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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The lactic acidosis due to linezolid has been linked to injury to hepatic mitochondria and with microvesicular steatosis, but is usually rapidly reversed with withdrawal of therapy.

This case report is about a 70 year old female patient admitted in the Medical Intensive Care Unit (MICU) with the complaints of vomiting since two days,difficulty in breathing , facial puffiness and decreased urine output.ABG(Arterial Blood Gas) analysis showed elevated potassium,low sodium and correction started for the same.

Patient had a history of taking tablet Linezolid and tablet Diclofenac since one month status post her spinal surgery. On the second day of admission in MICU, the patient was found to have Linezolid induced lactic acidosis from the ABG analysis with lactate 87mmol/L and HCO₃-18mEq/L and linezolid was withheld.

Lab results also showedanemia,thrombocytopenia,abnormal creatinine , blood urea nitrogen values and bone marrow suppression after the admission.Anemia and thrombocytopenia was treated using thiamine adjunctive therapy from day 2.Urine culture test showed presence of Amp C Klebsiella(colony forming units-CFU=80,000) and was prescribed Injection Clindamycin 600mg and Meropenem((1gm every8hourly).

Acute Kidney Injury(AKI) was suspected but resolved with dialysis. As the patient's condition improved she was shifted to the general ward on the 8^th day but was found to have tachypenia and bradycardia thus intubated and mechanically ventilated.Gradually she became better but pleural effusion was noted in lung scan,tap was done and was transudative in nature.Therefore patient was extubated and later on 11^th day urine culture sensitivity showed Candida tropicalis(greater than 1 lakh fungal colonycount-FCC) for which Injection Fluconazole(400mg)was started.In the general ward her treated continued with intravenous antibiotics,regular medications and other supportive measures,improved with the treatment and was discharged in a stable condition.

Conclusion: Physicians should be aware about the adverse effects of antibiotics and closely monitor for the effects before starting longterm therapy of antibiotics.

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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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Many surveys showed that people of age 65years or more are usually diagnosed with AD. The main treatment of AD includes Donezepil, Alantimine, Rivastigmine and Tacrine which belong to cholinesterase inhibitors. Memantine is an N-methyl-D-aspartate-receptor inhibitor which works by blocking excess activity of glutamate in brain and helps reduce the symptoms of AD. Memantine is a first and only member of a new class of medication showing clinical benefit and good tolerability in AD. Memantine has also exhibited efficacy and safety in a placebo-controlled trial.

This review is about the many theories proposed for the administration of memantine to AD patients receiving stable donezepil therapy would result in clinical benefit and are safe and well tolerated which has been researched. Many clinical trials are still ongoing.

This review is based on study on two groups of AD patients where one group is given placebo withdonezepil and other group is given 20mg memantine with donezepil; then both the groups are compared. Many clinical trial results are based on the comparative study of both the group of patients where the patients (40%) receiving memantine added to donezepil significantly outperformed those patients (52%) receiving placebo with donezepil.

Therefore many clinical trials had produced positive results when the drugs memantine and donezepil were concomitantly administered. Based on the studies the patients receiving antiglutamatergic treatment showed an improvement in the cognition scores for moderate to severe AD patients.

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The two main indications for the long-term use of PPIs are gastro esophageal reflux disease and concomitant use with the maintenance dose of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).

PPIs block the gastric H⁺,K⁺-ATPase, inhibiting gastric acid secretion. If the drug is discontinued, there is a potential risk for rebound hypersecretion, creating a sort of dependency on the drug because the body is acclimated to having acid suppressed.

The potential adverse effects relating to PPIs are Hypochlorhydria (11%- 24%) leading to pernicious anaemia and bone fractures(elevated risk after 7 years of continuous PPI therapy) and Hypergastrinemia (20%- 25%). Review of various literatures have shown that long-term PPI use is associated with upto fourfold increase in the risk of fundic gland polyps(upto 36%).

Other potential consequences of chronic PPI use are malabsorption of key minerals (calcium and magnesium) in the body, increased risk of infections, cancer (5%-12%), severe drug interactions and birth defects.

The most commonly seen infections with chronic PPI use are Enteric Infections and Community Acquired Pneumonia(CAP).A case-controlled study discovered an associated 2.5-fold risk of infection with concomitant PPI therapy. A population-based case-controlled study of7642 CAP cases identified, 11% were chronic PPI users.

Another study found that 50% of chronic PPI users are more likely to develop CAP.Elderly, malnourished, immune-compromised, chronically ill, and osteoporotic patients theoretically could be at increased risk from longterm therapy.

In conclusion, based on the above evidences, pharmacists are poised to educate patients about the benefits and risks associated with chronic PPI use.

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