations and mortality. The aims and strategies for reducing the incidence, morbidity, mortality, and health costs of CKD in India are outlined in this new chapter. Aim: A cross-sectional observational study to estimate the pattern of discharge prescription pattern in patients of CKD associated with hypertension and diabetes mellitus. Methodology: 100 patients with CKD and comorbidities of hypertension, diabetes, or both were included in observational cross-sectional research done at the Nephrology Department of Dhiraj Hospital. The laboratory findings, as well as their comorbidity, discharge prescription medicines, and comorbidity, were all documented and examined. Results: Calcium channel blockers (CCBs) were the most often recommended antihypertensive medication for hypertensive patients with CKD. Diuretics were the least often given class of antihypertensive medicine. In antidiabetic medication, class sulfonylurea and dipeptidyl peptidase-4 inhibitors had similar prescription rates which are the highest prescribing medication for diabetes mellitus with CKD. Biguanides were the least prescribed class of drugs. Conclusion: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers are widely used to treat hypertensive patients with CKD; but due to chances of arrhythmia, CCBs are prescribed. This research might aid in the identification of educational and quality-improvement opportunities to minimize medication-related errors and increase benefits in this population.

Background: In recent times, emphasis on pharmacovigilance (PV) is elevated due to increased cases of adverse drug reactions (ADRs) coming into notice. Psychotropic medications that are the mainstay of treating psychiatric patients are linked to various adverse drug reactions. The given study lays accentuation on determining the pattern of ADRs due to the use of antipsychotics and antidepressants. Objectives: In this study, we aim to determine the incidence of ADRs and their effect on the quality of life (QOL) of the patients after the ADR (s). Methodology: This is a prospective observational study of a total of 300 subjects receiving antipsychotics and/or antidepressants. They were screened for possible ADRs. Possible risk factors for the development of ADRs were also assessed. The difference in the pattern of ADRs in patients prescribed with Antidepressants (ADs) and/or Antipsychotics (APs) was observed. The average number of APs and/or ADs per prescription was calculated. The causality and severity assessment of the observed ADRs was done by the World Health Organization-Uppsala Monitoring Center (WHO-UMC) scale, Naranjo's algorithm, and Hartwig–Siegel scale, respectively. Lastly, the impact of ADRs on the QOL of the patients receiving APs and/or ADs was evaluated. Results: The prevalence of ADRs in patients receiving APs and/or ADs is 24.33%. Olanzapine is the most commonly prescribed AP while sertraline is the most commonly prescribed AD. Olanzapine and sertraline are responsible for the highest number of ADRs as AP and AD, respectively. Females are found to be at higher risk for developing ADRs. Multiple comorbidities and polypharmacy are also considered to be possible risk factors. The average number of APs and/or antidepressants per prescription is 1.94 drugs. APs are found to be responsible for a higher number of ADRs in comparison with ADs. The maximum number of ADRs falls into the possible criteria of causality assessment by the WHO-UMC scale and Naranjo's algorithm. All the observed ADRs fall into the mild and moderate category of severity by the Hartwig–Siegel scale. The ADRs have a significant impact on the physical health and psychological domain of QOL assessment. Conclusion: The need for PV is highlighted by the results obtained in this study. Intense monitoring and increased awareness can help improve the rate of ADR (s) occurrence in patients receiving psychotropic medications. As a result, the impact of ADRs on the QOL of the patients can also be reduced.

