Deepthi Avvaru, M Santhosh Reddy, Shinaj Azar MS, Shashikala Wali, Mahantesh V Patil, Ramesh Bhandari, M S Ganachari. Assessment of medication discrepancy, medication appropriateness, and cost analysis among patients with pediatric nephrotic syndrome: An ambispective cohort observational study. Archives de Pédiatrie. 2024; 31(2): 106-111 [Scopus] [WoS] [IF:1.8]
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ABSTRACT
Ashitha George Joseph, Santra Saji, Anagha Nivrutti Kumbhar, Shivakumar G., Ramesh Bhandari*, M. S. Ganachari. Current Drug Safety. Pharmacists’ Medication Reconciliation Interventions during Admission and Transfer from an Emergency Department at a Tertiary Care Hospital: A Randomized Pilot Study and Evaluation of Physician and Patient Perceptions. 2023; https://doi.org/10.2174/1574886318666230911144912 [Scopus] [WoS] [IF:1.5]
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Deepthi Avvaru, Raushan Kumar Chaudhary, Bhavana Doshi, Ramesh Bhandari*. Steroid as a Saviour and Culprit in Pemphigus Vulgaris Therapy: A Rare Case Series. Current Drug Therapy. 2023; https://doi.org/10.2174/1574885518666230816095340 [Scopus]
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Snehi Shrestha, Mubashir Angolkar, Ashwini Narasannavar, Nuha Al-akbari, Akshata K. Ritti, Ramesh Bhandari*. Perceptions and Challenges among Health Care Providers about HIV-TB Co-infected Children- A Qualitative Study. Indian Journal of Tuberculosis. 2023; https://doi.org/10.1016/j.ijtb.2023.05.018. [Scopus]
ABSTRACT
Pratheeksha T John, Varsha Mariam John, K Gowtham, Ashish Singh Parihar, Ramesh Bhandari*, M S Ganachari. Clinical Pharmacist Led Approach on Enhancement of Medication Adherence Resolving the Drug Related Problems with Selective Serotonin Reuptake Inhibitors among the Patients with Psychiatric Illness. A Prospective, Pre and Post-Non-Randomised Interventional Study. 2023; 57(2): 612-616 [WoS] [Scopus]
ABSTRACT
Introduction: Non-adherence is one of the most common barriers to the successful completion of treatment and it can be worst in psychiatric patients. Objectives: To assess, compare and resolve drug-related problems and medication adherence among psychiatric patients with SSRI and to assess the association between non-adherence and drug-related problems. Materials and Methods: In this prospective, non-randomized interventional study 90 psychiatry patients which were on SSRI treatment of both gender, aged more than 18 years were included. Written informed consent was obtained from the patient prior to enrol in the study. Results: Out of 90 patients enrolled, 51 (56.7%) patients reported DRPs and after pharmacist intervention, it was reduced to 26 (28.9%). Results showed a significant association between drug-related problems and medication adherence. Baseline and follow-up MARS scores are compared and found that there is a significant increase in the adherence score of patients after pharmacist intervention. Conclusion: This study results show that through proper patient education it is possible to improve medication adherence and to optimize medication use, which may reduce the DRPs. It will help eventually help to decrease drug-related morbidity and mortality.
Bhandari R*. Educational Transformation and Adaptation Challenges during COVID-19 Pandemic: An Indian Scenario. J Mod Educ Res, 2023; 2: 2. DOI: 10.53964/jmer.2023002
ABSTRACT
Because of the lockdown due to the coronavirus disease 2019 pandemic, all universities and affiliated institutions have stopped teaching-learning activities and public gatherings like workshops/conferences and postponed examinations. Various institutions in India have initiated online teaching platforms to continue the teaching-learning process during the unprecedented pandemic to overcome these situations. Various methods such as audio-visual aids, social apps like Whatsapp, and online teaching platforms like Zoom, Go-to-meeting, etc., were used for teaching-learning by different universities in India. Adaptation challenges like security issues in some online platforms, and difficulty in student learning assessment during online classes stress the fact that one education method does not fit all.
Bhandari Ramesh*, Ganachari Madiwalayya S. Monkeypox and its outbreak: is it a new pandemic? EUR J CLIN PHARM. Jul-Sep 2022;24(3):115-116. [Scopus]
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Bhandari, Ramesh*, Ganachari, M. S. Challenges in lipid profile management in dyslipidemia patients: Healthcare professional perspective. [abstract]. In: Virtual 2nd Annual African Regional Interest Group Meeting (AfRIG), 11–13 July 2022. Pharmacoepidemiology and Drug Safety September 2022;31(SI): 670. [WoS] [Scopus]
ABSTRACT
Background: Management of dyslipidemia is important to reduce cardiovascular diseases. Despite knowing, this fact only 17–35% of patients with dyslipidemia receive diet or drug therapy.
Objective: To identify the challenges in lipid profile management in dyslipidemia patients among health care professionals.
Methods: A cross-sectional study was conducted for 3 months in a tertiary care teaching hospital. Participants who were eligible were enrolled after taking written informed consent. The questionnaire (tool) was prepared after a thorough review of the literature and then validated by physicians, academic pharmacists, and clinical pharmacists.
Results: Out of 101 participants, 59 were physicians, 40 were Pharm. D interns, and 2 were working clinical pharmacists. Only 15 out of 40 physicians have attended seminars or continuing medical education on the management of dyslipidemia in the past year. It is surprising that only 38.61% (39) of healthcare professionals surveyed know about the Lipid association of India expert consensus statement on the management of dyslipidemia in Indians. Patient forgetfulness (66.67%) followed by the low education level of the patient (61.90%), High cost of the drugs (42.86%), and side effects of the treatment (42.86%) are the common reasons for non-compliance to the dyslipidemia therapy as reported by healthcare professionals.
Conclusion: Patient-related factors contribute to major challenges in the management of dyslipidemia. Future studies should focus on strategies to tackle patient-related factors to overcome the challenges in dyslipidemia management.
