International Journal of Basic & Clinical Pharmacology

A rare case of esophageal variceal bleeding from portal hypertension due to extrahepatic portal vein obstruction in a two-year-old

2024-09-19T22:19:00+0530

Extrahepatic portal vein obstruction (EHPVO) is a type of liver vascular disease characterized by cavernomatous transformation and obstruction in the portal veins. Congenital defects, numerous transfusions, trauma, sepsis, dehydration, and hypercoagulable disorders are important risk factors. Since most patients have no symptoms, acute extrahepatic portal vein obstruction is frequently disregarded. Hematemesis and splenomegaly without hepatic decompensation are among the symptoms that might occur in subacute and chronic stages. Imaging studies aid in the diagnosis; Doppler imaging is added to ultrasonography to visualize portal vein blood flow. MRI and CT scans are used to visualize portal vein blockage. Prevention of acute bleeding is the cornerstone in the management. Studies have shown that transhepatic thrombolysis is the preferred choice to avoid systemic side effects. Treatment for extrahepatic portal venous thrombosis involves an intrahepatic portosystemic shunt, which is usually followed by conservative measures to stop variceal haemorrhage. When other forms of therapy are ineffective, liver transplantation is carried out. This case report describes a rare instance of EHPVO in a two-year-old boy who was hospitalized due to recurrent fever, increased belly circumference, and a persistent feeling of fullness in the abdomen. The patient had a surgically placed splenorenal shunt, which helped him respond well to treatment.

Utilization patterns of drugs used in the treatment of chronic obstructive pulmonary disease in a tertiary hospital

2024-09-25T16:10:10+0530

Background: Chronic obstructive pulmonary disease (COPD) is a disease where there is a limitation of airflow that comes in and out of the lungs due to some abnormalities of the lung`s airway. COPD affects 10% of the global population and is associated with significant morbidity and mortality. The treatment aims to control the symptoms and achieve a good quality of life. The aim of this study is to identify the utilization patterns of different drugs used in the treatment of COPD in Sultan Qaboos University Hospital (SQUH).

Methods: This was a retrospective study that included 170 patients who received treatment for COPD. Patients’ data and drugs’ data were collected through accessing the TrackCare system at SQUH.

Results: The results show that 139 (81.8%) of patients were prescribed with muscarinic receptor antagonists followed by 131 (77.1%) patients who were prescribed with beta 2 receptor agonists. Salbutamol and tiotropium were the most specific drugs prescribed for 103 (60.6%) and 102 (60.0%) patients respectively. 24.7% of the patients received only one drug. There is evidence of a significant association between muscarinic receptor antagonist usage and gender.

Conclusion: This study shows the utilization patterns of drugs that were used in the treatment of COPD in a tertiary hospital.

A prospective observational comparative study of effectiveness and adverse effects of amitriptyline versus duloxetine in the treatment of somatoform pain disorders in a tertiary care hospital

2024-10-04T13:06:47+0530

Background: To compare the effectiveness and adverse effects as well as treatment compliance of amitriptyline and duloxetine in treating somatoform pain disorder.

Methods: This study was done on 100 patients, with 50 in each group, at Mandya Institute of Medical Sciences (MIMS) over 6 months. Group A was treated with amitriptyline 75 mg per day, and Group B with duloxetine 40 mg per day. Patient Health Questionnaire (PHQ-15) as well as Social and Occupational Functional Assessment Score (SOFAS) were used to compare effectiveness of treatment. For medication adherence Medication Adherence Rating Scale (MARS) was used. Adverse effects were also monitored. The baseline measurements were taken, and evaluations were conducted at 4th, 8th, and 12th weeks of follow-up.

Results: There were 31% males and 69% females. At baseline and after 12 weeks, Group A had average PHQ-15 scores of 14.72±6.13 and 3.16±0.97, respectively, while group B had scores of 17.12±5.45 and 7.22±2.46. During the same period SOFAS scores were 48.70±6.27 and 85.9±5.06 for group A, and 50.86±5.99 and 82.62±6.10 for group B. The effectiveness of Amitriptyline group showed statistically significant difference (p<0.05) when compared with Duloxetine. Group A experienced more adverse effects like dry mouth, drowsiness when compared to Group B.

Conclusions: Amitriptyline and duloxetine are effective in treatment of somatoform pain disorder; the effectiveness of amitriptyline was higher when compared to duloxetine in our study.

What do we know and how do we act: knowledge, attitude and practices around antimicrobial resistance

2024-10-01T09:28:25+0530

Background: The overuse and misuse of antibiotics has influenced a rise in antimicrobial resistance (AMR) thereby posing a significant threat to global health. Information on AMR has been available to the public; however, a gap exists in relay of information due to lack of effective interventions. This study focuses on exploring the knowledge, attitudes and practices (KAP) among rural, semi-urban and urban populations from Delhi NCR, India.

