Journal of Pharmaceutical Research

Abstract

METHODOLOGY: A prospective - observational study on diabetic knowledge was done in Inpatient and outpatient Department of a tertiary care hospital in Bangalore for a period of 6 months. The patients (inpatients and out-patients) suffering from Type-2 DM of either sex who were aged 35 years or above and satisfied the study criteria such as patient who are diagnosed with type2 DM for more than 1 year, who are on either parentral or oral hypoglycemic were enrolled prospectively for six months. The patient, clinical, medication and socio-economic data were collected. Different levels of education considered were: Post-gradates, graduates, schooling and illiterate. Michigan Diabetes Knowledge Testing scale was given to the enrolled patients to self-administer the scale in patient waiting area. Each answer was dichotomously scored. Accordingly, each correct answer is awarded a score of one while every incorrect or unsure answer was awarded a score of zero. The total score was categorized as: Score > 17= Better Knowledge, Score 11-17 = Average Knowledge and Score < 11 = Poor knowledge.

RESULTS and DISCUSSION: Totally 400 patients (Males 61%, Females 39%, mean age+/-0.6176) suffering from Type-2 DM were enrolled. Majority of the patients were graduates (198) 50% followed by patients with school level education (116), 29% , illiterate patients were (69), 17% and least number of patients were post graduates (17) 4%. Among the study patients, majority (205) 51.25% had poor knowledge followed by 182 patients (45.5%) who had average knowledge. However, 3.25% patients had showed better knowledge. This indicates that majority of the patients were with poor knowledge which resembles previous study conducted in South Africa that shows 66.9% of the population studied passed the diabetes knowledge test with more than 50% score².

CONCLUSION: Majority of the patients suffering from Type-2 DM have poor knowledge about their disease irrespective of their education level. This urges the need for educating diabetic patients.

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Methodology: The study protocol was approved by the hospital human ethical committee. The patients (in-patients and out-patients) suffering from Type-2 DM of either sex who were aged 35 years and above and patient diagnosed with Type 2 DM for more than one year who were either on parenteral or oral anti diabetic medication treatment were prospectively enrolled for six months. The patient, clinical, medication and socioeconomic data were collected into specialized patient profile form. Different levels education considered were: Post-gradates, graduates, schooling and illiterate. The patient medication adherence was assessed using Morisky Medication adherence scale. Each answer was dichotomously scored. Accordingly, each correct answer is awarded a score of zero while every incorrect or unsure answer was awarded a score of one. The scores were totalled and categorized as: Score 0 = High adherence, Score 1-3 = Moderate adherence and Score > 3 = Poor adherence.

Result and Discussion: Totally 450 patients (Males 61%, Females 39%) suffering from Type-2 DM were enrolled. Mean age of the patients was 61years. Majority of the enrolled patients were graduates (198) 50% followed by the patients with basic level of school education( 116) 29% , and (69) 17% were illiterate and least number of patients were post graduates (17) 4 %.

Among the patients who were assessed for their medication adherence, majority (219) (54.75%) had poor adherence followed by 31.5% patients who had moderate adherence. However, (13.75%) patients had high adherence. This indicates that majority of patients were not adherent to their medications. Research has shown that patients with diabetes mellitus have one of the lowest medication adherence rates at 65% to 85%.Factors that could influence the patients adherence were assessed and were able to find with four clear causes included forgetfulness (64.25%),feeling better (75%),feeling worse(79.25%) and inconvenience (61.75%).

Conclusion: Majority of the patients suffering from Type-2 diabetes mellitus have poor medication adherence.

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The most common co-occurring disorders with TS are Attention Deficit Hyperkinetic Disorder (ADHD) 50-60% and Obsessive Compulsive Disorder (OCD) 30-70%.

This Case report describes the history of a 38-year-old man who showed symptoms of tic disorder, was initially misdiagnosed as having psychosis that later proved to be Tourette Syndrome. The patient was presented to the Psychiatry department in the October 2013 with chief complaints of repetitive turning of face to the left, anger outbursts, involuntary raising of the upper limbs, foul words usage and occasionally counting fingers over the past year that intensified in the 15 days prior to admission.

The patient was prescribed a typical anti-psychotic such as Risperidone 2mg twice a day. Consequent admissions over the next one year showed new symptoms such as irritability, sudden movements of both upper and lower limbs, which progressed to jerking, hitting of his forehead multiple times, generalized body weakness, tremors of limbs that invariably led to disturbed sleep patterns. He was given combinations of neuroleptics such as Haloperidol and Olanzapine at doses of 5mg respectively with anti-depressants such as Lorazepam 1mg once daily and Fluoxetine 2omg thrice daily along with an anti-muscaranic agent Trihexyphenidyl 2mg twice daily.

The patient was non-compliant with the prescribed medications. The patient reported in June 2015 and was admitted for a period of one month with extra pyramidal symptoms (EPS) as a side effect of the anti Haloperidol. The doctors decreased the dose of Haloperidol to 2.5 mg once daily to minimize his symptoms. Although the tic symptoms decreased effectively during his hospital stay, there were clear abnormalities in his social interaction which the doctors diagnosed later as schizoid personality traits.

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EM is known to be caused by medications such as Barbiturates, Hydantoins, Nonsteroidal anti-inflammatory drugs, Penicillins, Phenothiazine and Sulfonamides.

Literature has revealed several cases of Fluoroquinolone (Ciprofloxacin) induced EM in India. Ciprofloxacin is mainly used in conditions such as Gonorrhea, Lower respiratory tract infection, Nosocomial pneumonia and mainly for Urinary tract infections.

This is a case report of a 43 year old female patient who reported to the Dermatology outpatient department of the hospital. She came in with symptoms such as multiple targeted dark coloured patches on legs, abdomen, hands and trunk. She also presented with a single whitish lesions on the mouth over the mucosal region of the hard palate.

The patient had a history of taking Tablet Ciprofloxacin 500mg for complaints of fever and burning micturition that developed 20 days before admission. In order to diagnose effectively, a biopsy was done which suggested Erythema Multiforme secondary to drugs.

The doctors prescribed oral prednisolone ( 30mg OD initially for 7 days which was tapered to 20mg OD for 7 days and later 10mg OD for 3 days) for the lesion over the mouth and Anti Histamines like Levocitrizine at 10mg BD for 15days for the itching.

A cream containing Aloevera and Vit E ( VenusiaMax) was prescribed for local application BD for 15days and a prophylactic course of anti-biotic ( Tab Amoxiclav 625mg BD for 6days) was initiated. After a period of 15days ,the patient showed no signs of recurrence and her symptoms subsided satisfactorily. The doctors then discharged her with a tapered dose of corticosteroid along with Tablet Ultracet for pain whenever needed.

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