Hospital Drug Research Articles

Low incidence of hepatitis B virus reactivation in patients with hematological malignancies receiving novel anticancer drugs: A report from a high epidemic area and literature review.

More and more novel anticancer drugs have been approved for patients with hematological malignancies in recent years, but HBV reactivation (HBV-R) data in this population is very scarce. This study aimed to evaluated HBV-R risk in patients with hematological malignancies receiving novel anticancer drugs. HBV markers and serum HBV DNA levels of patients with hematological malignancies receiving novel anticancer drugs in a tertiary cancer hospital were retrospectively collected. HBV-R risk in the whole cohort and subgroups was described. The relevant literature was reviewed to make a pooled analysis. Of 845 patients receiving novel anticancer drugs, 258 (30.5%) were considered at risk for HBV-R. The median duration of exposure to novel drugs was 5.6 (0.1-67.6) months. The incidence of HBV-R was 2.1% in patients with past HBV infection without prophylactic antiviral treatment (PAT) and 1.2% in all patients at risk of HBV-R. In a pooled analysis of 11 studies with 464 patients, the incidence of HBV-R was 2.4% (95% CI: 1.3-4.2) in all at-risk patients receiving novel anticancer drugs and 0.6% (95% CI: 0.03-3.5) in patients with anticancer drugs plus PAT. The incidence of death due to HBV-R was 0.4% (95% CI: 0.1-1.6) in all at-risk patients and 18.2% (95% CI: 3.2-47.7) in patients with HBV-R. Most episodes of HBV-R are preventable, and most cases with HBV-R are manageable. We recommend that novel anticancer drugs should not be intentionally avoided when treating cancer patients with HBV infection.

ВОЗМОЖНОСТИ ОПТИМИЗАЦИИ ЗАТРАТ НА ЛЕКАРСТВЕННОЕ ОБЕСПЕЧЕНИЕ ПАЦИЕНТОВ ЗА СЧЕТ ЦЕНТРАЛИЗОВАННОГО РАЗВЕДЕНИЯ ПРОТИВООПУХОЛЕВЫХ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ

The high level of costs for chemotherapy of malignant neoplasms requires the search for new solutions to reduce the cost of treatment. Centralized dilution of drugs is one of the most optimal solutions to this problem. But making such a decision requires a rather laborious calculation of the expected economic effects. The purpose of the study was to substantiate the economic benefits of centralized dilution of chemotherapeutic drugs in the regional oncological hospital. As materials, we took into account the number of spent 62 injectable forms of antitumor drugs in the departments of the Sverdlovsk Regional Oncological Dispensary, information on the implementation of 2098 chemotherapy regimens, acts on the disposal of unused drug residues, state contracts for the supply of drugs in 2022-2023. Methods of economic and mathematical analysis, modeling of economic situations with calculation of economic indicators were used to determine direct absolute and relative losses during the disposal of drug residues, as well as calculation of prevented economic damage. As a result, indicators were developed to determine the economic efficiency of the centralized drug dilution: the specific drug weight in the prescribing lists, absolute and relative financial losses, loss reduction coefficient. The relationship between the frequency of prescriptions and the potential for possible savings due to rational utilization of drug residues has been established. The average level of relative drug losses after the introduction of centralized drug dilution was 0.09% in 2023 against 5.54% of losses in 2022. The economic feasibility of using centralized drug dilution in large medical organizations is substantiated. The introduction of a centralized drug dilution in the Sverdlovsk Regional Oncology Dispensary prevented more than 20 million rubles of economic damage per month.

