Objectives: 1) To determine the WHO Prescribing Core Drug Use (PCDU) indicators in the management of acute fever (of less than 2 weeks duration) of the MBBS (allopathic) and BAMS (ayurvedic) General Practitioners (GPs) in Pune city. 2) To verify the appropriateness of the treatment. and 3) To compare the above parameters of the MBBS and the BAMS practitioners. Methods:Pune city was divided in five zones, north, south, east, west and central. A list of doctors was obtained from the Indian Medical Association and it was divided zone wise. 2 MBBS and 2 BAMS GPs. were selected per zone. An informed consent was obtained from the GPs. The sample size was 20 encounters per GP. The patients of all ages and both sexes, who suffered from fever of less than 2 weeks duration, were included in the study. The indicators which were studied were 1) the WHO Prescribing Core Drug Use indicators and 2) the complimentary drug use indicators for the appropriateness of the treatment. Results:1) The age, sex and diagnosis wise distribution of the patients was comparable in both the groups. 2) Among the WHO PCDU indicators, a highly significant difference was observed in the average number of drugs which was prescribed, the antibiotic usage and in the injections which were prescribed among the MBBS and the BAMS GPs 3) The use of the drugs from EDL and that of the generic drugs were comparable in both the groups.4) A marked irrationality was found in the injectable antimicrobials by the BAMS GPs.5) The selection of the antimicrobials was inappropriate in 64.14% and 17.5% of the encounters which were made by the BAMS and the MBBS GPs respectively. Conclusion:Among the BAMS GPs: the WHO prescribing core drug use indicators were all significantly abnormal and the percentage of the inappropriate prescriptions was alarmingly high (92%). Among the MBBS GPs:There was more use of the antimicrobials but the proportion of the inappropriate prescriptions was less (42%).

Purpose: Pancreatic enzyme replacement therapy (PERT) involves exogenous enzyme supplementation and is used in the treatment of pancreatic exocrine insufficiency. Clinical efficacy of PERT preparations is a function of physical properties and release kinetics that vary between commercially available products. In this study, we evaluated the physical properties, in vitro dissolution, and release kinetics of commercially available pancreatic enzyme preparations available in the Indian market. Methods: Physical properties such as particle size distribution and water content of the capsules were measured by dynamic light scattering and Karl-Fischer titration method, respectively. An analytical procedure based on the European pharmacopoeia (EP) method was used to determine lipase activity, and a modified United States pharmacopoeia (USP)based method was used for dissolution studies. Enzyme release was ascertained under gastroduodenal conditions in buffered media. Results: Considerable variations in physical properties such as particle size and water content were observed between pancreatic enzyme preparations. Some preparations failed to meet the labeled lipase content as per USP standards (>90% label claim) and showed inconsistent release behavior (>5% relative standard deviation). Conclusion: Differences exist between pancreatic enzyme preparations in terms of physical properties, dissolution, and release behavior that can affect their clinical efficacy. The present study suggests, therefore, that these preparations should not be used interchangeably.

<p class="abstract"><strong>Background:</strong> The objective was <span lang="EN-IN">to evaluate the clinicoetiological pattern and pharmacotherapy practices of new onset vertigo in India. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This multicentre, prospective, registry was conducted in adult patients across 37 centres. Enrolled patients were followed at week 1, month 1 and 3 to assess clinicoetiological characteristics, prescribed pharmacotherapy, safety and effectiveness of treatment.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Of the 1520 patients enrolled, 1428 (93.95%) completed the study. The mean (SD) age was 50.2 (±15.37) years and 53.2% were women. Of 202 patients reporting co-morbidities, 55.4% had cardiovascular disease and 38.6% had diabetes mellitus. Peripheral causes were predominant in majority (74.3%); benign paroxysmal positional vertigo (BPPV) being the most frequent (67.58%). Migraine affected 68.9% (80/116) patients, .as the central cause. Betahistine (74.6%) and prochlorperazine (21.75%) were the top two drugs of choice irrespective of origin, preferred by all treating specialists. Both the drugs significantly prevented recurrence by week 1 (prochlorperazine: 76.6%; betahistine: 64.2%) (p&lt;0.001) and over 3 months. A lower daily dose of betahistine (15.6±5.26 mg) was preferred. Almost half complained of nausea and vomiting; prochlorperazine significantly reduced recurrence of both within a week (p&lt;0.001). The treatments were well-tolerated with no reported adverse drug reactions. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The study demonstrates vestibular vertigo, BPPV to be the dominant type in Indian patients with new onset vertigo. Betahistine and prochlorperazine top the physicians’ preference list, with equal benefits in preventing recurrence. Prochlorperazine has an additional antinausea and antiemetic property, thereby may improve patient satisfaction. Prescription of a lower dose of betahistine calls for the need to sensitize physicians.</span></p>

<p>Vertigo is a condition associated with a spectrum of symptoms and ~30% of general population experience vertigo in their life time. In spite of being of high clinical importance, the management of vertigo is quite challenging. Though the literature supports the availability of various therapeutic interventions used in vertigo treatment, their effectiveness depends on accurate diagnosis, appropriate use of intervention, and physician’s awareness of the overlap between vestibular, autonomic, and psychological aspects of vestibular pathology. Unfortunately, several drugs act as tranquilizers and impede the process of vestibular compensation. Betahistine, a histamine analogue, is one of the most commonly used anti-vertigo drugs worldwide and has been supported by many clinical trials. There have been several oral communications in international conferences on the efficacy of using betahistine in several clinical vertiginous syndromes. The current review assesses the use of betahistine 48 mg twice daily for three months as an efficient and well-tolerated treatment for vertigo. Additionally, it highlights the low incidence of side effects even at high doses of betahistine and suggests that it may be considered as the first-line of treatment for vestibular dysfunction.</p>

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