Sheikh C, Donage N, Donga B, Benny S, Majjigeri K, Spoorthi S, Bhandari R*, Ganachari M.S. Real-world effectiveness of generic antihypertensive drugs of pradhan mantri bhartiya janaushadhi kendra. J Sci Soc 2022;49:195-200. [WoS]
ABSTRACT
Background: The Government of India started the Janaushadhi Scheme in 2008 to control individuals’ expenditure by providing low‑cost generic medicines for health benefits. Hence, this study aims to study the real‑world effectiveness of Jan Aushadhi generic antihypertensive medicines at a Pradhan Mantri Bhartiya Janaushadhi Kendra and also to assess knowledge and attitude toward generic drugs. Methods: This study was done in Pradhan Mantri Bhartiya Janaushadhi Kendra. Participants who were hypertensive and on at least one antihypertensive drug from Pradhan Mantri Bhartiya Janaushadhi Kendra were enrolled in the study. All the participants received three blood pressure (BP) measurements, i.e., two manual readings and an average of two taken. One digital reading is followed by questionnaires, which help assess patients’ knowledge and attitude using Pradhan Mantri Bhartiya Janaushadhi Kendra medicines. All the participants were evaluated for baseline, 1st‑month, 2nd‑month, and 3rd‑month follow‑up visits. The baseline, 1st‑month, 2nd‑month, and 3rd‑month data were compared using paired t‑test and Cochran’s q‑test. Results: The important findings were a considerable reduction in BP compared to the baseline, 1st‑month, 2nd‑month, and 3rd‑month follow‑up. Approximately half of the patients (53.36%) know the difference between generic and brand medicines. A significant proportion of the participants believe that taking Janaushadhi medication reduces the cost. Hence, considerable improvement was evidenced in all outcome measures. Conclusion: A significant reduction in systolic and diastolic BP was achieved for all the hypertension stages, providing the authentication that most hypertensive patients may benefit from low‑cost generic Jan Aushadhi medicines.
Y.R. Tiwari, S. Parghi, S. Roychowdhury, R. Bhandari*, M. S. Ganachari, Discrepancies occurred during multiple care transition process and their predictors in a tertiary care teaching hospital – a prospective observational study, Le Pharmacien Clinicien. 2022. https://doi.org/10.1016/j.phacli.2022.02.001. [WoS] [Scopus]
ABSTRACT
Introduction
Intense situations, shorter length of stay, miscommunication (verbally or written) amongst staff and patients, incomplete data sources, and conditions requiring immediate action create emergency department as hotspots for medication discrepancies. Despite the emphasis by international healthcare organizations, the transition of care remains unexplored in India. Hence, this study planned to assess and identify the discrepancies that occurred during multiple transitions care points and to estimate their predictors.
Materials and methods
Prospective observational study was conducted in patients admitted during October 2019–April 2020 in the emergency department and subsequently shifted to other wards until discharge. The medication reconciliation was performed at each transition level, and discrepancies were documented and analyzed to identify the predictors.
Results
A total of 165 patients were enrolled out of which 79 had discrepancies. The observed discrepancies were 159, of which 54 were intentional and 105 unintentional. Mean age of the patients was found to be 51.5 years, and the majority of the patients enrolled (38%) belonged to the middle age group, ie, 38–58 years. Unintentional discrepancies (66.04%) due to reconciliation errors, dominated over intentional (33.96%). Omission (42.7%) followed by substitution (20.7%) was the most discrepancies observed. 47.2% of discrepancies occurred during the transition from intensive care unit to general wards, and 32.1% occurred at discharge. Binomial logistic regression showed that age, number of medications, and co-morbidities are predictive factors for discrepancies.
Discussion
The majority of unintentional discrepancies occurred due to reconciliation errors rather than erroneous history documentation. Most of the study in tertiary care settings showed similar discrepancies varying in their numbers.
Conclusion
Emergency pharmacist-led reconciliation, especially during the transition from a special ward to a general ward and at discharge, will lead to early identification of discrepancies and prevent medication errors.
Raushan Kumar Chaudhary, Satish S. Karoli, Prarambh S. R. Dwivedi & Ramesh Bhandari*. Anti-diabetic potential of Corn silk (Stigma maydis): An in-silico approach. J Diabetes Metab Disord (2022). https://doi.org/10.1007/s40200-022-00992-7 [WoS] [Scopus]
ABSTRACT
Corn silk is known to possess anti-diabetic activity, the current study is aimed to predict the binding affinity of bio-actives from corn silk against targets involved in diabetes mellitus i.e. Protein Tyrosine Phosphatase 1-B (PTP1B), Glucose Transporter-1 (GLUT1), Dipeptidyl Peptidase-4 (DPP4), α-glucosidase, and α-amylase. The 3D molecular structure of bio-actives was retrieved from the PubChem database and the structure of targets was retrieved from protein data bank. Later, hetero atoms were removed using Discovery studio visualizer 2019. Molecular docking was performed using Autodock4.0. Ten different poses were obtained from which the pose possessing the highest binding affinity was visualized for protein-ligand interaction in Discovery studio visualizer 2019. Twenty-six bio-actives were docked against five different targets i.e. PTPN1B, GLUT1, DPP4, α-glucosidase, and α-amylase from which flavones were found to possess the highest binding affinity towards PTPN1B with a binding energy of -8.5 kcal/mol. Similarly, β-carotene, gallotannins, 3-O-caffeoylquinic acid, and stigmasterol were predicted to possess the highest binding affinity towards GLUT1, DPP4, α-glucosidase, and α-amylase with binding energy -11.1 kcal/mol, -10.7 kcal/mol, -8.9 kcal/mol, and -9.8 kcal/mol respectively. Our study screened the anti-diabetic potential of 26 bio-actives towards five different diabetic proteins indicating a possibility of bio-actives from corn silk to possess anti-diabetic potential which needs to be further validated via experimental protocols; this serves as a future scope as well as lacuna for the present study. Thus, bio-actives from corn silk have anti-diabetic potential and can be used in the future to investigate and develop novel anti-diabetic molecule.
