A Study of Polypharmacy in Patients with Co-Existing Diabetes Mellitus Type II and Hypertension in a Tertiary Care Center

Introduction Polypharmacy is most commonly defined as the use of five or more medications daily by an individual. In India, the prevalence of polypharmacy varies from 5.82 % to 93.14% in different states. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, prescribing cascade, and higher costs. Methods It is a non-interventional, observational, descriptive study carried out in 240 patients attending the medicine outpatient department of a tertiary care hospital, over a one-and-a-half-year duration. Results The study was carried out in 240 patients whose mean age was 53.97 ± 7.62 years, out of which 52.5% were male and 47.5% were female. 62% of the study population were from low socioeconomic status and 38 % were from the middle class. The mean duration in years for hypertension and diabetes was 7.1± 4.3years and 7.94+ 4.66 years respectively. Apart from various antihypertensive and antidiabetic medicines prescribed the study population was also prescribed Vitamins (51.6%), Hypolipidemics (42.5%), Miscellaneous (41.6%), Antiplatelets (40%), H2 blockers/PPI (35.8%), and Antibiotics (22.5%). Polypharmacy (5 or more than 5 drugs) was seen in 33.75% of the study population. Conclusion Polypharmacy has been found to be integral in patients suffering from hypertension with coexisting diabetes mellitus and other comorbidities. It is essential to practice judicious prescribing especially in patients with multiple conditions.

A CONCEPTUAL STUDY ON THE EFFECT OF NARIKELA KHANDA IN AMLAPITTA

Nowadays due to unawareness about Prakriti (psychosomatic constitution) people are practising inappropriate diet and lifestyle which leads to disturbances in the digestive system. The core principles in Ayurveda give prime im- portance to Agni, Prakriti, Ahara (food) and Vihara (lifestyle) in maintaining health. In the present era, people are scheduled to one or the other works due to which they are following unwholesome food and habits which may lead to the manifestation of many diseases. One of the common disorders which troubles a person a lot is Amlapitta. It is composed of the word Amla and Pitta. Amlapitta is a very common disease caused by Vidagdha Pitta with features like Amlaudgara, Tiktaudgara, Hrud Kantha Daha etc. It is the GI disorder described in Ayurvedic texts that closely resembles Gastritis in modern science. In the chronic stage, it may lead to ulcerative colitis. In modern medical science, they give some anta-acids, H2 blockers, Proton pump inhibitors, some steroids which have high prevalence costs and side effects. Today there is a need for a potent herbal formulation that can cure hyperacidity and ulcers. The present study is being undertaken to approach the disease Amlapitta through the formulation of Narikela Khanda. Keywords: Ayurveda, Amlapitta, Narikela Khanda.

STUDY OF DRUG UTILIZATION PATTERNS IN POSTPARTUM WOMEN IN GOVERNMENT MEDICAL COLLEGE, JAMMU (INDIA).

Background: There is a paucity of literature regarding rational prescribing practices especially during postnatal period.It was found worthwhile to assess the drug utilization patterns during postpartum period.It is known fact that the drugs prescribed during postnatal period have significant impact on the health of both mother and child. Material and Methods:A total of 1300 prescriptions of the patients which include 552 caesarian sections (cs) and 748 pervaginal (pv) delivery were randomly selected and studied. Results:It was recorded that the average number of drugs prescribed per prescription were 6.01 in cs patients and 10.95 in pv delivery group.The most commonly drugs that were prescribed were Antibiotics, analgesics, anti-inflammatory drugs, nutritional supplements (iron, calcium, multivitamins), H2 blockers and proton pump inhibitors (PPIs).In addition the other drugs included were oxytocin,prostaglandins,uetrine relaxants,antihyperttensives,bronchodilators,benzodiazepines,antifungal agents and antiepileptics.It was also found that 36.88%,16.75%,80.71% and 6.33% drugs prescribed were fixed dose combinations,generics,essential drugs and off label respectively in cs patients.Whereas, 42.96%, 13.23%, 78.81% and 8.2% drugs prescribed were fixed dose combinations, generic, essential drugs and off label respectively in pv patients. Conclusion: The results of this study reveals that there is need for educating prescribers regarding rational prescribing practices, especially during postnatal period when health of both infant and mother is at stake.

