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Background: Antiretroviral therapy (ART) has transformed the life of PLHIV with a longer life expectancy. The rising coexistence of noncommunicable diseases (NCD)s especially type 2 diabetes mellitus (DM) and hypertension (HTN) among PLHIV (people living with HIV) is much more complicated and demanding for the health system, patients, and their families. To document the current status of type 2 DM and HTN among known diabetic/hypertensive PLHIV attending ART center, tertiary care hospital of South Gujarat. Materials and Methods: A mixed method study (cross-sectional survey followed by qualitative in-depth interview) was conducted among 184 PLHIV on ART with history of Type 2 DM and/or Hypertension who were registered and availing services from ART center, tertiary care hospital. Convenient sampling technique was used. All the participants were interviewed using pre-designed, semi-structured questionnaire, during their routine visits. In -depth interview (IDI) has been conducted to explore the delivery of NCD services at ART Centre. Results: Out of 184 PLHIV on ART, the most common co-morbidities were Type 2 DM (46.2%), HTN (39.13%), and 14.67% had both. Among total 184 participants, 64.1% were males and 35.9% were females. Only 22.3% of participants were availing treatment services for the above at tertiary care hospital. The study results showed a range of findings involving ART adherence, BMI, RBS, and BP measurements were included. IDI results described the NCD service delivery at ART Center. Conclusions: Study results suggest that the services received by PLHIV with NCD require an overhauling. Routine monitoring and strengthening of existing services should be focused to upgrade the quality and continuum of the care provided to PLHIV with NCD. [ABSTRACT FROM AUTHOR]

Background: Pharmacological drugs and medications are being widely used for the control of non-communicable diseases like hypertension. Hill-Bone--Compliance to High Blood Pressure Therapy Scale (HB-HBP) is a newly developed specific questionnaire for assessing the anti-hypertensive medication adherence. Hence, this study was done to translate the HB-HBP in Tamil and to assess the construct validity and reliability of the Tamil version. Materials and Methods: Translation of HB-HBP to native language, Tamil was done by experts and piloted with subsample of hypertensive patients from rural Puducherry. Final Tamil-translated HB-HBP was administered among 328 Tamilspeaking hypertensive patients in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis (EFA) through the principal component method. Based on the minimum average partial and parallel analysis, three-factor model was distinguished. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient. Results: Three factor structures were obtained with eigenvalues of 6.5045, 2.8165, and 1.2261, respectively, which accounted for 75.34% of variance. Three-factor model assessed by the confirmatory factor method found Chi-square value of 1055.048 (P value <0.001). Goodness of fit revealed acceptable comparative fit index (0.773), Tucker-Lewis index (0721), standardized root mean square residual (0.077), and root mean square error of approximation (0.201). The reliability coefficient (Cronbach's alpha) for the scale was 0.9020. Conclusion: Our study concludes that the HB-HBP questionnaire is internally valid and consistent with a good reliability coefficient for application in Tamil-speaking patients with hypertension. [ABSTRACT FROM AUTHOR]

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care. [ABSTRACT FROM AUTHOR]

Background: Drug-resistant tuberculosis is a burgeoning threat to public health requiring novel strategies to combat the infection. Although national tuberculosis elimination programs focus on improving health services, challenges in eradicating tuberculosis still exist. Factors attributing to unfavorable outcomes are unknown in Warangal district of Telangana state. Methods: This study included 296 patients diagnosed with multidrug-resistant pulmonary tuberculosis. The study participants followed up for a maximum of 20 months to determine treatment outcomes. Statistical applications of Kaplan-Meier curve and log-rank test used to find the survival probabilities in subgroups. Results: The survival of multidrug-resistant pulmonary tuberculosis patients was ascertained, in male and female patients, aged between 31 and 50 years. Resistance to rifampicin was prominent. The study found a survival rate of 76.68% and a mortality rate of 23.31%. The log-rank test revealed a significant difference in survival in subcategories with and without comorbidities (P =.03), non-adherence to treatment (P =.0001), treatment duration (P =.02), regimens (P =.01), and grading of radiograph (P =.0001). Conclusion: This study identified factors that influenced the survival probability of multidrug-resistant pulmonary tuberculosis patients, including comorbidities, weight band, non-adherence to treatment, treatment duration, regimens, and grading of radiograph. These findings emphasize the need for enhanced management strategies to improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Combination products, amalgamating drugs, biologics, and medical devices, have revolutionized the healthcare landscape with their potential for innovative therapies. However, the intersection of diverse components within these products presents a complex regulatory environment, demanding rigorous attention to safety and efficacy. This article delves into the intricate landscape of regulatory considerations, safety, and efficacy assessments pertaining to combination products--a category at the intersection of drugs, devices, and biologics. The regulatory framework, primarily governed by the U.S. Food and Drug Administration (FDA), necessitates a nuanced classification determining the regulatory pathway. Collaboration between diverse regulatory centers, such as the Center for Drug Evaluation and Research (CDER) and the Center for Devices and Radiological Health (CDRH), underscores the integrated approach required for these innovative healthcare solutions. Safety considerations unravel the potential risks and adverse events associated with combining diverse components, emphasizing the need for robust risk assessment and mitigation strategies. The evaluation of efficacy involves sophisticated methodologies, clinical trials, and post-market surveillance, with recent advancements incorporating digital technologies. This comprehensive exploration aims to contribute to the evolving understanding and best practices in the regulatory and scientific realms, fostering collaboration and innovation in the development and assessment of combination products. [ABSTRACT FROM AUTHOR]

This paper demonstrates the synthesis and storage of molecular-imprinted polymers (MIP) at room temperature using bulk polymerization of atenolol (Ate), which is characterized by high sensitivity, low costs, and high stability. The research used 0.99:6:20 mmol ratios of template, monomer, and cross-linking agents for the polymerization in order to ensure an appropriate adsorption capacity. By making MIP for atenolol as Ate-MIP, which could be looked at with a UV-VIS spectrophotometer at 276 nm, Fourier- transform infrared spectroscopy (FT-IR), and scanning electron microscopy (SEM), a functional monomer of allyl chloride with cross-linking ethylene glycol dimethyl acrylate was made. Mass spectrometric (MS) detection may use allyl chloride to determine atenolol levels in pharmaceutical preparations. The GC/MS methods developed in this study are accurate, sensitive, and precise and can be easily applied to (NOVATEN/India and ATENOIOI/U.K.) tablets in pharmaceutical preparation. The elution process was applied to the template (Ate) from the Ate-MIP, which developed cavities, caused by using porogenic solutions of methanol, chloroform, and acetic acid (70:20:10, respectively). The maximum adsorption capacity of Ate-MIP was 2.9957 µmol/g, and the ratio of template to monomer was 1:1 in adherence to the Langmuir isotherm model. A solid-phase extraction (SPE) syringe packed with molecular imprinted polymers (MIPs) was used to selectively separate and pre-concentrate Ate from aqueous solutions and estimations of atenolol. [ABSTRACT FROM AUTHOR]