Background: Several studies suggest that adverse drug reactions (ADRs) are commonly seen among hospitalized elderly and found common causes of hospital admission leading to substantial morbidity and mortality among elderly. However, no meta-analysis was conducted till date to estimate the overall incidence of ADRs among elderly. Objectives: To estimate the overall incidence of ADRs in elderly patients, incidence of ADRs in elderly in different health-care settings, incidence of serious ADRs in elderly patients, and the continent-wise incidence of ADRs in elderly patients. Design: Meta-analysis and systematic review. Methodology: Studies were identified through searching different databases such as MEDLINE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Key, and Scopus (published from 1980 to October, 2015) and by hand searching the reputed journals on geriatrics and gerontology and references of the included articles. Original peer-reviewed research articles published in English, defined ADRs according to the WHO's or similar definition and assessed the incidence of ADRs in elderly or having sufficient raw data to determine the incidence were included. Disease- or treatment-specific studies were excluded. Before meta-analysis, the studies were evaluated for heterogeneity using Chi-square and I2 statistics. The overall incidence of ADRs among the elderly with 95% confidence interval (CI) was determined using a random-effects model (DerSimonian and Laird method). Subgroup analyses were performed based on study settings and continent where the studies conducted. All the analyses were carried out using Review Manager (RevMan, version: 5.3) software. Results: Of the 5747 articles retrieved, only 56 and 54 articles were included for systematic review and meta-analysis, respectively. The overall incidence (95% CI) of ADRs among elderly population was 12.94%. The health-care setting-wise overall incidences of ADRs in the elderly were 17.53%, 19.54%, and 6.92% in inpatients, outpatients, and patients hospitalized due to ADRs, respectively. The continent-wise overall incidences of ADRs in elderly were 12.15%, 22.94%, 12.34%, and 18.76% in Asia, Australia, Europe, and USA, respectively. Electrolyte disorders and skin rashes were the common manifestations of the drugs. Cardiovascular drugs and NSAIDs were the most common causative drugs for the ADRs among elderly. Polypharmacy was the major risk factor for ADRs in elderly population, irrespective of the type of health-care settings and continents. Conclusions: The incidence of ADRs in the elderly was higher and is a significant health-care burden in the elderly. Appropriate prescribing, proper compliance, and monitoring for ADRs are needed to decrease the incidence of ADRs in elderly patients.

Objectives: This study was conducted to investigate the potential role of clinical pharmacists in monitoring and developing a reporting system of radiation-related adverse events (RRAEs) in cancer patients and provided suggestive measures to prevent RRAEs to achieve a better therapeutic outcome for improving patient health-related quality of life. Methodology: This study was a prospective observational study conducted for a period of 2 years at a private academic oncology teaching care hospital. Patients on radiation therapy or chemoradiation therapy were enrolled and followed by clinical pharmacists on daily basis to identify adverse event(s) if any. Upon identification, adverse events were discussed with concerned radiation oncologists for authentication and graded as defined by the radiation therapy oncology group. Enrolled patients were also followed to ensure if they were provided adequate supportive care for RRAEs. Results: A total of 715 patients were followed during the study period. A total of 422 RRAEs were identified in patients who were on radiation therapy or chemoradiation therapy. The most common reported events were fatigue (n = 64, 15.16%), followed by mucositis (n = 55, 13.03%), diarrhea (n = 37, 8.76%), vomiting (n = 31, 7.34%), gastritis (n = 29, 6.87%), and dryness of the mouth (n = 22, 5.21%). Among the study patients who developed RRAEs, majority (n = 253, 60%) of them received a combination of chemotherapy and radiation therapy and 169 (40%) of 442 patients received radiotherapy alone. Cisplatin weekly monotherapy or cisplatin-based chemotherapy was commonly used pharmacological treatment in patients on chemoradiation therapy. Clinical pharmacists intervened to initiate adequate supportive care for nearly 20% (n = 84) patients. Conclusions: Clinical pharmacists may be contributing to monitoring and development of reporting systems for radiation-related toxicities/RRAEs in cancer patients. Teamwork of clinical pharmacists with radiation oncologists can improve the safety reporting of radiation and can ensure required medical and supportive care to manage RRAEs. [ABSTRACT FROM AUTHOR]

Background: Ureteric stones, characterized by the crystallization of mineral particles in stagnant urine, cause considerable discomfort and pain. Alpha-blockers are employed in the management of ureteric stones to alleviate symptoms by dilating the ureter and facilitating stone passage. Alpha-blockers have proven to be effective in improving the clinical outcomes of patients with ureteric stones, with Silodosin, Alfuzosin, and Tamsulosin emerging as promising options. Aim and Objectives: This study aims to evaluate the effectiveness and safety of Silodosin, Alfuzosin, and Tamsulosin in treating ureteric stones. It assesses their performance in patients at a Tertiary Care Hospital, aiming to identify the most suitable alpha-blocker for optimum outcomes. Materials and Methods: The study involved 60 patients with ureteral stones treated at the Urology Department of Dhiraj Hospital. Patients' responses to a structured questionnaire assessing variables related to ureteric stone development were collected. Physical examinations, along with radiological confirmation through X-ray, Ultrasound (USG), and CT-scan, were conducted. A 15-day follow-up assessed the efficacy of alpha-blockers. Statistical analysis and paired t-tests were employed to compare the drugs' effectiveness. Results: Silodosin demonstrated the highest stone expulsion rate at 95%, whereas Tamsulosin exhibited a 50% rate, and Alfuzosin recorded a 10% rate. Minimal side effects were observed, such as nausea, vomiting, and diarrhea, which were typical for patients with ureteric stones. Conclusion: Silodosin emerged as the most effective alpha blocker for promoting stone expulsion and ameliorating ureteric stone symptoms when compared to Tamsulosin and Alfuzosin. It is considered a pharmacologically superior choice for patients with ureteric stones, making it a valuable option in clinical practice. [ABSTRACT FROM AUTHOR]