COVID’s First and Second Waves in India: Lessons and Policy Implications

In this article, we argue that in a supply-deficient situation, a vaccination strategy that makes use of an analysis of the different stages of the COVID waves and the pattern of their geographical spread can prove to be far more effective than the current non-transparent mechanism of inter-state allocation of the vaccines. We divide the spread of the COVID waves into three stages: (a) seeding stage, (b) explosion stage and (c) subsiding and diffusion stages. In the seeding stage, two critical determinants of seeding the virus into the population are (a) the inter-state pattern of arrival of international passengers and (b) the inter-state pattern of the continuing active COVID-affected population from the previous wave. The explosion stage induces a policy response in the form of lockdowns which is followed by the wave starting to subside. But the lockdown also results in the migration of labour out of the state into the rural and less populated areas, leading to the diffusion stage. We advocate a vaccination strategy targeting universal coverage with strategic sequencing in which prioritisation is given to ‘saturation vaccination’ of high-density and high COVID-intensity urban areas. This would not only minimise the economic costs in terms of duration and spread of lockdowns but also the pressures on the inadequate health infrastructure in terms of availability of hospital beds, ambulances, oxygen and drugs. This strategy may be implemented in curbing the COVID’s subsequent waves which may hit India while its population is still only partially vaccinated.

Anesthesia and pain management drugs used in Libyan hospitals and clinics

Background: Pain management can pose multiple challenges in the acute care setting for hospitalists and front-line prescribers. The drugs used for the relief of pain in the surgical can divided into potent and mild analgesics. Objectives: Identifying the most important analgesics used in some Libyan hospitals and health centers. Method: This study is a documentary survey and a description of the reality of the use of some narcotic drugs in Libyan hospitals. It has been conducted in seven Libyan cities (zwarah, al-jmail, Sabratha, al-zawia, Tripoli, misratah and benghazi) during the period of (2. 10. 2022 to 10. 12. 2022). The participants have been divided into two main groups (Patients and specialists group) in a total number of 115 participants (Male and Females). Results: all the participants from the 1st group (Patients group) confirmed that they have taken one of the pain management drugs as one of the treatment plan prescribed by the physicians. The statistical analysis revealed that the most common drug of the pain management was paracetamol (58%) followed by Tramadul (30%) and finally Voltarine (12%). Discussion and conclusion: Pain and its treatment are major public health issues that we face as a society today. Patients with chronic pain present a special challenge. When they have pre-existing pain and undergo an operative procedure, it becomes important to differentiate pre-existing chronic pain from new acute postoperative pain.

EVALUASI PERSEDIAAN OBAT COVID-19 PADA MASA PANDEMI DAN FAKTOR YANG MEMPENGARUHI DI RUMAH SAKIT PEMERINTAH DAN RUMAH SAKIT SWASTA DI KOTA MAKASSAR

Background: Drug management realizes the availability of drugs needed to be effective and efficient, especially during the COVID-19 pandemic. The high use of COVID-19 drugs makes several types of drugs needed to experience vacancies, and due to changes in government regulations make some COVID-19 drugs stagnant.Objectives: To evaluate the supply of COVID-19 drugs during the pandemic and the factors that influence it in government and private hospitals in Makassar CityMethods: This study is a mixed-method study with a sequential explanatory design. Quantitative data were obtained retrospectively from January to December 2021 by searching drug management documents. Qualitative data was obtained through in-depth interviews with 12 informants.Results: The availability of COVID-19 drugs in government hospitals is 19.3 months, while in private hospitals, it is 13.6 months. Factors that affect drug supply are the method of planning drug needs, Lead Time, and several changes in guidelines.Conclusions: The supply of COVID-19 drugs is still excessive at that Public Hospital, and the factor that most influenced the supply of COVID-19 drugs was changes in guidelines.

Estimate of the prevalence of subjects with chronic diseases in a province of Northern Italy: a retrospective study based on administrative databases

ObjectiveTo find a definition of chronic disease based on literature review and to estimate the population-based prevalence rate of chronicity in a province in Northern Italy.DesignRetrospective observational study based on...

