Abstract Background: To conduct a network meta-analysis comparing the safety and efficacy of five anti-obesity drugs approved by the United States Food and Drug Administration (US FDA)-Bupropion/Naltrexone combination (BUP/NLX), Liraglutide (LIRA), Orlistat (ORLI), Phentiramine/Topiramate combination (PHEN/TPM) and Simaglutide (SGT) vs placebo. Methods : The study's eligibility criteria include randomized controlled trials (RCTs) with a focus on obese patients receiving BUP/NLX or LIRA or ORLI or PHEN/TPM or SGT versus placebo. We conducted a comprehensive search of electronic databases (PubMed, Embase, Cochrane Library, and Scopus) to identify relevant randomized controlled trials published, with no restrictions on the publication language or year. Three reviewers independently screened the studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Bucher's and Bayesian Meta-regression Simulation Method were used for indirect head-to-head comparison between various active drugs. RevMan Version 5.4 ® along with A Network Meta- Analysis Toolkit by Cochrane Methods were used. p-value less than 0.05 was considered significant. Results: Total 28 studies were included in this meta-analysis. PHEN/TPM combination exhibited (odds ratio :0.568, p value <0.001, cl 95%) ORLI (odds ratio: 0.889, p value <0.001, cl 95%), SGT (odds ratio: 0.922, p value <0.001, cl 95%). BUP/NLX combination exhibited a high (odds ratio: 4.61, p value <0.001, cl 95%) LIRA displayed the lowest (odds ratio: 1.109, p value <0.001, cl 95%). Network meta-analysis revealed. BUP/NLX combination exhibited highest Efficacy. ORLI found as safest among the evaluated drugs. SGT had significant likelihood of adverse events (odds ratio = 1.328, p-value<0.0001, Cl 95%) compared to ORLI (odds ratio = 0.138, p-value<0.0001, Cl 95%), BUP/NLX (odds ratio = 0.197, p-value<0.0001, cl 95%), and LIRA (odds ratio = 0.456, p-value < 0.001, Cl 95%), PHEN/TPM (odds ratio = 0.456, p-value<0.0001, Cl 95%). Discussion: These findings have important clinical implications for the management of obesity. The BUP/NLX , LIRA , and SGT can be considered as effective treatment options for weight reduction. However, healthcare providers need to carefully consider the safety profiles and potential side-effects of these medications when making treatment decisions. The study relied on aggregated data, which might introduce bias. High attrition rates and heterogeneity among studies limit the findings. It only compared common gastrointestinal side effects and didn't use the GRADE approach for evidence quality. Conclusion: Study provides evidence supporting the efficacy of anti-obesity medications compared to placebo. BUP/NLX combination, LIRA, and SGT emerged as the most effective agents, considering safety profile. Findings can guide clinicians about options for obesity management. Study Registration: The study is registered with PROSPERO (CRD42023465989).
Introduction: Drug-induced seizures are a growing problem due to their relatively high prevalence; poor prognosis and a large number of different drugs being associated with the etiology. Although rare, seizures reported with sertraline include myoclonic seizures, partial seizures, and generalized seizures. We report the case of a young female with no prior history of seizures who developed an episode of seizures with possible use of sertraline. Case Report: A 40-year-old female presented with the episode of seizures. On examination, Glassgow Coma Scale score was E1V1M4. Three months earlier, she was diagnosed with intraparenchymal hemorrhage (IPH) with neurological deficits. Levetiracetam was started as prophylactic for seizures. Sertraline was added for concomitant depression. Dose increase of sertraline was done by the psychiatrist due to inadequate response for depression. About 1½ months after the dose increase, she presented with seizures. Conclusion: IPH and neurological deficits could be causative for seizures. However, seizures as an adverse drug reaction of sertraline cannot be ruled out as they occurred after the dose increase of Sertraline. Although rare, one should be watchful for this adverse effect of sertraline.
Coumarin derivative, oral anticoagulants are one of the most common medications responsible for skin necrosis. The common complications of coumarin therapy are subcutaneous hemorrhage, intramuscular hematoma, visceral intramural bleeding, and cutaneous reactions, whereas skin necrosis is a rare and unpredictable complication of coumarin therapy. Here, we are reporting an unordinary adverse drug reaction (ADR) of anticoagulant-induced skin necrosis involving acenocoumarol. Acenocoumarol is an anticoagulant medication that is used to prevent blood clots.
Objective: To assess prevalence and pattern of off-label and unlicensed use of drugs in paediatric outpatient department.Methods: In this prospective study, children attending paediatric outpatient department of a tertiary care teaching hospital were enrolled.Demographic data, clinical history and completeprescription given to the patient were noted.Prescriptions were analysed for off-label and unlicensed drug use with the help ofrecent British National Formulary for Children (BNFC) and National Formulary of India (NFI).Results: Total of 170 patient's data was collected over 2 months with mean age 4.19 ± 3.66 years.Out of total of 405 drugs prescribed, 41 (10.1%)-BNFC and 32 (7.9%)-NFI were used in off-label manner.Number of children who received at least one off-label drug as per BNFC and NFI was 22.4% and 17.1%, respectively.Most common off-label drug was amoxicillin being 48.8%-BNFC and 34.4%-NFI of all drugs prescribed in this manner.Most common category for off-label prescription was inappropriate dose.Only one case was noted for unlicensed drug use.Offlabel drug prescribing significantly correlated with age of the patient and number of drugs per prescription.Conclusion: Off-label drug use is prevalent in paediatric outpatient department, amoxicillin being the commonest drug.
