Cost Analysis of Haemodialysis Patients in Government Tertiary Care Centre – A Pharmacoeconomic Study

The progression of chronic kidney disease (CKD) to End-Stage Renal Disease (ESRD) in India is rapidly increasing. Over 25 million of people suffering from ESRD, especially in rural areas. Many of these patients are not undergoing dialysis due to the factors such as lack of awareness, fewer treatment options, unaffordability prices due to low income, and minor reimbursement for chronic illness. The cost of hemodialysis in private hospitals is around 12.000 INR (Indian Rupee) per person monthly and 140.000 INR per year, which seem too expensive for middle and lower-middle-class of patients. Hence our study was aimed to analyze the healthcare cost of hemodialysis in government tertiary health care centers by analyzing the direct and indirect cost from the patient perspective. Sixty patients who underwent dialysis in Hassan Institute of Medical Sciences Teaching Hospital were included in this study. The demographic details, past and present medical history, cost per session of dialysis, laboratory examination, money spent on travel, and the working days lost were calculated. Out of 60 patient (male: 47; female: 17), 53 patients aged 18-65 years old. They belonged to lower-middle (38.33%), middle (23.33%), lower (21.66%), and upper-middle-class (8%). The average direct medical cost of each patient in one session of dialysis was 481.5 INR and indirect medical costs were 557.33 INR. Based on our observation, we conclude that the patients are having satisfactory outcomes, comparatively at low cost in our government dialysis unit. Government should encourage and also cover the mobile dialysis centers under government health schemes, by which the indirect medical cost can be reduced.

Antibacterial Activity of Red yeast rice Extract against Propionibacterium acnes ATCC 11827 and Methicilin-Resistant Staphylococcus aureus ATCC BAA-1683

Propionibacterium acnes ATCC 11827 and Methicillin-Resistant Staphylococcus aureus ATCC BAA-1683 are bacteria that cause skin infections, namely acne vulgaris and skin and soft tissue infection/SSTI. The increase in the number of resistant bacterial strains, such as MRSA, requires the search for alternative antibiotics, including using natural ingredients. Red yeast rice is a product of rice fermentation by Monascus purpureus, which is known to have antibacterial, antifungal, antitumor, antioxidant, anti-inflammatory, anti-cholesterol and immunomodulator. This study aims to determine the antibacterial activity of several red yeast rice extracts against these bacteria that cause skin infections. The research was carried out through the stages of collecting materials and identifying the yeast isolates, extracting of red yeast rice, phytochemical screening of red yeast rice extract, confirmation of bacterial test, preparation of bacterial test suspension, testing for bacterial resistance, testing for antibacterial activity of red yeast rice extract and determining the value of Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the most active extract. The results showed that the ethyl acetate and ethanol extracts had antibacterial activity against P. acnes ATCC 11827 and MRSA ATCC BAA-1683. Both extracts contain compounds from the polyphenols, flavonoids, quinones and saponins group. Ethyl acetate extract was the most active extract with MIC values against P. acnes ATCC 1182 and MRSA ATCC BAA-1683 of 50 mg/mL and 12.5 mg/mL. The MBC values of ethyl acetate extract against these bacterial tests were 100 mg/mL and 25 mg/mL. The ethyl acetate extract is more active against MRSA ATCC BAA-1683 than against P. acnes ATCC 11827. From the results of this study it is known that red yeast rice has activity against bacteria that cause skin infections, especially against MRSA

Antidiabetic Activity of Sungkai (Peronema canescens Jack) Leaves Ethanol Extract on the Male Mice Induced Alloxan Monohydrate