PRESCRIBING PATTERN OF DRUGS IN OUTPATIENT DEPARTMENT IN TERTIARY CARE HOSPITAL

Aim: The study was conducted to assess the prescribing behaviour for antimicrobials and various groups of drugs in tertiary care hospital in Puducherry. Prescription audit was done. Total 500 presc Method: riptions were analysed for sex wise distribution, no of patients for specic age group, antimicrobials prescribed in generic name, percentage of antibiotics, antacids, NSAIDs and multivitamins, among the prescribed drugs, groups of antibiotics, drugs prescribed from National List of Essential Medicines (2022), use ofxed drug combinations, injectable preparations if any. Results: Demographic analysis showed that out of 500 patients in OPD, most were female (53%) and in the age group between 41 to 60 years. In 500 number of prescriptions,9.96% of antibiotics were prescribed; uoroquinolones (5.42%) were prescribed more from antibiotics followed by extended spectrum penicillin (1.64%). 14.78%of antacids were prescribed; PPIs (11.28%) were prescribed more from antacids. 21.63% of NSAIDs were prescribed.11.66% were prescribed in generic names, 65.44% drugs were prescribed from National List of Essential Medicines (2022), 15.88% of FDCs were prescribed,6.13% of injectable preparations were prescribed. The rational use of antimicrobial agents is one of the main contribut Conclusion: ors to control worldwide emergence of bacterial resistance, side effects and reduced cost of the treatment

Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19 : A Randomized Platform Trial.

Previous trials have demonstrated the effects of fluvoxamine alone and inhaled budesonide alone for prevention of disease progression among outpatients with COVID-19. To determine whether the combination of fluvoxamine and inhaled budesonide would increase treatment effects in a highly vaccinated population. Randomized, placebo-controlled, adaptive platform trial. (ClinicalTrials.gov: NCT04727424). 12 clinical sites in Brazil. Symptomatic adults with confirmed SARS-CoV-2 infection and a known risk factor for progression to severe disease. Patients were randomly assigned to either fluvoxamine (100 mg twice daily for 10 days) plus inhaled budesonide (800 mcg twice daily for 10 days) or matching placebos. The primary outcome was a composite of emergency setting retention for COVID-19 for more than 6 hours, hospitalization, and/or suspected complications due to clinical progression of COVID-19 within 28 days of randomization. Secondary outcomes included health care attendance (defined as hospitalization for any cause or emergency department visit lasting >6 hours), time to hospitalization, mortality, patient-reported outcomes, and adverse drug reactions. Randomization occurred from 15 January to 6 July 2022. A total of 738 participants were allocated to oral fluvoxamine plus inhaled budesonide, and 738 received placebo. The proportion of patients observed in an emergency setting for COVID-19 for more than 6 hours or hospitalized due to COVID-19 was lower in the treatment group than the placebo group (1.8% [95% credible interval {CrI}, 1.1% to 3.0%] vs. 3.7% [95% CrI, 2.5% to 5.3%]; relative risk, 0.50 [95% CrI, 0.25 to 0.92]), with a probability of superiority of 98.7%. No relative effects were found between groups for any of the secondary outcomes. More adverse events occurred in the intervention group than the placebo group, but no important differences between the groups were detected. Low event rate overall, consistent with contemporary trials in vaccinated populations. Treatment with oral fluvoxamine plus inhaled budesonide among high-risk outpatients with early COVID-19 reduced the incidence of severe disease requiring advanced care. Latona Foundation, FastGrants, and Rainwater Charitable Foundation.

Development and validation of the nomogram to predict the risk of hospital drug shortages: A prediction model.

Reasons for drug shortages are multi-factorial, and patients are greatly injured. So we needed to reduce the frequency and risk of drug shortages in hospitals. At present, the risk of drug shortages in medical institutions rarely used prediction models. To this end, we attempted to proactively predict the risk of drug shortages in hospital drug procurement to make further decisions or implement interventions. The aim of this study is to establish a nomogram to show the risk of drug shortages. We collated data obtained using the centralized procurement platform of Hebei Province and defined independent and dependent variables to be included in the model. The data were divided into a training set and a validation set according to 7:3. Univariate and multivariate logistic regression were used to determine independent risk factors, and discrimination (using the receiver operating characteristic curve), calibration (Hosmer-Lemeshow test), and decision curve analysis were validated. As a result, volume-based procurement, therapeutic class, dosage form, distribution firm, take orders, order date, and unit price were regarded as independent risk factors for drug shortages. In the training (AUC = 0.707) and validation (AUC = 0.688) sets, the nomogram exhibited a sufficient level of discrimination. The model can predict the risk of drug shortages in the hospital drug purchase process. The application of this model will help optimize the management of drug shortages in hospitals.