India published its first edition of the National Essential Diagnostics List in 2019. The list depicts the list of diagnostic tests that can ensure affordable and quality healthcare delivery by removing barriers toward accessibility and reducing out-of-pocket expenditure. In 2024, the Indian Council of Medical Research has invited suggestions for revision of the list. Therapeutic drug monitoring (TDM) has been a promising modality and has been useful for a range of indications like monitoring medication adherence, diagnosing suboptimal treatment, detecting drug interactions, and guiding initiation or withdrawal of therapy. In this article, the authors make a case for inclusion of TDM for certain psychotropic drugs like lithium, sodium valproate, carbamazepine, and clozapine at the district hospital level. The authors have tried to justify the inclusion backed by recent evolving evidence. [ABSTRACT FROM AUTHOR]

Background: Para-suicide by self-poisoning is a major public health concern throughout the world, especially in developing countries. It is a cause of considerable morbidity and mortality as well as consuming scarce medical resources which would have been used otherwise. The survival of such patients to a considerable extent depends on the competence of the attending doctors, nature of toxic agent consumed and the availability of specific antidote. Objective: The sole purpose of this study is to provide proper knowledge and awareness of health professionals on the common toxic agents used for self-poisoning. Material and methods: This prospective study was conducted by identifying and reviewing all self-poisoning cases that were presented at the emergency department of JNMCH, A.M.U Aligarh, over a span of 2 years. A total of 375 cases of self-poisoning were entered into the emergency department register, but only 315 files were considered for this study. Results: In this study majority patients belong to 15-24 years' age group i.e. 153(48.57%) with male dominance. The most ingested substance for non-fatal self-poisoning was a pharmaceutical drug 71(22.54%) followed by agrochemicals like rat poison 60 (19.05%), Aluminium phosphide 46(14.60%) and organophosphate 33(10.48%). There were significant (p<0.01) gender differences noted in type of substance used. Conclusion: Accessibility has been noted as a factor affecting the choice of drug used. Implementing the pesticide act strictly will allow the government to have control over the production, sale, distribution, storage, and use of pesticides. [ABSTRACT FROM AUTHOR]

Background: Medical abortion with mifepristone and misoprostol can be provided up to 63 days' gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India. Methods: We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021. Results: Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment. Conclusion: Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed. Plain language summary: Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions. [ABSTRACT FROM AUTHOR]

Background: India has very rich diversity of medicinal plants. Medicinal plants are thought to be a rich source of ingredients that can be used in the development of pharmaceutical or synthetic drugs. Aside from that, these plants play an important role in the development of human drug all over the world. Whether in modern or traditional medicine, medicinal plants are used to maintain health, to treat a specific condition, or both. Nardostachys is one of the most important medicinal plant having several therapeutic properties. It is threatened in its natural habitat due to over exploitation for therapeutic purposes and high demand in the traditional medicine system. Keeping these points in mind, we attempted to investigate alternative uses of in vitro grown plants in place of wild plants without disrupting plant-based therapeutics and market demand. And then compare the root extract of the Nardostachys jatamansi plant's antioxidant and flavonoid levels under in vitro and natural growth conditions. Methods: Nardostachys jatamansi is a plant that is widely used in traditional medicine systems. Because of its wide spread use in traditional medicine, this plant is considered endemic. In our study, we compare of antioxidant quality and Flavonoid amount of Natural and in vitro propagated Nardostachys jatamansi. Firstly we cultivated in vitro plants from Nardostachys jatamansi nodal explants for comparative analysis. The methanol extract of in vitro grown and wild-type plant root extract was then prepared using the maceration method. The extract was subjected to a comparative DPPH method to determine the presence of antioxidant potential in natural and in vitro grown plants. Furthermore, the HPLC analysis was used to detect and quantify the amount of Quercetin in both natural and in vitro propagated plants. Result: When grown in vitro at a higher concentration, the roots of Nardostachys jatamansi have greater antioxidant potential than when they are grown naturally. They demonstrated antioxidant DPPH radical scavenging activity, with an IC50 value of 29.55 µg/ml for in vitro generated plants and 24.18 µg/ml for naturally grown plants. The concentration of Quercetin (mg/ml) for natural plant species is 1.95 and for in vitro propagate plant is 1.83. The HPLC analysis presents distinct peaks, with the main peaks having retention time for standard Quercetin (10.38) in the natural plant (10.34) and in vitro grown plants (10.32). In the end, natural-type species that had been produced in vitro were used to obtain the potential of micro propagated plants. The DPPH test and flavonoid were tested on the root extract of natural and in vitro plants. Both plants displayed promising antioxidant activity and an HPLC study identified the Quercetin component. [ABSTRACT FROM AUTHOR]

Introduction: Training young doctors is essential for carrying out need-based research. The field of Traditional Medicine (TM) has made significant contributions to modern medicine, and there is unlimited scope for exploring it further in search of improved treatment options. However, there is a lack of systematic research studies on traditional medicines. It was, therefore, considered necessary to assess the interest and awareness among modern medicine practitioners regarding Traditional Medicine Research (TMR). Aim: To assess the need for training in TMR among modern medicine practitioners. Materials and Methods: A cross-sectional questionnaire-based study was conducted in the Department of Pharmacology and Therapeutics at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India, from March 2020 to September 2020 among modern medicine practitioners from the Western region of India. A validated questionnaire was used to collect data regarding the level of training in research methodology, research experience including TMR, areas for training, attitude towards training in TMR, challenges in TMR, and therapeutic areas to focus TMR efforts. The data were analysed using descriptive statistics. Results: Out of 109 participants, 96 (88.1%) were trained in research methodology. At least one research project was undertaken by 91 (83.5%) participants. Ninety-seven percent of participants felt that TMR was necessary. TMR was conducted by 19 (17.4%) participants. Approximately 65 (59.6%) participants felt that conducting TMR poses challenges such as lack of funds, infrastructure, lack of belief in TM, unavailability of literature pertaining to TM, lack of expertise, and lack of corporate attention and marketing. Therapeutic areas identified to focus research efforts included lifestyle-related disorders, diabetes mellitus, cancer, ageing, allergic disorders, osteoarthritis, and obesity. Conclusion: All the participants expressed the need to undergo training in TMR. However, the experience of conducting TMR was limited. Lack of funds, infrastructure, and expertise were mentioned as the main hurdles in undertaking TMR. It is essential to conduct systematic and need-based training programs for modern medicine practitioners in basic research methodology and TMR. [ABSTRACT FROM AUTHOR]

In this article, we symmetrically explore the political underpinnings and connections of pharmaceutical drugs during the COVID-19 pandemic. We illustrate some different and shifting dynamics of expert-lay interplay, competing knowledge claims in politically charged environments, as well as actions and actors that can bring drugs to prominence. Focusing on three drugs, ivermectin, remdesivir, and Coronil, we offer three axes on which they can be apprehended within political logics: (a) ivermectin as a "populist drug" in the United States, (b) remdesivir as an "establishment drug" in the United States, and (c) Coronil as a "nationalist drug" in India. These three pharmaceuticals were politicized, and perhaps more surprising, politics became pharmaceuticalized. Trust in these treatments was intimately related to articulations of the threats posed by the pandemic and the best ways of addressing them, both manipulated politically by relatively powerful actors. [ABSTRACT FROM AUTHOR]