Kumar Chaudhary R, Bhandari R, Doshi B, Karoli SS, Spoorthi Marripalli S, Ganachari M. Gefitinib Induced Pemphigus Vulgaris with PRIDE Complex. Journal of Oncology Pharmacy Practice, Feb. 2022, https://doi.org/10.1177/10781552221076755 [WoS] [Scopus] [IF: 1.809]
ABSTRACT
Introduction: Pemphigus Vulgaris is a rare, noncommunicable, non-hereditary fatal autoimmune dermatological manifestation in which a painful blister initiates from the oral cavity. PRIDE complex stands for Papulopustules or paronychia, regulatory abnormality of hair and nails, itching, and dryness due to inhibition of EGFR. Both of these mucocutaneous manifestations are rare and are often caused by drugs. Case report: Our case reports 53-year-old patient presented with multiple crusted plaques, multiple hyperpigmented macules to patches, Solitary fluid-filled lesions on several parts of the body, and numerous erosions positive over buccal mucosa on initial follow up which was diagnosed as Pemphigus Vulgaris with PRIDE complex induced by Gefitinib. Management and outcome: The patient was treated with almost all possible treatment options, i.e., both steroids plus adjuvant therapy for pemphigus and antihistaminic, antibiotics, moisturizer, and lotions for PRIDE complex. The patient was initially admitted for infusion of the first dose of rituximab and later for management of flare-up condition and infusion of the second dose of rituximab infusion. Discussion: The complexity of the management of Pemphigus Vulgaris and PRIDE complex demands adequate monitoring of the patient's anti-cancerous therapy by clinical pharmacists, which can impact the clinical outcomes by providing pharmaceutical care and minimize the economic burden.
Arvind RK, Beerwala FA, Wali SC, Parihar AS, Ganachari MS, Bhandari R. A Randomized, Single Centered, Parallel and Open labelled Interventional Study on Effectiveness of Clinical Pharmacists on Adverse Event Following Immunization (AEFI) in Pediatric Population. Current Drug Safety. 2022 Jan 3. doi: 10.2174/1574886317666220103092844. [WoS] [Scopus]
ABSTRACT
Background: Adverse events are a major threat to any immunization programs, which in turn have proven to be a boon for developing nations like India. Hindering factors, such as inadequate knowledge, inappropriate attitude, incorrect practices, etc., of the guardian affect the vaccination rate.
Aim: This study aims to assess the effectiveness of clinical pharmacist intervention on an adverse event following immunization in the pediatric population receiving immunization.
Materials and methods: Pediatric subjects <5 yrs of both genders receiving immunization in a tertiary care hospital during the period of 8 months were considered. Subjects were randomized into control and interventional groups. Pharmaceutical intervention was done in interventional group in the form of patient counselling, and a patient information leaflet. Adverse event following immunization was recorded and analysed for both groups along with Knowledge, Attitude, and Practice scores of guardians' pre and post intervention through customized data collection forms. Microsoft excel and statistical software SPSS IBM version 22 was used to analyse the data.
Results: The study was conducted on a total of 88 subjects (n) in which 79 were <2 years, 1 and 8 were between 2-4 years and 4-5 years respectively. 49 Forty-ninesubjects (55.69%) were female, while 39 were male (44.31%) with a response and completion rate of 91.66%. 97.7% subjects received Bacillus Calmette-Guerin vaccination (majority), while 8.88% received pneumococcal special vaccine (minority). Adverse event following immunization was recorded in 31(35.22%) cases. Knowledge, Attitude and Practice scores increased by 42.17%, 52% and 12.67%, respectively in guardians after clinical pharmacist intervention.
Conclusion: This studydemonstrates that educational inputs, awareness programs, and proper medical professional intervention can act as a helping factor to fight against AEFI and towards the success of an immunization program.
Raushan Kumar Chaudhary, Melwin Johns Philip, Ashly Santhosh, Satish S. Karoli, Ramesh Bhandari, M. S. Ganachari. Health economics and effectiveness analysis of generic antidiabetic medication from jan aushadhi: An ambispective study in community pharmacy. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021; 15: 1-7. [WoS] [Scopus]
ABSTRACT
Background and aims: The pharmacotherapy of diabetes mellitus has a colossal economic burden, which demands cost-effective therapy, as the patients have to be on treatment lifelong. Thus, our study aimed to study cost variation and effectiveness analysis among type 2 diabetic patients.
Methodology: We conducted ambi-spective research for the adult type 2 diabetes patients who underwent substitution of branded anti-diabetic therapy with the generic alternative from "Jan Aushadhi" for more than one month and were not using any other anti-diabetic medicines.
Results: Among the monotherapy, glimepiride (2500%) and vildagliptin (20%) were found to have wide and narrow percentage cost variation respectively whereas, metformin Hcl 500 mg plus voglibose 0.2 mg was estimated to have the highest (891.7%), and teneligliptin 20 mg plus metformin 500 mg with the lowest (137.29%) cost variation in case of combined therapy. Similarly, generic substitutions were cost-effective in most patients, whereas the increased cost of brand drugs didn't justify its effectiveness. There was no significant difference between glycated hemoglobin (HbA1c) of brand and generic anti-diabetic drugs (t = 0.774, p = 0.22).
Conclusion: The adaptation of generic drugs can significantly reduce the economic burden of treatment. Thus, healthcare professionals should promote generic medicines by prescribing & dispensing generic drugs and erasing misconceptions prevailing among patients.
Shuvam Sharma, Sachin Patil, Ashwini Narasannavar, Ramesh Bhandari. A study on knowledge and practice of dispensing drugs without prescription by pharmacists in Belagavi City. Journal of the Scientific Society. 2021; 48(3):197-202. [Wos]
ABSTRACT
Background: The pharmacists were trained mainly to dispense medicines only over prescriptions. Despite guidelines, practice of dispensing medicines without prescription has been widely practiced worldwide. The problem and burden of drug resistance are increasing worldwide due to this practice. Objective: The objective of this study is to assess the knowledge and practice of pharmacists on drug dispensing practices without prescription in Belagavi City. Materials and Methods: A cross-sectional study was conducted between January and April 2021 among 80 pharmacists in different areas of Belagavi city. Pharmacists were selected by the simple random technique. Data were collected using the structured questionnaire. The obtained data were tabulated, and the Chi-square test was used to determine the association between the nominal variables. Results: Pharmacists had a good knowledge about laws regarding practice of dispensing without prescription. The practice of dispensing nonover-the-counter drugs without prescription was found to be 32.5% in an average. Pharmacists' fear of losing customers was the primary reason for dispensing without prescription. A significant association was found between knowledge score of pharmacists and job status of pharmacist (P = 0.043*) and location of pharmacy (P = 0.05*). The frequency of dispensing medicines without prescription was found to be significantly associated with age of staffs dispensing (P = 0.04*) and with their education status (P = 0.04*). Conclusion: Pharmacists had an average level of knowledge regarding the practice of dispensing drugs without prescription in India. However, pharmacists tend to dispense medicines without prescription on request of patients.