Background: This observational, prospective cross-sectional study aimed to assess the safety and efficacy of metoprolol and bisoprolol in the treatment of Coronary Artery Disease (CAD) patients. Materials and Methods: The study received institutional ethics approval and was conducted at a tertiary care private teaching hospital over six months. Ninety CAD patients were included, with demographics and clinical characteristics recorded. Vital signs were measured at baseline, 48 hr, 7 days, and 1 month. Angina severity was assessed using the Canadian Cardiovascular Society Grading Scale and New York Heart Association classification. Statistical analysis compared outcomes between metoprolol and bisoprolol groups. Results: Male patients (72.22%) received metoprolol more frequently, while bisoprolol was preferred among females (28.88%). Age had minimal influence on medication choice. Metoprolol-treated patients had higher Left Ventricular Ejection Fraction (LVEF) values (50.26%) compared to bisoprolol-treated patients (45.78%). Regional Wall Motion Abnormalities (RWMA) was similar between groups. Both medications effectively reduced hypertension severity and vital parameters, with significant reductions in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Heart Rate (HR) with metoprolol. The prevalence of chest pain decreased in both groups, with Class III patients achieving complete relief. Breathlessness symptoms improved overall, with some patients experiencing relief while others showed reduced symptoms. Side effects were low in both groups, but metoprolol had a slightly higher incidence. Conclusion: Metoprolol and bisoprolol demonstrated safety and efficacy in managing CAD patients. Metoprolol showed advantages in LVEF improvement and greater reduction in SBP, DBP, and HR, but it had a slightly higher side effect incidence. Both medications effectively alleviated chest pain and breathlessness symptoms. This study provides valuable insights into the clinical characteristics and outcomes associated with metoprolol and bisoprolol in CAD patients, supporting their use in managing cardiac symptoms and hypertension. [ABSTRACT FROM AUTHOR]

Acquired Immunodeficiency Syndrome (AIDS) is a sexually transmitted disease that can be passed from partner to partner, mother to child, or through blood exchange using infected syringes. AIDS symptoms might vary depending on characteristics such as age, gender, and physical activity. Headaches, muscle and joint discomfort, rashes, diarrhoea, weight loss, coughing, night sweats, sore throat, stomatitis, swollen lymph nodes, malaise, oral yeast infections, shingles (herpes zoster), and lung infections are all common symptoms. The Food and medication Administration (FDA) of the United States authorised Lenacapavir, a novel AIDS therapy medication, in 2022. Lenacapavir is a capsid inhibitor available in tablet and injection form that directly targets the Human Immunodeficiency Virus Type 1 (HIV-1) Capsid Protein. Various research and papers, like the Capella study, which assessed the safety and efficacy of subcutaneous Lenacapavir, were used to assess the safety and efficacy of Lenacapavir. The Calibrate study shed light on the absence of phenotypic resistance to Lenacapavir in HIV Gag cleavage site mutants and isolates resistant to existing medication classes. These studies also included data from a proof-of-concept clinical research on HIV patients examining phenotypic resistance to Lenacapavir and its efficacy as a monotherapy. The approval of Lenacapavir represents a viable new therapy option for those living with HIV. Its method of action, as well as promising safety and efficacy results from numerous studies, offer hope for better outcomes in the treatment of this severe disease. [ABSTRACT FROM AUTHOR]

Introduction: Renal impairment is characterized by a progressive decline in glomerular filtration rate, a significant public health issue worldwide associated with high morbidity and mortality. In most cases, renal impairment is associated with comorbidities such as hypertension and diabetes, which require multiple drug therapy during a course of treatment, leading to polypharmacy. Objective: The objective of this study was to assess the prescribing pattern of drugs in renal-impaired patients at Dhiraj General Hospital. Materials and Methods: A total of 150 patients with renal impairment were finally recruited after strictly obeying the selection criteria in this cross-sectional, observational study conducted over 6 months in a tertiary care teaching hospital, directorate general of hydrocarbons. Relevant data were extracted by interviewing the patients and from prescriptions, case records, and investigational reports. Results: Of the total 150 patients, 94 (63%) were male and 56 (37%) female. The highest numbers of patients were in the age group >60 years (59 patients, 39.3%). Anemia was the most common comorbidity (143 patients, 95%) observed, followed by hypertension (129 patients, 86%) and diabetes mellitus (64 patients, 43%). A total of 1693 drugs were prescribed to 150 renal-impaired patients. Each patient received an average of 11.19 ± 3.51 (8%) drugs. Polypharmacy was seen in all patients. Drugs acting on the cardiovascular system constituted the bulk of the prescriptions (25.87%), followed by gastrointestinal (GI) drugs (18.72%), vitamins and minerals (14.94%), and antibiotics (8.33%). Conclusion: There is polypharmacy in patients with renal impairment due to associated comorbidities. The prevalence of polypharmacy was high in patients with chronic kidney disease (CKD). Antihypertensive drugs, drugs used for the GI system, antibiotics, and antidiabetic drugs were frequently used in CKD patients. [ABSTRACT FROM AUTHOR]

