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Context: The Indian government is dispensing newer direct-acting antiviral (DAA) drugs, which may have impact on hepatitis C virus (HCV) patients’ quality of life (QoL). Aims: To evaluate different DAA regimens and impact on QoL in terms of quality-adjusted life year (QALY) in HCV patients and to measure cost-effectiveness. Methods: This prospective, observational study was carried out on patients who were diagnosed with HCV. Recruited patients were followed up until 12–24 weeks. Patients were recruited following the selection criteria. Along with demographic and drug details, the regimens used were analyzed and evaluated for cost minimization, cost-effectiveness, and cost–utility analysis. For health quality check, the Chronic Liver Disease questionnaire (CLDQ) was used which was also used for QALY assessment. Data were entered into MS Excel 2016. Difference in between the regimens for total cost was done using unpaired t-test and ANOVA test using SPSS 25.0. Overall cost-effectiveness, cost minimization, cost utility and cost of illness analysis was also calculated. P < 0.05 was considered statistically significant. Results: A total of 31 patients were enrolled. A total of five drugs, namely, sofosbuvir, daclatasvir, ribavirin, velpatasvir, and ledipasvir were widely used. Sofosbuvir was most common (46.25%)component of drug combination in our study. A total of five types of regimen were used according to the genotype of patients. With 44,260.13 ± 15,884.92 INR of the total drug cost, 70.97% of patients spent around 30,000–40,000 INR for the whole pharmacotherapy. The total indirect cost was 2768.39 ± 3916.13 INR with the total direct cost of 48,660.90 ± 15,356.39 INR. The total cost including direct as well as indirect cost spent during 6-month therapy by 61.29% of patients was 40,000–50,000 INR. Based on the CLDQ score, QoL was 64.1 ± 25. Regimen 2 (sofosbuvir + velpatasavir) stood out with the lowest cost. Regimen 5 (ribavirin [200 mg] + sofosbuvir [400 mg] + velpatasvir [100 mg]) was found to be the most cost-effective. Considering 1 life year with good health after treatment, QALY was 0.31. Conclusions: Ribavirin (200 mg) + sofosbuvir (400 mg) + velpatasvir (100 mg) was found to be the cost-effective and cost-saving regimen among DAAs.

Aims: The present study was carried out to describe the patterns of prescription and drug use in Ophthalmology outpatients at GG hospital, Jamnagar, Gujarat, India. Methods: Total of 600 patients were included during 3 months duration and average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with antibiotics prescribed, percentage of encounters with an injection prescribed, percentage of drugs prescribed from the WHO Essential Drug List 2015, number of fixed dose combinations prescribed and percentage of antimicrobial agents prescribed were analyzed. Results: Prescription analysis showed that the average number of drugs per prescription was 3.20%. Eye drops were the most commonly prescribed (66.8%) dosage form, followed by ointment (18.4%), capsules (8.66%) and tablets (6%). Dosage forms were recorded in 99.2% drugs, information about the frequency of drug administration was present in 96% of the drugs and duration of therapy was recorded in 84.7% of the drugs prescribed. The drug classes that were used most frequently were Antibiotics (45%), Ocular lubricants (24.7%), NSAIDS (17.4%) and Anti-allergy medications (8.1%). Conclusion: Common prescription errors were minimum. However polypharmacy was common.

Background: A number of antimicrobial drugs are prescribed to the patients in Intensive Care Unit (ICU). Drug utilization research was defined by WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. There is lack of information about the use of antimicrobial agents in the ICU at GGGH till date. So we decided to conduct this type of study. Methods: A prospective observational study was carried out for 12 months. Patients of age >18 of both sexes who was admitted in ICU were included in the study while pregnant and lactating women excluded. The prescribing pattern was analyzed by using World Health Organization basic drug indicators. Results: Among 611 patients, 373 (61.04%) were male and 238 (38.95%) were female. The most common emergency was post-operative 204 (33.38%).The most common prescribed antimicrobial drug group and drug was antiamoebic drugs and metronidazole respectively in 437 (24.04%) out of total drugs prescribed. The numbers of antimicrobial drugs prescribed per patient were 2.97. 68% drugs were prescribed from WHO and national EML list. Total 57.26% drugs were prescribed by generic name. Average antimicrobial drug cost per patient was 1805.34 rs. Conclusions: Despite of limitations of present study it gives important conclusion about how antimicrobial drugs are used in GGGH ICU. This information can be used for improvement of current treatment strategies.