Chaudhary Kumar Raushan, Metgudmath R. Anjali, Bhandari Ramesh, Karoli S. Satish, R. Kumar Uday, Fixed Drug Eruptions Secondary to Fixed Drug Combination (Ofloxacin/Ornidazole): A Cross Sensitivity Case Report. Current Drug Therapy. 2021; 16(5): 1-6. [WoS] [Scopus]
ABSTRACT
Background: Fixed drug eruption (FDE) is an erythematous cutaneous patch caused by certain drugs through activation of immunologic reactions in the body. The onset of FDE is 30 minutes to 8 hours and is estimated to occur in upto 16-21% of all cutaneous reactions. The irrational combination of fluoroquinolones and nitroimidazole is the most prescribed drug for diarrhea in India, and the drug is found to cause FDE either individually or in combination. Cross sensitivity is the major issue associated with Fluoroquinolones and nitroimidazole.
Case Report: Our case is of a 45-year-old male who developed FDE due to a combination product of ofloxacin and ornidazole with past FDE history due to a combination product of norfloxacin and tinidazole. The patient presented with erythematous patches all over the body, swollen lips, mucosal erosion over the buccal cavity, and glans penis.
Discussion: The patient was successively treated after the withdrawal of the culprit drug with oral Antihistamines, corticosteroids, and other topical creams and gels, which correlates with the standard management of FDE.
Conclusion: Proper prescribing knowledge, documentation of drug allergies, and educating patient about allergic reaction play vital role to prevent future drug related problems.
Bishnu Dev Pant, Sharad Chand, Sophia M George, Nandakumar UP, Pukar Khanal, CS Shastry, Sujit Kumar Sah, Ramesh Datta Pant, Jeevan Bhatta, Jeet Bahadur Moktaan, Sunil Nepal, Ramesh Bhandari*, Sujan Basnet. Lacunas in the Preparation of Nepal for COVID19 till the Third Stage of Disease Transmission. Journal of Young Pharmacist. 2021;13(2):91- 96. [WoS]
ABSTRACT
The novel coronavirus was renamed as coronavirus disease 2019 (COVID-19) by the world health organization, began its spread in December 2019, in the city of Wuhan, China. Global bodies and governments weren’t prepared to handle the impact of the virus on society. Nepal’s landlocked nation encountered its incident confirmed case of COVID-19 during the first week of January, with the primary host being a student with a travel history from its place of inception. The nation is deficient in its health resources. The country mainly focused on the stringent implementation of washing of hands, wearing masks, restricting general movement, and maintaining social distancing in public. The disease transmission reached to the third stage, which began within three months after the confirmation of the first case of COVID-19. The lack of tropical hospitals, laboratory and diagnostic facilities added to the challenges faced by the country. This paper is a comprehensive review of the overall preparation and steps taken by the federal system of Nepal to combat the virus’s effects till the third stage of transmission. It concludes with the practical limitations faced by the governing authorities of the nation while implementing these measures.
Kambalimath Praveen S, Bhandari Ramesh, Patil Sachin R, Angolkar Mubashir. Impact of an awareness program on adverse drug reaction reporting among community pharmacist. European Journal of Clinical Pharmacy. 2021;23(2):133-138. [Scopus]
ABSTRACT
Background: In the modern system of medicine, treatment extensively depends on drugs. These drugs are sometimes known to cause adverse and unexpected side effects along with the required intended outcomes. In the community, adverse drug reactions cause loss of life, financial burden, and strain on already overworked healthcare teams, emerging as a major reason for concern towards Public Health.
Objective: 1) To assess the knowledge, attitude, and practice of pharmacists towards adverse drug reaction reporting in Belagavi. 2) To assess the impact of awareness program on knowledge, attitude, and practice of community pharmacists-urban Belagavi.
Method: Pharmacists were selected by simple random sampling method. Data was collected through a questionnaire following which pharmacists were given education on adverse drug reactions reporting with the help of leaflets. After a one-month same questionnaire was administered to assess the impact of education on adverse drug reaction reporting. The data was analyzed by using summary statistics and paired t-test. Outcome measure was gain in the scores of knowledge, attitude, and practice of adverse drug reactions reporting among community pharmacists.
Results: Average knowledge score, attitude score, and practice score of the participants in pre-test was found to be 35 ±23.87, 56.9 ±20.79, and 26.67 ±17.747 respectively which was increased to 87.86 ±13.623, 66.9 ±10.68, and 72.5 ±23.784 respectively after effective education and providing them with the leaflet (intervention). There is a statistically significant difference between pre and post-test scores of the knowledge (p = 0.0001), attitude (p = 0.001), and practice (p = 0.0001). Knowledge level was significantly different by the community pharmacist’s education level (x2 = 4.093, p = 0.0001).
Conclusion: Knowledge, attitude, and practice-based education program using leaflets were more effective on adverse drug reaction reporting and pharmacovigilance among community pharmacists. Approximately half of the pharmacists (38.33%, No. = 23) reported adverse drug reactions to regional National Pharmacovigilance Centers followed by an awareness program on adverse drug reaction reporting.