Methods: This study was a cross-sectional questionnaire based online survey conducted across rural, semi-urban and urban areas of Delhi NCR for one month (June-July 2024). The questionnaire comprising 28 close-ended questions was administered in English and Hindi languages to participants aged 15-80 years. The questionnaire focused on knowledge, awareness and practices of antibiotics and antimicrobial resistance.

Results: A total of 500 participants attempted the survey out of which 435 (87%) were aware about antibiotics. About 479 (95.8%) participants had earlier consumed antibiotics out of which 336/497 (70.1%) participants consumed antibiotics prescribed by doctors. Among 479 participants, 253 (52.8%) completed the course however 311 (69.1%) of the participants kept the antibiotics for reuse. Nearly 191/479 (39.9%) participants practiced antibiotics misuse by consumption of antibiotics when having similar symptoms as previously observed. The assessment of participants revealed that only 216/500 (43.2%) participants were knowledgeable about AMR. The participants aware of AMR agreed that the antibiotic practices of reuse (n=69/216, 31.9%), poor quality (n=87/216, 40.3%), lower dosage (n=81/216, 37.5%) and not completion of course (n=77/216, 35.6%) can result in AMR.

Conclusions: The study highlights that despite the participants being informed about antibiotics and followed medical advice their practice of reusing antibiotics raises the need for tailored interventions to promote awareness about AMR and appropriate use of antibiotics.

Evaluation of rationality of geriatric patients prescription based on STOPP/START criteria in a tertiary care hospital

2024-10-04T10:42:52+0530

Background: The geriatric population (65 years and above) is a challenge to treat for the medical fraternity, exposing them to the risk of potentially inappropriate prescription (PIP) and thus, increasing the risk of adverse drug reactions (ADR). The over-use of drugs and irrational choice lead to the prescription of a potentially inappropriate medication (PIM) and the underuse of appropriate drugs leading to potential prescribing omission (PPO). Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) criteria is one of the most effective tools to check the rationality of the prescribed drugs.

Methods: The study was a six-month (March 2023 to August 2023) prospective observational design. A total of 193 patients were enrolled in the study. Case report forms were used to confirm the diagnosis and medications. Geriatric patients who fulfilled the study inclusion criteria were assessed using the STOPP/START toolkit version 2.

Results: The majority of the study participants belonged to age group 65 to 70 years. Out of these 40.4% of the study participants had Potentially Inappropriate Medications based on STOPP criteria and 31.1% had Potential Prescription Omissions based on START criteria.

Conclusions: Potentially Inappropriate Prescriptions were assessed using STOPP/START criteria in version 2. A high prevalence of PIM and PPO was found. Co-morbidity and polypharmacy were linked to a higher chance of PIM. Thus, this criterion can be used to generate rational prescriptions for the elderly population.

A randomized, open-label and prospective study to compare the efficacy and safety of synbiotics and rosuvastatin along with concomitant ursodeoxycholic acid in non-alcoholic fatty liver disease in North India

2024-10-07T09:38:54+0530

Background: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disorder without significant alcohol consumption with a global prevalence of 32%. It is strongly associated with dyslipidemia, obesity, insulin resistance and gut dysbiosis with no current USFDA approved pharmacotherapy. Thus, this study aims to compare the efficacy and safety of Synbiotics and Rosuvastatin along with concomitant Ursodeoxycholic Acid (UDCA), in treatment of NAFLD.

Methods: An interventional, randomized, open-label, prospective and parallel study of 12 weeks with patients randomly divided into two groups- A and B of thirty each. Group A was prescribed Synbiotics (Velgut) 5 billion CFUs BD and Group B was prescribed Rosuvastatin 20 mg OD along with UDCA 300mg BD in both the groups. Patients were followed up every 15 days and mainly assessed on hepatic profile, ultrasound grading, FibroScan, fibrosis indices and lipid profile along with safety profile and compliance.

Results: On comparison, Group A showed significant improvement in hepatic parameters (p<0.001) whereas Group B showed better improvement in lipid profile (p<0.001). In case of ultrasonography for hepatic steatosis and assessment of liver stiffness by FibroScan, both Group A and B showed comparable improvement over 90 days (p=0.143 and p=0.722, respectively) with no worsening of any grades. Both groups performed similarly in terms of safety (p>0.05) and patients showed good compliance (p>0.05).

Conclusion: Combination of Synbiotics and UDCA (Group A) seems to be more efficacious than Rosuvastatin and UDCA (Group B) in North-Indian NAFLD patients over a period of 3 months. Further extensive research with more sample size and studies with longer duration are needed to validate the role of these combination therapies in NAFLD.