Interdisciplinary Pharmacoeconomic Research Concerning the Рharmacotherapy of Alcoholic Hepatitis in Conditions of Covid-19 Pandemic

Substantiated the relevance and necessity of the chosen research topic as a result of a review of the scientific literature on the epidemiology and pharmacotherapy of patients with alcoholic hepatitis. Contradictory evidence exists regarding the association between international and national clinical protocols for the management of alcoholic hepatitis in the context of the COVID-19 pandemic. Author undertook the present study to justify the procurement of drugs for patients with alcoholic hepatitis based on pharmacoeconomic calculations for hospitals. This study is based on pharmacoeconomic, organizational and legal, forensic and pharmaceutical approaches to pharmacotherapy with using literature review. Clinical and pharmacological analysis of basic therapy of alcoholic hepatitis was performed. Pharmacoeconomic studies have been conducted. According to the results of the ABC analysis, group A includes one drug (INN Ursodeoxycholic acid). According to the results of VEN analysis, it was proved that one drug (INN Prednizolone) belongs to category V (Vital). This study provides an opportunity to make administrative and managerial decisions in determining the pharmacotherapy of patients with alcoholic hepatitis to improve the use of drugs in hospitals.

Ferric Derisomaltose Evaluation in Patients with Non-Dialysis-Dependent Chronic Kidney Disease or Peritoneal Dialysis.

Iron deficiency anemia is common in patients with advanced chronic kidney disease (CKD). Ferric derisomaltose (FDI) enables iron repletion in a single dose, unlike other forms of iron for IV administration, which require multiple doses. Protocols are commonly used with other IV irons, but there are limited Canadian data for FDI, and no protocol exists. To evaluate the efficacy and safety of FDI for patients with CKD and to ascertain information related to its use in Canadian provinces. This retrospective cohort study involved patients with non-dialysis-dependent CKD (NDD-CKD) and patients undergoing peritoneal dialysis (PD) who received FDI in a tertiary hospital in Nova Scotia between June 2020 and May 2021. Each patient was followed for a minimum of 6 months. The efficacy outcomes were the changes from baseline in hemoglobin, transferrin saturation (TSAT), and ferritin after the first dose of FDI and at 3 and 6 months. The safety outcomes were the frequency and types of adverse reactions to FDI. Electronic surveys were sent to 33 Canadian renal pharmacists to gather information about FDI use, dosing, administration, monitoring, funding, and safety in their respective organizations. A total of 52 infusions were administered to 35 patients during the study period. The median times between doses 1 and 2 and between doses 2 and 3 were 19.1 and 6.6 weeks, respectively. The median change from baseline to first post-FDI follow-up blood work was significant for hemoglobin (9.0 g/L, p = 0.023), TSAT (11 percentage points, p < 0.001), and ferritin (271.4 μg/L, p < 0.001). Median darbepoetin doses decreased from baseline to 6 months (p < 0.001). Three adverse reactions occurred. At least 15 (65%) of the 23 survey respondents reported that FDI was funded by their province or was listed on their hospital drug formulary. This study provides evidence that FDI is an effective and safe treatment for anemia in NDD-CKD and PD patients.

Solve the Problem of Expensive Drugs in Hospitals by Blockchain

Effective treatment of major diseases has always been one of the key research topics for doctors. Some researchers have found that the lack of drugs and the proliferation of counterfeit drugs have a great impact on disease treatment, especially in developing countries. However, there is still a gap in research on drug cost control and hospital official drug pricing. As we all know, blockchain technology has been used in securities trading and other fields to reduce the costs of both parties. Therefore, the research topic of this paper is how to reduce the cost price of drugs purchased by hospitals nationwide or even globally, so that the price of drugs can be reduced to a win-win situation for hospital patients. The structure of this article is as follows: First, it introduces the current status of the application of blockchain technology at home and abroad, so that people can more clearly understand which transactions around them have used this technology. Later, this article will describe the working mechanism of blockchain technology, and finally introduce how to use this technology in drug trading. Through research, it is found that the point-to-point transaction of blockchain technology can greatly reduce the cost and time for hospitals to purchase drugs, reduce the price of expensive drugs in hospitals, enable more patients to get effective and rapid treatment of diseases, and reduce the phenomenon of family decline caused by illness. This shows that the effective reduction of drug purchase costs through blockchain technology is conducive to overcoming the problems of diseases and maintaining the stable income of hospitals.

Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China.

China developed an innovative episode-based payment scheme for outpatient care, namely "Ambulatory Patient Groups (APGs) + capitation" payment, to constrain inflation in outpatient expenditures. This study aimed to assess the effects of this payment method on volume and expenditures in Chinese public hospitals. A quasi-experimental study was conducted with 7 municipal and 12 county hospitals from Jinhua as the intervention group and 15 municipal and 24 county hospitals from three neighbouring cities as the control group. The payment reform was introduced to municipal and county hospitals in the intervention group in January 2020 and January 2021, respectively. Monthly data on volumes and outpatient expenditures were collected from each hospital from January 2019 to December 2021. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms. Outpatient visits in municipal hospitals decreased by 1417.54 (p=0.048) per month on average compared with control ones after the reform was implemented, whilst that in county hospitals increased by 1058.04 (p=0.041) per month on average. The trend of drug expenditures (β 7=-1.41, p=0.019) in municipal hospitals dropped, which was accompanied by an immediate reduction in consumable expenditures (β 6 =-6.89, p=0.044). The funding reform also led to the significant declines in drug (β 6=-10.96, p=0.009) and consumable (β 6=-4.78, p=0.041) expenditures in county hospitals. Municipal hospitals experienced the drop in the trend of total outpatient expenditures (β 7=-3.99, p=0.018) over the same period. The strength of the "AGPs + capitation" payment for outpatient care lies in its ability to control the excessive growth of medical expenses through correcting inappropriate incentives. However, minimising potential cost-shifting and risk-shifting to uninsured service items should be given attention.

Profile of patients undergoing treatment with long-acting injectable antipsychotic drugs in a psychiatry hospital in Portugal

IntroductionThe treatment with long-acting injectable antipsychotics (LAIAs) is more and more frequent and it shows advantages regarding adherence, effectiveness and tolerance.ObjectivesTo describe and compare the profile of patients under treatment with LAIAs in a psychiatric hospital in Portugal.MethodsAn observational and retrospective study was carried out with the collection of data referring to patients hospitalized with a first psychotic episode between 01/01/2019 and 30/06/2022 in a psychiatric hospital in Portugal and the respective evaluation of sociodemographic and clinical data through the information recorded in the clinical files.ResultsDuring the 42 months of the study, we selected 78 patients who presented psychotic symptoms on admission. Patients with a history of previous psychotic episodes and prescription of antipsychotic therapy prior to hospitalization were excluded.Of 78 patients hospitalized with a first psychotic episode, 34 - which corresponds to approximately 44% - were discharged with LAIAs.Patients receiving LAIAs had an average age of 39 years. The average number of days of hospitalization was 28 days; 41% were female (n=14) and 59 were male (n=20); 35% (n=12) consumed psychoactive substances previously on admission to hospital; 62% (n=21) were discharged under the compulsive treatment regimen. Regarding the diagnosis at discharge, based on the international classification of disease-11 (ICD-11), the most common were schizophrenia, psychotic disorder induced by psychoactive substances and acute and transient psychotic disorder.From the statistical analysis carried out, no correlation was observed between the rate of readmissions and the administration of LAIAs, nor was there any correlation between the rate of readmissions and compulsive outpatient treatment.ConclusionsDespite what is described in the literature, in the sample under study, the LAIAs were not superior in the variables studied, namely in reducing the readmission rate. Possible explanations for the results obtained may be justified by the size of the sample under study and the follow-up time of the cases.Disclosure of InterestNone Declared