Background: Use of drugs itself may result into illness and death due to their adverse effects. In India 10-20% of inpatients developed adverse drug reactions. Most of these problems can be overcome by undertaking hospital based intensive monitoring. Objective of this study was to estimate the incidence and document the spectrum of ADRs in studied patients in terms of causality, severity, frequency, type and preventability. A prospective, observational, single centre study conducted among the indoor patients of the department of general medicine, Guru Gobind singh government hospital, Jamnagar over a period of 12 months. Methods: Admitted patients who either had developed a clinically suspected ADR after admission (group A) or were admitted primarily because of an ADR (group B) were included. In all ADR related patients the necessary data was recorded on a pre-designed case record form, NCC-PvPI form and analysis was done. Results: Total 3566 patients were screened. 87 patients had 101 ADRs, among them 62 from group A and 25 from group B with 2.44% incidence. In causality, by WHO-UMC and by naranjo scale most common ‘probable’ category in group A (54.7%) and group B (50%) and 89.9% group A and 84.6% in group B respectively.95.05% ADRs were ‘Not preventable’. Hartwig seigle’s scale maximum ADRs 65.4% ADRs in group A and 73.1% in group B were ‘moderate’ in severity. Conclusions: Intercurrent illness, longer hospital stay and poly pharmacy was playing a major role in occurrence of multiple ADRs with 2.44% incidence in our setup.

Background: Psychotropic drugs have a great importance in psychiatric practice. Today many newer drug like selective serotonin reuptake inhibitors and atypical antipsychotic drugs has changed treatment protocol. Hence, the study was carried out to find morbidity pattern of psychiatric illness and prescribing pattern of psychiatric illness. Methods: A prospective cross-sectional study was carried out for 12 months. Patients of all ages and both sexes were included in the study while inpatients and referred patients were excluded. The prescribing pattern was analyzed by using World Health Organization (WHO) basic drug indicators. Results: Among 600 patients, male patient were 291 (48.50%) and female patient were 309 (51.50%). The most common disorder was depression 208 (34.66%) followed by schizophrenia 192 (32.00%). The numbers of psychotropic drugs prescribed a patient were 2.51. 39.39% drugs were prescribed from the WHO essential medicines list. Total 89.18% drugs were prescribed by generic name. Benzodiazepines were the most common prescribed drugs. Atypical antipsychotic drugs were commonly used than typical antipsychotic drugs. Central anticholinergic drug was used in 43.15% patients receiving antipsychotic drugs. Conclusion: Overall, the drugs were prescribed rationally. Benzodiazepine should be prescribed only for short-term duration. Use of central acting anticholinergic drugs with all antipsychotic drugs was not justified.

Background: Glutamate modulators are having immense potential and are newer entities for treating drug resistant depression. The objectives were to generate statistical evidence on basis of existing data of ketamine, memantine, riluzole and d-cycloserine in resistant depression.Methods: A total of 14 RCTs following PRISMA guidelines and matching inclusion and exclusion criteria were collected of ketamine (5), memantine (3), riluzole (2) and d-cycloserine (4) vs placebo in drug resistant depression. Only RCTs with primary diagnosis of drug resistant depression (Previously on two standard antidepressant therapy) were included. Studies with treatment response rate, 50% reduction in total score of the depression rating scale-Montgomery-Åsberg Depression Rating Scale or the Hamilton Depression Rating Scale or Beck Depression Inventory was chosen as clinical outcome measure. RevMan 5.3 software was used for the analysis.Results: In ketamine group using random effect model SMD was 2.122 (95% CI 0.659-3.584). P-value was statistically significant (random effect p