Mahantha Vastrad, Shashikala Wali*, Madiwalayya Shivakantayya Ganachari, Ashish Singh Parihar, Ramesh Bhandari. Clinical Pharmacist Approach towards Effectiveness of Pulmonary Rehabilitation of the Patient with COPD: A Randomized Controlled Study. Indian Journal of Pharmaceutical Education and Research. 2021; 55 (1) Suppl: S318-S324. [Scopus] [WoS]
ABSTRACT
Background: COPD is characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. Pulmonary rehabilitation is widely accepted as a best result outcome treatment for COPD patients. Clinical pharmacist play a very important role in patient prescription analysis, promoting the Quality of life, patient education, in developing the drug regimen, sensitivity and allergic condition of the patient to the drugs, finding out any ADRs. Objectives: To compare and assess the impact of pharmacist approach on Health related quality of Life of COPD patients undergoing pulmonary rehabilitation at two different time point. Results: Total 112 patients were screened as per study criteria, 70 were recruited and randomized into control and intervention groups of 35 each, respectively. Compared to baseline QOL score, it was improved at the follow-up in intervention group. Out of 35 subjects 33 subjects has shown good and very good QOL (94.28%). All the domains of QOL were improved compared to control group at the follow-up. Highest improved domain was physical health domain among all (difference 25.83) and lowest was socio-economic domain (difference 12.14) Mean total score of quality of life at follow-up has the significant difference 18.1 (p<0.0001). Conclusion: This study elaborated that quality of life of patients with COPD undergoing pulmonary rehabilitation was improved after the clinical pharmacists approach when compared to only standard treatment (control group).
Kumar Chaudhary Raushan, Karoli Satish S, Bhandari Ramesh*, Ganachari MS. Carbamazepine Induced Dress Syndrome with Regiscar Analysis: A Case Report. European Journal of Clinical Pharmacy. 2020; 22(4): 256-259. [Scopus] [Google Scholar]
ABSTRACT
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome is a life-threatening drug-induced eosinophilic and systemic symptom caused by mainly antiepileptic drug. The incidence rate of this reaction in the patient new to carbamazepine/phenytoin is 1 per 1,500 patients. The clinical presentation of this syndrome is fever, skin rash, eosinophilia, lymphadenopathy, organ failure, etc. The mortality rate is 2-14% and mainly due to liver failure. We report one case of carbamazepine induced DRESS syndrome in an old 65 years woman who is known case of seizure disorder and hypertension was on carbamazepine and nifedipine for the same respectively. She was admitted with the complaints of fever, burning sensation of the abdomen, facial edema, bilateral pedal edema and swelling of upper limb. On dermatological examination xerosis with mild scaling of skin was observed and on laboratory investigation showed anemia associated with leukocytosis, eosinophilia, increased in hepatic enzymes and HScCRP (High Sensitivity C-Reactive Protein) and decrease in the total protein, albumin with minimal ascites. The patient complies with the diagnostic criteria given by Bocquet et al., RegiSCAR (Registry of Severe Cutaneous Adverse Reaction) study group and Japanese consensus group for DRESS syndrome with RegiSCAR score of 4. The patient was managed with the antihistaminic, glucocorticosteroid, leukotriene receptor antagonist, hepatoprotective drug, etc. and on discharge prescribed with the tapering dose of glucocorticosteroid, hepatoprotective syrup, and vitamin supplements. This case can be helpful for the clinician to diagnose and manage the patient with DRESS syndrome effectively.
Ramesh Bhandari, C. S. Shastry, Sharad Chand, R. Anusha, Arun J., Dhurba Rana Chhetri, H. N. Girish. Clinical and Laboratory Aspects of Dengue Fever in Tertiary Care Hospital. Research Journal of Pharmacy Technology. 2020; 13(12): 5783-5786. DOI: 10.5958/0974-360X.2020.01008.2 [Scopus] [Google Scholar]
ABSTRACT
Background: Dengue is a debilitating condition caused by a flavivirus. The female Aedes mosquito widely transmits this virus. The prevalence of mosquito-borne diseases like dengue and malaria is very high in the northern and southern parts of Karnataka. Objectives: This study aims to find the prevalence of dengue and its clinical occurrence in a tertiary care teaching hospital. Methodology: A prospective observational study was carried out in a tertiary care teaching hospital in a hospitalized patient diagnosed with dengue fever. Patients who satisfied the inclusion criteria were enrolled in the study. All the relevant data was collected in a specially designed data collection form. The data were analyzed by using computer tools like Microsoft Excel and SPSS software version 20.0. Results: In our study out of a total of 315 patients males were higher than female and the dengue was commonly prevalent in the age group of 15-30 years followed by 30-45 years. Fever (99.7%) and generalized body ache (GBA, 58.5%) were the most common clinical presentations. Ns1 antigen (67.61%) was found to be positive in the majority of patients. Blood hematocrit was elevated (26.63%) in most of the abnormal cases and white blood cell count (36.19%) and platelets (96%) counts were decreased. Platelet was found the most common laboratory parameter to get affected in dengue fever. Conclusion: The most common symptoms for dengue are concluded as fever, GBA, Headache and joint pain in our study. Blood hematocrit was elevated, but WBC and platelet counts were severely decreased. The prevalence was found higher in the monsoon season of September to November. All the patients enrolled in the study were counseled regarding diseases, and education was provided on various preventive measures.