Associations between polysubstance use and psychiatric comorbidities

IntroductionPolydrug use studies mention demographic and socioeconomic factors that may influence this problem. One of them is the existence of psychiatric comorbidity; Rentrop’s study (Rentrop et al., 2014) finds in a sample of 50 patients that all patients had at least one axis I disorder, 90% at least one axis II disorder, which may compromise the outcome of detoxification and dehabituation treatments (Rentrop et al., 2014). Another study found that 44.9% of patients admitted to a psychiatric unit are polydrug users (Karam et al., 2002).ObjectivesTo study the possible association of polydrug use with psychiatric comorbidity in patients admitted to a general hospital and presenting drug use.MethodsWe made a descriptive retrospective study through the use of electronic medical records. The drug use history was obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.ResultsMore cases of poly-consumption together with psychiatric comorbidity are found than expected in the χ² Test, with significant results (χ² = 27.2; p&lt;0.001). The mean age of the patient with poly-consumption and psychiatric comorbidity is 34.9 years.Psychiatric comorbidityPolydrug useNoYesTotalNoObserved2960296Expected28411.64296YesObserved21721238Expected2299.36238TotalObserved5132153451321534ConclusionsPsychiatric comorbidity in patients with polydrug use may be overlooked (Kruckow et al. 2016). Identifying patients with dual diagnosis is important given that these patients suffer decreased treatment compliance and life expectancy compared with single-diagnosis patients (Kruckow et al., 2016).ReferencesRentrop, M., Zilker, T., Lederle, A., Birkhofer, A., &amp; Hörz, S. (2014). Psychiatric comorbidity and personality structure in patients with polyvalent addiction. Psychopathology, 47(2), 133–140. https://doi.org/10.1159/000351784Kruckow, L., Linnet, K., &amp; Banner, J. (2016). Psychiatric disorders are overlooked in patients with drug abuse. Danish medical journal, 63(3), A5207.Disclosure of InterestNone Declared

The Impact of Hospital Pharmacy Operation on the Quality of Patient Care

This paper presents the role, tasks, and place of a hospital pharmacy in the structure of the entire facility. The role of hospital drug management and pharmacy seems to be extremely important in providing patients with high-quality care. Particular emphasis was placed on the distribution systems of medicinal products and medical devices in the hospital. The advantages and disadvantages of the classical distribution system and modern systems such as unit-dose and multi-dose-and the most important differences between them-are presented. Difficulties related to implementing modern distribution systems in hospitals were also discussed. The information provided is presented in the context of the legal regulations in Poland.

Emergency department experiences of people who use drugs who left or were discharged from hospital against medical advice.

People who use drugs (PWUD) frequent emergency departments at a higher rate than the general population, and experience a greater frequency of soft tissue infections, pneumonia, and chronic conditions such as, HIV/AIDs and hepatitis C. This population has distinct health care considerations (e.g. withdrawal management) and are also more likely to leave or be discharged from hospital against medical advice. This study examines the experiences of PWUD who have left or been discharged from hospital against medical advice to understand the structural vulnerabilities that shape experiences with emergency departments. Semi-structured qualitative interviews were conducted with 30 PWUD who have left or been discharged from hospital against medical advice within the past two years as part of a larger study on hospital care and drug use in Vancouver, Canada. Findings characterize the experiences and perceptions of PWUD in emergency department settings, and include: (1) stigmatization of PWUD and compounding experiences of discrimination; (2) perceptions of overall neglect; (3) inadequate pain and withdrawal management; and (4) leaving ED against medical advice and a lack of willingness to engage in future care. Structural vulnerabilities in ED can negatively impact the care received among PWUD. Findings demonstrate the need to consider how structural factors impact care for PWUD and to leverage existing infrastructure to incorporate harm reduction and a structural competency focused care. Findings also point to the need to consider how withdrawal and pain are managed in emergency department settings.