Children and adolescents living with HIV (CALHIV) encounters compromised health and well-being especially in developing countries. Understanding the health-related quality of life (HRQOL) of CALHIV living in India is vital in planning and developing comprehensive care approach. A systematic review and meta-analysis were conducted to explore and examine the HRQOL of CALHIV in India. Five electronic databases were searched, retrieving 2,729 citations with a final eight studies that met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The included studies predominantly evaluated quality of life using the Paediatric Quality of Life Inventory, with a mean self-reported HRQOL score of 77.62 (95% CI 72.91–82.34, I2 = 93%). HRQOL of CALHIV observed to be better than other chronically ill children. However, CALHIV demonstrated lower HRQOL than the matched general population. Younger age children and boys reported better HRQOL. Poor socio-economic status, immunological status and advanced clinical stages noted to be adversely affecting HRQOL. HRQOL of children reared in institutional care reported to better or in par with family reared children. The review highlights the sparse evidence investigating the HRQOL of children with HIV in India, and the need for further well-designed studies in this population. A population-specific holistic-care approach recommended to be benefiting the well-being of CALHIV. [ABSTRACT FROM AUTHOR]

In the context of the COVID-19 pandemic, gaining insights into how academia has responded to this urgent challenge is of great significance. This article presents academic response patterns at a global, regional and national level from an analysis of publication volume versus reported cases of COVID-19, scientific collaboration and research focus. We also compare academic activity associated with this newly emerging infection to that related to long-standing infections. Our results show that the research community has responded quickly to COVID-19. The highly developed countries, which have the highest number of confirmed cases, are also the major academic contributors. National-level analysis reveals diverse response patterns from different countries. Specifically, academic research in the United Kingdom remained at a relatively constant level throughout the whole year (2020), while the global share of China's research output was prone to shift as its domestic pandemic status changed. Strong alliances have formed among countries with academic capabilities in response to the COVID-19 pandemic. The distribution of disciplines is relatively decentralised, indicating that a diverse and broad knowledge base contributes to the COVID-19 literature. Most of the analysed countries show dynamic patterns of research focus that vary over time as the pandemic evolves, except India. As one of the world's biggest suppliers of vaccines, India makes consistent efforts on vaccine research, especially those related to pharmaceutical preparations. Our findings may serve as resources for fostering strategies to respond to future threats of pandemics. [ABSTRACT FROM AUTHOR]

Background: Patients with cardiovascular disorders (CVD) possess multiple comorbidities and are prone to be prescribed multiple drugs, thus predisposing them to various drug-drug interactions (DDIs). Objective: This study was carried out to assess the potential-DDIs (pDDIs) among the drugs prescribed to hospitalized patients with CVD and associated factors. Method: It was a retrospective study conducted with the help of the medical records department. Medical records of all the patients admitted to the cardiology department of our tertiary care center from January 1st, 2019, to December 31st, 2019, were included for analysis using Lexicomp, an up-to-date drug interaction screening tool. The pDDIs were divided into classes A, B, C, D, and X, and those belonging to classes D or X were considered clinically significant. Multiple logistic regression was used to analyze the association between the factors associated with and the occurrence of clinically significant pDDIs, with a P -value <.05 considered statistically significant. Results: Almost all the records reflected (335/338) at least 1 pDDI. A total of 4966 pDDIs were detected, of which the majority belonged to category C (75.3%), and 5.1% of pDDIs were clinically significant. The patients who were prescribed more than 10 drugs per day (OR = 2.46; 95% CI: 1.27-4.82; P =.008), prescribed parenteral formulation (OR = 1.84; 95% CI: 1.57-2.21; P <.0001), or had a diagnosis of acute coronary syndrome (OR = 2.33; 95% CI:1.1-5.12; P =.03) were associated with clinically significant pDDIs. Other factors, that is, female sex, use of fixed-dose combinations, and the triad of diabetes mellitus, hypertension, and dyslipidemia, were positively associated with clinically significant pDDIs. Conclusion: Even though every patient had at least 1 pDDI, the prevalence of clinically significant pDDIs was relatively less. Use of >10 drugs/day, parenteral formulation, patients with acute coronary syndrome were significantly associated with clinically significant pDDIs. [ABSTRACT FROM AUTHOR]

Background: India has 2.1 million people living with HIV/AIDS (PLHIV). The objective of this study was to ascertain the extent of anti‑retroviral therapy (ART) adherence and reasons for nonadherence among PLHIV in India. Methods: We conducted a systematic review and meta‑analysis using the following criteria: (1) Observational or experimental studies conducted in India and (2) English language studies. Published during January 2012–June 2018 with data collection during the same period (3). 95% ART adherence rate (primary outcome). We reviewed bibliographic databases (PubMed, Scopus) and extracted relevant data. The forest plot was used to display the meta‑analysis results. Analyses were performed in Stata 14 using the “Metaprop_one” function. Results: A total of 511 records were identified after removing duplicates, 59 full‑texts were screened of which 15 studies were included in the meta‑analysis. Only one study was conducted in rural India, with <95% adherence reported by all its participants. The PLHIV reported several reasons for their ART nonadherence including forgetfulness (8/15), running out of pills (3/15), distance from the health center and associated travel (2/15), alcohol abuse (3/15), concealment of HIV status from family (2/15, felt stigma (2/15), depressive symptoms (2/15), and fear of side‑effects (2/15). The overall pooled estimate of ART adherence was 54.1% (95% confidence interval [CI] 27%–81%), while among facility‑based studies, the ≥95% adherence rate was significant higher. 62% (95% CI 46%–0.78%). Conclusions: Despite the universal provision of free of cost ART to all PLHIV in government health facilities in India, suboptimal adherence to treatment persists in nearly half of these patients. [ABSTRACT FROM AUTHOR]