Aim/Background: The Cytochrome P450 (CYP) enzyme family, consisting of 57 distinct genes, plays a pivotal role in various biological processes. These genes encode enzymes with multifaceted functions, impacting vital processes like arachidonic acid metabolism, xenobiotic detoxification, eicosanoids production, and drug metabolism. Moreover, CYP enzymes are indispensable for the synthesis of bile acids, steroids, and numerous metabolic pathways. They also participate in the hydroxylation of retinoic acid, illustrating their remarkable versatility. While some CYP enzymes still have undiscovered functions, their role continues to captivate researchers across diverse domains. Additionally, mutations in CYP genes can give rise to inborn metabolic disorders, leading to clinically significant diseases, underscoring the importance of CYP enzymes in maintaining metabolic equilibrium and overall well-being. Beyond their initial association with hepatic drug detoxification, recent research has unveiled a broader spectrum of enzymatic processes undertaken by cytochrome P450. The complexity of CYP enzymes is progressively unfolding, emphasizing their clinical significance and opening new avenues for drug development, precision medicine, and patient care. methodology: This abstract presents a comprehensive overview of the literature on cytochrome P450 enzymes and their diverse functions. The information was gathered from a wide range of sources, including scientific articles, textbooks, and research publications. The analysis covers the genetic basis of CYP enzymes, their roles in various metabolic pathways, and the clinical implications of CYP gene mutations. Additionally, the abstract highlights the recent advances in our understanding of CYP enzymes and their expanding role in maintaining human life. Results: The results of this study showcase the remarkable diversity of functions performed by cytochrome P450 enzymes. They are intricately involved in processes critical to human health, ranging from drug metabolism to the synthesis of vital biomolecules. The study underlines the clinical significance of CYP enzymes, as mutations in these genes can lead to severe metabolic disorders and diseases. Furthermore, it emphasizes the evolving understanding of CYP enzyme complexity and its implications for drug development, precision medicine, and patient care. Conclusion: In conclusion, this abstract sheds light on the exceptional versatility and clinical importance of cytochrome P450 enzymes. Their diverse functions have far-reaching consequences for human health, making them a focal point of research in pharmacology and medicine. The evolving understanding of CYP enzyme complexity paves the way for future advancements in drug development and personalized patient care, offering new possibilities for enhancing the well-being of individuals and populations. This research underscores the significance of CYP enzymes and their potential to revolutionize the fields of medicine and pharmacology. [ABSTRACT FROM AUTHOR]

Background: Acute Kidney Injury (AKI) is a common condition and can happen due to drugs like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and which can be reversible by discontinuing NSAIDs. This research aims to examine the risk factors and occurrence of AKI in individuals using NSAIDs, while also investigating the potential correlations between AKI and conditions such as hypertension, gout, and emergency medical situations. Materials and Methods: A comprehensive total of 125 patients were included based on specific criteria, encompassing both inclusion and exclusion parameters. The medical histories of these patients were meticulously reviewed, with relevant data duly documented, and concludingly subjected to statistical examination. Results: Among the 125 patients studied, 10 individuals were diagnosed with AKI, resulting in an incidence rate of 8%. Notably, 80% of these AKI cases were observed in the older age group (45-65 years), with 60% being male and 40% female, indicating a higher risk in male patients. Additionally, 40% of the AKI patients had a pre-existing condition of hypertension, which posed a higher susceptibility to AKI development. The diagnosis of AKI was based on laboratory parameter changes, particularly serum creatinine levels, and adhered to the KDIGO scale (Kidney Disease Improving Global Outcomes). Conclusion: Following the examination of NSAID users, it was concluded that the elderly population and individuals with a history of hypertension face the highest risk of developing AKI, leading to elevated serum creatinine levels. Additionally, male patients exhibited a higher frequency of AKI compared to their female counterparts. Notably, a significant number of patients were found to have taken Diclofenac for an extended duration, which correlated with increased serum creatinine levels and a potential link to AKI development. Consequently, Diclofenac usage warrants consideration as a drug that may contribute to the onset of AKI. [ABSTRACT FROM AUTHOR]