Sungkai (Peronema canescens Jack) is an alternative natural ingredient that can be used as an antidiabetic containing several secondary metabolites which are thought to reduce blood glucose levels by inhibiting the action of the α-glucokinase enzyme and increasing the activity of antioxidant enzymes and being able to regenerate β-cells, damaged pancreas so that insulin deficiency can be overcome. The aim of this study was to determine the effect of P. canescens leaves ethanol extract on antidiabetic activity and to determine the effect of various doses of sungkai leaf ethanol extract as antidiabetic. The scientific research method used in this study was a completely randomized design (CRD) and data analysis used in this study is the one way ANOVA, following by the Duncan test. Blood glucose measurement in treated mice was carried out 3 times. Mice were devided into five groups, three mice in each group, and each group was administered different dosages of sungkai extract (T1 = extract 175 mg/kg body weight; T2 = extract 350 mg/kg body weight; T3 = extract 700 mg/ kg body weight). First, the mice were acclimatized for six days and the injection of treatment was started at day 7. Blood glucose levels, urine volume, body weight and daily drinking of mice was carried out before induction (day 0), after induction (day 8) and after the end of treatment for 10 days (day 18), was carried out using the Point of Care Test (POCT) method using the Easy Touch GCU. The results showed that the ethanol extract of sungkai leaves had the potential to reduce blood glucose levels in mice. The ethanol extract of sungkai leaves at a dose of 350 mg/kg body weight has the most optimal potential to reduce blood glucose levels, urine volume, daily drinking, and body weight.

A Comparative Study to Evaluate Efficacy and Safety of Daily Dosing versus Alternate-Day Atorvastatin Therapy in Patients with Dyslipidemia

Dyslipidemia is a well-recognized risk factor for the development of diseases associated with atherosclerosis, including coronary artery disease and stroke. Statins are the first choice hypolipidemic drug which are the most effective and best tolerated agents for treating dyslipidemia. Atorvastatin confers an HMG-CoA reductase inhibition up to 20-30 hours which makes it even effective on the next day. The present study is randomized open labeled study done at Victoria Hospital - Bangalore to compare efficacy and safety of daily dosing versus alternate-day atorvastatin therapy in patients with dyslipidemia. A total of 86 patients with dyslipidemia were randomized into 2 groups. Group A received 10 mg of atorvastatin daily (DS) and group B received 10 mg of atorvastatin on alternate day (AS) for six weeks. Among the 86 patients included in the study, mean age of the participants in the AS group was 53.12 ± 10.32 whereas that in the DS group was 52.26 ± 11.13. LDL-C decreased by 25.3% versus 22.4% (CI 0.95, P = 0.35) on daily and alternate-day dosing, respectively. Also 12.5% versus 15% (CI 0.95, P= 0.83) improvement was seen with HDL-C. Both dosage regimens provided reductions in total cholesterol (20.7% versus 20.2%) and triglyceride (20.7% versus 21.2%). There was no statistically significant difference in reduction in lipid parameters between two groups. Adverse effects were found less occurred in alternate day therapy than daily therapy. Gastrointestinal disturbances and myalgia were most commonly reported in both groups. Hence this study concludes alternate-day atorvastatin is as effective as daily atorvastatin in dyslipidemia.

Effectiveness of Highly Active Anti-retroviral Therapy (HAART) in the Adult Population in the Ashanti Region of Ghana

AIDS is the late stage of infection with the Human Immunodeficiency Virus (HIV). Even though the Highly Active Antiretroviral Therapy (HAART) for the management of HIV/ AIDS has been in existence in Ghana since 2003, there is still limited data on their effectiveness. This study therefore sort to ascertain the effectiveness of HAART used at Anti-retroviral therapy (ART) Centres in the Ashanti region of Ghana by assessing its effects on immunological and haematological markers as well as some significant indicators such as body temperature and blood pressure changes. The study was a retrospective cross sectional study which reviewed medical record folders of 156 HIV infected patients who had attended the selected ART centres in the Ashanti region of Ghana between 2010 and 2014. About 49% of the study population had a significant rise in their CD4 counts after six months strict adherence to specific HAART regimen. HAART effectively reduced viral loads and increased CD4 counts in most of the patients whose medical record folders were reviewed. Socioeconomic factors, formal education and lack of health literacy had a significant effect on adherence to the HAART regimen, however; marital status of patients did not have any significant effect on adherence, CD4 counts and the haemoglobin concentration of patients. Based on results obtained from this study, HAART could be considered as effective in the adult population in the Ashanti region of Ghana provided there is a high level of adherence. Immunological and haematological markers for the assessment of effectiveness could also improve with high adherence recommended HAART regimen