Abstract Background: The elderly stand a greater risk of drug-drug interactions (DDIs). This study was an earnest attempt at in-depth prescriptions analysis and evaluating the potential DDIs (pDDIs) among patients in the geriatric outpatient department (OPD). Aims and Objectives: The aim is to conduct prescriptions analysis of patients and to evaluate the pDDIs among patients in the geriatric OPD. Materials and Methods: A retrospective observational study began after Institutional Review Board approval. Demographic details, clinical profile, and drugs prescribed were recorded. The prescription analysis was done by prespecified criteria and pDDIs were identified using various tools. Results: Prescriptions of 202 patients with a mean age of 68.76 years were collected. Mean drugs prescribed were 6.07. Total number of fixed-dose combinations (FDCs) and over-the-counter drugs were 669 (40.50%) and 430 (26.03%), respectively. 129 (63.9%) prescriptions were incomplete in terms of dose, duration, frequency, or dosage form. Maximum interactions - 367 (34.42%) were found with aspirin followed by cardiovascular drugs. Total prescriptions with pDDIs were 137 (67.82%) Out of 34 (3.82%) serious interactions, pharmacodynamic pDDIs were seen with aspirin and enalapril/ramipril and pharmacokinetic were between omeprazole/rabeprazole and clopidogrel. Consequences of common pDDIs were identified as deterioration in renal function and hyperkalemia. The number of interactions was positively correlated with number of FDCs and number of drugs prescribed ( r = 0.427, P = 0.0001 and r = 0.189, P = 0.0001, respectively). Conclusion: Prespecified prescription analysis criteria were one of the most useful tools to improve prescribing patterns. Drug interactions can be reduced by prescribing minimum drugs in elderly, alteration in time of dosing and fractionation of dose along with amalgamating the use of online DDI checker in hospital information system. Training of prescribers especially in geriatric patients is the need of the hour.
This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients’ details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation.
Background: Hypertension is one of the most common comorbidity across the whole world so its true measurement is important for its diagnosis as well as management. For diagnosis of estimating blood pressure (BP), the most common non-invasive modalities are manual mercury sphygmomanometer and digital BP monitor device.
Aim and Objective: The objective of the study was to comparative evaluation between normal sphygmomanometer and digital BP instrument in normal healthy volunteers.
Materials and Methods: The study begins after obtaining permission from the Institutional Ethics Committee. The written consent of the individual was obtained. Persons above 18 years of age, who gave their written consent and receiving antihypertensive treatment, are included in the study. Persons having diabetes, severe hypertension, psychiatric disorders, and smoked before 30 min are excluded from the study. BP is measured according to JNC-8 criteria. The study was a cross-sectional observational study.
Results: A total of 102 individuals were analyzed age group accordingly. The data were analyzed by unpaired t-test for comparing BP measured by mercury and digital sphygmomanometer with a significance value set at P < 0.05 as significant. The comparison of each modality was done using an unpaired t-test and P values were found as follows: Systolic BP, P = 0.1856 and diastolic BP, P = 0.891.
Conclusion: BP is one of the most common and must necessary medical procedure done in each and every person before any medical and surgical procedure. As there is no significant difference between digital and manual sphygmomanometer, so we can use digital as an alternative option of manual carefully as per need.
Background Adverse drug reactions (ADRs) represent a significant public health concern, contributing to mortality, morbidity, and healthcare costs worldwide. Healthcare practitioners especially doctors play a vital role in identifying and reporting ADR. This study investigates the prevalence of knowledge regarding ADR among doctors and enhances it with educational intervention. It also explores the association between demographic factors and baseline ADR awareness. Methods A prospective cross-sectional interventional study was conducted among doctors in Ahmedabad, India, to evaluate their knowledge of ADR reporting and the effectiveness of an educational video intervention. Pre- and post-intervention questionnaires were administered to assess knowledge improvement. Statistical analysis, including paired t-tests and chi-square tests, was performed to evaluate the intervention's impact and explore associations between demographic factors and ADR awareness. Results Analysis of pre- and post-intervention questionnaires revealed a significant increase in correct response rates post-intervention, indicating the effectiveness of the educational video intervention. Demographic factors, particularly age, were associated with ADR awareness. Following the intervention, participants demonstrated an improved understanding of ADR definitions, WHO causality assessment, reporting mechanisms, and challenges faced by pharmacovigilance programs. All participants found the video helpful and expressed intent to share their knowledge post-intervention. Conclusion The results of the study suggest that educational video intervention can serve as an effective tool for understanding ADR concepts and pharmacovigilance practices. Moreover, the association of demographic factors, particularly age, with ADR awareness further emphasizes the importance of educational interventions in addressing specific population needs.
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