This novel approach recognizes that healthcare is not a one-size-fits-all endeavor and aims to tailor treatment plans and interventions according to gender and sex. Many people are aware that certain diseases and diagnoses are exclusive to one sex such as ovarian or prostate cancer. While that's true, there are health care issues that affect both sexes but receive different treatment, sometimes radically so. However, there are many subtle and distinct differences in anatomy, physiology, and metabolism in body parts shared with men. Women's hearts, brains, and hormones react differently to diagnostic tests, medications, and other treatments compared to men. The term "Bikini Medicine" describes a cutting-edge method of healthcare delivery that emphasizes tailored and comprehensive care while encouraging patient autonomy and empowerment. This phrase, which takes its name from the well-known bikini, emphasizes the value of embracing uniqueness, self-assurance, and self-expression in the medical community. Women do have diseases, disorders, and diagnoses that are specifically related to female organs like their breasts, ovaries, and uterus. Women's health is not simply the bits that are covered by a bikini. By creating ideas and methods designed to give individuals a more active say in revolutionizing women's healthcare. Even though legislation calls for more females to be included in rigorous pharmaceutical, scientific, and medical device studies, there still are not enough females represented. These differences may cause disability, deformity, and even death for some women. Health forms routinely ask for sex and/or gender right next to the name, birthday, and address. Both sex and gender have an impact on healthcare access and treatment. This approach may involve incorporating complementary and alternative therapies, addressing lifestyle factors, and considering social determinants of the traditional healthcare landscape leading to improved women patient outcomes and satisfaction. [ABSTRACT FROM AUTHOR]

Background: In recent times, emphasis on pharmacovigilance (PV) is elevated due to increased cases of adverse drug reactions (ADRs) coming into notice. Psychotropic medications that are the mainstay of treating psychiatric patients are linked to various adverse drug reactions. The given study lays accentuation on determining the pattern of ADRs due to the use of antipsychotics and antidepressants. Objectives: In this study, we aim to determine the incidence of ADRs and their effect on the quality of life (QOL) of the patients after the ADR (s). Methodology: This is a prospective observational study of a total of 300 subjects receiving antipsychotics and/or antidepressants. They were screened for possible ADRs. Possible risk factors for the development of ADRs were also assessed. The difference in the pattern of ADRs in patients prescribed with Antidepressants (ADs) and/or Antipsychotics (APs) was observed. The average number of APs and/or ADs per prescription was calculated. The causality and severity assessment of the observed ADRs was done by the World Health Organization-Uppsala Monitoring Center (WHO-UMC) scale, Naranjo's algorithm, and Hartwig–Siegel scale, respectively. Lastly, the impact of ADRs on the QOL of the patients receiving APs and/or ADs was evaluated. Results: The prevalence of ADRs in patients receiving APs and/or ADs is 24.33%. Olanzapine is the most commonly prescribed AP while sertraline is the most commonly prescribed AD. Olanzapine and sertraline are responsible for the highest number of ADRs as AP and AD, respectively. Females are found to be at higher risk for developing ADRs. Multiple comorbidities and polypharmacy are also considered to be possible risk factors. The average number of APs and/or antidepressants per prescription is 1.94 drugs. APs are found to be responsible for a higher number of ADRs in comparison with ADs. The maximum number of ADRs falls into the possible criteria of causality assessment by the WHO-UMC scale and Naranjo's algorithm. All the observed ADRs fall into the mild and moderate category of severity by the Hartwig–Siegel scale. The ADRs have a significant impact on the physical health and psychological domain of QOL assessment. Conclusion: The need for PV is highlighted by the results obtained in this study. Intense monitoring and increased awareness can help improve the rate of ADR (s) occurrence in patients receiving psychotropic medications. As a result, the impact of ADRs on the QOL of the patients can also be reduced. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD), also known as chronic renal insufficiency, progressive kidney deterioration, or nephropathy, is an illness, in which the kidneys fail to function properly. When prescription and over-the-counter medications are combined, the risk of adverse drug reactions and interactions increases, which are the main causes of hospitalizations and mortality. The aims and strategies for reducing the incidence, morbidity, mortality, and health costs of CKD in India are outlined in this new chapter. Aim: A cross-sectional observational study to estimate the pattern of discharge prescription pattern in patients of CKD associated with hypertension and diabetes mellitus. Methodology: 100 patients with CKD and comorbidities of hypertension, diabetes, or both were included in observational cross-sectional research done at the Nephrology Department of Dhiraj Hospital. The laboratory findings, as well as their comorbidity, discharge prescription medicines, and comorbidity, were all documented and examined. Results: Calcium channel blockers (CCBs) were the most often recommended antihypertensive medication for hypertensive patients with CKD. Diuretics were the least often given class of antihypertensive medicine. In antidiabetic medication, class sulfonylurea and dipeptidyl peptidase-4 inhibitors had similar prescription rates which are the highest prescribing medication for diabetes mellitus with CKD. Biguanides were the least prescribed class of drugs. Conclusion: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers are widely used to treat hypertensive patients with CKD; but due to chances of arrhythmia, CCBs are prescribed. This research might aid in the identification of educational and quality-improvement opportunities to minimize medication-related errors and increase benefits in this population. [ABSTRACT FROM AUTHOR]