Context: Combating human immunodeficiency virus/acquired immunodeficiency syndrome epidemic has been possible due to advances in prevention strategies and Antiretroviral therapy (ART). Optimal adherence to ART is a major factor in achieving the desired immunological, virological, and patient well‑being outcomes. Several socio‑demographic, patient, treatment, and health‑care system‑related factors influence nonadherent behavior to ART. Aims: This study was planned to assess (1) ART adherence level, (2) factors and reasons associated with nonadherence, and (3) impact of suboptimal adherence on treatment outcomes. Settings and Design: This was a cross‑sectional analytical study of 300 patients in a tertiary care hospital in Puducherry, India. Methods: Random sampling was used to collect data from patient treatment cards and a predesigned structured questionnaire. The pill count method was used to calculate adherence level. Statistical Analysis Used: Nonadherence was chosen as a dependent variable and factors affecting adherence were chosen as independent variables. Test for significance was carried out by Chi‑square test and Fisher’s exact test. Results: Optimal adherence was seen in 68.3%. Factors significantly associated with nonadherence were lower education level, high prior CD4 count, irregular follow‑up, missing doses in the past, and being late for pharmacy pill refills. Adherence was positively associated with mean increase in CD4 count over 6 months. Conclusions: In our study, the adherence rate is suboptimal which can lead to failure of ART. Nonadherence was associated with a decrease in CD4 count overtime. Most of the factors significantly affecting ART adherence were patient behavior related. These factors can be used for target intervention during reinforcement adherence counseling. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study is to identify drug-related problems (DRPs) for elderly cancer patients receiving chemotherapy by implementing pharmaceutical care services. Methods: In this interventional study, patients were followed after each cycle till 12 weeks. The MOATT-MASCC teaching tool was used to educate patients about their therapy. The outcome measures included the occurrences of any DRPs such as inappropriate medication dose, dosage form, route of administration, therapeutic duplication, failure of the patient to adhere to the medication regimen, adverse drug reactions (ADRs), and drug–drug interactions (DDIs) and to resolve it. Results: On 186 patients, there were 38% ADRs, 16% DDIs, 6% non-adherence to therapy, 4% medical conditions for which no medication was prescribed, and 1% therapeutic duplication and transcribing error was identified. A total of 226 ADRs were documented. Nausea and vomiting were the most frequently occurring ADRs (24%) and platinum compounds caused the highest number of ADRs. Assessments of causality showed that the majority of cases are 'probable' (50%). In evaluating the severity of ADRs, 53% of ADRs were 'moderate' and 51% of ADRs were 'probably' preventable. Upon assessing the DDIs, 35% of the prescriptions had 'monitor therapy'. All of the DRPs, that were identified were notified to the treating oncologists and resolved without any disagreement. Conclusions: Pharmaceutical care is essential for elderly cancer patients. Oncologists and pharmacists should work together to identify and manage DRPs as well as educate patients about their disease. This will help in improved patient care and a better therapeutic outcome. [ABSTRACT FROM AUTHOR]

Background Medications can rarely cause esophageal injury and present with acute symptoms. Multiple factors, including the type of medication, comorbidity, and method of ingestion play a role in causing drug-induced or pill esophagitis (PE). We analyzed the clinical, endoscopic, and histopathological profiles of PE cases at our gastroenterology outpatient clinic. Methods Medical records of PE cases were reviewed retrospectively over a period of 5 years at a tertiary care hospital in India from May 2017 to May 2022. The data were collected and analyzed using descriptive statistical analysis. Results A total of 30 patients diagnosed with PE were involved in the study. A slight male preponderance of 56.7% was noted with a mean age of 40.7 years. Odynophagia was the dominant symptom (70%) with a mean duration of symptoms of 5.63 days. The most common location was at the mid-esophagus (80%) followed by the lower esophagus (10%). The majority (56.7%; 17/30) had over-the-counter (OTC) drug consumption, followed by doxycycline (33.3%; 10/30). Kissing ulcers were seen in 30% of the subjects; 90% of the patients received a combination of proton pump inhibitors and sucralfate suspension for 2 weeks along with discontinuation of the causative drug, with a 96.7% resolution rate. Conclusion OTC medication and antibiotics such as doxycycline are the leading cause of PE. Prompt recognition and discontinuation of the causative drug are crucial in preventing complications. Patient education is vital in preventing PE regarding the usage of OTC medicines in developing countries. [ABSTRACT FROM AUTHOR]

The article assesses the quality standards of available health care services as per the Indian Public Health Standards (IPHS) at all the 22 District Hospitals (DHs) in Haryana and also brings out a ranking of districts within the State based on these parameters. A structured schedule was prepared using IPHS norms and guidelines, and data was collected from all the DHs in the State on required components of quality standards. The article uses different statistical tools such as mean, standard deviation, coefficient of variation (CV) for analysis and attempts preparing a composite IPHS Index based on the type and number of services available. It found that the overall mean percentage score of observed quality standards was 66.5% across 22 DHs in Haryana (8 DHs>70%, 11 DHs between 60% and 70% and 3 DHs < 60%). Further, ranking across the State shows DH Panchkula on top with rank one whereas DH Charkhi Dadri appears at last with rank 22 based on the laid IPHS parameters. The article asserts that the observed quality standards are not fully matched with expected quality standards at DHs in Haryana and recommends the need for periodic reviews, perpetual monitoring of these standards and functioning, and emphasises on systemic management of the required IPHS parameters to ensure provisioning of optimal healthcare services at these hospitals. [ABSTRACT FROM AUTHOR]

Reproductive Health Account construction was a long-envisioned dream in the State of Karnataka, India, for capturing inter-actor fund flows in reproductive health. Previous attempts in few states lead to successful identification of enablers and disablers within this systemic context. A Reproductive Health Account was constructed using primary reproductive health expenditure data, collected from a pre-estimated sample size of 519 households spread across 15 villages, using probability proportional to size method, from two selected sub-districts Channapatna and Ramanagara, having mediocre performance indices, within Ramanagara District of Karnataka. Secondary data were extracted from public health websites. Expenditures incurred on six types of health services by respondents of reproductive age group (15–49) during financial year, 2017–2018, within two sub-districts was collected over financial year, 2018–2019. Processed data were then converted to four 'origin to destination' matrices each capturing fund movement among two actors, based on accounting principles of National Health Account to develop a contextual Reproductive Health Account. Study included four actors namely financial sources, financial agents, health providers and health activities, all pertaining to reproductive health domain. Matrices helped identify a massive 87.23% burden on households, majorly financed by mortgage bearing astronomical interests and sale of meagre assets. Public sector healthcare at 5.47% was found performing unsatisfactorily. Tertiary level was absorbing disproportional amount of 62.93% funds in conjunction with the laboratory and imaging services. Moreover, pharmaceutical bills at 22.97% caused prolonged distress to these households. Government intervention towards absence and shortage of quality infrastructure at the primary and secondary sector levels needs reviewing, for containment of the massive out-of-pocket expenditures. [ABSTRACT FROM AUTHOR]

Background and Objectives: Osteoarthritis (OA), which mostly affects lower extremity joints like the knee and hip and significantly impairs elderly people, is a key contributor to chronic pain. The primary goals of OA treatment are to improve mobility and reduce discomfort. Non-steroidal antiinflammatory drugs (NSAIDs) are often used to treat symptoms despite their negative side effects. The need for safe and effective alternative medicines that could offer OA patients benefits for both symptomatic alleviation and disease-modifying outcomes remains, nevertheless. The purpose of this study was to evaluate the prescription patterns and their rationality in OA patients. Materials & methods: A prospective cross-sectional was carried out study that included all newly diagnosed and previously treated OA patients. The study enrolled about 400 patients, whose prescriptions were examined. The data was examined using descriptive statistics, which were then presented as percentages. Results: In comparison to males, almost twice number of women had OA. The most frequently affected joints were knee and hip. The most frequently used NSAIDs among the patients were aceclofenac and diclofenac, whereas piroxicam received the fewest prescriptions. The most frequently used adjutants in the treatment of OA patients were gastro protective medications, calcium supplements, and SYSDOA (symptomatic slow-acting drugs for OA. Conclusion: Although NSAIDs are preferred, SYSDOA and non-pharmacological therapy including alterations in lifestyle and regular light exercise have altered the course of OA treatment. [ABSTRACT FROM AUTHOR]