Changes in Hemoglobin Levels in Patients with Hiatal Hernia and Anemia Demonstrates a Durable Resolution When Surgery Utilized

Objective: To describe the patterns of care of patients presenting with anemia and a hiatal hernia and to document hemoglobin levels at each stage of care. Background data: Anemia may be associated with hiatal hernia. Current medical guidelines recommend iron supplements and proton pump inhibitors (PPIs) as initial steps, but not surgical repair is not routinely recommended despite evidence of cure. Methods: Retrospective review of patients with anemia and hiatal hernia who underwent surgical repair. Hemoglobin, PPI use, and symptoms were assessed at diagnosis, preoperatively, and postoperatively. Results: We identified 116 predominantly female patients with type 3 hernias with 52.6% (n = 61) having Cameron ulcers. At baseline, 24.1% (n = 28) were transfused, 52% (n = 60) started on iron supplements, 72% (n = 84) on PPIs, and 10% (n = 12) on H2-blockers. Referral to surgery occurred 454 days (IQR: 129-1332) after anemia diagnosis. The mean Hgb at diagnosis was 9.79 (range: 4.8-12.7) in females and 10.9 (range: 7.7-12.9) in males, increasing to 11.1 (range: 5.4-15) and 11.4 (range: 5.8-15.9) with medical management. After laparoscopic repair, it increased to 12.3 (range: 8.1-14.8) and 13.4 (range: 8.9-16.8) at short term follow up. This was sustained at 12.8 (range: 8.8-17.7) and 14.2 (8.1-17) long term. Medical management normalized Hgb in 36% (n = 40/111); whereas surgery normalized Hgb in 62% (n = 64/104) short term and 74% (n = 69/93) long term. Cameron’s ulcers were associated with normalization in 85% (38/45) but only 62% (n = 21/34) when not present. Conclusion: Anemia associated with a hiatal hernia improves with medication, but the addition of surgery normalizes Hgb, appears durable, allows cessation of medication, and improves quality of life.

Machine Learning Approaches to Predict Hepatotoxicity Risk in Patients Receiving Nilotinib

Background: Although nilotinib hepatotoxicity can cause severe clinical conditions and may alter treatment plans, risk factors affecting nilotinib-induced hepatotoxicity have not been investigated. This study aimed to elucidate the factors affecting nilotinib-induced hepatotoxicity. Methods: This retrospective cohort study was performed on patients using nilotinib from July of 2015 to June of 2020. We estimated the odds ratio and adjusted odds ratio from univariate and multivariate analyses, respectively. Several machine learning models were developed to predict risk factors of hepatotoxicity occurrence. The area under the curve (AUC) was analyzed to assess clinical performance. Results: Among 353 patients, the rate of patients with grade I or higher hepatotoxicity after nilotinib administration was 40.8%. Male patients and patients who received nilotinib at a dose of ≥300 mg had a 2.3-fold and a 3.5-fold increased risk for hepatotoxicity compared to female patients and compared with those who received <300 mg, respectively. H2 blocker use decreased hepatotoxicity by 11.6-fold. The area under the curve (AUC) values of machine learning methods ranged between 0.61–0.65 in this study. Conclusion: This study suggests that the use of H2 blockers was a reduced risk of nilotinib-induced hepatotoxicity, whereas male gender and a high dose were associated with increased hepatotoxicity.

Abstract P453: Histamine 2 Blockers and Nimodipine in Aneurysmal Subarachnoid Hemorrhage Patients

Background: Histamine (H) 2 blockers led to a significant increase of the relative bioavailability of nimodipine and therefore may change tolerability of nimodipine in patients with aneurysmal subarachnoid hemorrhage (SAH). Objective: To determine the effect of H2 blockers on outcome of SAH patients being treated with nimodipine on outcomes. Methods: We analyzed data from Cerner Health Facts® which collected data from participating facilities from January 1st, 2000 to July 1st, 2018. We identified SAH patients who underwent endovascular or surgical treatment for intracranial aneurysm and received nimodipine with or without H2 blockers. Outcome was defined by discharge destination and classified into none to minimal disability, moderate to severe disability, or death. Results: A total of 815 (54.8%) of 1488 SAH patients received H2 blockers in addition to nimodipine. There were no differences in rates of cerebral ischemia (8.8% versus 9.8%) or performance of angioplasty (3.8% versus 3.7%) between patients who did or did not receive H2 blockers. There were no differences in rates of intubation/mechanical ventilation (26.0% versus 29.3%) or intra-procedural cerebral infarction (3.4% versus 2.8%) between the two groups. There was no difference in in hospital mortality rates (10.9% versus 10.2%) or none to minimal disability (41.8% versus 38.2%) between patients who did or did not receive H2 blockers. Conclusions: H2 blockers are frequently used with nimodipine in SAH patients and did not appear to adversely affect rates of death or disability. The finding does not support any clinically significant interaction between H2 blockers and nimodipine in SAH patients.

