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Objective: To evaluate adherence to medication and study factors associated with nonadherence in chronic kidney disease (CKD) patients. Methods: A prospective, cross-sectional, questionnaire based study was conducted in Nephrology department of a super specialty hospital. Patients above 18 years of age, suffering from CKD from six months or more were interviewed using self-designed, semi-structured questionnaire to get information about adherence to medication, diet restriction and lifestyle modification (n = 150). Morisky medication adherence questionnaire was used to calculate overall adherence. In this higher score indicates poor adherence. Main outcome measures included prevalence of non-adherence and factors associated with the same. Results: Average number of medicines taken by each patient was 8.0+1.612 (mean+SD) per day. Non-adherence to medication schedule was reported in 34% patients. Common causes of non-adherence were high cost (21.3%), complex dosing schedule (20%), fear of adverse effects (16%). Sixty-eight% patients were not aware about importance of taking each medicine. Sixteen% stopped taking medicines due to high cost. Forty-two% suggested that government should adopt measures to provide free medicines to poor patients. In Morisky medication adherence questionnaire high, medium and low adherence was reported in 7.3%, 55.3% and 37.3% of patients, respectively. Moderately positive correlation was observed between poor adherence and number of concurrent illnesses and number of medicines taken. Conclusion: Since majority of patients were not aware about importance of taking each medicine, creating awareness about the same is essential for improving adherence to therapy. Measures to provide free medicines to non-affording patients need to be implemented since high cost was other major cause of non-adherence. [ABSTRACT FROM AUTHOR]

Objectives: Health-related quality of life (QOL) is an important outcome in epilepsy treatment. Very few studies have been carried out on the quality of life in epilepsy (QOLIE-31) in India. The present study aimed to determine the level of health-related QOLIE-31 in patients of epilepsy. Materials and Methods: This was a cross-sectional, questionnaire-based study conducted in a tertiary care teaching hospital. Respondents were adults aged at least 18-year-old with a diagnosis of epilepsy. QOLIE-31 was used for collecting data on health-related QOL. The unpaired t-test or one-way analysis of variance was used to compare means of QOL scores between groups. Results: Totally, 60 patients of epilepsy were included in the study. The mean (standard deviation) total score of QOLIE-31 was 64.61. A score of cognitive and medication effect were significantly better in carbamazepine group as compared to valproate group. Conclusions: Patients on monotherapy had a better QOL as compared to patients receiving polytherapy. [ABSTRACT FROM AUTHOR]

Context: Prescribing is a challenging task requiring knowledge of essential medicine (EM), rational use of medicines (RUM) and personal drugs (P-drug). Though the majority of clinicians recognize the importance of RUM, most of them have not been able to apply this knowledge in their medical practice. Aims: The aim of the following study is to assess knowledge, attitude and practice of clinicians about RUM, EM, P-drugs, and sources of drug information. Settings and Design: A cross-sectional, questionnaire based study. Subjects and Methods: Study was carried out in 100 respondents including faculty members and junior residents (JRs) in a tertiary-care teaching hospital. Statistical Analysis: Univariate analysis was carried out using fisher's exact test. Results: Nearly 93% respondents were aware about EM, but only 79% prescribe them. Percentage is significantly higher in respondents of age more than 30, having clinical experience <5 years and in faculty members as compared to residents. Nearly 87% respondents were aware about RUM, but only 83 % practice it. Though 30 % respondents practiced P-drug concept only 1% were aware about STEP criteria. Practicing P-drug concept was significantly more in JRs compared to faculty members (P < 0.0001). None of the respondents were aware about the number of drugs in National List of EMs of India. Conclusions: It is an encouraging finding that higher percentages of clinicians were aware about EM and also prescribed it. However, level of understanding related to P-drug concept and existence of essential medicines list are much below par. Also prescribing by trade name and heavy dependency on medical representatives for drug information is the matter of concern. [ABSTRACT FROM AUTHOR]