The prevalence of overweight and obesity has more than doubled since 1980, and it is predicted that around two-thirds of the global burden of the disease will be attributed to chronic non-communicable diseases. Developing countries are experiencing a more dramatic rise in the prevalence of obesity in recent years. As per National Family Health Survey-5 (NFHS-5), one in every four Indians is now having obesity. It has been reported that being overweight and obese is a significant problem among different socioeconomic spectrums of men and women in India, especially among the elderly, people residing in urban regions, and diverse socioeconomic strata. There is an urgent need to identify obesity as a chronic disease requiring immediate attention, mandating timely screening, timely treatment, and economical ways of achieving and managing weight loss across the country. In this review, the authors have discussed various aspects of overweight and obesity and critically appraised the current status of obesity in India, its public health implications, the significance of screening, the role of BMI and other parameters in diagnosing obesity, and the need for treatment and cost-effective prescriptions. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’, a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40–0.56). Tobacco use (OR = 0.76, CI 0.59–0.98) and never having attended school (OR = 0.75, CI 0.62–0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48–1.02), feelings of anxiety (OR = 0.84, CI 0.66–1.08) and feelings of depression (OR = 0.90, CI 0.70–1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51–2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions—as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status. [ABSTRACT FROM AUTHOR]

Buprenorphine (BUP) effectively suppresses non-prescription opioid use and increases treatment retention in opioid use disorder (OUD). However, short prescription length may interfere with treatment retention and recovery. We wanted to examine whether the outcomes of BUP treatment differ in high (HPL up to 4 wk) and low-prescription (LPL 1–2 wk) length groups. We compared time to treatment discontinuation (TD), non-prescription opioid-positive urine screen, buprenorphine-negative urine screen, and self-reported non-prescription opioid use between two different cohorts of LPL (case record: June 2018 to August 2019; n = 105; observation endpoint: 31 October 2019) and HPL groups (case record: June 2020 to Aug 2021; n = 133; observation endpoint: 31 October 2021). We used Kaplan-Meier survival analysis and log-rank tests for between-group comparisons. We used Cox regression analysis to adjust for age, opioid potency, comorbidities, family income, and marital status. Subjects' age and buprenorphine dose were significantly lower, and the percentage of high-potency opioid users was significantly higher in the LPL group. In the unadjusted survival analysis, the median time to BUP discontinuation in the HPL was longer than that of the LPL [LPL= 22.4 ± 4.3 wk; HPL = 33.1 ± 8.5 wk; χ2(1)= 5.7; p=.02]. The survival distributions of other outcomes did not differ between groups. When adjusted for covariates, neither the prescription length nor other covariates independently predicted any treatment outcome. Higher prescription length might be associated with longer treatment retention. We provide preliminary evidence to support greater flexibility in BUP treatment, enhancing its scalability and attractiveness. [ABSTRACT FROM AUTHOR]

Opioid dependence affects several neurocognitive domains, which can negatively affect the treatment outcome. Examining the relationship between neurocognitive functions and short-term treatment retention in subjects on buprenorphine-naloxone-based agonist treatment. We recruited 56 subjects (aged between 18 and 45 years) registered between March 2017 and December 2017. We excluded subjects dependent on other substances (except cannabis and tobacco), along with medical and other psychiatric comorbidities. During the first week of the agonist treatment, we assessed executive function, decision-making, attention, psychomotor speed, and working memory with the Wisconsin card sorting test (WCST), Iowa gambling test (IGT), and Trail making and verbal and visual N-back tests. Treatment retention was assessed after 12 weeks. The mean age of the subjects was 26 (±5.9) years. Twenty-eight (50%) subjects were retained in the treatment. Neurocognitive functions at the treatment entry did not differ between subjects retained in the treatment and those who dropped out. A higher severity and lower duration of dependence and use were associated with higher treatment discontinuation. The regression model, with the cognitive functions and significant clinical variables, could explain 38% variance for treatment retention. Neurocognitive functions at the treatment entry did not predict retention in opioid agonist treatment. There is some evidence of baseline cognitive functions predicting treatment retention in substance use disorders We wanted to test it in a group of patients on buprenorphine (naloxone)-based agonist management Relevant clinical and demographic variables were controlled for Executive functions, decision-making, attention, psychomotor speed, and working memory at the treatment entry did not predict retention at the end of three months Longer duration of opioid use (and dependence) was associated with better treatment retention [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to assess the impact of health education on lifestyle modification and disease status of diabetic patients for 6 months in rural Mysuru in Southern India. Materials and Methods: A quasi-experimental study was conducted among 104 patients with type 2 diabetes mellitus in rural Mysuru, India from July to December 2022. Participants were assigned to two groups: intervention (n = 52) and control (n = 52), and their data were collected. The intervention group was educated about the disease and its management and was given printed pamphlets containing information to be followed, whereas the participants in the control group were asked to continue their routine health checkups. The body mass index (BMI), weight, fasting blood sugar (FBS), knowledge about the disease, and behavior changes were recorded and compared between the two groups before and after 6 months. Results: The mean FBS value, BMI and weight decreased significantly in the intervention group after 6 months (FBS: 164.79 ± 47.59 mg/dL vs. 141.92 ± 25.63 mg/dL, P < 0.001; BMI: 22.97 ± 3.75 kg/m2 vs. 22.62 ± 3.29 kg/m2, P < 0.05; weight: 62.82 ± 11.92 kg vs. 61.54 ± 10.67 kg, P < 0.05). The posttest period also showed an improvement in physical activity, diet, and medication adherence in the intervention group compared to the control group (P < 0.05). The knowledge scores also improved postintervention which was statistically significant with the Wilcoxon signed-rank test (P < 0.05). Conclusions: The effectiveness of the educational intervention was also supported by lower FBS levels and decrease in BMI and weight compared to before. The findings of this study may help and make it easier to plan studies on people with diabetes mellitus in various settings. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to treatment is a recognized problem and the most challenging aspect of treatment, particularly in first‑episode schizophrenia (FES). We aimed to identify a set of individuals in the social milieu of patients as opinion makers who play significant role in influencing treatment‑seeking behavior in patients with FES. Materials and Methods: Patients with a diagnosis of schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), first episode, were administered with a 20 items semi‑structured questionnaire to identify the individuals and their role in treatment‑seeking behavior of patients with FES. Results: A total of 72 patients were enrolled in the study. The mean age of the sample was 29 years (standard deviation [SD] ±7.35), and the mean duration of illness was 9.2 (SD ± 0.58) months. Our study shows that apart from treating psychiatrists, patient’s family members and relatives play a crucial role in influencing treatment‑seeking behavior such as treatment commencement, drug dose, formulation, place of treatment, etc., A large number of patients went to faith healers on the advice of family members (34.7%) and also followed the advice of family members regarding the duration of treatment (63.3%) as well as discontinuing treatment (63.3%). Conclusion: The index study concludes the role of family members/relatives as opinion makers in the social milieu of patients with FES in influencing treatment‑related decisions and affecting adherence to treatment. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study is to explore the perceptions and practices of diabetes management through focus group discussions (FGDs) among adults with diabetes in rural Tamil Nadu. Materials and Methods: A qualitative study was conducted among individuals with diabetes who were part of the Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND). A total of 16 FGDs were conducted using a semi-structured FGD guide that elicited perceptions of the different aspects of diabetes management and knowledge about diabetes prevention. The sample size was based on the attainment of thematic saturation. All FGDs were audio-recorded and transcribed verbatim. The textual data was then coded into meaning units and grouped into themes. Data were analyzed using NVIVO software version 10.0. Results: There were varied responses with respect to diet, medication adherence, regularity of follow-up, knowledge about diabetes, and diabetes prevention. Most participants had limited knowledge of the disease and did not have regular hospital visits. Several participants were unable to adhere to the diet prescribed by healthcare providers, as they lived alone or were dependent on someone in the family for dietary needs. Most participants were unaware that diabetes could be prevented. Some participants were interested in serving as "Diabetes ambassadors" to educate rural societies about diabetes. Conclusions: Understanding the perceptions and practices about diabetes management and prevention strategies could help primary healthcare workers effectively treat, manage, and prevent diabetes in underserved rural populations. [ABSTRACT FROM AUTHOR]