Carbapenems for the Treatment of Pneumonia: A literature review regarding resistance, risk factors, and mortality

Carbapenem is one of antibiotic to treat respiratory infections such as pneumonia that frequently used in tertiary care facilities and started to create resistances. This study aims to review the resistance of carbapenems, assess the risk factors for resistance that leads to mortality, and the more effective antibiotic treatment options to overcome the resistance. Assessment of the use of carbapenems in pneumonia through previous studies were carried out by searching the articles in search engine databases in 2011 to 2021. Articles reporting carbapenems resistance, risk factors, and mortality were selected based on inclusion and exclusion criteria. Of 14 articles included in inclusion criteria, 4 studies reported the occurrence of resistance to gram-negative bacteria such as Acinetobacter aumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, and 10 articles reported risk factors and mortality. The risk factors for carbapenems resistance are the history of carbapenems use, duration of hospitalization, use of mechanical ventilation, high Simplified Acute Physiology Score (SAPS) scores, and high Acute Physiologic and Chronic Health Evaluation (APACHE). Carbapenems resistance causes mortality such as septic shock, high Sequential Organ Failure Assessment (SOFA) scores, and elevated risk at > 60 years of age, female sex, and inappropriate choice of antibiotics. The results showed that imipenem has higher resistance than other carbapenems members, the risk factors for carbapenems resistance are dominated by a history of carbapenems use, mortality caused by high score SOFA, and colistin can be the current choice to overcome carbapenems resistance.

Antibacterial Activities of Parijoto (Medinilla speciosa Blume) Fruit Extracts Against Clinical Isolates of Salmonella typhi and Shigella dysenteriae

Medinilla speciosa (M. speciosa) Blume is a plant originating from Mount Muria, Kudus District, Central Java, Indonesia. Its fruit has been used by the local community to treat mouth sores, diarrhea, inflammatory, hyperlipidemia, cancer, bacterial infection and nutrients for pregnant women. However, the antibacterial activity against Salmonella typhi (S. typhi) and Shigella dysentriae (S. dysentriae) is yet unknown. Thus, the aim of this study was to determine the antibacterial activities of M. speciosa fruit extracts against clinical strain of S. typhi and S. dysentriae. Plant determination and sample preparation were conducted. The fruits of M. speciosa were extracted by gradual maseration using n-hexane, ethyl acetate and methanol as solvents. Phytochemicals were screened by Fransworth method. Antibacterial activity was determined using agar well diffusion. The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values and comparison study of antibacterial activity were determined. The results showed that all of the extracts exhibited antibacterial activities, with the greatest activity shown by the methanol extract. This extract was more effective against S. dysenteriae than S. typhi, as evidenced by the largest inhibition diameter and lowest MIC (25 mg/mL) and MBC (50 mg/mL) values. With regard to the results of phytochemical screening, the antibacterial activity of methanol extract could be due to the presence of alkaloids, flavonoids, polyphenols, quinones, saponins and tannins. From the comparative antibacterial activity value indicated that in order to give the same inhibition diameter with 1 ppm of chloramphenicol, 312.3 ppm methanol extract is needed. It can be conclude that M. speciosa fruit has a potential to be developed as natural antibacterial agent, especially to treat bacillary dysentery

Inventory Control of Drugs Listed in Private Health Insurance at Pharmacies in South Tangerang using ABC Analysis