Context: Nonsteroidal antiinflammatory drugs (NSAIDS) are mainstay of therapy in various inflammatory conditions. Its long-term use is associated with acid peptic diseases requiring prophylaxis with antiulcer drugs. Thus the question arises whether inhibition of gastric acid secretion affects the bioavailability of NSAIDS. Thus prescribing NSAIDS together with H2 blockers seems to be a safe strategy but the combination becomes less effective for its primary intention. Aims: To evaluate the effect of combination therapy on efficacy of NSAIDs in terms of analgesic, antiinflammatory and antipyretic activity. Settings and Design: Experimental study in albino rats. Materials and Methods: Evaluation of analgesic activity was done by acetic acid writhing model, antiinflammatory activity was assessed using carrageenin-induced paw edema and for antipyretic activity yeast was used (n = 6). Gastric juice pH was analyzed. Statistical Analysis: Comparison between different groups was done by one-way analysis of variance (ANOVA) followed by Tukey's test using Graph pad prism software version 5.01. The analgesic, antiinflammatory, and antipyretic activity was significantly reduced when aspirin, diclofenac and piroxicam were combined with famotidine. There was a pH rise in H2 blockers pretreated groups, which was more with famotidine as compared with ranitidine pretreated group. Conclusions: Prescribing NSAIDs and H2 blockers together seems to be safe strategy but the drug combination becomes less effective for its primary intention of reducing pain, fever, and inflammation. [ABSTRACT FROM AUTHOR]

Objectives: Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. Altered mineral metabolism contributes to bone disease and cardiovascular disease. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level. No studies about the utilization pattern of PBs in CKD patients have been reported from India. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs. Materials and Methods: This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Demographic, clinical, and medication details were collected in a specially designed proforma. Results: A total 111 prescriptions were included in the study. Average number of drugs per prescription was 9.47. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list. Out of total prescribed drugs (1052), most commonly prescribed were vitamins and minerals (24.71%), cardiovascular drugs, (22.14%), and hematopoietic agents (20.15%). Considering individual drugs, five most commonly prescribed drugs were multivitamins (14.82%), iron (8.65%), folic acid (8.55%), calcium carbonate (8.17%), and calcitriol (5.60%). A total of 11.02% of prescribed drug were PBs. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB. No patient was prescribed lanthanum carbonate. Conclusion: This study identified a wide variety of drug classes including PBs prescribed in CKD patients. Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier. [ABSTRACT FROM AUTHOR]

Context: The cognitive and psychomotor functions may become impaired in epileptic patients due to underlying etiology, effect of seizures and side-effects of antiepileptic drugs. It is desirable for the drug to have a minimal effect on cognitive abilities. Few studies have evaluated the psychomotor effects of newer antiepileptic agents and hence do not have the proper evidence base for their psychomotor adverse effects. Aims: The aim of this study is to evaluate the effects of gabapentin (GBP), vigabatrin (VGB), valproate (VAL) on psychomotor functions. Settings and Design: Randomized, prospective, double-blind, placebo (PLB) controlled crossover study. Subjects and Methods: A total of 24 healthy volunteers were included to administer single oral doses of GBP 300 mg, VGB 500 mg, sodium valproate 200 mg and PLB following a Latin square design. The objective parameters - six-digit cancellation test, digit symbol substitution test, critical licker fusion test, arithmetic ability test, digit span test, hand steadiness test and subjective parameters like visual analog scale (VAS) were tested at 0, 1, 2 and 3 h. Statistical Analysis Used: Repeated measures ANOVA was used to compare the difference in mean score. Fisher's exact test was used for statistical analysis of adverse effects. Results: Sodium valproate impaired all subjective and objective psychomotor functions while GBP, VGB did not show any impairment when compared with PLB. GBP when compared with VGB, no difference was observed in any test, but when both the drugs were compared with sodium valproate, statistically significant difference at the end of third hour was observed. Conclusions: VGB and GBP have few adverse cognitive and psychomotor effects as compared with sodium valproate, therefore are safe as add on therapy or monotherapy. [ABSTRACT FROM AUTHOR]