Use and misuse of glucocorticoids in the community of Raxaul Block, North Bihar

Masih, Shelesh; Stephen, Sharon Cynthia; Armstrong, Lois; Finny, Philip

doi:10.1177/0049475514567756

Cited by 10 publications

(15 citation statements)

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“…The first reason being the significant number of patients prescribed inappropriate unlabeled glucocorticoids either as part of local remedies or as injectables by unqualified medical practitioners. 16 The second reason being an increased prevalence of undiagnosed hypopituitarism among older menopausal women due to post-partum pituitary necrosis (Sheehan's syndrome) reflecting poor obstetric care received decades earlier. 17 With this background we planned this study to prospectively ascertain the prevalence of adrenal insufficiency among inpatients admitted to medical wards with EuVHNa.…”

Section: Previous Presentationmentioning

confidence: 99%

“…Secondary AI among patients with EuVHNa is likely to be higher in India because of two reasons. The first reason being the significant number of patients prescribed inappropriate unlabeled glucocorticoids either as part of local remedies or as injectables by unqualified medical practitioners ( 16 ). The second reason being an increased prevalence of undiagnosed hypopituitarism among older menopausal women due to post-partum pituitary necrosis (Sheehan’s syndrome) reflecting poor obstetric care received decades earlier ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia

Kumar

Ghosh

Jacob

2021

Endocrine Connections

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Background: The diagnosis of SIAD requires the exclusion of secondary adrenal insufficiency (AI) among patients with euvolemic hyponatremia (EuVHNa). Studies have suggested about 2.7% to 3.8% of unselected patients presenting to the emergency room with EuVHNa have undiagnosed AI and it is as high as 15% among patients admitted to specialized units for evaluation of hyponatremia. Objective: To study the prevalence of AI among inpatients with EuVHNa in a general medical ward setting Methods: This was a prospective, single centre observational study conducted among general medical inpatients with EuVHNa, defined as patients with a serum Na <135 mmol/L, clinical euvolemia and urine spot sodium >30mmol/L. Additionally patients with recent vomiting, current renal failure, diuretic use and those with uncontrolled hyperglycemia were excluded. Adrenal functions were assessed by a modified ACTH stimulation test called Acton Prolongatum™ stimulation test (APST). A cut off cortisol value of <18mg/dl after 60 minutes of ACTH injection was used to diagnose AI. Results: One hundred and forty-one (141) patients were included and underwent an APST. APST suggested 20/141 (14.2%) had undiagnosed AI. The most common cause of AI (9/20) was secondary AI because of the use of steroids including inhaled steroids and indigenous medicines contaminated with steroids. In 5 (3.5%) patients hypopituitarism was newly diagnosed. Despite primary adrenal insufficiency not commonly presenting as EuVHNa, 2/20 patients had primary adrenal insufficiency. Conclusions: AI is much commoner in our country among inpatients with EuVHNa primarily driven by exogenous steroid use and undiagnosed hypopituitarism.

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Section: Previous Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia

Kumar

Ghosh

Jacob

2021

Endocrine Connections

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“…[ 17 ] Antibiotics are not the only drugs that are prescribed irrationally[ 17 18 19 20 ] as the published research work in North India is beginning to show that glucocorticoids are a class of drugs that are silently misused. [ 21 22 23 24 ] In a hospital-based study conducted in north Bihar, among 22 patients who were presented with glucocorticoid misuse over 6 months, more than half were self-prescribed and the remaining were prescribed by local practitioners. [ 21 ] There is a dearth of literature regarding the magnitude of its misuse in South India and Kerala.…”

Section: B Ackgroundmentioning

confidence: 99%

“…[ 21 22 23 24 ] In a hospital-based study conducted in north Bihar, among 22 patients who were presented with glucocorticoid misuse over 6 months, more than half were self-prescribed and the remaining were prescribed by local practitioners. [ 21 ] There is a dearth of literature regarding the magnitude of its misuse in South India and Kerala.…”

Section: B Ackgroundmentioning

confidence: 99%

Evaluation of Glucocorticoids Utilization in Central Kerala using Pharmacy Sales Overview