A two-year retrospective observational study of adverse drug reactions related to intravenous drug formulations

Introduction: Adverse drug reactions are the major obstacles to patient safety and drug therapy monitoring. Objectives: The present article provides information on intravenous products induced adverse drug reactions collected by spontaneous reporting method through an established pharmacovigilance wing working under NCC-PVPI in an Adverse Drug reaction monitoring center-Nalgonda, Telangana. Methods: A total number of 100 intravenous products induced ADRs were collected from different age groups by observational retrospective study for the year January 2018 to December 2019. Results: The results showed that the most affected age group was 20-29 yrs (28 %). The major contribution of the gender that exposed to ADRs was female- 73 % Most intravenous product induced ADRs were reported from the Department of OBG (46 %). Drug: Ceftriaxone-induced ADRs were (38 %). The most frequently reported ADR was fever and chills (56 %). Out of 100 ADRs, one was certain, 90 were probable/likely, and the remaining 9 were possible as per the WHO-causality scale. Conclusions: In the present work, most of the ADRs were because of intravenous antibiotics followed by anesthetic agents, antiepileptic drugs, ringer lactate, dextrose normal saline, and H2 blockers.

The Ayurvedic Management of Urdhwaga Amlapitta with Vamana.

The Amlapitta is one of the most common disease of Annavaha Srotas which bears the direct impact of the dietic errors that a person indulges. Amlapitta Vyadhi is complex of symptoms correlated with acid peptic disease/gastritis/hyperacidity described in modern medicine science.Many new drugs are available like antacids, proton pump inhibiters,H2 blockers, in modern medicine system but all they provides symptomatic relief instead of complete cure of disease and they also have adverse effects.The case of Amlapitta was treated with Vamana (Therapeutic emesis) therapy, as indicated in Kashyap Samhita. A 53 years old female patient presented with complaints of Chardi(Vomiting), Hritkanthadaha(burning sensation in chest and throat), Tikta-Amlodgara(Acid eruction with bitter and sour taste and Hrullas( Nausea) since 1 year.Dadimashtak Churna for Deepan, Pachana.Panchatikta ghrit for internal oleation was used .External oleation and sudation was done with Nirgundi oil .Vamana dravya madanphal phant while Yashtimadhu Kwatha was used for Aakanthapan as Vamanopaga dravya.On the follow up day it was seen that patient got complete relief from Chardi, Hritkanthadaha while significant improvement was seen in Hrullas and Tikta-Amlodgara and there was no recurrence of disease seen . Thus Vamana therapy is effective in patient of Urdhwaga Amlapitta.The Amlapitta is one of the most common disease of Annavaha Srotas which bears the direct impact of the dietic errors that a person indulges. Amlapitta Vyadhi is complex of symptoms correlated with acid peptic disease/gastritis/hyperacidity described in modern medicine science.Many new drugs are available like antacids, proton pump inhibiters,H2 blockers, in modern medicine system but all they provides symptomatic relief instead of complete cure of disease and they also have adverse effects.The case of Amlapitta was treated with Vamana (Therapeutic emesis) therapy, as indicated in Kashyap Samhita. A 53 years old female patient presented with complaints of Chardi(Vomiting), Hritkanthadaha(burning sensation in chest and throat), Tikta-Amlodgara(Acid eruction with bitter and sour taste and Hrullas( Nausea) since 1 year.Dadimashtak Churna for Deepan, Pachana.Panchatikta ghrit for internal oleation was used .External oleation and sudation was done with Nirgundi oil .Vamana dravya madanphal phant while Yashtimadhu Kwatha was used for Aakanthapan as Vamanopaga dravya.On the follow up day it was seen that patient got complete relief from Chardi, Hritkanthadaha while significant improvement was seen in Hrullas and Tikta-Amlodgara and there was no recurrence of disease seen . Thus Vamana therapy is effective in patient of Urdhwaga Amlapitta.

The Effects of Ranitidine Treatment on the Risk of Necrotizing Enterocolitis in Preterm Infants: A Case-Control Study

Introduction: Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. Materials and Methods: One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. Results: Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). Conclusions: We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio.