041877   PATWARDHAN V G, MUGHAL Z M, PADIDELA R, CHIPLONKAR S A, KHADILKAR V V, KHADILKAR A V (Hirabai Cowasji Jehangir Medical Research Institute, Pune - 411 001, Maharashtra, Email: anuradhavkhadilkar@gmail.com) : To study impact of treatment with Rosuvastatin versus Atorvastatin on 25 hydroxy Vitamin D concentrations among adult Indian men- a randomized control trial. Indian J Pharmacol 2020, 52(5), 365-71.

Dyslipidemias are on the rise and are increasingly being treated with statins. As the metabolism of cholecalciferol and cholesterol are interrelated, reduction in cholesterol synthesis by statins is likely to affect Vitamin D status. (1) The aim is to study the effect of treatment with statins (Atorvastatin/Rosuvastatin) on 25‑hydroxy‑Vitamin‑D (25OHD) among newly detected subjects with dyslipidemia for 6 months (2) To study the impact of 25OHD concentrations on the efficacy of statin treatment. This was a prospective, balanced randomized (1:1), open‑label, parallel‑group study, in apparently healthy Indian adult men (south Asian, 40–60 years). At baseline, serum lipids and 25OHD concentrations were measured. Based on the Adult Treatment Panel III guidelines, subjects were divided as per lipid concentrations into controls (who did not require statin treatment) and intervention (who required statin treatment) groups. Random allocation of subjects was done in two groups for receiving intervention for 6 months: Atorvastatin group (n = 52, received Atorvastatin) or Rosuvastatin group (n = 52, received Rosuvastatin). Lipids and 25OHD concentrations were measured at the end line. Atorvastatin group presented significant reduction (P < 0.05) in 25OHD, total cholesterol (TC) and low‑density‑lipoprotein‑cholesterol (LDL‑C) concentrations at the end line. In the Rosuvastatin group, significant drop in TC, LDL‑C and high‑density lipoprotein cholesterol (concentrations (P < 0.05) was observed, while 25OHD concentrations showed no significant change. Mean 25OHD concentrations were significantly correlated with a reduction in LDL‑C concentrations in Atorvastatin group. Treatment with Atorvastatin resulted in a reduction in 25OHD concentrations; further, its efficacy in reducing LDL‑C concentrations was related to the 25OHD concentrations.

2 illus, 3 tables, 35 ref

041875   JO S, LEE J B, JIN Y, JEONG T, YOON J C, PARK B (Chonbuk National Univ, Jeollabuk-do 54907, Korea, Email: baeklee@jbnu.ac.kr) : Change in jaw occlusive power by paralysis of masseter muscle with a neuromuscular blocker: Sion’s masseter muscle paralysis. Indian J Pharmacol 2020, 52(4), 324-30.

We aimed to determine whether jaw occlusive power decreases with the injection of neuromuscular blocking agents in masseter muscle – a method we named Sion’s masseter muscle paralysis (SMP). A randomized, placebo‑controlled animal study was conducted in which researchers were blinded to group allocation. We used 12 male mongrel dogs aged 10–12 months and weighing 30–35 kg. Four groups were formed: a conventional dose (CD) group (0.004 mg/kg succinylcholine in 4 ml normal saline [NS]); a high dose (HD) group (0.04 mg/kg succinylcholine in 4 ml NS); a placebo group (4 ml NS); and no intervention group. To measure the jaw occlusive power, 1 kg weight was hung sequentially on a specifically designed device on the animal’s lower jaw. At −4, −2, 0’, +2, +4, +6, +8, +10, +20, and +30 min, we measured the jaw occlusive power, oxygen saturation (SpO₂), and end‑tidal carbon dioxide (ETCO₂). After SMP, jaw occlusive power began to decline in CD and HD group. The arithmetical mean jaw occlusive power values at −4, −2, 0’, +2, +4, +6, +8, and +10 min were 9.7, 9.7, 9.7, 8.7, 8.3, 7.3, 6.7, and 6.3 kgw in the CD group and 9.7, 9.3, 8.7, 8.0, 6.7, 5.0, 5.0, and 5.3 kgw in the HD group. No abnormalities in SpO₂ or ETCO₂ were detected. Jaw occlusive power was decreased after SMP with succinylcholine, without inducing respiratory complication.

3 illus, 1 table, 22 ref

041872   SHUKLA G, TEJUS A, VISHNUPRASAD R, PRADHAN S, PRAKASH M S (Pharmacology Dep, Army Coll of Medical Sciences, New Delhi, Delhi - 110 010, Email: ddmtejus@gmail.com) : A prospective study to assess the medication adherence pattern among hypertensives and to evaluate the use of cellular phone text messaging as a tool to improve adherence to medications in a tertiary health‑care center. Indian J Pharmacol 2020, 52(4), 290-5.

The aim of the study was to assess improvement in adherence to medications using mobile phone text messaging (short message services [SMSs] and social media). The objective was to assess the pattern of adherence to medication in hypertensives and to assess the improvement in adherence pattern to antihypertensive medications using mobile phone text messaging as a tool. After obtaining informed consent, the study participants’ blood pressure was recorded, and their adherence to medications was graded as high, medium, and low using the Medication Adherence Questionnaire. Then, messages in the form of either SMSs or WhatsApp were sent regularly (once every 3 days) reminding them of the importance of regular medicine intake. After 2 months of follow‑up, again blood pressure was recorded and adherence graded. Data were tabulated and statistically analyzed. Majority of study participants in who were initially placed in medium to low grading of adherence (65.2 %) moved toward high adherence (88.4 %) at follow‑up after receiving messages for 2 months. A statistically significant decrease was noted in systolic (8.3 mmHg, P < 0.001) and diastolic blood pressure (2.4 mmHg, P < 0.002) at the end of follow‑up. Nonadherence to medication is a global phenomenon to be tackled at the earliest. Our study clearly brings out the importance of improving adherence by regular reminders as messages. Hence, there is a wide scope to avail means to improve the adherence pattern and maximize the health benefits.

6 tables, 25 ref

041871   JOSHI R, TRIPATHI M, GUPTA P, GULATI S, GUPTA Y K (Pharmacology Dep, All India Institute of Medical Sciences, New Delhi - 110 029, Email: yk.ykgupta@gmail.com) : Prescription pattern of antiepileptic drugs in a tertiary care center of India. Indian J Pharmacol 2020, 52(4), 283-9.

The present study aimed to determine the pattern of prescription of antiepileptic drugs (AEDs) in a cohort of patients with epilepsy (PWE) attending a tertiary care center of North India. Demographic variables including age, gender, age at onset, type and frequency of seizures, and prescription of all AEDs (dose and duration) were noted. Descriptive analysis of the use of AEDs was done, and their different combinations were studied. A total of 1187 prescriptions were evaluated. Demography showed 65.7 % of males; mean age of 21.9 years (range: 2–77 years), generalized seizures (53 %), and focal seizures (47 %). Only 21.8 % of the patients were seizure free with no seizure in 1 year of treatment. The five most frequently prescribed AEDs out of 12 AEDs were sodium valproate (VPA) (49.6 %), clobazam (CLB) (39.3 %), levetiracetam (LEV) (28.4 %), carbamazepine (CBZ) (27.3 %), and phenytoin (PHT) (26.5 %). Monotherapy was effective in 36.6 % of the patients. Sodium VPA (39.4 %), PHT (25.6 %), and CBZ (20.1 %) were commonly used as monotherapy. Polytherapy was required in 63.4% of the patients, and most commonly prescribed combinations were PHT + CLB (n = 53), sodium VPA + CLB (n = 62), CBZ + CLB (n = 45), PHT + sodium VPA + CLB (n = 28), and CBZ + sodium VPA + CLB (n = 31). Polytherapy is a very common practice in our tertiary care center. Sodium VPA, a highly prescribed AED, results in good control of generalized seizures, whereas focal seizures are well controlled by CBZ alone as well as in combination. The present study highlights the commonly prescribed combinations of AEDs resulting in control of different types of seizures.

5 illus, 2 tables, 28 ref

041870   RAO M V V, MAULIK M, JUNEJA A, ADHIKARI T, SHARMA S, GUPTA J, PANCHAL Y, YADAV N (ICMR-National Institute of Medical Statistics, New Delhi - 110 029, Email: dr_vishnurao@yahoo.com) : Clinical Trials Registry – India: A decadal perspective. Indian J Pharmacol 2020, 52(4), 272-82.

To present a descriptive analysis of the clinical studies registered in the Clinical Trials Registry – India (CTRI) and deduce its impact. We searched the CTRI database for all registered clinical studies from July 20, 2007 to May 31, 2018. Extracted data were analyzed in three time periods i.e., Periods 1, 2, and 3 based on the major activities and milestones of the CTRI. In addition, comparative registrations of the various Primary Registries of the WHO were compiled and registration policy of Indian journals with regard to trial registration assessed. A total of 20,160 clinical studies were submitted to the CTRI in the designated study period. Of the registered 14,341 clinical studies, 10,485 (76.3 %) were interventional trials which were either regulatory (n = 2004), academic non‑regulatory (n = 3855), or those conducted as part of PG thesis (n = 4626) trials. Regulatory trials registration numbers varied according to the Indian regulatory scenario. PG thesis trial registrations showed a steep rise, although unlike regulatory trials, these were mostly retrospective registrations. CTRI registration numbers were comparable to that in other Primary Registries. Instructions to authors of 48 % indexed Indian journals made a mention of trial registration. The CTRI has a strong global presence and has enhanced the transparency of regulatory trials as well as academic research particularly thesis‑based work. The latter is expected to help improve standard of research and prevent repetitive research. Additional support from Indian journal editors by strict implementation of prospective registration is crucial for increasing compliance by researchers.

3 illus, 4 tables, 30 ref

041869   MOKHTARE M, NIKKHAH M, BEHNAM B, AGAH S, BAHARDOUST M, MASOODI M, FAGHIHI A (Rasoul Akram Hospital, Tehran, Iran, Email: marjanmokhtare@yahoo.com) : A comparative study of the effect of 10‑day esomeprazole containing levofloxacin versus clarithromycin sequential regimens on the treatment of Iranian patients with Helicobacter pylori infection. Indian J Pharmacol 2020, 52(4), 266-71.

Helicobacter Pylori (H. pylori) treatment may be different depending on the host and microbial factors in each region. The study was planned to estimate the effect of two 10‑day esomeprazole containing clarithromycin and levofloxacin sequential therapies on H. pylori treatment. Totally, 186 H. pylori‑infected patients with gastro‑duodenal ulcer who had not yet received treatment for infection, were enrolled. We randomly designated patients to group A (N = 94) who treated with esomeprazole 40 mg and amoxicillin 1 g bid during the early half of treatment, and continued the same dose of esomeprazole with levofloxacin 500 mg and tinidazole 500 mg bid during the second half of treatment and Group B (N = 92) who treated with the identical treatment excepting clarithromycin 500 mg bid as a substitute of levofloxacin. To assess eradication, C14‑urea breath test was implemented 8 weeks afterward treatment. Finally, 172 patients completed the trial. We calculated 85.1 % (95 % confidence interval [CI] = 77.9–92.3) and 83.7 % (95 % CI = 76.2–91.2) eradication intention‑to‑treat analysis (P = 0.302) and so, 93.0 % (95 % CI = 87.6–98.4) and 90.0 % (95 % CI = 83.6–96.3) eradication by per‑protocol analysis (P = 0.420) for Group A and B, respectively. No significant difference was seen among regimens. Drug adverse reactions were not significantly different between regimens. Group A had a 97.8 % adherence rate to treatment and Group B had 98.9 %. Both esomeprazole containing sequential regimens including levofloxacin and clarithromycin showed good eradication rates in spite of significant differences in antimicrobial resistance patterns in vitro. The efficacy of esomeprazole in lowering gastric acidity beside its antimicrobial effect should be considered in H. pylori regimens.

1 illus, 3 tables, 21 ref

041868   BHARATHI B P, RAJ J P, SALDANHA K, RAO P N S, DEVI D P (Pharmacology Dep, St. John’s Medical Coll, Bengaluru - 560 034, Karnataka, Email: p_nidhin@hotmail.com) : Medication errors in neonatal intensive care unit of a tertiary care hospital in South India: A prospective observational study. Indian J Pharmacol 2020, 52(4), 260-5.

Medication errors (MEs) can prolong hospital stay and are a cause of morbidity and mortality. Studies evaluating MEs and its determinants in Indian neonatal intensive care units (NICUs) are limited. Therefore, this study was done to assess the prevalence, characteristics, determinants, and outcomes of MEs in an Indian NICU setting. A prospective observational study was conducted over a 1‑year period (January– December 2016) among neonates receiving medications in NICU. Systematic random sampling was done, and data were collected using a semi‑structured questionnaire after obtaining informed consent from the mother. An ME self‑reporting system was also established. Data were analyzed using Chi‑squared test and Student’s t‑test. Binary logistic regression was used to analyze the determinants of MEs. Among 269 babies included in the study, 57 % (n = 154) were male babies with mean (standard deviation [SD]) birth weight of 2.59 kg (0.701). About 79 % (n = 213/269) of the neonates were appropriate for gestational age. The mean (SD) duration of stay in NICU was 7.58 (5.07) days, and 67 % of the babies had polypharmacy (use of ≥5 medications). The prevalence of MEs was 22 % (95 % confidence interval [CI]: 16.96 %, 26.84 %, n = 108) of all babies, of which only 2 % (n = 2) were life threatening. Seventy‑seven percent (n = 83) of these errors occurred during administration/preparation and 18 % (n = 19) while prescribing. The significant determinants of MEs (adjusted odds ratio [95 % CI]) include polypharmacy (4.126 [1.917–8.880]), duration of stay >7 days (1.335 [1.198–1.488]), and babies referred from outside (2.592 [1.217–5.521]). MEs were common in NICU setting. The occurrence of life‑threatening MEs was minimal. Longer duration of hospital stay, polypharmacy, and babies born outside were significantly associated with occurrence of MEs.

2 illus, 2 tables, 27 ref

041867   PRAKASH M V S S, SIVASANKAR S, ELAKKUMANAN L B, MOHAN V K, KAMALADEVI R K (Anaesthesiology and CC Dep, JIPMER, Puducherry - 605 006, Email: munaganuri1975@yahoo.co.in) : Comparison of medication acceptance of intranasal midazolam administered by parents versus doctors in children – A randomized trial. Indian J Pharmacol 2020, 52(4), 254-9.

The positive effects of midazolam as a premedication in pediatric patients are well documented. Although there are many studies regarding the route and dosage of administration, literature does not have any evidence on the outcome of medication acceptance based on the person administering the drug. The aim of this study was to compare the medication acceptance and preoperative anxiolysis of intranasal midazolam administered by parents and anesthesiologists. This prospective randomized study was conducted in sixty children belonging to the American Society of Anesthesiologists Class 1 or 2 belonging to either sex, aged between 1 and 9 years, undergoing elective surgeries. Group P received intranasal midazolam administered by parents, whereas Group D received intranasal midazolam administered by doctors. Various scores were assessed. Children were more sedated in Group P. Clinically, medication acceptance was better in Group P when compared with Group D, but a statistically significant difference in medication acceptance was seen only in patients who are >4 years of age. Parental separation, Ramsay Sedation Score, and mask acceptance were better in Group P than in Group D. Intranasal midazolam when given by parents produces better preoperative anxiolysis and easier parental separation as compared with administration by a medical staff.

2 illus, 2 tables, 15 ref

041866   SUTHAR J, PATEL R (Pharmacology and Clinical Pharmacy Dep, Charotar Univ of Science and Technology, Changa, Gujarat, Email: jalpasuthar.ph@charusat.ac.in) : Morbidity pattern and drug prescribing study in pregnant women of rural part of Charotar region. Indian J Pharm Pract 2020, 13(4), 348-54.

Pregnancy is a normal physiological condition where drug treatment presents a special concern because certain drugs that harm to the fetus due to the potential teratogenic effects of drugs. Therefore, the present study was planned to carry out with the objective to evaluate the drug prescribing pattern, morbidity and categories of safe drug prescribing among all the pregnant women. A cross-sectional observational study was carried out in 400 pregnant women who attended inpatient and outpatient department at CHARUSAT Hospital during 8 months of study. Demographic details, prescribed drugs, medical history and diagnosis were recorded in CRF. The prescription pattern was assessed and drugs were classified based on USFDA Risk Classification. In present study, iron (82.65 %), folic acid (53.62 %), calcium (58.51 %) and vitamins (82.84 %) were found the most frequently prescribed drugs during pregnancy. Anti-emetics, PPIs and H2 blockers, Antibiotics, Anti-hypertensive agents prescribed drugs during labor. The majority of drugs (49.05 %) prescribed were from category B. Anemia (66.75 %) was found to be a top most morbidity in pregnant women. Other obstetric morbidities like PIH, Breech presentation, Oligohydramnios, Meconium stain Lycor were observed during study period. Majority of the drugs (49.05 %) prescribed as per FDA category B. No drug was prescribed belonging to the category X in study. Anemia was found in (66.75 %) of pregnant women. Whereas PIH was found in (4 %) of pregnant women.

4 illus, 4 tables, 30 ref

041865   USIFOH S F, OLUTAYO O A (Clinical Pharmacy and Pharmacy Practice Dep, Benin Univ, Benin City, Nigeria, Email: sfusifoh@uniben.edu) : Knowledge, behavior, attitude and practice of hospital pharmacists to adverse drug reactions in the elderly in a tertiary hospital in Nigeria. Indian J Pharm Pract 2020, 13(4), 341-7.

Adverse drug reactions (ADRs) including interactions is a drug therapy problem worldwide in the elderly and are a common cause of hospitalization. To assess the knowledge, behavior and attitude of hospital pharmacists to adverse drug reactions in elderly patients in University College Hospital (UCH), Ibadan. A descriptive cross-sectional random sampling of 100 pharmacists in UCH, Ibadan with a selfadministered structured questionnaire that assessed the knowledge on the safety of specific drugs, adverse drug reactions, behavior and attitude of pharmacists to ADRs reporting in the elderly. The response rate was 95 %, mean age was 37.55 ± 5.62; females were 53.7 % and males 46.3 %. The majority, 90.5 % were married and 45.3 % had a B.Pharm degree. Many 67.4 % had poor knowledge of ADR; however, 63.2 % within the age range of 31-40 years had good knowledge. Those trained in pharmacovigilance had a moderate knowledge of 22.2 % while those without training had 50 % of them with poor knowledge. Majority 86.3 % did not have knowledge of STOPP/START as well as Beer’s criteria as a screening tool in the elder. However, the majority had good behavior and attitude on ADR reporting. There was statistical significance between knowledge score and age, cadre and training in pharmacovigilance with P-values of 0.012, 0.015 and 0.021 respectively. Many of the respondents had poor knowledge of ADR in the elderly but they have good behavior and attitude towards ADR reporting. Therefore, educational intervention for hospital Pharmacists on ADR in the elderly is needed.

2 illus, 5 tables, 25 ref

045416   RAHMAN M M, ISLAM F, AHMED T, AZAD M A, SUMI M A, AKTER K S, SHERIN S (Pharmacy Dep, Daffodil International Univ, Dhaka-1207, Bangladesh) : Phytochemical investigation and evaluation of antioxidant and thrombolytic properties of leave extracts of Gardenia coronaria Buch-Ham. J Med Plants Stud 2020, 8(2), 44-8.

The objective of the present study was to assess the diverse pharmacological efficacies of methanolic extracts of the whole plant of Gardenia coronaria Buch.-Ham This study will disclose the Phytochemicals, antioxidants and thrombolytic activity which have the possibility to be used in the coming future to open a new line of investigation. The Gardenia coronaria, one of the necessary traditional medicinal plants in Bangladesh. In the rural area this plant is used by a lot of people as a treatment from various disease. Total sum of the flavonoids was spectrophotometrically ascertained by aluminum chloride colorimetric assay while total phenolic and tannin content by Folin Chiocalteu’s reagent. Antioxidant activity, ascertained by DPPH free radical scavenging assay giving some comparison between the resultant activities with the standard. The thombolytic activity was assessed based on the method of minor alterations. The percentage of clot lysis was 87.58% when 100 μl of streptokinase (30,000 I.U.), and the methanolic extract displayed the least clot lysis activity (26.79%), much less compared to the standard. It can be elicited that the extract of Gardenia coronaria Buch.-Ham contains antioxidant and thrombolytic activity. The potential of these activities probably because of the availability of most of the phytochemicals supporting previous claims and verify its uses as an expected folk medicine.

4 illus, 1 table, 24 ref

045415   TESSEROMATIS C (Pharmacology Dep, National and Kapodistrian Univ of Athens, Greece) : Drugs in greek mythology and medicine. J Med Plants Stud 2020, 8(2), 38-43.

Geomythology has revealed that the ancient Greeks were aware of the importance of hygiene, and for this reason changed the flow of rivers, drained lakes, and built dams. Excavations in Asia, Egypte and Greece revealed plant seeds. The first mention of the term medicine is attributed to Agamemnon. The drug-poison-antidote citations in the Homeric era revealed pharmacological, toxicological and herbal applications, e.g. Circes’ psychotropic herbs and preparations and the use of copper and sulphur as disinfectant. The effect of opium on the central nervous system is evident in the Odyssey. In Minoan Crete, the capsules of the Papaver somniferum L. appear on the statuette of the Poppy Goddess. Hippocrates contributed the evolution of European Medicine and Pharmacy and abandoned theocratic theories. Galen produced drugs from medicinal plants. Despite the progress of chemistry and the industrialization of drugs, herbal medicines are still promoted by companies and the public for self-medication at high rates.

81 ref

041864   JHA N, SHRESTHA S, SHANKAR P R, KHADKA A , ANSARI M, SAPKOTA B (Clinical Pharmacology Dep, KIST Medical Coll, Lalitpur, Nepal, Email: nishajha32@gmail.com) : Antibiotic dispensing practices at community pharmacies in Kathmandu and Lalitpur Districts of Nepal. Indian J Pharm Pract 2020, 13(4), 336-40.

Antibiotics are often dispensed irrationally especially in community pharmacies. The present study was conducted to evaluate antibiotic dispensing practices among community pharmacies. A crosssectional study was conducted in Kathmandu and Lalitpur districts, Nepal from October to November 2018 among the community pharmacies listed in different directories. Systematic random sampling was used to sample 78 community pharmacies based on a 5 % margin of error and a 95 % confidence level. Data was collected using a structured questionnaire and analyzed using SPSS version 21 for Windows. Out of 78 pharmacies, 54 (69.2 %) were in Kathmandu district. Antibiotics were dispensed without a prescription by 67 (85.9 %) pharmacies. Brand substitution was seen in 43 pharmacies (55.1 %). Antibiotics per prescription were three in 51 cases (65.4), followed by two antibiotics in 27 (34.6 %). Advice regarding completing the course of antibiotics was provided by 59 (75.6 %) pharmacies and an insufficient course of antibiotics was dispensed in 23 (29.5 %) pharmacies. Nine pharmacists (11.5 %) replaced prescribed antibiotics with cheaper brands. Azithromycin [69 (22.2 %)] was the most dispensed antibiotic followed closely by Amoxycillin [68 (21.9 %)]. Dispensing antibiotics without a prescription was seen in most pharmacies which can adversely impact the rational use of antibiotics. The findings of this study may necessitate strengthening the implementation of the framed guidelines for ensuring the safe and rational use of antibiotics.

1 illus, 2 tables, 30 ref

041863   RAMYA M, SURESH N, JOSE J (Pharmacy Practice Dep, PSG Coll of Pharmacy, Coimbatore, Tamil Nadu, Email: ramz.pharmd@gmail.com) : Impact of drug interaction on time in therapeutic range of patients receiving oral anticoagulation therapy. Indian J Pharm Pract 2020, 13(4), 332-5.

Drug-drug interactions (DDIs) are a significant consideration in Anticoagulation management. The objective of this study was to identify DDIs with Vitamin K Antagonists (VKAs) and to assess the effect of DDIs on Time in Therapeutic range (TTR) (percentage of time a patient’s INR is within the desired treatment range). An Observational study carried over a period of 6 months. Patients taking VKAs are included in this study. Patient data were collected from patient records and hospital information system. TTR calculation was done using the Rosendaal method. Drug interaction was checked using the Drug interaction checker (Micromedex) and online Lexi Interact. Criticality index was calculated using “Failure Modes, Effects and Criticality Analysis” (FMECA) method. Association between DDIs and TTR were assessed. Fifty four DDIs were identified in a total of 150 patients (mean age 55.47 years, 56.66 % women). Twenty one drugs were potentially interacting with VKAs. Four drugs have a criticality index of ≥10 are considered as high risk for interacting with VKAs. The mean TTR was 33.12±26.06 %, 20 patients (13.33 %) were under good control and 130 patients (86.67 %) were under poor control. Out of fifty four DDIs, Fifty one DDIs (94 %) are in poor control population. Drug interaction and clinical events such as bleeding and thromboembolism were significantly associated (p=0.01). Drug interaction (p=0.02) was a significant predictor of poor control of TTR. DDI is one of the major factors that alter the percentage number of days the patients were in the desired INR range (TTR).

2 illus, 1 table, 13 ref

041862   CHAITRA D, MANASA K, PUNEEM U S, PERAVENA S K, KURAPATI M, MURTHY S V (Affiliated to Kakatiya Univ, Narsampet - 506 332, Telangana, Email: sgvmurthy@gmail.com) : The assessment of sleep quality and insomnia severity in cardiovascular diseases. Indian J Pharm Pract 2020, 13(4), 326-31.

Presence of altered sleep quality in cardiovascular disease proceeds to worsen the disease burden and shows an impact on quality of life. The aim of the study is to assess the sleep quality and insomnia severity in cardiovascular diseases and to determine the correlation between sleep quality, insomnia and cardiovascular diseases. This is a prospective observational study conducted over a period of 6 months in subjects visited the cardiac care center with a diagnosis of cardiovascular diseases recruited and assessed for sleep quality and insomnia severity by using Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) respectively. A total of 203 patients were included in the study. Mean age of study population was 55.9 years. In this study male patients are more than the females in reporting cardiovascular complaints. The total percentage of poor sleep quality was found to be high among the study population and moderate severe insomnia in fewer cases. The present study found significant correlation between sleep quality and insomnia severity among Left Ventricular Dysfunction (LVD), Diabetes Mellitus (DM), diastolic BP and systolic dysfunction, diastolic dysfunction and stress. Alteration in sleep quality and severity of insomnia are prominent among cardiovascular disease subjects. There is a need for in-depth assessment of sleep quality and insomnia among various cardiovascular diseases to provide better patient care.

6 tables, 19 ref

041861   SRINIVASAN A, THAMBI S S, KRISHNARAJAN D, PRAKASAM K C A (Pharmacy Practice Dep, JKKMMRF Annai JKK Sampooraniammal Coll of Pharmacy, Nammakal - 638 183, Tamil Nadu, Email: smithasarahthambi@ gmail.com) : Incidence and impact of various complications on pregnancy related anxiety in women attending an obstetrics clinic in a tertiary care hospital. Indian J Pharm Pract 2020, 13(4), 317-25.

Pregnancy itself is associated with a slight percentage of risk. The presence of any complication can worsen it. The study aimed to check the incidence and impact of various complications on pregnancy-related anxiety. This was a prospective observational study. All pregnant women irrespective of gestational weeks were included in the study. The anxiety levels of all pregnant women were checked using PRAQ-R2. A total of 212 women enrolled for the study but 12 women backed off due to incomplete data and finally 200 pregnant women attending an OBG clinic in a Tertiary care hospital were included in the study. The anxiety level scores of both pregnant women without any complication and those with complication was studied and compared. Correlation and significance were checked statistically. The incidence of complications in pregnancy was 46%. The most common complication seen among the study population was thyroid problem. Pregnant women having some kind of complications showed a slightly higher score of anxiety when compared to women who didn't have any complications. Pregnant women with a wheezing problem, thyroid problem and PIH showed moderate levels of anxiety while pregnant women with other complications showed mild anxiety level. Pregnant women having twins showed a moderate level of anxiety. Age and parity of pregnancy had a significant effect on anxiety which was also proved statistically. Pregnant women having complications have slightly more levels of anxiety when compared to pregnant women who didn't have any complications along with present pregnancy.

2 illus, 10 tables, 10 ref

041860   ARIF M A, HABIB M A, AMITABH V, NAJMI A K, AKHTAR M (Pharmacology Dep, School of Pharmaceutical Education and Research (Formerly: Faculty of Pharmacy), Jamia Hamdard, New Delhi - 110 062, Email: makhtar_ph@jamiahamdard.ac.in) : The incidence of heparin induced thrombocytopenia of chronic kidney disease (ckd) patients on maintenance of hemodialysis visiting to HAH Hospital, Jamia Hamdard, New Delhi. Indian J Pharm Pract 2020, 13(4), 311-6.

The present study was planned to record the incidences of heparin induced thrombocytopenia of Chronic Kidney Disease (CKD) patients on maintenance of hemodialysis. This is a prospective observational study, which enrolled 50 patients visiting dialysis unit after satisfying selection criteria. Different parameters like demographic details, educational status, working status, blood pressure, platelets counts, stage of CKD, etc. were recorded. The sources of data included physicians prescribing data, the patient’s medication profile, questionnaire and laboratory test reports. The observations were recorded in the prescribed performs. A total of 50 patients with CKD, 34(68 %) were males, 16 (32 %) were females, mean age 47.22 years with maximum number belong to age group 48-57 years. A total of 12 % patients had a family history of CKD. About 26 % of the total patients had a single concomitant whereas 24 % of the patients had double concomitant conditions and the most frequent concomitant condition was anemia followed by hypertension. The Hb level was lower than the nomal limits and their eGFR level below 15ml/min/1.73m² hence they were all at stage 5 of CKD. All patients showed different platelet level and upon dialysis, it was decreased markedly. This showed that heparin induced thrombocytopenia during dialysis. Only 2 (4 %) of the patient had clot formation in dialyzers and extracorporeal circuit and decrease in platelet count during hemodialysis. This study strongly recommends the monitoring of platelet count in CKD on maintenance of hemodialysis receiving heparin.

7 tables, 27 ref

041859   ALAM A, WADHWA T,HASSAN E (Clinical Pharmacy and Pharmacology Dep, RAK Medical and Health Sciences Univ, Ras Al Khaimah, UAE, Email: tarun@rakmhsu.ac.ae) : Acute coronary syndrome – exploring the evidences clinical pharmacist driven cardiac review. Indian J Pharm Pract 2020, 13(4), 304-10.

Acute Coronary Syndrome is the most common type of coronary artery disease. Coronary artery disease and acute coronary syndrome together responsible for approx. 7 million deaths which accounts for around half of the global burden. World Health Organization report exemplified that 17.9 million deaths occurred in 2016 due to cardiovascular diseases which represents 31% of all global deaths. Known family history, age, male gender, hypercholesterolemia, diabetes mellitus, hypertension, lack of physical activity, abdominal obesity, cigarette smoking, psychosocial factors, consumption of too much alcohol and consumption of less fruits, vegetables and polyunsaturated fatty acids are some of the risk factors associated with coronary artery disease. Patients’ sign and symptoms, past medical history, ECG changes and determination of cardiac markers (Troponin and CK MB) are used to stratify patients into low, medium or high risk of death or MI, likelihood of failure of pharmacotherapy and need for immediate coronary angiography or percutaneous coronary intervention. For the management of acute coronary syndrome, cardiac drugs are recommended in addition to surgical interventions with specific goals for short and long term of treatment. Cardiac drugs need to be used cautiously in patients with coronary thrombosis as these category of drugs are responsible for increased incidence of adverse drug reactions thereby affecting the patient’s health status and economic condition. Therapeutic interventions like smoking cessation, managing dyslipidaemia and controlling blood pressure not only prevent coronary artery disease but also delays its progression and complications.

3 illus, 1 table, 40 ref

041857   HAQ M M U (Pharmacy Practice Dep, Deccan School of Pharmacy, Hyderabad - 500 001, Telangana, Email: misbahjed@gmail.com) : A review on pathogenesis and epidemiology of coronavirus disease (Covid-19). Indian J Pharm Pract 2020, 13(4), 288-93.

Coronavirus disease (COVID-19) is a communicable disease and SARS-COV 2 is the causative agent of a potentially fatal disease this is of exceptional international public fitness concern. Based on the large number of infected people that were exposed to the most animal market in Wuhan City, China, its miles cautioned that this is in all likelihood the zoonotic foundation of COVID-19. Person-to-individual transmission of COVID-19 infection led to the isolation of sufferers that were eventually administered plenty of treatments. Extensive measures to lessen the individual-to-character transmission of COVID-19 were implemented to govern the current outbreak. Special interest and efforts to guard or reduce transmission have to be implemented in susceptible populations which include children, health care providers and elderly people. In this review, the Pathophysiology and Epidemiology of COVID-19 are highlighted.

9 illus, 41 ref

046727   WAAD S K, AL-SILAYKHEE W M, ALHMADI H B, AREAN A G (Al Muthanna Univ, Samawah, Iraq) : Protective role of quercetin plus vitamin C on infection of rats with Klebsiella pneumoniae and Pseudomonas aeruginosa. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194403.

This study was performed on fifty adult male laboratory rats (Rattus norvegicus) of 175 – 200 grams weights. The animals were randomly allocated into five equal groups of ten rats each. The groups of rats were: First, control group where the animals were fed on a standard diet along the experiment period; the Second and Fourth groups, where also maintained on a standard diet while the Third and Fifth groups were also maintained on a standard diet and they were orally dosed with Quercetin (20 mg) and vitamin C (500 mg) daily. Suspension in phosphate buffer solution (PBS) was made for the bacteria and colony forming unit (CFU) count was done after making 10-folds serial dilutions. The rats of the second and third groups were intramuscularly injected with 16×106 (CFU) of Klebsiella pneumoniae while those of fourth and fifth groups were intramuscularly injected with 20×105 (CFU) of Pseudomonas aeruginosa. After 48 hours of challenge with bacteria, all the rats of the second group and 4 rats of the third group died. On the other hand, all the rats of fourth group and 3 rats of the fifth group died. The organs of died animals of all groups like the stomach, spleen, liver, and thigh muscle were immediately picked up and weighed after death and well homogenized with (PBS) to obtain counting of (CFU) in the organs mentioned. Passing 3 days later, the survived 6 rats of third group and the survived 5 rats of fifth group were euthanized and their organs were treated as the same as the process mentioned before to gain the organs (CFU) count. The results in this study clarify that the use of Quercetin plus vitamin C has led to increase the survival of rats challenged with bacterial infection and the organs bacterial count of them was significantly less than those rats maintained without supplementation with Quercetin and vitamin C at (P≤0.05).

3 tables, 32 ref

041856   ANTHAM M, MULUKUNTLA M, PUCHCHAKAYALA G, GUDURU V K (Kakatiya Medical Coll, Warangal - 506 007, Telangana, Email: gudurukumar00@gmail.com) : Anti-convulsant drugs prescribing pattern and efficacy comparison in paediatric epilepsy population in a tertiary care teaching hospital. Indian J Pharm Pract 2020, 13(3), 266-70.

To conduct the study of the drug usage pattern and its efficacy and tolerability comparison of most commonly used anti-epileptic drugs. The data included patient’s age, sex, types of seizure, aetiology, past and present treatments, dose and duration of therapy and associated adverse effects. A total of 150 subjects (children) who received Sodium valproate (n=88), Carbamazepine (n=21), Phenytoin (n=7), Clobazam (n=11), Levetiracetam (n=4) and remaining in combinations (n=19) as long-term management, were enrolled in the study. Assessed for a period of 12 months for the management of seizures and also the adverse effects incidents. Total, 91 (60.7) subjects endured from seizure episodes throughout the study interval of 12months. 131 (87.3 %) patients were treated with Monotherapy, the rate of seizure remission was 81 (61.8 %) and 19 (12.6 %) patients were with multidrug therapy, the rate of seizure remission was 11 (57.8 %). The rate of seizure remission was found statistically significant.60 patients treated with Sodium Valproate, 19 patients treated with Carbamazepine, 1 patient treated with Phenytoin, 9 patients with Clobazam, 2 patients treated with Levetiracetam were observed to be seizure free. The most commonly occurred type of seizures was GTCS and Focal/Partial type. Overall, 67 (44.6 %) patients had adverse effects; of the highest incidence was cognitive impairment, mood alterations and dizziness which developed more often with Sodium Valproate and Carbamazepine. In our collected and observed study in tertiary care teaching hospital the majority of patients were prescribed with Sodium Valproate and Carbamazepine. It appears that Sodium Valproate and Carbamazepine has highest efficacy rate and Levetiracetam had better tolerability. Sodium valproate and Carbamazepine had balanced effectiveness and tolerability.

4 illus, 3 tables, 17 ref

041855   KUMAR V V, REDDY A H, SUDHARSHAN J, LOKENDRANATH G, UGANDAR R E, CHETTY C M (Pharmacy Practice Dep, Santhiram Coll of pharmacy, Nandyal - 518 112, Andhra Pradesh, Email: vijay66vvk@gmail.com) : A study on impact of pharmacist interventions on therapeutic outcomes of type ii diabetic patients in a tertiary care teaching hospital. Indian J Pharm Pract 2020, 13(3), 259-65.

The management of type II diabetes mellitus is a complex, which requires continuous medical care by the health care professionals and good self-care efforts by patients. Pharmacist interventions programs delivered by the pharmacists are known to help the patients with diabetes benefited in achieving treatment goals, improving outcomes. To study the impact of pharmacist interventions on therapeutic outcomes, determined by hemoglobin A1c (HbA_1c) and secondarily on blood glucose levels, blood pressure, medication adherence, self-care activities and health related quality of life. A Prospective randomized controlled study is conducted with 150 type II diabetic patients. Of those, 75 patients were in intervention group received the pharmacist interventions over a period of 4 months and 75 patients were in control group, whereas control group do not receive interventions. The primary outcome measure was change in HbA_1c and secondary outcomes were changes in fasting blood glucose, blood pressure, medication adherence, self-care activities and health related quality of life. A population of 150 patients completed the study. The intervention patients exhibited a significant reduction in HbA_1c values than the control group, the intervention group showed a greater reduction in the fasting blood glucose and blood pressure levels between baseline and end of the 4 months than the control group. Improvements were observed in Quality of life, self-reported medication adherence, self-care activities in the intervention group. A pharmacist interventions program resulted in better glycemic control, quality of life, medication adherence and self-care of type II diabetic patients over a 4-month period.

5 tables, 17 ref

041854   KADER H A, MEERA N K, SIDDIQUE A, AHMED A (Pharmacy Practice Dep, Qassim Univ, Buraydah, Saudi Arabia, Email: getabu2u@gmail.com) : A study on aluminium levels in patients undergoing haemodialysis at a tertiary care Hospital. Indian J Pharm Pract 2020, 13(3), 252-8.

Aluminium studied as a potentially toxic metal and is commonly found in earth’s crust. Aluminium toxicity may lead to: aluminium-induced bone disease, microcytic anaemia and neurological manifestation, such conditions more particular seen in patients with chronic renal failure and principally patients on haemodialysis. The objective of our study was to measure a serum aluminium levels in patients undergoing haemodialysis at tertiary care hospital, Bengaluru. This was a prospective study, conducted on 50 patients who were on maintenance haemodialysis for more than 6 months. 5 ml of the blood was drawn from the antecubital vein from the patient before haemodialysis process. Collected blood samples were estimated for aluminium levels by GFAAS. The dialysis fluid and RO water were also tested similarly for presence of aluminium to correlate the possible contamination. The results were; 6(12 %) patients had serum aluminium levels within baseline i.e. <20μg/L, 18(36 %) patients had serum aluminium levels between 21-60μg/L and 26 (52 %) of the patients had serum aluminium levels above 60μg/L. The aluminium content varied in the dialysate fluid reaching greater than the standard safety limit. In our study we found that aluminium toxicity is a serious problem in patients undergoing haemodialysis. Patients performing haemodialysis for longer period showed higher level of aluminium. Patients age of 50 years and on haemodialysis for duration 3 years need to be monitored carefully for aluminium toxicity. The major source of elevated serum aluminium in our study participants appears to be dialysate fluid, use of aluminium utensils, OTC products and food habits of consult patients.

3 illus, 5 tables, 32 ref

046726   ALBDAIRI A A H, HUSSEIN H K (Babylon Univ, Babylon, Iraq) : The level of serum progesterone on the day of HCG administration in assisted reproduction cycles. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194402.

During stimulated IVF- ET cycle spontaneous LH surge occur in about 20 – 50 % of cycle stimulated with gonadotropin without the pituitary suppression of GnRH agonist. This has been related to maturation and recovery of oocyte together decrease fertilization and implantation rate, this spontaneous LH surge is associated with increase in serum progesterone , so without pituitary suppression with GnRH , the rise of serum progesterone in the per ovulatory period may indicate the occurrence of spontaneous of LH surge, the aim of study is to indicate cutoff point of progesterone in the day of HCG administration. : This was a retrospective, non-interventional cohort study of patients undergoing ICSI at Tiba infertility center in Babylon, from period 2015 - 2019, all patient age from 20 – 45 years old under long protocol, had at least one grade I embryo transferred, total amount of patients was 1457. At second day of menstrual cycle we stimulate by used recombinant FSH, measured on second day of menstruation serum FSH, LH and estrogen levels, transvaginal ultrasound used to monitored the follicles. when follicle became 14 mm in size we used antagonist. 3 or more follicles gotten 18 mm in diameter. Activation gave either hCG alone or mixture of hCG and agonist. After 14 days from embryo transfer we checked HCG and after that after 10 days transvaginal ultrasound was done. In our study showed the significant association between positive pregnancy outcome and progesterone level at day of HCG trigger were 79.2 % of female with positive pregnancy at progesterone level < 1.5, while 9.3 % of female with positive pregnancy at progesterone level > 2.5, There is a significant differences of LH at day of HCG activate rendering to progesterone level day of HCG activate, progesterone level ( < 1.5) had more chief level at day of HCG activate with mean and SD (5.38 ± 2.52), and reduction when the level progesterone rise. Pregnancy cannot depend on progesterone level at day when HCG administration for assisted reproduction cycles treated with GnRH agonists and gonadotrophins. So cutoff point of progesterone can reach to above 1.5 ng/ ml and expected of pregnancy at this level.

2 illus, 4 tables, 25 ref

041853   RANI P, TIWARI P, SHARMA V (Pharmacy Practice Dep, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar - 160 062, Punjab, Email: ptiwari@niper.ac.in) : A comparison of antimicrobial usage in icus and wards of a private tertiary care Hospital: A prospective study. Indian J Pharm Pract 2020, 13(3), 246-51.

Appropriate use of antimicrobials is the best possible way to safeguard the effectiveness of existing antimicrobials and to reduce the development of antimicrobial resistance. This study aims to evaluate and compare the utilization pattern of antimicrobial drugs in intensive care units (ICUs) and wards of a private tertiary care hospital. This is an observational prospective study carried out in ICUs and wards of private tertiary care hospital. In-patients receiving at least one antimicrobial agent were included in the study while patients with incomplete information were excluded out of the study. Utilization pattern of antimicrobial drugs was analyzed using RPM plus indicators recommended by World Health Organization. Student’s t-test was used to determine statistical difference between continuous variables of ICUs and wards. The number of patients studied in ICUs and wards was 405 and 561, respectively. In ICUs, the average number of medications prescribed was 13.49±1.41, of which average number of AMDs was 2.49±1.61. While in wards, the average number of medication was 10.51±5.17, of which average number of AMDs was 1.91±1.27. Overall 75 % antimicrobials were administered by parenteral route. The findings of this study indicate that there is scope of improvement in extent of use of parenteral antimicrobial therapy.

1 illus, 4 tables, 22 ref

041852   JANGA A R, KOKA N S, MOPARTHI S, MOHANA J N, GAVINI S B, NADENDLA R (Pharmacy Practice Dep, Chalapathi Institute of Pharmaceutical Sciences, Guntur - 522 034, Andhra Pradesh, Email: swapnamoparthi@ gmail.com) : Assessment of diabetes risk and nutritional status: A cross sectional epidemiological study on students of graduation and under graduation from Guntur. Indian J Pharm Pract 2020, 13(3), 240-5.

This epidemiological study is to assess the diabetes risk and nutritional status and stating their association among healthy students of graduation and under graduation in between age 18 to 24 years. Objectives: To predict and assess the diabetes risk, nutritional status and assess the association between diabetes and nutritional status. The study was designed to be a cross-sectional study. It was conducted in students of graduation and under graduation in Guntur District, Andhra Pradesh over one month from 1^st October to 1^st November which includes 57 students. Students are enrolled based on Inclusion and exclusion criteria. Specially designed data collection form used to obtain the data required for the study. In our study we collected data from 57 students out of the 31 (54.38 %) were males and 26 (45.21 %) were females. Diabetes risk assessed by using IDRS, AUSDRISK tool, nutritional status by Using MNA-SF and shown that malnutrition having impact on diabetes risk. We came to a temporary conclusion that most of the students have moderate to low risk of diabetes mellitus. Students who are at risk of malnourishment and malnourished having moderate to high risk of diabetes mellitus.

4 illus, 4 tables, 12 ref

041851   OSARENMWINDA M I, ERAH P O, EROMHONSELE P E (Clinical Pharmacy and Pharmacy Practice Dep, Benin Univ, Edo State, Nigeria, Email: ikponmwosa.osarenmwinda@uniben.edu) : Incidence of undiagnosed diabetes mellitus in rural community, Edo South, Benin City. Indian J Pharm Pract 2020, 13(3), 232-7.

The rate of diabetes is on the increase in Nigeria. Rural populace is most unlikely to receive routine medical screening or preventive services, tend to be severally ill when diagnosed and receive less optimum care. To determine the incidence of undiagnosed diabetes mellitus among rural population. This was a cross-sectional study carried out at Iru community (off Abudu-Ogada Road) of Orhionmwon Local Government Area of Edo State. Data was collected using structured questionnaire. Part of World Health Organisation (WHO) stepwise approach for non-communicable diseases surveillance and Type 2 Finnish Diabetes Risk Assessment Form were used for clinical data collection. The respondents’ data on anthropometric, blood glucose and blood pressure measurements, waist circumference and hip ratio were measured using standard criteria’s. Data were analysed with Statistical Package for the Social Sciences (SPSS) version 20. Less than half of the study participants had positive family history of diabetes (15.0 %) and hypertension (25.2 %). 23.7 % of the rural respondents had incidence of unknown diabetes. Majority of the respondents (70.1 %) had a lower risk of (1in 100) to developing diabetes mellitus within 10 years. Age, occupation, level of income per month, family history of diabetes and hypertension, distanced to health care facilities, ever seen doctor within last 12 months, ever had blood pressure measured, physical inactivity’s, BMI and alcohol consumption among study participants were found to be associated with low, slightly elevated and moderate risk to developing diabetes mellitus within 10 years with P-value <0.05. There was poor knowledge of diabetes among rural community residents. Significant incidences of undiagnosed diabetes mellitus have been observed.

4 tables, 37 ref

046725   HUSSAIN N A, KADHEM Q I, HUSSAIN A M (Al-Nahrain Univ, Baghdad, Iraq) : The practicing and attitude of some medical students at Al-Nahrain College of medicine towards cosmetic rhinoplasty. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194401.

Rhinoplasty in universal is connected with cosmetic surgery carried out to produce alterations in the interior and exterior components on the nose for merely cosmetics good reasons to get better look. It was common cosmetic procedures around the world because the nasal deformities effect on the psychology of the person as a negative impact on their self-confidence and social interaction with others. : The study is an attempt to display the practicing and attitude of some medical students towards cosmetic rhinoplasty and its relation to some studied variables. A cross-sectional study was conducted at Al-Nahrain medical college, during March 2016. A total of 200 undergraduate students were given a semi constructed questionnaire .The sample selected randomly by systematic random sampling. The practicing of rhinoplasty among this sample was 10.5 %. Most of them happy with their nose appearance. 56.5 % of the sample see this surgery socially accepted in Iraq. There was significant relation between person undergoing rhinoplasty and presence of family history of it. More than half of the medical student found cosmetic rhinoplasty is socially accepted in Iraq. Despite the majority of them had no family history of undergoing rhinoplasty but there was significant difference between doing such surgery and the presence of family history. More than two third of the students included in this study like more awareness program on cosmetic surgery. Encouragement for more studies to be done for this subject, and developing an educational program to increase awareness about rhinoplasty. 

2 illus, 4 tables, 17 ref

041850   SIVASAKTHI K, KOSHILA K S, MOHAMMED K S, VISWA S (Pharmacy Practice Dep, JKKMMRF’s Annai JKK Sampoorani Ammal Coll of Pharmacy, Komarapalayam - 638 183, Tamil Nadu, Email: sakthi.siva1292@gmail.com) : Assessment of knowledge, attitude and practice about self medication among rural areas in Erode District. Indian J Pharm Pract 2020, 13(3), 228-31.

In India, it is very common to observe self-medication practice, which is emerging as a challenge to health care providers. Few studies were conducted at community level in rural India to assess the magnitude of self-medication practices. This study aims to assess the awareness of self-medication practices and attitude among rural areas in Erode district. A Cross sectional study was conducted with a self-directed survey based questionnaire among 150 people who held permanent residence in rural areas in Erode district with different socio-economic backgrounds from the age group of 20 to 50 yrs. Among the 150 samples, the maximum study sample lies in the age category between 20-30 years, 53.33 % were men and 46.67 % were women, 28.67 % of people were graduate. The most common reason for self-medication was doctor’s clinic far from home (22.39 %) and doctor’s fee (22.34 %). The most common symptoms used for head ache (22.01 %) and fever (16.77 %).87 % of people take self-medication under the source of pharmacy shop. Over 90 % of people saw the information at the time of taking self-medication but only 40 % of people should understand the information partially. Commonly used medicines were analgesics (44 %) and antibiotics (42 %). Self-medication is a global phenomenon. Study reveals that with increasing the literacy, the demand of self-medication also increasing day by day. So that pharmacists and other healthcare professionals should make the awareness to the public about self-medication.

2 illus, 3 tables, 18 ref

041849   KARUNAKARAN P, KAKKANATT A, BAI J (Clinical Pharmacy Dep, Aster Medcity, Kochi - 682 027, Kerala, Email: pri4ever.k@gmail.com) : Cutaneous adverse drug reactions (CADRS) at a quaternary care hospital in South India: Focus on reaction time and treatment cost. Indian J Pharm Pract 2020, 13(3), 222-7.

Cutaneous Adverse Drug Reactions (CADRs) are a major problem in drug therapy and is one of the leading causes of morbidity and mortality in health care. The purpose of the study was to evaluate the Mean Reaction Time, Causality, Severity and Preventability of CADRs and Treatment cost associated with CADRs. A prospective, observational study of patients diagnosed with CADR was carried out over a period of one year in the Department of Dermatology and Department of Clinical Pharmacy at a quaternary care hospital in South India. Diagnosis of CADRs was confirmed by the dermatologist and Clinical Pharmacist evaluated the suspected CADRs for Causality by WHO-UMC and Naranjo’s scale, Severity by Hartwig and Siegel scale and Preventability by Schumock and Thornton criteria. 42 CADRs were reported during the study period. Most commonly manifested CADR was Acneiform Eruption (23.8  %) followed by Maculopapular Rash (19.0 %) and drugs used for the management of CADRs accounted for INR 5807.93. Most common offending drug group was Anti-infectives (33.3 %) followed by Oral Steroids (23.8 %). WHO and Naranjo scale rated 95.2 % of CADR as probable and 4.7 % as certain/ possible (Naranjo scale). Hartwig and Siegel scale marked 64.20 % as moderate, 30.90 % as mild and 4.70 % as severe CADRs. According to Schumock and Thornton criteria 95.2 % of CADR were not preventable and 4.7 % were definitely preventable. Awareness about CADRs is essential for early detection and prevention. The healthcare system should promote mandatory reporting of CADRs for ensuring safe drug use and patient care.

1 illus, 6 tables, 22 ref

041848   MORRIES L, MARIYA N, JOSEPH J J, ABRAHAM S (Pharmacy Practice Dep, Nirmala Coll of Pharmacy, Muvattupuzha, Kerala, Email: suja@nirmalacp.org) : Newer oral anticoagulant therapy – prospects and practices: A review. Indian J Pharm Pract 2020, 13(3), 215-21.

The conventionally used anticoagulants for the treatment of thromboembolism include unfractionated heparin, low molecular weight heparin, fondaparinux and Vitamin K antagonists such as warfarin, phencoumarol. Though they were considered the milestones in anticoagulation therapy, their use in clinical practice is limited due to its certain patient related issues such as wide variations in dose response relationship, delayed onset and offset of action, narrow therapeutic range of clinical effectiveness, frequent monitoring and dose adjustment. In order to overcome the above drawbacks of conventional anticoagulants, FDA approved Newer Oral Anticoagulants that provide stable anticoagulation at a fixed dose without the need for laboratory control, making it more convenient therapeutic regimen. In this review, the use of newer oral anticoagulant drugs in current clinical practice as well as the facts and concerns related to its use, safety and efficacy in patients with concomitant diseases like antiphospholipid syndrome, chronic kidney disease and patients undergoing cardio version is focused. Moreover, the various newer developments and ongoing trials in the field of anticoagulation were also discussed. The emergence of new reversal agents that are currently under development and its role in paediatric populations will be also an added advantage for its development. In short, the use of new anticoagulants had shown improvements in safety and efficacy as well as they offer greatest promise and opportunity for the replacement of Vitamin K Antagonists and other conventional agents.

81 ref

046724   ALQURAISHI F, MOHAMMED S H, AL-HAKEEM Y (Surgery Dep, Al-Nahrain Univ, Baghdad, Iraq) : Oral desmopressin as an add-on therapy for men with benign prostate hyperplasia they suffering from persistent nocturia. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194400.

Men with benign prostate hyperplasia suffer from urinary tract infection especially in lower part of the tract and common manifestation of this infection is nacturia. Treatment of nocturia depends mainly on α-blockers; however, these drugs have limited success in relieving this symptom. This study aims to assess the efficacy of desmopressin (0.2 mg) as an add-on therapy with α-blockers in relieving refractory nocturia for men with BPH. : Inclusion criteria for this prospective, nonrandomized, open-label trial included men ≥ 60 years old with LUTS due to BPH; a total IPSS of ≥14 points; and persistent nocturia with ≥2 voids/night despite using α-blockers for at least 10 weeks prior to inclusion. Patients with diabetes mellitus, known neurogenic bladder dysfunction, uncontrolled hypertension, congestive heart failure, and those using diuretics were excluded from the study. Fifty one patients were included and categorized into two groups; those who continued on α-blocker treatment (n=22), and those for whom oral desmopressin (0.2 mg) was used as an add-on therapy (n=29). After four weeks of treatment, the International Prostate Symptom Score (IPSS), storage and voiding subs-scores, nocturia episodes, maximal flow rate (Q_max) and bother score were measured and compared with their respective baseline values. there were no difference significantly between the two groups in all measured demographic and clinical parameters (all p-values >0.05). After four weeks of treatment, the total IPSS, storage sub-score, nocturia episodes, and bother score were all significantly better in the group were desmopressin add-on ( P-values ≤0.05). No significant differences were observed in the voiding sub-score and Q_max value between the two groups (both p-value >0.05). adding desmopressin to α-blockers is active therapy for men with BPH and suffering nocturia and no initial response to α-blockers.

2 tables, 11 ref

041847   JAMES J, JOSEPH J, STEPHY P S, ABRAHAM S (Clinical Pharmacy Dep, Nirmala Coll of Pharmacy, Muvattupuzha - 686 661, Kerala, Email: suja@nirmalacp.org) : Revolutionary role of clinical pharmacist in specialised clinics: Professional approach for better patient care. Indian J Pharm Pract 2020, 13(3), 209-14.

The treatment associated economic burden of our country is rising at an alarming rate due to the prevalence of various disease conditions. Since the burden of disease and its management cost is increasing, India has got all reasons to be alarmed over matters of health. Without finding out and implementing newer alternatives to meet the health needs of the population, the present health system has to do more to come up with the struggles in order to provide the adequate healthcare services to get the desired outcome. Focussed or personalised care can be foreseen as a remedy and has been considered as a core component in achieving a sustained high quality health outcome. Specialised clinics devoted to an area of speciality aims at providing focussed or personalised care to the patient which enables to provide more medical attention to the patient by the involvement of multidisciplinary health professionals and is also cost effective. The specialised clinics plays a major role in timely follow ups to ensure that the patient gets the individualised optimal therapy.

59 ref

041846   RABBANI A A, RAO P G M, WADHWA T, GUPTA P K (Clinical Pharmacy and Pharmacology Dep, RAK Coll of Pharmaceutical Sciences, Ras Al-Khaimah, UAE, Email: tarun@rakmhsu.ac.ae) : Safety profile of warfarin versus dabigatran in adult patients with non-valvular atrial fibrillation – a prospective cohort study. Indian J Pharm Pract 2020, 13(2), 180-91.

Atrial fibrillation is the most commonly encountered sustained cardiac arrhythmia associated with extensive cardiovascular morbidity and mortality. Warfarin is the most recommended drug therapy for the prevention of thromboembolic events or stroke in patients with atrial fibrillation. Due to availability of newer drugs like dabigatran, the need for frequent PT/INR monitoring and bleeding risk has reduced drastically. Although, studies are lacking regarding its safety profile and therapeutic use in clinical practice. The main objective of the present study was to assess the safety profile of warfarin versus dabigatran in patients with non-valvular atrial fibrillation. This was a prospective cohort study carried out for a period of nine months. All adult patients, who were prescribed with either warfarin or dabigatran in non-valvular atrial fibrillation were included in the study. Patients were monitored initially for occurrence of adverse drug events and subsequently during their follow-up visits at 3 and 6 months. Reported ADEs were analyzed for various clinical characteristics and causality, severity and preventability using standard assessment scales. A total of 75 patients (35 in warfarin and 40 in dabigatran cohort) were recruited. Out of 75, 38 patients experienced 70 ADEs (31 in warfarin and 39 in dabigatran cohort) which accounted for an overall incidence of 51 %. Elevated coagulation profile (20 %) followed by chest discomfort (10 %), thrombocytopenia (7.14 %), abdominal pain (7.14 %), anemia (10 %), gastritis (5.71 %) and hematemesis (5.71 %) were the most common reported ADEs among others. Dabigatran (55.71 %) was associated with higher number but less severe ADEs as compared to warfarin (44.28 %). Majority of ADEs were found to be probable (53 %) in nature, moderate (57 %) in severity, predictable (71 %) and not preventable (40 %). Dabigatran being a costly alternative appears to be safer than warfarin.

10 tables, 35 ref

041845   CHRISTIAN P,PATEL J, DESHAPANDE S, SHAH S (Pharmacology and Pharmacy Practice Dep, K.B Institute of Pharmaceutical Education and Research, Gandhinagar, Gujarat, Email: princyraju.3454@gmail.com) : Study use of antiepileptic drugs in pediatric ward at GMERS hospital, Gandhinagar, India. Indian J Pharm Pract 2020, 13(2), 174-9.

Epilepsy, a common neurological disorder characterised by a transient paroxysm of neuronal discharge and the condition seizure disorder is reported majorly among pediatric population. Around 4-10 % of children suffer atleast 1 seizure in their first 16 years of life. It includes febrile convulsion (typical or atypical), epilepsy or any neurological disorder. Anti-epileptic drugs are the primary therapeutic measure to control seizure and manage epilepsy. To determine rationality of therapy, it is necessary to have knowledge on how drugs are prescribed and used to treat a particular disease or a group of diseases in the clinical setting and so due to paucity of data on anti-epleptic drugs usage amongst pediatric population in India, drug use study was conducted. The study aims to determine the utilization pattern of anti-epleptic drugs in in-patient admission in pediatric wards of GMERS Hospital, Gandhinagar. The study was a prospective observational cross sectional study which was conducted for a period of 4 months. Data of 132 pediatric patients prescribed with anti-epleptic drugs by were enrolled and the resource used to collect data included subjects case notes which was recorded on a pre-structured data collection form. Utilization pattern of anti-epleptic drugs was assessed based on socio-demographic variables, clinical profile, therapy and newer and conventional drugs. Total 1687 patients were admitted, out of which 132 were prescribed with anti-epleptic drugs. Majority of anti-epleptic drugs were prescribed in 2-12 years age group (59 %) and in boys (56 %). Febrile convulsion (40 %) being the most commonly diagnosed condition followed by epilepsy (29 %) amongst the study population. Midazolam were administered to 113 patients (41 %), being the most frequently prescribed benzodiazepine the frequently used dual therapy was midazolam+phenytoin followed by midazolam+clobazam. The most used triple therapy was midazolam+phenytoin+sodium valproate. Phenytoin was the most used anti-epleptic drugs and midazolam was the most used benzodiazepens Midazolam monotherapy was used as a first line drug for management of seizure attack. If seizure was not controlled with midazolam then phenytoin was added. Conventional anti-epleptic drugs were used more as compared to newer AEDs.

2 illus, 4 tables, 9 ref

041844   SHRESTHA S, BHATTARAI B, GHIMIRE A, KARMACHARYA Y, KHANAL S, SHAHUKHAL S (Pharmacy Dep, Kathmandu Univ, Dhulikhel, Kavre, Nepal, Email: swetashres@gmail.com) : Impact of pharmacists’ counseling in patients’ knowledge of warfarin in a tertiary care cardiac centre: A prospective randomized controlled study. Indian J Pharm Pract 2020, 13(2), 166-73.

Warfarin is the mainstay of anticoagulation therapy; however, its’ use has been associated with many complications especially bleeding. Adequate patients’ knowledge on warfarin can improve anticoagulation control with reduction in adverse drug reactions and other associated complications. The objective of the study was to assess the impact of pharmacist’s counseling on patient’s knowledge of warfarin. A prospective randomized controlled study was carried out in Shahid Gangalal National Heart Center, Kathmandu, Nepal. A simple random sampling technique was used to enroll the participants in the intervention and control groups. A total of 99 patients participated in the study. Both the groups were administered the same questionnaire to assess their baseline knowledge. Verbal counseling of 20 min was provided to the intervention group whereas the control group received no pharmacist intervention. Final assessment of the knowledge level of both groups was done after a period of 2 months using the same questionnaire. A significant increment in percentage of patients with adequate knowledge on warfarin was found in the counseled group after intervention (p<0.05). The results further suggested that significantly increased proportion of patients in the intervention group achieved a better control of INR (International Normalized Ratio) after the intervention. No significant association was found between duration of therapy, gender, age and the knowledge score of the patients. Pharmacist provided counseling can significantly improve patients’ knowledge on warfarin.

1 illus, 8 tables, 18 ref

046723   AL-AZAWI I H, ABBAS M H (Al-Qadisiyah Univ, Al-Qadisiyah , Iraq) : Determination Enterococcus faecalis in asymptomatic urinary tract infection associated with diabetes type 2 patients in Suwayrah General Hospital-Iraq. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194399.

Asymptomatic Urinary Tract Infection is common in diabetes type-2 patient and predisposes these patients to more severe urinary tract infections (UTIs). Enterococci have been documented to cause infection of the urinary tract and other sites. Although several species of Enterococcus have been recognized, Enterococcus faecalis has been considered one of the major agents of urinary tract infections. To determine the percentage Enterococcus faecalis of ASB , antimicrobial resistance in diabetics and non-diabetics in urine sample and detection of enterococcal surface protein (esp) gene. : The study involved a total of 611 participants including 197 diabetes mellitus patients and 414 non-diabetics in Suwayrah-Wasit-Iraq. Mid-stream urine was collected from consented subjects and dipstick , general urine examination and bacterial culture were conducted for each sample. Isolates were identified using standard biochemical tests and VITEK-2 system. All collected samples are asymptomatic bacteriuria. There was a significant difference in the percentage of asymptomatic bacteriuria (ASB) between diabetics and non-diabetics (P = 0.010). There was no significant difference in resistance between diabetics and non-diabetics (P > 0.05). Enterococcus faecalis isolates showed (50 %) resistance to Erythromycin and Levofloxacin. The esp gene was observed in all Enterococcus faecalis isolates. The females of age more than 60 years old have the higher percentage of asymptomatic UTI. Erythromycin and Levofloxacin were more resistance in Enterococci isolated.

1 illus, 2 tables, 19 ref

041843   PAVANI B, KRISHNA T R, NEHA T, VAMSI K K, KALYAN V B, RAMESH G, GOTTIPATI S S, BABU P S (Pharmacy Practice Dep, Vignan Pharmacy Coll, Vadlamudi - 522 213, Andhra Pradesh, Email: bpavani97@gmail.com) : Naproxen (alone) vs tramadol hydrochloride +acetaminophen in the management of osteoarthritis of the knee: A 13 week prospective study at tertiary care hospital. Indian J Pharm Pract 2020, 13(2), 160-5.

The main aim of the study is to assess the effectiveness of Naproxen (Alone) Vs Tramadol Hydrochloride + Acetaminophen in the management of osteoarthritis of the knee. To determine and evaluate effectiveness of drugs prescribed, Cost effectiveness analysis. The present Prospective, Observational study with 100 subjects were from Orthopaedic department with Osteoarthritis of the knee. The subjects were selected on the basis of inclusion and exclusion criteria. The subjects were followed for every 14 days (2,4,6 weeks) and the severity of the pain was calculated by using Oxford knee score. All statistical analysis was carried out with SPSS software. Paired t-test was calculated for two groups and the result was found to be statistically significant. When compared to Group B (Tramadol Hydrochloride + Acetaminophen), Group A (Naproxen) was found to be highly significant. Naproxen was ranked the most effective individual knee OA treatment for improving both pain and function followed by Tramadol Hydrochloride + Acetaminophen. Group B treatment shows cost effectiveness. Further research is required to investigate the use of these drugs in treating OA of the knee. Hence it is necessary to make awareness to physicians and pharmacists, therefore clinicians should promote the rational use of these drugs in the management of OA of the knee.

6 illus, 9 tables, 10 ref

041842   CHINTHOJU S, KANCHA R, MURTHY S V, MADHUBABU S, SMITHA T (Pharmacy Practice Dep, Affiliated to Kakatiya Univ, Narsampet - 503 332, Telangana, Email: smithakatyan@gmail.com) : The analysis of neurologic manifestations with major electrolyte abnormalities. Indian J Pharm Pract 2020, 13(2), 156-9.

Neurologic manifestations caused by the major electrolyte abnormalities in neurologic conditions. The clinical significance of electrolytes in clinical practice and their abnormalities are developing in any of the neurological manifestations and along with other complications. The neurological manifestation requires effective management of the electrolyte disorder, which are primarily reversible. In this study we examined electrolyte imbalances that are threatening the life and examined the existent symptoms in neurological patients. In this prospective study subjects satisfying the inclusion criteria were enrolled and examined for their neurologic manifestations and analyzed different electrolytes levels. Patients’ demographics, electrolyte investigations, diagnosis and details of neurologic symptoms were noted. Electrolyte levels in various neurologic diseases were compared and correlations between the electrolyte abnormalities and neurologic manifestations made to identify the electrolyte imbalances and preceding symptoms. For this study subjects with symptoms along with pertinent neurological diseases enrolled. A total of 218 patients, of them 161 patients found with electrolyte abnormalities. This study included the patients diagnosed with various neurologic diseases such as spondylosis (66.5 %), Migraine (13.7 %), Head injury (5.5 %), Stroke (5 %) and seizures (1.37 %) and other conditions (7.79 %). The patients’ electrolytes data revealed significant changes in sodium, potassium and calcium electrolyte anomalies resulting in neurologic manifestations. We infer that patients with disturbances in various electrolytes are at high risk for the development of various manifestations. Appropriate recognition, monitoring and management should be done to minimize the effects of the neurological complications.

5 tables, 15 ref

046722   ALQARAGHULI H A , HASHIM H M (Al-Nahraine Univ, Baghdad, Iraq) : Vitamin D and its association with the severity and / or the control of asthma among adult Iraqi asthmatics. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194398.

Asthma is one of the common chronic diseases with variable presentations and pathogenetic mechanisms. Vitamin D is thought to influence the expression as well as the severity, control and treatment responses in some asthmatic patients.  To examine the possible association between asthma severity and level of control with vitamin D level in a sample of Iraqi adult asthmatics. Randomly selected 50 patients with asthma diagnosis were evaluated for medical factors of asthma harshness and control with measurement of 25-hydroxyvitamin D serum level (mean age ± SD: 48.5 ± 14.05 years, 30 % males, FEV1:1.44 ± 0.63 L, 60 % severe, 60 % poorly controlled). Most of asthmatic patients (96 %) were found to have vitamin D level of less than 30 ng/ml (17.66 ± 7.06 ng/ml) and this was related to severity of airway obstruction (mild: 28.71 ± 5.52 ng/ml, moderate: 19.9 ± 4.56 ng/ml, severe: 13.81 ± 4.22 ng/ml, p < 0.001) as well as control of asthma (controlled: 27.13 ± 6.12 ng/ml, partly controlled: 20.62 ± 4.21 ng/ml, uncontrolled: 17.66 ± 7.06 ng/ml, p < 0.001). In addition, the 25(OH)D level was significantly associated with history of ER visits and hospitalizations. No significant association between the gender, age, BMI, the presence of allergic rhinitis and the status of vitamin D level. low levels of 25(OH)D were common in this sample of Iraqi adult asthmatics and was most prevalent and severe in those with severe and/ or uncontrolled asthma. This finding supports the hypothesis of possible vitamin D role in asthma.

3 illus, 4 tables, 20 ref

041841   KUMAR A, KRISHNA V N V, SINDUSHA P, SUSRITHA M (Pharmacy Practice Dep, Aditya Coll of Pharmacy, Surampalem - 533 437, Andhra Pradesh, Email: amit.britind@gmail.com) : Point prevalence study of use and consumption of antibiotics by using anatomical and therapeutic chemical classification and defined daily dose methodology in tertiary care hospital. Indian J Pharm Pract 2020, 13(2), 151-5.

The aim of this study is to identify the use and consumption of antibiotics in tertiary care hospital by using Anatomical and therapeutic chemical classification and Defined daily dose index. A point prevalence study was conducted at tertiary care hospital. A total of 640 patients were included in this study and taken from different medical departments. Patient’s demographic and biological data was collected from the medical records. Antibacterial drugs were classified according to ATC/ DDD index and antibiotic consumption was measured by DDD/ 100 Patient days. The mean age of 640 patients was 44 (sd 13.53). About 78 % of the antibiotics are prescribed from the NLEM (2018-2019). The consumption of antibiotics is higher in departments like surgery (92.18 %), Orthopaedics (87.5 %) and General medicine (81.25 %) followed by Gynaecology (78.13 %) and Pulmonology (50.2 %). The DDD/ 100 Patient days in Gynaecology were 19.4, in Pulmonology unit 45.2, in surgical unit 24.82, in General medicine unit 33.6 and in Orthopaedics 30.23. In our study the rate of utilisation of antibiotics was found to be 78 %. Broad spectrum antibiotics like cephalosporin’s and aminoglycosides are prescribed frequently in the hospital which leads to increase in the microbial resistance. The DDD of ceftriaxone (1250) and cefixime (400) is higher when compared to aminoglycosides i.e. amikacin (700). The DDD of cephalosporins is higher when compared to other antibiotics. Inappropriate use of antibiotics leads to increase in the microbial resistance. Prescribers are forced to use broad spectrum antibiotics when other antibiotic therapy options are not available.

5 tables, 35 ref

041840   KIRUBAKARAN J J, SUREKHA K L, MANASA S, SATYANARAYANA A N V C, SRILAKSHMI K V, PALIVELA H, KUMAR P, DHANARAJU M D (Pharmacy Practice Dep, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, Email: john.mpharm@gmail.com) : Evaluation and management of atopic dermatitis. Indian J Pharm Pract 2020, 13(2), 145-50.

Atopic dermatitis is the most predominant disease seen mostly in children and the prevalence of disease is 10 % to 20 %. The pathogenesis of the disease includes immunological, food allergies, pollen grains, breast feeding and secondary infections. To identify the cause and to evaluate the appropriate treatment of the patients with atopic dermatitis. A total of 116 patients are included in the study conducted in skin care and paediatric hospital in the area of Rajahmundry, India. From the study conducted, we observed that the occurrence of the disease is in different age groups and most of the patients are affected by pollen grains (10 %) followed by pets and respiratory illness (5.3 %), allergies (5 %) and pollutants (4.6 %) and family history (3.3 %) respectively. On evaluation, the treatment topical steroids are found to be more prominently used followed by emollients, antibiotics, antihistamines and immunomodulators. As per the study, we conclude that the occurrence of the disease is mainly due to pollen grains followed by other determined causes as seen in the area of Rajahmundry.

7 illus, 1 table, 17 ref

041839   SEBASTIAN S, JUSTIN S, ATHIRA P S, DANIEL L, SATHYAMURTHY G, MENAKA K,THANGAVEL S (Pharmacy Practice Dep, Nandha Coll of Pharmacy, Erode, Tamil Nadu, Email: snehakadumathil@gmail.com) : Role of clinical pharmacist in medication management of inotropes and vasopressors in intensive care unit. Indian J Pharm Pract 2020, 13(2), 138-44.

Medication management of inotropes and vasopressors are essential in critically ill patients, as it is considered as important life-saving medications. The present study was carried out to understand the effect of these drugs on unstable patient and identifying drug-related problems like significant interactions, adverse effects, incompatibility and its factors. A prospective observational study was carried out in the medical, surgical Intensive Care Unit for a period of 6 months. All the interventions and drug related problems were categorized based on the Pharmaceutical Care Network Europe. Out of 150 study population male patients were more and the majority of patients were from the age group of 60-80 years (56.66 %). Most of the admissions were due to septic shock (50 %). Noradrenaline (64 %) were mostly prescribed. This study illustrates that there is an increased effect of drugs on hemodynamic instability based on mean arterial pressure and heart rate. By comparing before and after administration there was a significant (P<0.0001) increased effect in unstable patients. Among 108 significant drug interactions, dobutamine (50.92 %) shows high in frequency. Tachycardia (18.66 %) is the most common adverse drug reactions. Among 11 incompatible combinations, Dobutamine+pantoprazole (30.18 %) shows the highest and the factors affecting the incompatibility of drugs such as diluents used, rate and duration of infusion, pH of drug solution. Out of 126 recommendations given by clinical pharmacist, 70 problems were solved. Interventions made by a clinical pharmacist improves medication safety in critically ill patients by the safe and effective use of inotropes and vasopressors.

2 illus, 5 tables, 12 ref

041838   SUNNY S, VAJJAPALLY P, BANDARU S S B, EGGADI V, KULANDAIVELU U, BANDARI R (Clinical Pharmacy Dep, Vaagdevi Coll of Pharmacy, Warangal, Telangana, Email: eggadivenkey@gmail.com) : Evaluating the outcomes of surgical versus conservative treatments in head injury: A comparative observational study using different scales. Indian J Pharm Pract 2020, 13(2), 132-7.

This study is to evaluate the outcomes of surgical versus conservative treatment in head injury by using different scales to rate the quality of life in both the treatments. To evaluate the outcomes of surgical versus conservative treatment in Head injury. A prospective, comparative observational study was conducted in Neurosurgery department in a tertiary care teaching hospital for a period of 6 months. All the patients with head injury were included in the study and reviewed.Among the subjects two groups are made in which one group includes the subjects who are treated with conservative treatment and the other group who have undergone surgical treatment among these two groups GCS scale, four score scale and dementia rating scale are assessed and both the treatments are compared. Patients with head injury between age groups of 20 to 70 years were recruited for this study. The patients recovery analysis according to GCS for conservative (93.06 %) and surgical (50.40 %), FSS for conservative (90 %) and surgical (56.75 %), DRS for conservative (100 %) and surgical (50.04 %). Based on the severity it is decided whether conservative or surgical treatment is given to the patient, but primary choice of treatment should be conservative treatment for patients with less severity as patients under conservative treatment had better recovery and memory compared to that of patients under surgical treatment.

10 illus, 12 ref

041837   KAPOOR M (Pharmacy Practice Dep, ISF Coll of Pharmacy, Moga, Punjab, Email: monikakapoor01.mk@gmail.com) : Spearman’s rank correlation and factorial analysis: Socio-demographic characteristics of diabetic hypertensive patients presenting to a tertiary care hospital. Indian J Pharm Pract 2020, 13(2), 125-31.

The main objective of this paper is to explore exploratory factor analysis and Spearman’s Rank Correlation which indicates the relationship between the duration of the disease with socio-demographic characteristics of the patients presenting to the hospital. Prospective Observational Study. The study was carried out in the Department of Medicine of the Punjab Institute of Medical Science and Hospital (PIMS), Jalandhar for a period of 6 months from June 2018 - November 2018 after Recieving approval from the Institutional Ethics Committee. After calculating the sample size using Epi Info, the study was conducted on a total of 250 patients. The study was analyzed using SPSS version 24. The age group of the study was 22 to 86 years. According to the Kolmogorov Smirnov (KS) and Shapiro-Wilk (SW) p value was found to be p=0.009^a and p=0.058^b respectively. Age was found to be normally distributed because the p-value was found above the cut-off point with Skewness -0.200, Kurtosis 0.178 and standard error 0.762. It was observed that there is a significant moderate positive correlation between age and duration of HTN (r = 0.408, p = 0.001). Further analysis was observed that age, social habits and physical activity also has a wide impact on the duration of disease. Numerous factors are observed to be directly associated with the socio-demographic characteristics of the patients. During the study, it was observed that age, social habits and physical activity also has a wide impact on the duration of the disease itself.

5 illus, 11 tables, 26 ref

041836   TAMANG P (Pharmacy Practice Dep, Sri Venkateshwara Coll of Pharmacy, Chittoor - 517 127, Andra Pradesh, Email: pemtamang393@gmail.com) : Study on the prevalence of depression and anxiety among diabetes mellites patients in tertiary care Hospital- a prospective cross-sectional study. Indian J Pharm Pract 2020, 13(2), 117-24.

Diabetes mellitus is one of the most predominant, chronic disease afflicting globally with its amplifying burden. The association of diabetes with psychological disorders exists with depression and anxiety being the most common, often remains undiagnosed or unidentified eventually leading to a decline in functional abilities and self-care, worsening the health profile of the patients and contributing to both morbidity and mortality. This study explores the association of psychiatric problems with diabetes mellitus and their related risk factors. To investigate the association and the prevalence of psychiatric disorders (depression and anxiety) among diabetic patients and access their associated risk factors. A prospective cross-sectional study was conducted for six months in 105 diabetic patients from the outpatient department. Hospital Anxiety and Depression Scale (HADS) was used to evaluate the symptoms of anxiety and depression. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Overall 53 (50.5 %) were observed with the symptoms of anxiety while 45 (42.9 %) with symptoms of depression respectively. The prevalence of marked anxiety and depression was observed higher in a female. Anxiety and depression were also common among participants with moderate social support. Anxiety and depression were greater among patient who were illiterate (OR=1.50, 95 % CI 0.92-5.38), unemployed (OR=7.50, 95 % CI 1.29-43.61) with low income (PR=3.09 95 % CI 0.92-10.36) and who were retired (OR=6.00, 95 % CI 0.81-44.35). The result showed a high prevalence of depression and anxiety among female than in the male. Most of the patients developed moderate or severe anxiety and depression. Various factors such as low income, age, low education, unemployed, uncontrolled diabetes were associated with anxiety and depression. Awareness programs and health education should be conducted. Counseling and appropriate medication should be initiated to reduce future complications.

6 tables, 25 ref

041835   KUMAR V, RAJ A K, MAHROOF R, FABIN M, ANSIL M (National Coll of Pharmacy, Mukkam, Kozikode, Kerala, Email: tovishnuk20@gmail.com) : Role of Etomidate in critical care for rapid sequence intubation. Indian J Pharm Pract 2020, 13(2), 113-6.

Rapid sequence intubation is a process involving the administration of a sedative induction agent and a paralytic agent to facilitate endotracheal intubation. Administration of an induction agent followed by a rapidly acting neuromuscular blocking agent to produce unconsciousness and motor paralysis provide optimal intubation condition and protect the patient’s airway. Etomidate is gamma amino butyric acid agonist administered to facilitate a state of unconsciousness; it has a rapid onset of action and duration of action for 4-10 min, minimal cardiovascular effects, respiratory depression of histamine release and provides protection from myocardial and cerebral ischemia. This review discuss the importance of Etomidate as the first line induction agent in emergency department. A detail literature review of rapid sequence intubation in emergency department was carried out from PubMed using the keywords Etomidate, Ketamine, Propofol, Rapid sequence intubation. Etomidate is the first line drug in thermodynamically stable patients and in traumatic brain injury. However, it should not be used as an infusion or as repetitive bolus doses for maintenance dosage adjustment in elderly patients. Etomidate when used provides sedation within 1 min and eliminates critical monitoring requiring only basic monitoring parameters like blood pressure, pulse and ECG readings. Incidence of hypotension is low and when occurs can be managed with IV fluids, the sedation lasts for about 30 mins. However patient specific factors must also be considered during the selection of intubating agent.

20 ref

046720   JUMAA A H, JARAD A S, AL-UBOODY W S H (Dentistry Dep, AL-Yarmouk Univ, Baghdad, Iraq) : The effect of esomeprazole on cell line human cervical cancer. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194396.

Esomeprazole is an inhibitor of the proton pump that reduces gastric acidity and is used in indigestion treatment; Esomeprazole is a promising treatment for tumors, such as melanoma and B cell leukemia, through several mechanisms, including rapid cellular acidification and activation of many types of caspase enzymes, which in turn lead to the activation of cellular apoptosis This work was designed to assess the toxicity of the (Esomeprazole) on (HeLa cell line) in vitro at concentrations starting from one - ten thousand μg/ milliliter and compared with cytotoxicity of vincristine and methotrexate at concentrations between one - ten thousand μg/ milliliter In 3 incubation periods The results showed that the cellular toxicity of one μg / milliliter was a lot of more than the cellular toxicity of ten and a hundred μg / milliliter. The results additionally showed that toxicity of esomeprazole was considerably more than vincristine and methotrexate on HLA cells at seventy two hours.

6 tables, 24 ref

041834   PATEL I, GADWAL T, SHRESTHA S, KHIERI S, MILLER M K, GUY J W, CHANG J, JOHNSON M (Pharmacy Practice Dep, Marshall University School of Pharmacy (MUSOP), Huntington-25755, West Virginia, USA, Email: pateli@marshall.edu) : Cultural competency education in pharmacy curricula-need and implementation. Indian J Pharm Pract 2020, 13(2), 97-112.

Cultural competency is the ability to interact effectively with people of different cultures. Development of cultural competency skills among health professions students has been a challenge to integrate into curricula. However, further integration of cultural competency concepts may be needed in the future as some literature has shown that training in this area can lead to benefits in patient outcomes. To date there have been different methodologies used to enhance cultural competency including didactic training, community engagement and experiential models focused on communication. The Substance Abuse and Mental Health Services Administration has also provided a multi-step plan to help in advancing health professionals’ skills in the area of cultural competency. In addition, the Accreditation Council for Pharmacy Education has made cultural competency a major standard for pharmacy programs, thus further integration of valuable instructional methods for cultural competency are needed. Other professional organizations have also started to develop tools and resources to help educate individuals in the area of cultural competency. In the future, further integration of cultural competency education will be necessary to comply with accreditation standards and to improve health professionals’ skillset, which may in turn result in improved patient outcomes.

2 tables, 81 ref

046719   JASIM W M (Kirkuk Technical Institute-Northern Technical Univ, Kirkuk, Iraq) : Knowledge assessment of working women regarding breast cancer / control and prevention in Kirkuk Technical Institute. Med Legal Update 2020, 20(1), 10.37506/v20/i1/2020/mlu/194395.

Breast cancer is the most common cancer in women both in the developed and less developed world In Iraq, it is the commonest type of female malignancy, accounting for approximately one-third of the registered female cancers according to the latest Iraqi Cancer Registry. A descriptive cross-sectional study was conducted on working women in Kirkuk Technical Institute during the period from 1st April till 30th June / 2016 to assess their knowledge regarding breast cancer prevention and control methods. The total number of included studied women was 71 from different scientific departments after distributing a special questionnaire form and face to face interview was done after receiving the written agreements to participating in the study. Majority of working women are technical (52.2 %), married (74.7 %) aging above 40 years (47.8 %) with employment years above 15 years (50.0 %). Both electrical and survey dept. go with the establishing of breast cancer prevention at adulthood after fully maturated (44 %, 45 %) respectively in comparison to 57.7 % of study women from electronic dept. go with the starting of cancer prevention at the birth of a first child . The main recommendation of the study is  that further researches should be done because there is a need for increased efforts towards developing and widely available cancer educational program that focuses on the main preventive measures and encouraging the women with breast disease, not only providing them with information but also for the ability to make her decision to control the disease.

4 tables, 20 ref