Background: In hospitalized patients who are elderly and frequently have multiple comorbidities, anemia is very prevalent. The two types of anemia that are most common are iron deficiency anemia and chronic illness anemia. To assess the frequency and causes of different types of anemia in hospitalized patients using a diagnostic parameter. Materials and Methods: According to the inclusion and exclusion parameters, a total of 111 patients were enrolled. Information was gathered from the patient's medical documents after they were examined. Statistical analysis was done. Results: Anemia was most frequently seen in people between the ages of 31 and 45, with 22.03% of men and 40.38% of women, and a mean age of 37.24. years. Of these, 56.75% had anemia of mild severity. It was also found that patients with chronic kidney disease and iron deficiency are the most common causes of anemia, respectively. Anemia due to chronic disease was more prevalent (30.63%), followed by iron deficiency anemia in 27.92%. Malaise (48.64%) and pallor (36.03%) were the most prevalent symptoms and signs, respectively. Conclusion: In hospitalized patients, anemia played a significant role in deciding mortality, morbidity, and outcomes. Early detection, haemoglobin level restoration, and maintenance in these individuals may have a substantial impact on the clinical improvement of various pathological conditions. [ABSTRACT FROM AUTHOR]

Tolosa-Hunt Syndrome is an uncommon condition characterized by painful ophthalmoplegia affecting the third, fourth, and/or sixth cranial nerves, which is caused by an unknown etiology of non-specific inflammation in the cavernous sinus or superior orbital fissure. a 60-year-old diabetic male patient who recovered from covid-19, 15 days before, came with complain of sharp and intense unilateral headache, ptosis, ophthalmoplegia and loss of vision in right eye in the past 10 days diagnosed with Tolosa-Hunt Syndrome was presented. He was suffering from a right-sided headache, periorbital pain, and double vision. Right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the ocular division of the trigeminal nerve were discovered during the examination. The optic nerve and lateral rectus muscle revealed abnormal signal intensity variations on magnetic resonance imaging showed the minimal proptosis noted on the right side with mild edema in the right periorbital soft tissues and small enhancing soft tissue in the right cavernous sinus region which suggested the possibility of Tolosa Hunt Syndrome of the head and orbit. Pain and ptosis were greatly reduced after 72 hours of steroid treatment. Tolosa-Hunt Syndrome is an exclusionary diagnosis with a clinical presentation, normal tests, and magnetic resonance imaging. Recurrent unilateral orbital pain, ipsilateral oculomotor paralysis, and a quick reaction to steroids characterize Tolosa-Hunt syndrome, a severe ophthalmoplegia Treated with intravenous methyl prednisolone (40 mg) once a day with other supportive care therapy. Yet, there was no reversal of vision loss and ptosis. However, the headache subsided and the patient was discharged after 7 days. In Vadodara, Gujarat, India this is most likely the first occurrence and reported case of Tolosa-Hunt syndrome. [ABSTRACT FROM AUTHOR]

