Ashwani K Gupta

To Assess the Quality of Life (QOL) of Caregivers and Patients Suffering from Chronic Obstructive Pulmonary Disease (COPD)

Rationale: Chronic Obstructive Pulmonary Disease (COPD) is associated with physical and psychological burdens. The impact of disease has been studied on patients but it also has a profound and pervasive effect on family and friends resulting in psychological strain, social isolation, relationship strains and financial strains from the added responsibilities of managing the patients. Few studies have found a significant burden on both caregivers and patients alike, but the data from the Indian setup in lacking. Hence, we designed this study to assess the Quality of Life (QOL) of caregivers and patients suffering from COPD. Methods: A cross-sectional study was carried out with forty-six COPD patients and their primary caregivers. Patients were assessed with St. George’s Respiratory Questionnaire (SGRQ), and WHO-QOL-Bref scores. The caregivers were divided into two groups. Group 1 volunteers were caregivers of patients recently diagnosed with COPD (Last 1 year), whereas Group 2 were caregivers of patients with COPD diagnosed more than 1 year back. The caregivers in both the groups were subjected to Zarit Burden Interview (ZBI) and WHO-QOL-Bref scores. Results: 46 patients and caregivers were enrolled in the study. Majority of patients were over the age of 50 years (55.67 ± 12.45), and 67% caregivers were females. Patients had poor QOL as per SGRQ. The caregivers in Group 1 had significantly lower (p < 0.05) burden as compared to Group 2 as evident by ZBI scores. The WHO-QOL-Bref scores in all the 4 domains were significantly higher in Group 1 which predicts a better quality of life. Conclusion: COPD takes a toll not only on the patient but also the caregiver of the patients. The amount of burden increases as the disease progress with worsening quality of life.

Current scenario of attitude and knowledge of physicians about rational prescription: A novel cross-sectional study

Background: In the last 30 years concepts in pharmacology have moved from Essential Medicines (EM) to P-drugs via the Rational Use of Medicines (RUM), but no structured study has evaluated the level of understanding among the working clinicians about these concepts. Aim: The present study was designed to assess the attitude and knowledge of clinical practitioners about the concepts of RUM, EM, P-drugs, and sources of drug-information, across North India. Materials and Methods: A cross-sectional study was carried out in and around the teaching hospitals attached to Medical Colleges, enrolling 504 clinicians from six centers across North India to fill-up a questionnaire containing 25 questions. Statistical Analysis: The results were compiled using percentages and averages. Univariate analysis, which explores each variable in a data set separately, was carried out by using the Fishers exact test. Results: Only one-fourth of the participants claimed that they always prescribed Essential Medicine; no one could correctly count the number of drugs / drug combinations in the Indian Essential Drug list; only 15.1% of the clinicians wrote the generic names of drugs on the prescription slip; about one-third of clinicians were not fully aware about the adverse effects, drug interactions, and contraindications of the drugs they prescribed; about 83% of physicians admitted to relying on information from Medical Representatives and an interest in research activities seemed to be lost. Conclusion: Results show a sorry state of affairs among clinicians, as far as the level of understanding about EM, P-drugs, and RUM is concerned, and it points toward arranging more continuing medical education (CME) for clinicians with regard to these concepts.

To study the levels of C - reactive protein and total leucocyte count in patients operated of open and laparoscopic cholecystectomy.

BACKGROUND The recovery from laparoscopic cholecystectomy (LC) is rapid and most of the patients are discharged on the 1st post-operative day. There is an increased concentration of certain serum proteins, known as acute-phase reactive proteins (APRP) during the post-operative period depends on the degree of tissue damage and the inflammatory reaction. There is a direct positive correlation between the concentrations of APRP, especially C-reactive protein (CRP), and the severity of inflammation. This study was done to study the levels of C - reactive protein and Total Leucocyte Count in patients operated either by Open Cholecystectomy (OC) and Laparoscopic Cholecystectomy (LC). MATERIALS AND METHODS This prospective study was conducted on 50 patients after approval from the Institutional Ethics Committee. Twenty five patients underwent open cholecystectomy and the other 25 had laparoscopic cholecystectomy. The pre and post operative concentrations of serum C-reactive protein (CRP) and total leukocyte count (TLC) were compared in both the groups. RESULTS There were no differences in the preoperative serum CRP and TLC concentrations - in both the groups. Serum CRP rose significantly following OC compared to that of patients who underwent LC (10.52 ± 1.96 mg% vs. 8.88 ± 1.23 mg %). There were also significant differences in the post-operative TLC ( 9.49 ± 1.05 m/mm3 for the OC group vs. 8.57 ± 1.31 m/mm3 for the LC group), and the post-operative hospital stay (5.5 ±1.5 days vs. 1.9 ± 0.9 days). There was no correlation between serum CRP concentrations and the other post-operative parameters. CONCLUSION The study provided the biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.

Canagliflozin in Type 2 Diabetes Mellitus

Canagliflozin is a sodium-glucose co-transporter-2 inhibitor that lowers the renal threshold for glucose, resulting in a greatly increased urinary glucose excretion and reduced blood glucose concentrations in patients with hyperglycaemia. This group of drugs has been used as monotherapy and as an adjunct therapy to all antidiabetic drugs. The present review evaluates the concept, therapeutic potential and limitations of canagliflozin as potential antidiabetic agent.