Aims and Objectives: To compare the efficacy of ritodrine versus nifedipine in prevention of preterm labour at day two and seven. Methodology: All randomised control trials which follows PRISMA guidelines 2009 and in which Ritodrine and Nifedipine was compared head to head for the treatment of Pre-term labour. Clinical trial registries,MEDLINE, SCOPUS, EMBASE database were searched for MeSH terms Ritodrine, Nifedipine, pre-term labour and having primary outcome as number of delivery at day 2 and 7. Observational studies, unpublished studies, RCTs not following PRISMA guidelines were excluded. Data was analyzed using RevMan 5.3 version® and Odd’s Ratio was calculated to determine the difference at day 2 and 7. Both fixed effect and Random effect model was utilized to calculate the difference. P value less than 0.05 was considered as statistically significant. The I2 will be used to measure the heterogeneity between studies and a value > 30.0 will be considered to reflect heterogeneity. Results: A total of 6 Head to head RCTs were included in the studies. At day 2, according to fixed effect model, statistically ritodrine was having more likelihood for delivery as compared to nifedipine(Odd’s ratio=1.492, CI=1.013-2.197, P=0.043) but according to random effect model the difference was not statistically significant(Odd’s ratio=1.468, CI=0.919-2.344, P=0.108). At day 7, according to fixed effect model, ritodrine was having more likelihood for delivery as compared to nifedipine(Odd’s ratio=1.196, CI=0.852-1.679, P=0.302) and according to random effect model the difference was not statistically significant(Odd’s ratio=1.143, CI=0.720-1.815, P=0.572). Conclusion: Ritodrine causes more deliveries at day 2 and 7, so nifedipine is a better tocolytic as compared to ritodrine.

Stevens–Johnson syndrome (SJS) is an acute life-threatening mucocutaneous reaction, characterized by extensive necrosis and detachment of the epidermis from the skin. The overall incidence of SJS is seen in five cases per million people per year. SJS is typically caused by drugs and is a kind of idiosyncratic reaction. Adverse drug reactions such an SJS have a remarkable effect on patient's safety issues. We encountered nine cases of antiepileptic drug (AED)-induced SJS, specifically with carbamazepine, oxcarbazepine, and phenytoin. To manage the reaction, the clinician withdrew the drug in all 8 cases, and in 1 case, the patient was shifted to valproate and symptomatic treatment was provided. There is still a controversy whether or not all AEDs can cause SJS. Recent studies have investigated the role of genetic factors - HLAB*502 allele in the development of AED-induced SJS in patients of Asian ancestry.

Background: Prescription audit is one of the methods to assess drug utilization and rationality of prescribing. Irrational prescribing is a worldwide problem. It is due to the faulty prescribing habits, lack of training amongst health care personnel, pressure from the pharmaceutical companies, and a lot of other reasons. Methods: The study was conducted by noting the details of patients admitted during 3 months from April to June 2015 in the Guru Gobind Singh Government Hospital, Jamnagar. Prescriptions were collected from the inpatients of medicine, surgery, obstetrics & gynecology, pediatrics, orthopedic randomly and analyzed according to the WHO core prescribing indicators. Results: Three hundred six prescriptions were analysed in which 1986 drugs were prescribed. Mean number of drugs per prescription was 6.49%. In our study, 63.34% drugs were prescribed by generic names and drugs on NLEM were 73.01%. Dosage forms used were mostly oral (69.54%). Infectious and parasitic diseases were the most common illnesses (16.01%) followed by diseases of respiratory system. The most common drug groups prescribed were GIT, antimicrobials, antihistaminics, multivitamins and minerals. The incidence of poly-pharmacy was also common with maximum number of prescriptions (26.8%) having 5 drugs per prescription. Conclusion: Prescription audit is an important measure to improve the quality of care afforded by the hospitals. Data generated on morbidity pattern coupled with current practices of treatment of these diseases provides an objective basis for preparing an NLEM. By this data we conclude that poly-pharmacy is quite common. Most of drugs were prescribed according to the NLEM 2011.