Trupti Rekha Swain

Nonadherence to anti-HIV medication is associated with higher level of anxiety: Experience from a tertiary care hospital of Odisha

Aim: To correlate the level of anxiety with nonadherence to antiretroviral medication. Materials and Methods: This observational, cross-sectional, hospital-based study was conducted in 78 patients attending antiretroviral therapy (ART) center of a tertiary care hospital of Odisha. The study duration was 6 months. Patients were designated as nonadherent by referring to the white card. Utilization of ART drugs and adverse drug reactions were included in a predesigned format. The anxiety level of all included patients was scored as per Hamilton Anxiety Rating Scale. Mean anxiety score of the adherent group was compared with that of the nonadherent group. Possible causes of nonadherence leading to high anxiety level were evaluated. Results: 46% of patients in the nonadherent group had very severe, 17% had moderate to severe, 28% had mild to moderate and 9% had a mild level of anxiety. In the adherent group, however, mild to moderate level of anxiety was observed only in 10% patients. Conclusions: Anxiety is associated with sub-optimal medication adherence in HIV infected patients.

Pricing and availability of some essential child specific medicines in Odisha

Objectives: Continuous availability of affordable medicines in appropriate formulations is essential to reduce morbidity and mortality in children. Odisha an eastern Indian state records very high mortality of children. The study aims at documenting the availability and prices paid for purchasing essential child-specific medicines. Materials and Methods: The survey of 34 essential medicines was conducted in six randomly selected districts of Odisha. Data were collected from medicine outlets of the public, private, and other sector (Nongovernmental Organization [NGO]/mission sectors) of six randomly selected districts, using WHO/Health Action International medicine price collection methodology. For each medicine surveyed, data were collected on the highest and lowest-priced formulations available in each facility. Results: Both public sector and other sector health facilities procure only one brand of medicines, mean percentage availability of medicines being 17% and 21.8%, respectively. In the private sector, the mean percentage availability of the high and lowest-priced medicines for a particular drug product was 10.8% and 38.5%, respectively. The public sector procurement price is 48% lower than international reference prices. In the private sector, high-priced, and low-priced products are sold at 1.83 and 1.46 times the international reference price, respectively. Substantial price variation was observed for some medicines across individual outlets. Medicines were found to cost 2.08 times their international reference price in NGO/mission sector facilities. Conclusions: The availability of childrens medicines in public sector facilities of Odisha state is poor. Medicines for children cost relatively high in both private and NGO sectors compared to the international reference price. The availability medicines should be improved on an urgent basis to improve access of medicines for children of Odisha.

Pricing and components analysis of some key essential pediatric medicine in Odisha state

Objective: Study highlighting prices, i.e., the patients actually pay at ground level is important for interventions such as alternate procurement schemes or to expedite regulatory assessment of essential medicines for children. The present study was undertaken to study pricing and component analysis of few key essential medicines in Odisha state. Methodology: Six child-specific medicines of different formulations were selected based on use in different disease condition and having widest pricing variation. Data were collected, entered, and analyzed in the price components data collection form of the World Health Organization-Health Action International (WHO-HAI) 2007 Workbook version 5 – Part II provided as part of the WHO/HAI methodology. The analysis includes the cumulative percent markup, total cumulative percent markup, and percent contribution of individual components to the final medicine price in both public and private sector of Odisha state. Results: Add-on costs such as taxes, wholesale, and retail markups contribute substantially to the final price of medicines in private sector, particularly for branded-generic products. The largest contributor to add-on costs is at the level of retailer shop. Conclusion: Policy should be framed to achieve a greater transparency and uniformity of the pricing of medicines at different health sectors of Odisha.

L-asparaginase-induced abnormality in plasma glucose level in patients of acute lymphoblastic leukemia admitted to a tertiary care hospital of Odisha

Objectives: The objective of this study was to evaluate any abnormal change in plasma glucose levels in patients treated with L-asparaginase (L-Asp)-based chemotherapy regimen in patients of acute lymphoblastic leukemia (ALL). Materials and Methods: This retrospective, hospital-based study was conducted in patients of ALL, admitted to the Clinical Haematology Department of a tertiary care hospital of Odisha from August 2014 to July 2015. Indoor records of 146 patients on multi-centered protocol-841 were evaluated for any alteration in plasma glucose level, time of onset of hypo/hyperglycemia, and persistence of plasma glucose alteration. Results: Twenty-one percent of patients showed abnormal plasma glucose level. Most of these patients developed hypoglycemia and were of lower age group. Most of these patients developed hypoglycemia and were of lower age group, whereas a majority of higher age group patients developed hyperglycemia. In majority of the cases, abnormal glucose developed after three doses of L-Asp. Hypoglycemia subsided whereas hyperglycemia persisted till the end of our observation period. Conclusions: L-Asp produces more incidences of hypoglycemia than hyperglycemia in a good number of ALL patients towards which clinicians should be more vigilant. However, hyperglycemia persists for a longer duration than hypoglycemia.

Association of Male Infertility to Metabolic Syndrome and Other Related Disorders

Metabolic syndrome is a common global problem. This condition is also multifaceted and potential precursor to significant disturbance of numerous physiologic processes. The interconnected complexities of this disorder may varies from, life threatening risk of cardiovascular atherosclerotic diseases, type 2 diabetes, and hypertension to many of other metabolic diseases like male or female infertility. This review article cogitate the literature regarding metabolic syndrome and male reproductive health. The association between abdominal obesity, insulin resistance, systemic hypertension, and dyslipidemia are each examined with regard to their interconnected deleterious effects on male fertility. At the conclusion of this manuscript, we propose a new metabolic syndrome with male infertility paradigm. Supplementary acquisition particularly addressing the components of metabolic syndrome and their impact on male reproduction will enhance our understanding of the underlying pathophysiology. These studies may also help elucidate the role for therapeutic intervention.

Prescribing pattern of antibiotics in community-acquired pneumonia in a teaching hospital of Southeast Asia

Objective: To study and describe the antibiotic prescribing habits of physicians for 117 patients with community-acquired pneumonia (CAP). Materials and Methods: A medicine consultant or a pulmonologist supervised and treated 45 (38%) patients. Out of 45 patients, 7 (16%) were given macrolide, 12 (26%) received beta-lactam antibiotics, 14 (31%) were given a combination of beta-lactam and macrolide, and 12 (26%) were given a combination of more than one antibiotics. Seventy-two (62%) patients were seen by other specialists, of whom 5 (6%) were given macrolide, 35 (48%) were given beta-lactam, 4 (6%) were administered a combination of beta-lactam and macrolide, 2 (3%) received quinolones, and 26 (36%) patients received various combinations. In 47 out of 117 patients, therapy was modified, which included 12 patients who underwent step-down switch. The duration of hospitalization was 26 days for those patients whose therapy was modified. Patients who underwent step-down switch had a hospital stay of 7 days, whereas those who did not have any modification in the treatment stayed for 10 days in the hospital. Results: Beta-lactam antibiotic was more commonly used, at least 3.8 times more than a macrolide. Other combinations of antibiotics were given in 28%, 68%, and 44% of patients treated by a medicine specialist, pulmonologist, and other specialties, respectively. Conclusion: These data demonstrate that in spite of the advances of knowledge in the management of CAP, there exists variability in the prescribing habits of the attending physician.