Introduction: In the management of hypertension and diabetes mellitus, a systematic response like modifications in lifestyles is needed along with the medication. The study was conducted to determine the impact of comprehensive lifestyle modifications on hypertension and diabetes and to compare it with that of physical activity alone as a health education intervention. Materials and Method: A risk factor-based community intervention trial was conducted for one year in 3 villages in coastal Karnataka. The sample of 305 was calculated depending on the expected change in blood pressure and an equal sample size was drawn from each of the villages using a systematic random sampling method. Baseline data on blood pressure level, random blood sugar, and HbA1c levels were recorded. After 1 year of intervention, all the parameters were further recorded along with the adherence to medication for these non-communicable diseases. Results: The mean difference between the groups suggested that participants with physical activity intervention reported a statistically significant reduction in systolic blood pressure. In the comprehensive lifestyle modification group, there was a significant reduction in both diastolic blood pressure and glycated hemoglobin levels (21 mmHg and 2.1%; p < 0.001). Conclusion: The study indicates that in the management of hypertension and diabetes mellitus, the impact of comprehensive lifestyle modifications was more significant compared to physical activity alone. [ABSTRACT FROM AUTHOR]

Background: Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines. Methods: This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances. Results: Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3–6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2–8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty. Conclusion: TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors. [ABSTRACT FROM AUTHOR]

Background and object: The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition, with irrational drug use, which is also a global concern. Thus, drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings. The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders. Materials and methods: A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months. All legible prescriptions consisting neurological medications irrespective of patient's gender, aged ≥ 18 years were included for the study. The World Health Organization (WHO) core drug use indicators were used to assess the drug prescribing and utilization patterns. Results: A total of 310 prescriptions were reviewed, where male predominance was found to be 56.45%. Out of 310 prescriptions, drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders. The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin (14.8%) and valproic acid (6.45%). By following the WHO core drug prescribing indicators, 65.47% of drugs prescribed from the India National List of Essential Medicines, 2022, followed by 29.83% of drugs prescribed in generic name and 10.86% of prescriptions including injections. Conclusion: The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators. But, the extent of polypharmacy prescriptions was very high. Therefore, interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety. [ABSTRACT FROM AUTHOR]

This paper summarizes the current approaches in method of extraction of okra mucilage and application in pharmaceutical drug delivery system. Okra is a species of Abelmoschus esculentus L. belongs to the family of malvacae. In India, medicinal activity of okra is reported in traditional system like Unani, siddha and Ayurveda. Pharmacological uses of okra are anti-cancer, anti-diabetic, anti-oxidant, anti-microbial and anti-ulcer activity. Easily available in tropical and sub-tropical countries, non-toxic, biodegradable and cost effective used as excipient. Okra mucilage's were extracted in different method using acetone, ethanol etc. It is a property of highly viscous the may retard the drug in sustained release. This article mainly scrutinized that okra mucilage approaches in pharmaceutical drug delivery system. [ABSTRACT FROM AUTHOR]

The National List of Essential Medicines (NLEM) is a dynamic list of medicines consisting of agents used to manage diseases that are of public health importance in a country. In NLEM 2022, 16 medications have been mentioned under the section "Medicines used in the treatment of Psychiatric Disorders" (section 23). We welcome the addition of buprenorphine, buprenorphine+naloxone, and nicotine replacement therapy and hope to see medications for alcohol dependence in the future NLEMs. [Extracted from the article]

Background: According to WHO Self-medication can be defined as the use of drugs to treat self-diagnosed disorders, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms. Aim & Objective: To assess and improve the level of awareness regarding self-medication non-prescription medicines and over the counter drugs, to assess the prevalence and determinants of self-medication practices among undergraduate students. Settings and Design: A cross-sectional study design was used to carry out a study at tertiary care centre. Methods and Material: Sociodemographic characteristics, self-medication knowledge and general questions on self-medication were asked from study participants. Statistical analysis used: SPSS software version 26. Self-medication knowledge was scored and categorized as excellent/good and poor knowledge. Comparison of knowledge scores among medical, nursing and physiotherapy students was done using ANOVA test. Results: The prevalence of OTC drug usage was found out to be 304(79.4%). Highest prevalence was noted amongst medical students i.e., 186(83.4%) followed by nursing and physiotherapy students which were similar at 55(73.3%) and 63(74.4%) respectively. Mean knowledge scores of MBBS, nursing and physiotherapy students showed significant results with F-statistic value of 21.63 (p=0.00). Conclusions: Self-medication happens to be a common practice among medical and paramedical students. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation is the treatment of choice for patients suffering from end‑stage renal disease and health‑related quality of life (HRQoL) is routinely used for measuring the outcome. Although the generic HRQoL questionnaire provides useful information on multiple dimensions, they fail to capture emotional and behavioral components of well‑being, which is supplemented by the Transplant Effects Questionnaire (TxEQ). The present research studies the impact of these two questionnaires on various parameters affecting the health of kidney transplant recipients. Methodology: This cross‑sectional study included 500 postrenal transplant patients within 5 years of transplant (18–70 years) evaluating HRQoL using a Short Form Survey‑36 Questionnaire and emotional/behavioral outcomes using a TxEQ. Results: Mean age of participants was 44.92 ± 5.86 years and males constituted the majority (>75%). The mean physical component score (PCS) was 41.3 ± 9.2 and the mental component score (MCS) was 48.1 ± 8.4. The highest score was observed for bodily pain, followed by role limitations attributable to emotional problems (RE). The PCS was significantly higher among younger participants, among males, among participants who have got a transplant >24 months ago, and among participants who had serum creatinine levels <2 mg/dl (*P < 0.05). However, the mental component score did not differ significantly in any of the matched variables. In TxEQ, medication adherence had the highest mean score, followed by perceived responsibility toward others. Conclusion: In our study, we concluded that reduced physical functioning among female gender, illiterate patients, with increasing age, in employed section, and with associated comorbidities such as hypertension and with a history of rehospitalization. [ABSTRACT FROM AUTHOR]