Drug prescription pattern in asthma in a tertiary care hospital in South India

2024-10-07T12:58:26+0530

Background: Asthma, a chronic inflammatory disorder of the airways, affecting millions of individuals is a global health concern. It necessitates long-term management for optimal outcomes. impacting therapy costs and patient’s compliance. This study was done to analyse current prescribing trends in the management of asthma patients. This study examines current asthma treatment trends to enhance patient care and disease outcomes.

Methods: This is an Observational cross-sectional study conducted at Government T. D. medical college, Alappuzha between October 2019 to September 2022. All patients clinically diagnosed with or a previously known case of asthma between 18-60 years of both sex attending the outpatient department of Pulmonary Medicine who gave consent for study were included. Data was collected by interviewing and from the patients OP card using a prestructured proforma. Data collected included patient details, allergy and smoking history, comorbid conditions, drugs prescribed for asthma along with dose, route and frequency of administration, concomitant medications, diagnostic tests if any.

Results: Out of 200 asthma cases, 119 (59.5%) were females. The mean age was 43.95±10.62 years. 21 patients (10.5%) were smokers. 57 (28.5%) patients had an allergic predisposition. Hypertension n=48 (24%) was the most common comorbidity among the patients. A mean of 3.05±1.52 drugs per prescription. Out of 609 drugs prescribed, 450 (73.89%) drugs were from the National list of essential medicines (NLEM) and 366 (60.09%) drugs were from the WHO essential list. A combination of LABA with ICS was the most common drug given in 121 (60.5%) patients followed by Glucocorticoids 101 (50.5%) and PDE-inhibitor-Deriphylline 74 (37%) patients. Antibiotics was prescribed in 43 (21.5%) patients. 164 (82%) patients received a combination therapy. Out of the 609 drugs prescribed, 334 (54.8%) were oral followed by inhalational route 264 (43.3%).

Conclusion: Study demonstrates the variability of drug utilization in asthma patients. The rising significance of PPMS (Prescription pattern monitoring studies) stems from heightened marketing of new medications, shifts in prescribing patterns and drug consumption, escalating worries regarding delayed adverse reactions, drug costs, and prescription volumes.

Comparative study of efficacy and safety of erythropoietin and darbepoetin for treatment of anemia in chronic kidney disease patients: a comparative, observational and prospective study

2024-10-08T23:06:14+0530

Background: Anemia is a common prognosis of chronic kidney disease (CKD). It is predominantly managed with erythropoietin and darbepoetin. The objective of this study was to compare the efficacy and safety of erythropoietin injection versus darbepoetin for treating renal anemia amongst patient with CKD.

Methods: Patients of either gender diagnosed with anemia due to CKD, irrespective of dialysis who had haemoglobin less than 12g/dl were included in the study. Comparison of efficacy and safety of erythropoietin and darbepoetin was done based on the laboratory values of hemoglobin (Hb), red blood cells (RBCs), haematocrit (PCV) and adverse events respectively.

Results: A total of 108 patients met the inclusion criteria; 54 of them were treated with erythropoietin and 54 were treated with darbepoetin. The changes in Hb, RBCs and PCV in the group of patients who were on erythropoietin were 1.16, 0.49 and 3.76 respectively. Similarly, the changes in Hb, RBCs and PCV in the group of patients who were on Darbepoetin were 1.19, 0.42 and 3.52 respectively. The differences in the changes of Hb, RBCs and PCV in the both groups of patients were 0.04, 0.07 and 0.24 respectively. A total of 4 adverse events (HTN, vomiting, headache and joint pain) were reported by 24 (44.44%) patients of erythropoietin group and a total of 1 adverse event (HTN) was reported by 19 (35.19%) patients of darbepoetin group.

Conclusion: Both erythropoietin and darbepoetin were found to be equally effective and safe for the treatment of anemia in CKD patients.

Effectiveness and safety of daily versus alternate-day rosuvastatin dose in dyslipidemic patients: a prospective, randomized and open-label study

2024-10-10T12:20:44+0530

Background: Dyslipidemia is considered to be an important risk factor for development of atherosclerotic cardiovascular disease (ASCVD). Statins, also called HMG CoA reductase inhibitors are considered to the most effective lipid lowering agents. This study assessed the effectiveness and safety of daily versus alternate day dosing regimens of rosuvastatin in dyslipidemia patients.

Methods: This study was conducted for a period of 12 weeks. Study subjects comprised patients of either sex in age group 18-65 years diagnosed with dyslipidemia and a total of 90 subjects completed study who were randomly distributed to three groups, A (rosuvastatin 10 mg daily), B (rosuvastatin 10 mg on alternate days) and C (rosuvastatin 20 mg on alternate days).

Results: Rosuvastain significantly lowered total cholesterol, low density lipoprotein-cholesterol and triglycerides in all groups (p<0.001). High density lipoprotein-cholesterol increased, but non-significantly (p>0.05). Intergroup differences were not statistically significant. Group A reported slightly more adverse events than group B and group C.