Objectives: The present study was focused on assessing the clinical characteristics which include the symptom profile, triggering factors, prescription pattern, headache-related disability, and its impact on patients' HRQoL. Methods: A cross-sectional observational study was conducted from October 2019 to March 2020 at the Department of Neurology, Dhiraj General Hospital-Vadodara. The data was collected from the prescription prescribed by the respective neurologist and by filling a pre designed questionnaire. All patients who met the inclusion criteria enrolled in a study. Results: In this study, the incidence of migraine is higher in females (78%), than males (23%). The majority of patients were having a severe disability and severe impact on HRQoL with high MIDAS (Migraine Disability Assessment Scale) and HIT-6 (Headache Impact Test-6) scores in opposing MSQoL v2.1 [Migraine Specific Quality of Life (Version 2.1)] where the majority of patients gained less score showing poor quality of life. A higher MIDAS score was observed in chronic migraineurs than episodic migraineurs (32.42 ±18.65 and 30.15 ±18.93) while HIT-6 showed a comparable score (63.98 ±6 and 63.38 ±6.29). Unlike MIDAS and HIT-6, MSQoL v2.1 showed less scores in chronic migraineurs than episodic migraineurs (45.66 ±22.59 and 48.82 ±23.77) which depicts that chronic migraineurs had a poor health-related quality of life than the episodic migraineurs. Conclusion: To conclude, healthcare professionals routinely evaluate the quality of life and related disability to determine whether patients are receiving effective treatment and whether any additional treatment strategies are warranted to enhance QOL. [ABSTRACT FROM AUTHOR]

Background: Nowadays, brand-name drugs are becoming an out-of-pocket expense which comprises 80% of total health-care expenditures. However, generic drugs are less expensive than brand-name drugs with the same therapeutic effect, but many doctors hold negative views of generics and resist prescribing. This study was designed to assess the knowledge, attitude, and practice of doctors toward generic medicines. Methods: This was a questionnaire-based cross-sectional study conducted in a multispecialty private hospital. The study participants were doctors who were practising in a hospital during the study period (January 2017 to July 2017). The questionnaire comprises 35 questions related to demographics, knowledge, attitude, and practice evaluation of generic medicines. Descriptive statistics was applied to represent participant characteristics and response rates. Results: A total of 86 questionnaires were distributed to the doctors and the response rate was 37%. The majority of doctors who participated in this survey perceived that generic medicine is effective, safe, and has same active component, dose, and bioequivalent as the brand medicines. Majority of the doctors (72%) believe that generic drugs were manufactured by poor techniques. However, more than three-quarter of doctors (78%) routinely prescribed generic drugs. Conclusion: Most of the doctors had an honest angle about the efficacy and safety of generic medicine. However, a high proportion of physicians believe that the generic drugs are of poorer quality. To have a better understanding of the generic drug, the doctor must be well informed about the generics products during their academic career that will significantly impact health-care budgets. [ABSTRACT FROM AUTHOR]

Background: Several studies suggest that adverse drug reactions (ADRs) are commonly seen among hospitalized elderly and found common causes of hospital admission leading to substantial morbidity and mortality among elderly. However, no meta‑analysis was conducted till date to estimate the overall incidence of ADRs among elderly. Objectives: To estimate the overall incidence of ADRs in elderly patients, incidence of ADRs in elderly in different health‑care settings, incidence of serious ADRs in elderly patients, and the continent‑wise incidence of ADRs in elderly patients. Design: Meta‑analysis and systematic review. Methodology: Studies were identified through searching different databases such as MEDLINE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Key, and Scopus (published from 1980 to October, 2015) and by hand searching the reputed journals on geriatrics and gerontology and references of the included articles. Original peer‑reviewed research articles published in English, defined ADRs according to the WHO’s or similar definition and assessed the incidence of ADRs in elderly or having sufficient raw data to determine the incidence were included. Disease‑ or treatment‑specific studies were excluded. Before meta‑analysis, the studies were evaluated for heterogeneity using Chi‑square and I2 statistics. The overall incidence of ADRs among the elderly with 95% confidence interval (CI) was determined using a random‑effects model (DerSimonian and Laird method). Subgroup analyses were performed based on study settings and continent where the studies conducted. All the analyses were carried out using Review Manager (RevMan, version: 5.3) software. Results: Of the 5747 articles retrieved, only 56 and 54 articles were included for systematic review and meta‑analysis, respectively. The overall incidence (95% CI) of ADRs among elderly population was 12.94%. The health‑care setting‑wise overall incidences of ADRs in the elderly were 17.53%, 19.54%, and 6.92% in inpatients, outpatients, and patients hospitalized due to ADRs, respectively. The continent‑wise overall incidences of ADRs in elderly were 12.15%, 22.94%, 12.34%, and 18.76% in Asia, Australia, Europe, and USA, respectively. Electrolyte disorders and skin rashes were the common manifestations of the drugs. Cardiovascular drugs and NSAIDs were the most common causative drugs for the ADRs among elderly. Polypharmacy was the major risk factor for ADRs in elderly population, irrespective of the type of health‑care settings and continents. Conclusions: The incidence of ADRs in the elderly was higher and is a significant health‑care burden in the elderly. Appropriate prescribing, proper compliance, and monitoring for ADRs are needed to decrease the incidence of ADRs in elderly patients. [ABSTRACT FROM AUTHOR]