Objective: Neurological disorders are a major cause of morbidity, mortality and disability. These adversely affect the quality of life among all age group patients. Majority of neurological disorders include Epilepsy, Headache, Cerebrovascular disorders with hemiparesis, Neuropathic pain, Extrapyramidal syndrome, Cervical myelopathy and Parkinson's disease. This study was done with aim to evaluate the prescription pattern of various drugs in different types of neurological disorders and to use the WHO / INRUD prescribing indicators to assess the rational drug prescribing. Materials and Methods: A Prescription-based, Observational prospective study was carried out in a tertiary care hospital at South India. The prescription data of patients attending the neurology outpatient department was analysed over a period of 2 months. Rational use of drugs was analysed by the INRUD Scale. Results: Out of these, 166 patients were male, whereas 134 patients were female. Most prevalent neurological disorders were Trigeminal neuralgia (25.66%), 9.97% of the patient population received injections, with 4% receiving Inj. Dexamethasone 8mg. Overall drug prescribing performance scoring was 3.55. Conclusion: Our study revealed good Prescribing pattern as shown by WHO scale-IRUD/INRUD. Further such studies with large sample size are needed so as to guide clinicians toward rationale drug. [ABSTRACT FROM AUTHOR]

Introduction: Medication compliance is one of the most difficult challenges in the management of schizophrenia in India. Compliance broadly means the extent to which a person's behavior, in terms of taking medications, following diets and executing lifestyle changes, visiting for follow-up, etc., coincides with medical and health advice. The current study has tried to assess the attitudes and reasons for compliance as well as noncompliance among patients with schizophrenia, which can provide the basis for planning effective interventional strategies for the mental health professionals for improving compliance of the patient in the future. Methodology: A hospital-based noninterventional cross-sectional study was done on 135 schizophrenic patients attending the outpatient services in the Department of Psychiatry, Government General Hospital, Kurnool, hospital by convenient sampling method for 6 months from October 2021 to March 2022, after obtaining approval from the institutional ethical committee. Data were collected and entered in Microsoft Excel and analyzed using the Statistical Package for Social Sciences (SPSS) 16 version software. Results: The prevalence observed in the present study, 75 (55.56%) participants were compliant, i.e., had a positive attitude toward medication and 60 (44.44%) participants were noncompliant toward medication. Higher mean scores for the Positive and Negative Syndrome Scale score were seen in the compliant group (101.25 ± 19.27) than the noncompliant group (100.98 ± 22.51). Conclusion: Main reasons for drug noncompliance identified in the present study were financial difficulty, distance from the hospital, improvement or no improvement in symptoms, side effects, lack of insight into the mental illness, and lack of awareness about the need for long-term medication. [ABSTRACT FROM AUTHOR]

Background: The rates of medication non-adherence among Indian patients with schizophrenia are high, and its detection poses problems. Comparisons of suitable measures to detect medication non-adherence in schizophrenia from Indian outpatient settings are scarce. Aim: This study compared simple and inexpensive methods of detecting medication non-adherence in schizophrenia among outpatients from a tertiary-care center in North India. Materials and Method: A longitudinal comparison of two self-reports, the Morisky Medication Adherence Questionnaire and the Drug Attitude Inventory-10, clinicians' ratings employing the Compliance Rating Scale, and clinic-based pill counts was conducted among 70 outpatients with schizophrenia. The rates and detection of medication non-adherence, associations with determinants of treatment non-adherence, and agreement between measures were examined at intake and after six months of follow-up (n = 53). Results: The self-reports had greater ability to detect medication adherence (specificity 41–65%; positive predictive values 25–51%; negative likelihood ratios 0.86–1.14) and moderate ability to detect medication non-adherence (sensitivity 27–65%; negative predictive values 49–69%; positive likelihood ratios 0.78–1.10). They yielded higher medication non-adherence rates, detected changes in medication non-adherence over time, and were associated with the other measures and the well-known correlates of medication non-adherence. Clinicians' ratings and pill counts had high sensitivity (56–90%) but low specificity (35–49%) to detect medication non-adherence. Conclusion: Self-reports are comparatively better screening options for detecting medication non-adherence among Indian outpatients with schizophrenia. However, the sequential use of different measures could lead to better recognition of medication non-adherence. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about psychotropic medicines would compromise the treatment of medical students with psychiatric illnesses. Aims: This study aims to estimate attitude of medical students toward psychotropic medicines. Materials and Methods: This was a cross-sectional and observational study carried out among the undergraduate medical students over the period of 5 months. Participants were informed before interactive session for the maximum attendance. Self-report attitude toward psychotropic medications questionnaire was used to measure the attitude of medical students toward psychotropic medicines. Descriptive statistics, Mann–Whitney U-test, and Pearson correlation test were used to find the variables association with the attitude toward psychotropic medications questionnaire. Results: A total of 500 participants completed the pro forma. The mean age of the participant was 20.34 ± 1.12. Out of them, 39.2% were male and 60.8% were female. Although many medical students believed psychotropic medicines would be a better treatment option and positive attitude toward taking prescribed dose of medication, they were ambivalent toward efficacy and tolerability of medications. Being male, from rural domicile, and living in a joint family significantly reported a negative attitude toward psychotropic medicines. Conclusions: Medical students significantly reported ambivalent attitude toward efficacy and tolerability of psychotropic medicines. Workshop on myths related to psychiatric illness and psychotropic medicines should be organized to correct their negative belief. [ABSTRACT FROM AUTHOR]

Background: Analgesic use needs to be regulated due to its adverse effects. This study aimed to analyse the change in prescription rates and patterns of the analgesics prescribed for various oral conditions and to analyse their trends across different age groups and gender to promote rational prescription of drugs and eventually influence regulatory policies. Methods: Secondary analysis was conducted on medical audit data collected from the private health sector in India. The prescription rate per 1000 persons per year was calculated from May 2013 to April 2016 using the mean projected population (PP) of India. Cross-tabulations were conducted to analyse the prescription rate and their changes across different age groups, gender and oral conditions. Findings: The mean analgesic prescription rate was highest among the 20-40 age group, and the highest increase was noted in 'non-steroidal anti-inflammatory drug (NSAID) combinations' (3.56 per 1000 persons per year) from May 2013 to April 2016. The 'NSAID combinations' group was also the most prescribed medication across all the oral conditions, with 'diseases of hard tissues' having the highest prescription rate (41.4 and 45.6 per 1000 persons per year, respectively, for 2013-14 and 2015-16). Interpretation: The results indicate an overall increase in the analgesic prescription rate, especially 'NSAID combinations' for each dental disease and age group, a finding that is hard to explain. Due to the lack of prescription guidelines in India, it is difficult to assess whether these analgesics were prescribed rationally or not. [ABSTRACT FROM AUTHOR]