Aishwarya C Hiremath, Ramesh Bhandari, Shashikala Wali, M. S. Ganachari, Bhavana Doshi. Impact of clinical pharmacist on medication adherence among psoriasis patients: A randomized controlled study. Clinical Epidemiology and Global Health. 2021. https://doi.org/10.1016/j.cegh.2020.100687 [Scopus][Web of Science]
ABSTRACT
Background: Psoriasis is a chronic inflammatory disease and requires long term management due to which patients become non-adherent to the therapy. Hence this study aims to assess the impact of clinical pharmacists to improve medication adherence in patients with psoriasis. Materials and methods: This is a randomized controlled study conducted at a tertiary care teaching hospital in the dermatology department, among 68 patients. Aged 18–65 years from the outpatient department diagnosed with psoriasis disease and on treatment were enrolled in the study. Patients with multiple co-morbidities like HIV, hepatitis B/C, and vulnerable populations like lactating and pregnant women are excluded from the study. Enrolled patients are then randomized after taking the Informed consent form. The interventional groups of patients were provided with a patient information leaflet and pharmacist education and counselling along with standard care. Medication adherence of the patients was evaluated at the baseline level to the follow-up after 1 month. Results: Total of 68 were enrolled in the study, out of which 63 completed the study. There was no difference observed at the pre-test in both the groups. After the intervention, there was a significant difference in the experimental group after post-test (U = 200.00, p = 0.0001). Adherence was improved in the experimental group. Conclusion: There is a need for clinical pharmacists in providing the patients with knowledge about long term disease management like psoriasis. The implement of specialty pharmacists in dermatological disorders is an excellent choice to address the unattended needs of the patient
S. Nepal, A. Giri, S. Nepal, C. S. Shastry, S. Chand, S. Aryal, P. Khanal, R. Bhandari. Outdated and unused medicines disposal practice among the undergraduate paramedical students – a pharmacist’s intervention. Le Pharmacien Hospitalier et Clinicien. 2020; 55: 327-333. [Scopus] [WoS]
ABSTRACT
Background > The majority of the patients remain unaware of the disposal of unused and outdated medicines. Objective > This study was conducted to assess the disposal practice of unused and outdated medicines among undergraduate paramedical students in Butwal (Nepal), and to assess the impact of pharmacist's intervention. Methodology > A multi-stage random sampling technique was done and an interventional study was conducted in undergraduate paramedical students through a self-administered questionnaire regarding knowledge and drug disposal practice. The pre- and post-test analyses were done using the Statistical Package for Social Science (SPSS version 22), and the results were compared. Results and discussion > A total of 150 valid and complete responses were received, in which 43.3% male and 56.7% female participated. Among the disposal practice of unused medicines, 33.3% gave to their friends or relatives, whereas about 28.0% percent of the respondents kept unused till expiry, and for the disposal practice of expired medicines 32.7% disposed of the expired medicines through flush whereas 32.0% threw away in household garbage. After the intervention, 46% returned unused medicine to medical stores, whereas about 20.0% of the respondents kept unused medicines at home until it is expired. In total, 44.0% returned unused medicine to medical stores. A total of 35.3% disposed of expired medicines through flush recklessly. Conclusion > Mc Nemar's test was implied for the comparison of pre- and post-intervention study, which showed a 31% improvement in proper disposal practice of unused and expired medicines after an intervention. Thus, the intervention resulted in positive change in the disposal practice of unused and expired medicine among the respondents.
Niharika P, Sujit Kumar Sah, Mansura Begum, KG Alekhya, Ramesh Bhandari. Chronic Consumption of Alcohol-induced Multiple Organ Dysfunction Syndromes with the Involvement of Five Organ Damages: A Fatal Case Report. Journal of Young Pharmacists. September 2020; 12(3): 285-287. [WoS][Google scholar]
ABSTRACT
Multiple organ dysfunction syndromes are defined as damage to one or more organs and failure of homeostasis between anti-inflammatory and pro-inflammatory reactions. This leads the precipitation and activation of inflammatory cytokines and damages tissues results in MODs. The risk factors includes acute severe pancreatitis, sepsis, shock, stroke and alcohol consumption. These multivariable risk factors may precipitate MOD. We presented 25 years of male patients presented with MOD with a history of excess alcohol consumption and associated acute severe pancreatitis, sepsis and renal failure. The laboratory parameters reveal elevated WBC, neutrophil, bilirubin, AST, ALT, serum amylase and lipase, renal function tests and a significant reduction in lymphocytes and platelets counts. Patients died after the 16th day of treatment due to multiple organ failures. Our study concluded that chronic excessive alcohol consumption may lead to MODS and even rarely death.
Shashikala Wali, Niranjana Mahantshetti, M S Ganachari, Ashish P, Ramesh Bhandari. Evaluation of antiepileptic medication adherence among paediatric epileptic patients: a randomized prospective study in a teaching hospital. International Journal of Pharmaceutical Research. September 2020; 12(2):1078-1083. [Scopus][Google scholar]
ABSTRACT
Background: Epilepsy is a Neuro-degenerative disorder characterized predominantly by recurrent and unpredictable seizures and discharges from the cortical cells of the brain. Long term therapy is required for treatment of epilepsy. The non-adherence is the serious concerned in cases of all patients. Objectives: To compare and assess the medication adherence of antiepileptic drugs on paediatric patients at different point interval. Methodology: The prospective, randomized study has been conducted in out-patient department of Paediatric at tertiary care hospital of Belagavi district, Karnataka, for 12 months including 1 follow-up of 6 month interval. The patients newly diagnosed with epilepsy of either sex aged between 1 to 18 years with signed with assent and consent were collected. Results: 103 epileptic patients were screened for the study. In that, 65 patients were found to fit for study criteria. Randomized into 2 groups control n= 24 and Intervention = 41. There was no significant difference (p=0.903) observed in gender distribution among both groups, similar findings p=0.116 was found in age distribution. Medication adherence observed among both the groups at baseline level were no significant difference (p=0.718) was observed in control group (6.92±1.01) and in interventional group (6.78±1.03), highly significant improvement p= 0.0001*** observed in interventional group (3.61±1.49) instead of control group (5.38±1.23). Conclusion: Clinical pharmacist assists in recommended antiepileptic medication use process by counselling which will increase medication adherence, reduces risk of seizure and enhance quality of life.
Kala Bahadur Rawal, A. Ashvil, S. Anusha, Min Bahadur Luhar, RLN Murthy, P. Krishnaveni, Vibitha Vinod, Ashish Giri, Lavanya Voora, Ramesh Bhandari*. Efficacy Of Acitretin In Management Of Acrodermatitis Continua Of Hallopeau And Consequence Of Medication Non-Adherence In Ach: A Case Report. International Journal of Pharmaceutical Research. September 2020; 12(2):1-3. [Scopus][Google scholar]
ABSTRACT
Introduction: Acrodermatitis Continua of Hallapeau (ACH) is a rare chronic inflammatory disease condition characterized by the sterile pustular eruption of fingers, toes, and nails. There is very less evidence on standard treatment of ACH, but it can be managed with conventional anti-psoriatic therapy as well as newer agents like the biological products. Case presentation: a 69 years old female patient admitted to female skin ward unit B with a known case of Acrodermatitis Continua of Hallapeau and on treatment since last five months, the patient was maintaining well with tablet Acitretin 25mg, due to the financial problem she was unable to continue medication as per the advice of a physician and discontinued the therapy after 40 days. The ACH condition relapsed more aggressively, resulting in the hospitalization of the patient. Treatments: The patient was treated with conventional anti-psoriatic therapy, systemic and topical antibiotics, emollients, antiallergic, antipyretic, calcium and vitamin D3 supplements, and saline compression during the rehospitalization. Conclusion: Safe, effective, and low-cost therapy can prevent the incidence of relapse. Hence, adequate counseling from a clinical pharmacist can help in speedy recovery and prevention of hospitalization.