A West syndrome (WS) also known as infantile spasm is a severe epilepsy syndrome. The rate of infantile spasm is approximately 2.5-6.0 cases per 10,000 live births. Its prevalence rate is 1.5-2.0 cases per 10,000 children aged 10 years or younger. This case provides insight into the west syndrome in a view to catch the viewer's attention to this rare life-threatening disease. Clinical details includes in this case study are as follows. A one year old male patient visited to paediatric department at multispecialty hospital with having a weight of 5.9 kg and height of 63 cm admitted to the paediatric ward with the complaints of dry productive cough associated with noisy breathing (acute on onset), running nose, low-grade fever, and little regurgitation after feeding since last 3 days. As per patient's past medical history and EEG report (showing hypsarrathymiafocal epileptiform over the left central and temporal region and developmental delay), it was revealed that the patient is a known case of a west syndrome and severe malnutrition since May 2018. Outcome of this study was optimization in pharmacotherapy and patient counselling points and necessary life style modifications may be helpful for the physician for better management of this rare condition and boosts up the research interest of the clinicians for evolving newer and effective treatment approaches. The most important aspect of this case report is the prevention of the consequences of this syndrome by providing an effective treatment that delays the progression of the disease and the precautions to be taken particularly maintaining health hygiene to prevent infections. [ABSTRACT FROM AUTHOR]

Ewing's sarcoma is a highly malignant tumor of bone that occurs in children's, adolescents, and young adults. Ewing's sarcoma has an extremely high fatality rate. The main objective of this study was to spread awareness to the healthcare professionals regarding rare clinical condition, drug related problems with preventive measures and clinical management of rare disease. The main clinical pharmacist intervention made after reviewing the patient case profile clinical pharmacist has suggested a preventive measures and clinical management of drug related problems to medical oncology for better therapeutic outcome in cancer care, so patient health related quality of life will be improve. The following drug related problems and clinical managements are mentioned in below. Clinical pharmacist has monitored and reported ifosfamide induced hematuria and suggested to prescribe Injection Mesna 200 mg at 0-4-8 hourly for prevention of ifosfamide related bladder toxicity. Clinical pharmacist after reviewing of all previous CBC results and suggested to medical oncologist to prescribe Injection Pegfilgrastin 300 mcg SC (1 day) instead of Injection Filgrastine 300 mcg SC (4 days). Pegfilgrastin has a better efficacy, potency and reduced the prolongation of hospital related cost because of reduction of frequency of treatment drug. We have described a unique case of Ewing's sarcoma and its clinical management so many healthcare professional will get critical information related to rare type of cases. In this case role of clinical Pharmacist's interventions is most important for achieving better therapeutic outcomes and patient health related quality of life and cost in cancer care as well as reduced the burden of the medical oncologist. [ABSTRACT FROM AUTHOR]

Adverse reactions and its toxic effects are major problem we have to face during the treatment courses for extensively drug-resistant Tuberculosis (XDR-TB). Here one case indicates the importance of awareness about the psychiatric adverse reactions due to XDR-TB therapy and its toxic adverse reaction of it. Cycloserine-induced psychosis is more life threatening problem and it may be risk to life. A 28-year-old male on XDR-TB therapy got admitted for his Acute Psychiatric Episode, There was no any history of taking any addictive drug and no history mental illness among family member. His body weight was measured 45 kg. he is being treated with Tab Valproate 200mg. (1-1), Tab Trifluoparazine 5mg. + Tab Benzhexol HCl. 2 mg. (0-0-1), Tab Quetiapine 200mg. (0-0-1), Tab Resperidone 1mg. (1-1-1), Tab Nitrazepam 1mg. S.O.S. Patient was feel better and recovered after Capsule cycloserine was stopped and occurance of Acute Psychiatric Episode stopped. Other drugs like ethambutol and levofloxacin may causing psychotic Problem was also ommited because there was no relapse of Acute Psychiatric Episode. His Mental Health becomes normal after stopping the treatment of Capsule cycloserine. However, we conclude that no other anti-tubercular drug accelerated the psychiatric effects of cycloserine. [ABSTRACT FROM AUTHOR]