Background: Medical ethics and professionalism have been included in the competencies which an Indian medical graduate should achieve to become globally relevant. This study was done to describe medical ethics and professionalism and explore the factors affecting it, among the medical students in India. Methods: A cross-sectional study was conducted among undergraduate medical students of India in 2022; data were collected using google documents and analyzed using SPSS v20.0. Results and Conclusion: Two thirds of the participants were aware of the principles of medical ethics. Medical college lectures/seminars were the source of ethics for majority of the participants. Around 32.2% had conflicts in their medical school. Though 99.6% of the participants opined that the patient deserve respect, only one third (34.3%) opined that medical errors should be shared to the patients. Prevalence of consumption of alcohol, smoking, drugs among medical students were 5.6%, 3.1% and 0.7% respectively. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to medication is the major challenge in treating mental illness, resulting in worsening symptoms and prolonging the course of the illness. Caregivers spend a considerable amount of time with the patients. Therefore, proper training and education for caregivers help to improve treatment outcomes. Aim: This study aims to evaluate the effectiveness of caregiver intervention for improving medication adherence (CIIMA) on level of medication adherence and attitude toward medications among nonadherent patients with mental illness. Methods: This study was an experimental study using a randomized pretest posttest control group design. The study was conducted in the psychiatric outpatient department of tertiary care hospital in the eastern India. Eighty nonadherent patients with mental illness and their primary caregivers were randomly allocated to the experimental and control group using the concealment allocation method. Patients were assessed for their level of medication adherence using medication adherence rating scale, their attitude toward medication were assessed using drug attitude inventory and reasons for medication nonadherence were assessed using the Rating of Medication Influence. CIIMA consisted of individual psycho-education, pill card monitoring, weekly telephonic and text reminders provided to the experimental group, and routine treatment was provided to the control group. The level of medication adherence and attitude toward medication were reassessed for both groups after 1 month of the initial assessment. Results: After 1 month of CIIMA, 87.2% of patients in the experimental group were adherent to medication as compared 18.4% in the control group (P < 0.001), significant improvement in their attitude toward medication and treatment in the experimental group as compared to the control group (P = 0.001). Conclusion: CIIMA is an effective, low-cost, nurse-led intervention can be delivered in the inpatient and outpatient units for improving medication adherence thereby preventing future relapse of their mental illness. [ABSTRACT FROM AUTHOR]

Medication nonadherence (MNA) poses a significant challenge in the management of major psychiatric disorders. The present study was undertaken to determine the prevalence of MNA among patients with psychiatric disorders in India and to identify the factors associated with MNA. The following databases were searched systematically: PubMed, Directory of Open Access Journals, and Google scholar. Articles originating from India published in peer reviewed English language journals before May 15, 2021 reporting the prevalence of MNA and associated factors among patients with psychiatric disorders were retrieved and the relevant data were abstracted. The pooled prevalence of MNA was calculated using the inverse variance method. Factors associated with MNA were synthesized and described. A total of 42 studies (pooled N = 6,268) were included in the systematic review. Among these, 32 studies (pooled N = 4,964) reported the prevalence of MNA and hence were eligible for meta analysis. The pooled prevalence of MNA was 0.44 (95% confidence interval [CI] 0.37-0.52). The pooled prevalence of MNA for psychotic disorders, bipolar disorders, and depressive disorders were 0.37 (95% CI, 0.28-0.46), 0.47 (95% CI, 0.23-0.72), and 0.70 (95% CI 0.60-0.78), respectively. Negative attitude toward medications, polypharmacy, greater severity of illness, lack of insight, and cost of medications were associated with MNA. Quality appraisal of the included studies revealed that most studies did not categorize and address nonresponders and did not provide any information on nonresponders. To conclude, about half of the patients with psychiatric disorders in India are nonadherent to their psychotropic medications. Evidence based interventions to improve medication adherence in these patients need to be developed and implemented proactively keeping in mind the factors associated with MNA. [ABSTRACT FROM AUTHOR]

Background: Diabetic peripheral neuropathy (DPN) is a microvascular complication of type 2 diabetes mellitus (T2DM) which may be attributed to chronic uncontrolled hyperglycaemia. DPN increases the risk of foot ulcers and non traumatic amputations, leading to disability, morbidity and poor quality of life for the diabetics. Aims: This study aims to find out the prevalence of peripheral neuropathy amongst T2DM patients and ascertain the correlates for the same. Settings and Design: A cross sectional study was conducted amongst 104 diabetic individuals of Bankura city of West Bengal using principles of simple random sampling technique. Materials and Methods: Data on peripheral neuropathy were collected using Michigan Neuropathy Screening Instrument and correlates were assessed by a pre designed pre tested schedule consisting of background and socio demographic characteristics along with medication adherence rating scale. Statistical Analysis Used: Data were entered into Excel (Microsoft Inc.) and all calculations were done using IBM Statistical Package for the Social Sciences (SPSS) (Version 20.0, IBM). Data were analysed and presented using principles of descriptive and analytical statistics. Results: The prevalence of DPN was 59.1%. The presence of co morbidities, poor socio economic status, polypharmacy, food insecurity, catastrophic health expenditure and lack of social insurance were found significantly associated with DPN. Conclusions: DPN prevalence was found to be considerably high. Multiple factors were found to culminate it, upon which socio economic and health care affordability issues were prominent. A multi disciplinary approach focusing on them using Patients oriented evidence that matters approach, diabetes education and periodic screening of the diabetic population may help in mitigating the morbidity risks. [ABSTRACT FROM AUTHOR]

Background: There is underutilization of long-acting injectable (LAI) antipsychotics for first-episode schizophrenia (FES) despite having convenient dosing and treatment retention. LAIs are predominantly used for patients with poor compliance, chronic course, and multiple relapses. Materials and Methods: Seventy-two treatment naïve patients with the first episode of Schizophrenia (DSM-5) were assessed for baseline severity of psychopathology using the positive and negative syndrome scale (PANSS) and quality of life (QOL) using the WHOQOL-BREF scale. Patients were randomized to receive either oral haloperidol or LAI haloperidol for a period of 12 weeks. Results: Both the groups had a significant reduction in PANSS scores and improvement in QoL over 12 weeks period (P = 0.0001). The LAI group showed greater adherence and significantly better quality of life than the oral group (P = 0.023). The mean numbers of side effects were less in the LAI group at week 2 as compared to the oral group. Conclusion: LAI haloperidol is similar to oral haloperidol in patients with FES with respect to treatment response and offers benefits in form of a lesser number of side effects during early treatment, overall better adherence rates, and better QOL. [ABSTRACT FROM AUTHOR]

The article focuses on the reasons for the prevalence of Multidrug Resistant Tuberculosis (MDR TB) and the impact of COVID-19 on Tuberculosis. Topics include the spread of MDR TB due to irregular treatment and poor adherence to medications, the importance of early diagnosis using molecular tests, and the challenges faced in managing TB during the COVID-19 pandemic.