Iman M A Khan, Ramesh Bhandari, Sowmya Spoorthi M, M. S. Ganachari. Perception, attitude, and practice towards COVID-19 crisis: A web-based cross-sectional survey. International Journal of Pharmaceutical Research. June 2020; 12(1):2207-2213. [Scopus][Google scholar]
ABSTRACT
Background: The current situation of pandemic is unusual and rare. Understanding common public mindset towards the COVID-19 pandemic is essential. Hence, this study aimed to understand the people’s thinking, apprehension, and reaction towards the pandemic. Method: A Google survey form (26-item questionnaire) was created and shared through social media to include as many participants as possible. The questionnaire consists of questions regarding general identity (socio-demographic factors), emotional and physical health, empathy, economic impact, feelings towards measures taken by the Government, daily routine as well as their thoughts on this pandemic. Summary statistics (mean, median, mode) were used to represent the data based on their characteristics of data. Results: The response rate is 36 % (288) out of which majority were female (62.5%). 182 (62.8%) respondents followed the guidelines recommended by WHO. Around 73% of participants donated to either charity/trust or personally to known needy persons. Many people are using social media (n=170) more than ever before and the least number of people were praying (n=2). During lockdown most of the participants (n=156) were working/studying from home. Conclusion: The ordinary citizen has painted a rather grim picture of the current crisis and has become mentally depressed due to the global situation, extreme health concerns, and loss of job or income opportunities. This will lead to an increasing number of self-harm incidents and also suicides as the person might feel overwhelmed, hence to prevent and mitigate this the Psychiatry Health Services must be available, reach out to people and reassure them.
Santosh Aryal, Shastry C. S, Sharad Chand, Vinay B. C, Nandakumar U.P, Ramesh Bhandari, Kala Bahadur Rawal, Lavanya voora. The Linkage Between Occupation and Stress Among Community Health Workers: An Indo-Global Perspective. Biomedicine. 2019 39 (3): 388-393. [Scopus][Google scholar]
ABSTRACT
Occupational stress is inevitable in all workers, and community health workers are of no exception. High stress among the workers substantially decreases there work efficiency. Occupational stress varies and depends on several predisposing and precipitating factors, including sex, marital status, education, work experience, the magnitude of workload, and individual's satisfaction toward their job. In addition to the above demographic factors, it heavily depends upon other factors including role ambiguity, lack of clarity in the job, inadequate staffing, peer pressure, deadlines to be completed, poor decision making, physical or mental disability, interpersonal conflicts, family and social issues and many more. The workers who can cope with occupational stress show better productivity in the care they provide. The psychological and emotional wellness plays a crucial role in the positive re-appraisal of the workers. The enhanced social relinking of the workers, the reward system in work environment, increased payments to the workers, sorting and prioritizing of work, planning, and its execution, optimizing the workload, the capability of logical reasoning, practicing the spiritual activities shows the better coping of stress among the health workers.
Lavanya Voora, Sujit Kumar Sah, Ramesh Bhandari, C.S. Shastry, Sharad Chand, Kala Bahadur Rawal, U.P. Nandakumar, B. C. Vinay. Doctor of Pharmacy: Boon for Health Care System. Drug Invention Today. 2020; 14 (3): 153-158. [Scopus][Google scholar]
ABSTRACT
Pharm D is a new professional academic course that started in the year 2008 in India. It has a broad spectrum compared to those of other conventional professional pharmacy courses. The unique feature of prefixing (Dr.) and provision of joining Ph. D after Pharm D allure the students all over the country. The syllabus is designed to cater to the clinical needs and fill the gap between patients and doctors. Graduated students have plenty of opportunities both in India and abroad in the field of healthcare services. Despite having a well-designed syllabus, Pharm D is still facing several problems at the practice level for its recognition. Although it has been a decade and more, the program is still in its budding stage. Pharm D students are striving continuously for appropriate attention and recognition by regulatory authorities as well as by the community.
Lavanya Voora, C.S. Shastry, Ramesh Bhandari, Degam Sukeerthi, Kala Bahadur Rawal, and Sharad Chand, Phenytoin Induced Erythroderma. J Young Pharm. 2019; 11(3): 320-321. [WoS][Google scholar]
ABSTRACT
Phenytoin is a frequently prescribed anticonvulsant/antiseizure drug due to its high efficacy. Erythroderma is an intense and widespread reddening of the skin due to inflammation which may often be associated with peeling of skin termed as exfoliative dermatitis. Erythroderma is a rare but severe Adverse Drug Reaction (ADR) of phenytoin. Here, we report a case of a patient who developed erythrodema during the treatment regimen including phenytoin prescribed for the treatment of alcoholic withdrawal seizures. ADR was confirmed by using the World Health Organization (WHO) and Naranjo’s causality assessment scale. The erythroderma condition was managed clinically by withdrawing the causal medication and administration of anti-histamines and corticosteroids with other supportive therapy. This case explains the adverse drug reaction occurring drugs used for cure. Hence there is a strong need for a pharmacovigilance programme and its awareness all over the nation.
Sharad Chand, C.S. Shastry, Vinay B.C, Ramesh Bhandari*, Sujit Kumar Sah, Kala Bahadur Rawal. Brown, White and Blue Bagging in Special Pharmacy: An Emerging Trend to Minimize Medication Error. Journal of Global Pharma Technology.2019; 11(8): 01-04.[Scopus][Google scholar]
ABSTRACT
Advancement in the sector of specialized pharmacy evolved a new concept of bagging system beyond the scope of traditional pharmacy service. Managed care organizations (MCOs) bring up the healthcare system in the network where the services are made available for the betterment of treatment and secure documentation system for reimbursement. Certain models namely brown bagging, white bagging, and blue bagging system are promising models for this system. These models generally cover expensive and high-risk medication to minimize the wastage and related drug related problems. In these models, all the prescribed medications reach to the health professionals, which meticulously review all the medications before its administration. This potential system has several advantages over the conventional pharmacy practices, despite several advantages many associated risk and disadvantages are equally challenging. But it can be concluded that benefits are outweighing the risk associated with these models, which may have more impact on patient wellbeing. Hence, this system of special pharmacy service can be recommended in the scope of hospital pharmacy and pharmacy practice.