Finny¹,

Mathew²,

Johnson³

et al. 2021

Indian Journal of Endocrinology and Metabolism

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Background: Misuse of prescription drugs is a major public health problem in India and developing countries. Emerging evidence indicates that glucocorticoids are a class of drugs that are silently misused. These drugs are inexpensive and easily available as over-the-counter drugs in India are widely used by local practitioners and self-prescribed by patients for swift symptomatic relief of febrile illnesses, joint pain, asthma, other respiratory illnesses, and skin diseases. Many people have become dependent on glucocorticoids unintentionally and remain completely unaware of the metabolic changes occurring in their bodies. Methodology: A descriptive cross-sectional study involving 38 pharmacies in Thiruvalla municipality of South India was conducted to indirectly assess the utilization of glucocorticoids in the region using a pharmacy sales overview. Results: Most people approach pharmacies with prescriptions than without. A high majority of pharmacists do not have any knowledge about the uses (37%) or adverse effects (66%) of glucocorticoids. More than 50% of the community pharmacies have more than 1% of their sales attributed to glucocorticoids when compared with the total sales volume of drugs.

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“…Over the past 20 years, prescriptions for oral glucocorticoids have risen by 34% in the United Kingdom ( 14 ). Among 113 patients surveyed in India, 88.4% of glucocorticoids were considered inappropriate, including imprecise diagnosis and incorrect indications by standard clinical and evidence-based practice guidelines ( 15 ). In France, oral glucocorticoid prescription rates are over 17%, yet most were inappropriately used ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China

Zeng

Xingqin

et al. 2022

Front. Public Health

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BackgroundInappropriate use of glucocorticoids in primary care institutions is serious. It not only causes economic burden, but leads to many adverse reactions. The purpose of this study is to explore systemic glucocorticoid prescription pattern and factors of inappropriate use in primary care institutions.MethodsThis is a retrospective study. Systemic glucocorticoids prescribed in 58 primary care institutions in Guizhou province of Southwest China in 2020 were selected from the Health Information System. All prescriptions were classified as appropriate or inappropriate use. Inappropriate use was classified into the following two categories: (a) Inappropriate indications; (b) Inappropriate selection of glucocorticoids. Multivariate analysis was used to explore the factors associated with inappropriate use of systemic glucocorticoids.ResultsA total of 63,315 glucocorticoid prescriptions were included in the analysis. Diseases of the respiratory system (60.8%) and diseases of the skin and subcutaneous tissue (23.1%) were the most common indications for use. Injections (89.8%) predominated and dexamethasone (86.5%) was the most prescribed glucocorticoid. 68.2% of all prescriptions were inappropriate. Compared to physicians with a college degree, physicians with a junior college (OR: 1.12, 95% CI: 1.08–1.17) and technical secondary education (OR: 1.12, 95% CI:1.05–1.19) were more likely to prescribe glucocorticoids inappropriately as were attending physicians (OR: 1.12, 95% CI: 1.01–1.25) and resident physicians (OR: 1.31, 95% CI: 1.15–1.48) compared to associate chief physicians. The risk of inappropriate glucocorticoid use was highest in patients 65 years of age and older (OR: 6.00, 95% CI: 5.62–6.40). In contrast, prescriptions given by injection were more likely to be used inappropriately than those given orally (OR: 0.44, 95% CI: 0.41–0.46).ConclusionInappropriate use of systemic glucocorticoids without appropriate indications was extremely prominent in primary care institutions of Guizhou Province, especially in diseases of the respiratory system and among the elderly. The risk of inappropriate glucocorticoid use was highest in patients 65 years of age and older. It is important to note that physicians younger than 33, with more than 40 years of service, and attending or residents were more likely to inappropriately prescribe glucocorticoids.

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Use and misuse of glucocorticoids in the community of Raxaul Block, North Bihar

Abstract: Glucocorticoid misuse will contribute to the burden of hypertension, diabetes, osteoporotic fracture, tuberculosis, cataracts and deaths due to hypoadrenal crisis. One in 15 people in Raxaul Block are likely to have a suppressed hypothalamo-pituitary-adrenal axis.

Cited by 10 publications

References 7 publications

Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia

Prevalence of adrenal insufficiency among patients with euvolemic hyponatremia

Evaluation of Glucocorticoids Utilization in Central Kerala using Pharmacy Sales Overview

Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China

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