Pattern of adverse drug reactions with chemotherapeutic drugs in a tertiary care hospital of North India: a retrospective study

Background: Adverse drug reactions are important causes of mortality and morbidity in the patients. Early detection, evaluation and monitoring of ADRs is essential to improve public health. Methods: This was an observational, non-interventional and retrospective study conducted at the ADR monitoring centre of a tertiary care hospital of North India. Suspected ADR forms reported over a period of 4 years involving at least one chemotherapeutic drug with at least one dose were analyzed. Results: A total of 261 chemotherapeutic drugs associated ADRs were analyzed. Out of these, maximum numbers of ADRs were reported by males (54%). Maximum reporting was done by Skin and VD department (37.93%). Causality assessment was probable in maximum number of cases (54%). Most common ADRs were skin rashes (21.46%), followed by jaundice, urticaria and fixed drug eruptions. Maximum ADRs were suspected to be caused by Anti tubercular drugs (31.42%) followed by anticancer drugs (14.56%). Conclusions: ADRs due to antibiotics and anticancer drugs is a significant health problem.

Recent Advances in ZnO-Based Nanostructures for the Photocatalytic Degradation of Hazardous, Non-Biodegradable Medicines

Antibiotics are pervasive contaminants in aqueous systems that pose an environmental threat to aquatic life and humans. Typically, antibiotics are developed to counteract bacterial infections; however, their prolonged and excessive use has provoked unintended consequences. The presence of excessive amounts of antibiotics and anti-inflammatory, anti-depressive, and contraceptive drugs in hospital and industrial wastewater poses a significant threat to the ecosystem, with groundwater containing drug concentrations of &lt;1 mg/L to hundreds of µg/L. According to the literature, 33,000 people die directly from drug-resistant bacterial infections in Europe annually, which costs EUR 1.5 billion in health care and productivity loss. Consequently, the continuous spread of antibiotics in the ecosystem has led to greater interest in developing a sustainable method for effective antibiotic removal from wastewater. This critical review aims to present and discuss recent advances in the photocatalytic degradation of widely used drugs by ZnO-based nanostructures, namely (i) antibiotics; (ii) antidepressants; (iii) contraceptives; and (iv) anti-inflammatories. This study endows a comprehensive understanding of the degradation of antibiotics using ZnO-based nanomaterials (bare, doped, and composites) for effective treatment of wastewater containing antibiotics. In addition, the operational conditions and mechanisms involved during the photocatalytic degradation process are systematically discussed. Finally, particular emphasis is devoted to future challenges and the corresponding outlook with respect to toxic effects following the utilization of ZnO-based nanomaterials.

Drug safety among Hypertensive patients treated with antihypertensive drugs in Tertiary care Teaching Hospitals

Introduction:- Hypertension is one of the essential health problems Worldwide. According to JNC I to VIII guidelines treatment of hypertension with various type of antihypertensive drugs either mono therapy or combination therapy is updated time to time. Selection of a drug is often based on the benefit-risk ratio is also called drug safety even no one drug has totally safe and can be measured on the basis of occurrence of beneficial effect verses Adverse effect. The reporting of ADRs in nations is still low as comparison to providing 10% of total medication in the world. So the present study is proposed on entitled Drug safety among Hypertensive patient treated with antihypertensive drugs in Tertiary care teaching Hospitals. Materials and Methods:- This was a prospective and observational study carried out in the department of Pharmacology, Santosh Medical College and Hospital, Ghaziabad in collaboration with Department of Medicine, Muzaffarnagar Medical College, Muzaffarnagar, A total 234 hypertensive patient of both gender and age above 18 years treated with any types of antihypertensive drug were selected for the study. ADRs were recorded and evaluated with the help of ADRs form uploaded by CDSCO-PvPI of whose causality assessment and severity score that were calculated by appropriate scale and. Observation and Results:- A total 16.67% of prevalence of ADRs were found in this study of whose Risk/Benefit were calculated and found that ARBs and BBs groups were the safest group of antihypertensive drug with smallest number of ADRs prevelance 14.14% and 15.15% with risk benefit ratios 0.16 and 0.18 respectively. Conclusion:- The results of the above study would be useful for the physicians in rational selection of drug therapy for treatment of hypertensive patients. The present data suggest that the ADRs monitoring needs to be done in hospital settings continuously so that untoward effect caused by different medicines can be identified and documented to make better health care system and to stop further burden of unnecessary use of drug by patients health care system.