Inventory control in pharmacies must be appropriately and effectively maintained to promote continuous drug affordability and availability in the community within the healthcare delivery system. Initially, effective drug planning and procurement are essential to attain proper drug selection, quantification, and procurement based on the consumption pattern with good economic impact and clinical value. Therefore, the ABC analysis method is suggested to be implemented to optimize efficient budget and effective drug planning. This study aimed to investigate the planning and procurement process of drug listed in private health insurance using the ABC analysis method in the pharmacies X and Y. This study was non-experimental study with descriptive analysis utilizing qualitative and quantitative data. Drug enlisted in the private insurance data in 2019 were taken retrospectively. Based on the ABC analysis results, in pharmacy store X, drug listed in group A showed 83 items with the highest investment value of 86.38%, group B showed 102 items with 15.61%, and group C showed 129 items with the lowest investment value of 4.79%. Meanwhile, in pharmacy Y, drug listed in group A showed 87 items with the highest investment value of 89.62%, group B showed 100 items with 7.62%, and group C showed 134 items with the lowest investment value of 2.76%. Using the ABC analysis to manage the drug inventory system could assist pharmacy store X and Y in planning the procurement of drug listed in the private healthcare insurance effectively. Also, taking into account the values of consumption and investment are obtained efficiently.

An Intensive Monitoring of Adverse Drug Reactions in Indoor Patients of Paediatric Department at Tertiary Care Teaching Hospital in Gujarat, India.

they differ from adults in pharmacokinetic and pharmacodynamics responses. ADRs reported in adults do not predict those in children. Thus, this study aimed to intensively monitor ADRs occurred in inpatients of paediatric department of tertiary care teaching hospital to assess the same in terms of incidence, causality, severity and preventability. A prospective observational single centre study was done in the paediatric department of SSG hospital, Vadodara over duration of 8 months. The ADRs were actively monitored and collected reports were analysed for ADR pattern, demographic profile, causality, severity, and preventability. A total of 66 ADRs were documented during the period of 8 months. Among these 53.03% ADRs occurred below the age of 1 year, 89.13% ADRs occurred due to antibiotics, 56.06% ADRs are of Diarrhoea and vomiting and 80.43% ADRs developed after receiving drug intravenously. As per WHO-UMC criteria, 46.96 % ADRs were of probable while 51.51% ADRs were of possible causality while as per Naranjo scale 60.61% ADRs were of probable and 39.39% ADRs were of possible category. As per severity scale 69.70% reactions were mild and 30.30 % reactions were moderate. Probably preventable ADRs were about 57.58%. ADRs occurred more among infants and antibiotics were more commonly implicated. Most of the reactions were of mild severity and were probably preventable. Certain Precautionary measures can lead to significant prevention of ADRs in paediatric patients.

A Randomized, Prospective Study to Compare the Efficacy and Safety of Omega-3 Fatty Acids as Additional Therapy to Methotrexate versus Methotrexate Monotherapy in the Management of Moderate to Severe Plaque Psoriasis

Psoriasis is a chronic, inflammatory, hyperproliferative, immune-mediated skin disorder, having a prevalence of 0.44-2.8% in India. Methotrexate is a widely used systemic regimen for moderate to severe psoriasis. Supplementation of omega-3 fatty acids has decreased the severity of the disease in some studies. This study aimed to assess the efficacy and safety of omega-3 fatty acids as an add-on to methotrexate versus methotrexate monotherapy in patients with moderate to severe plaque psoriasis. A total of 40 patients with moderate to severe plaque psoriasis were recruited in the study and randomized into two groups of 20 patients each. Group O received omega-3 fatty acids as add-on to methotrexate and Group M received methotrexate monotherapy. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Physician’s Global Assessment (PGA) were assessed at baseline, 4 weeks, 8 weeks and 12 weeks of treatment. The adverse events were assessed throughout the study period. There was a significant decrease in PASI and DLQI scores from baseline to end of 12 weeks in both groups (p<0.001) but the difference between the two groups was not significant (p>0.05). A higher number of patients had a PGA score of 0 or 1 at the end of 12 weeks in Group O (60%) as compared to Group M (40%) but the difference between the groups was not significant (p=0.34). The treatment was well tolerated in both the groups, with most common adverse events being nausea, diarrhea and epigastric pain. This study showed that the treatment in both the groups was equally effective in decreasing the severity of psoriasis and was well tolerated.