Sharad Chand, Ramesh Bhandari, H.N. Girish, Degam Sukeerthi, Sujit Kumar Sah, Lavanya Voora. Isoniazid Induced Psychosis. Global Journal of Pharma Technology. May 2019;11(5): 11-14. [Scopus][Google scholar]
ABSTRACT
Isoniazid (INH) is one of the primary drugs used in the treatment of Mycobacterium tuberculosis infection. The common side effects of INH are peripheral neuropathy, hepatitis, rashes. Rarely psychosis, convulsions, and even death have been reported on regular doses of this drug. We present a case of Isoniazid induced psychosis occurring in a 36-year-old female patient was admitted to the general medicine unit for tuberculosis. The case was analyzed for suspected ADR and found to be probable ADR of isoniazid. The drug was discontinued, and anti-tubercular therapy was changed to modified approach, i.e. (R- Rifampicin 450mg, I- Ethambutol 800mg, S-Streptomycin 750mg and O- Ofloxacin 400mg) which shows clinical improvement in the patient.
Nisi Grace Kuriakose, Ramesh Bhandari, B.L.V. Krishna Sai, E. Jayalakshmi, P. Reddy Teja. A Study to Assess and Evaluate Prescribing Patterns of Antihypertensive Drugs in Medicine Ward of a Tertiary Care Teaching Hospital at Vijayanagara Institute of Medical Sciences, Ballari, Karnataka. Journal of Advances in Medical and Pharmaceutical Sciences. May 2018;17(1): 1-9. [Google scholar]
ABSTRACT
A prospective observational study was carried out for the period of six months in inpatient department of General Medicine ward of a tertiary care teaching hospital at Vijayanagara Institute of Medical Sciences, Ballari, Karnataka. Objective: To assess and evaluate Prescribing Patterns of Antihypertensive Drugs. Results: A total of 200 subjects were covered during the study period. Out of 200 subjects, 88 were males (44%) and 112 were females (56%). Prevalence of hypertension was more in the age group of 60-79 years [(n=90), 45%]. The patients were categorized depending on the stages of hypertension that they met. 45 patients (22.50%) belonged to the pre-hypertension stage, 56 patients (28%) belonged to stage – 1, hypertension, and 99 patients (49.50%) belonged to stage – 2 hypertension. The results revealed that the maximum number of patients 92 underwent dual therapy, followed by 79 monotherapy, 27 triple therapy and 2 of the patients were treated with more than three drugs. The study showed that 39.5% were prescribed with a single antihypertensive agent, 46% with two, 13.5% with three and 1% with more than three agents. Conclusion: Most of the prescriptions were rational, but further improvement is needed. Further studies focused on the rationale for the choice of drug based on demographic data, economic status, associated conditions and complications would give additional insights into prescribing patterns in hypertension in India.
Sharad Chand, Ramesh Bhandari, Varun lal. Prednisolone Induced Cushing’s Syndrome in Seropositive Inflammatory Arthritis. Indo American Journal of Pharmaceutical Research. May 2018;8(04): 595-597. [Google scholar]
ABSTRACT:
Aim-The main aim of the study is to report the drug related problem occurred in order to prevent its recurrence Case presentation-A 23 year female patient presented with complaint of generalized swelling of body since 8 days, breathlessness since 3 days and fever since 3 days. She is Known case of seropositive inflammatory arthritis since 1 year and taking prednisolone 20 mg b.i.d. Examination-She was having tachycardia, oedema, moon shape face. Lab investigation-her serum cortisol level is elevated and anti CCP antibodies were present hence diagnosed as prednisolone induced cushingoid syndrome with seropositive inflammatory arthritis. Treatment-She was treated with Inj. Furosemide 4o mg IV b.i.d., Neb. Budesonide + Salbutamol every 6 hourly, Tab. Hydroxychloroquine 200 mg PO b.i.d., Tab. Methotrexate 15 mg PO Once a week, Tab. Calcium carbonate 500 mg PO o.d. and other symptomatic treatment. Conclusion-The prednisolone was withdrawn in tapered manner and the patient became normal and discharged.
Ramesh Bhandari*, Sharad chand, Varun lal. Beta Thalessemia Major; Rare Haematological Disorder. World Journal of Pharmacy and Pharmaceutical Sciences. May 2018;7(5): 1442-1445. [Google scholar]
ABSTRACT:
Introduction: The thalassemias are a group of inherited autosomal recessive diseases. In β thalassemias, there is a reduced or absent production of the globin β chain. More than 100 β-Thalassemia mutations have been identified, and they tend to produce severe anaemia. Heterozygotes are usually symptomless, whilst homozygotes are more severely affected. Case presentation: A 7 year old male paediatric patient appears in paediatric ward with complaints of facial puffiness since 8 days, hurried breathing associated with cough and fever increasing during walking and running. He is K/C/O β Thalessemia major since the age of 6 months and done packed red blood cells transfusion 3 times in past. No any significant family history is present. On examination he is having facial puffiness, pedal edema (+++), pallor (+++) and icterus (++). Per abdominal examination reveals distension of abdomen and palpable liver (6cm). On lab Investigation his CBC reveals microcytic hypochromic anemia (Hb-4.2 gm%) with anisopoiklocytosis in haemolytic process, HbA – 30.5%, HbF – 66.3 % hence diagnosed as Beta thalessemia major with severe anemia and hepatosplenomegaly. Treatment: He was treated with packed cell transfusion 150 ml on alternative day (total 2 times), Inj, Furosemide 20mg/ml BD, Tab. Paracetamol 250 mg TDS, Inj. Ceftriaxone 500 mg IV, Inj. Amikacin 150 mg IV BD.
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