Conclusions: Alternate-day rosuvastatin therapy showed effectiveness statistically similar to the daily dose therapy in dyslipidemic individuals. It also exhibited fewer side effects, suggesting it could be a feasible approach for managing dyslipidemia, providing a more economical and potentially safer alternative to daily administration.

Assessment of risk factors, complications and treatment patterns of diabetic patients in India

2024-10-10T15:35:33+0530

Background: Early identification of risk factors and comorbidities is essential for optimizing treatment strategies in diabetes. The diabetes in India (DIAB India) study aims to evaluate risk factors, glycemic status, comorbidities, and initial management choices in newly diagnosed T2DM

Methods: A retrospective, observational, multicenter study was conducted with a large cohort of 19,230 patients pan India. Data was collected from patient health records and meticulously stored into a standard format. Demographic data (age, gender, weight, height, risk factors, and blood pressure), clinical presentation (family history, complications, glycemic indices, and comorbidities), and choice of management were recorded and used for analysis.

Results: Obesity and family history were most common risk factors for T2DM and were significantly correlated with its severity (p<0.001). The most common comorbidity was neuropathy (59.8%) followed by nephropathy (27%) and CV events (25%). Obese patients have higher mean hemoglobin A1c (HbA1c) of 8.4%, fasting blood glucose (FBG) (160 mg/dL), and postprandial blood glucose (PPBG) (233.6 mg/dL) compared to non-obese. Both single and combination therapies led to significant improvements in HbA1c (Single: pre- 7.47, post-6.87; Combination: pre-8.26, post-7.13), FBG (Single: pre-138.94, post-118.89; Combination: pre-161.21, post-128.2), and PPBG (Single: pre-200.88, post-163.83; Combination: pre-235.10, post-177.87) levels after treatment, with combination therapy showing greater reductions across all markers (p<0.001). The improvement in glycemic control was greater in patients who followed dietary advice (p<0.001).

Conclusions: Obesity and family history were the most common risk factors contributing to diabetes in the newly diagnosed Indian patients. The comorbidities usually associated with diabetes are identified as neuropathy and cardiovascular conditions. While dietary measures are not widely used, significant improvement in glycemic status is reported using pharmacotherapy (monotherapy or combination). Choice of pharmacological and non-pharmacological treatments should be tailored to patient preferences, demographics, comorbidities, age, and other factors.

Comparison of safety and efficacy of silodosin versus mirabegron in medical expulsive therapy for lower ureteric stone: a prospective, open label and randomized controlled trial

2024-10-10T22:31:32+0530

Background: Urolithiasis the most common condition affecting genitourinary tract and affect 5 to 10% of population worldwide. Almost all ureteric stones are symptomatic, and patients need to receive immediate evaluation and pain relief treatment. Passage of stone is facilitated by medical expulsive therapy (MET). Overall, 71-98% for stones in the distal ureter that are 5 mm or smaller passes with MET while 29-98% for stones in the proximal ureter that are 5 mm or smaller passes with MET. Silodosin (alpha-1 adrenergic receptor antagonist) and mirabegron (β-3 agonist) were compared for stone expulsion and analgesic effects for symptomatic relief.

Methods: The study was conducted in the department of pharmacology and the department of urology at Dr. R. P. G. M. C., Kangra at Tanda Himachal Pradesh, India which is 700 bedded multispecialty tertiary health care from August 2023to May 2024 and follow-up was done for 4 weeks after initiation of treatment, to compare the safety and efficacy of silodosin versus mirabegron in medical expulsion therapy for lower ureteric stone of size≤10 mm in adults.

Results: In our study patients in silodosin treatment arm had a smaller number of colick episodes (mean 1.65±1.02) during MET as compared to group (mean 2.23±1.07) receiving mirabegron (p=0.011). Patients in silodosin group had significantly lower analgesic requirement (mean 2.10±1.58) as compared to patients in mirabegron (mean 3.30±1.96) which is also statistically significant (p=0.002). Patients in silodosin group had highly significant lower time for stone expulsion (mean 10.0±5.3) as compared to that in patients in mirabegron group (mean 15.7±7.1) (p=0.0004). Overall, incidence of side effects was similar in both groups.

Conclusions: Silodosin demonstrated superior efficacy over Mirabegron in terms of reducing colic episodes, analgesic requirement and stone expulsion time in the management of ureteric calculi. No significant adverse events were reported in either group during the study period

Efficacy of panchakarma based ischemia reversal therapy along with diet modification in management of ischemic heart disease

2024-10-21T14:59:18+0530

Background: Aim was to evaluate the efficacy of panchakarma-based ischemia reversal therapy combined with diet modification in the management of ischemic heart disease.

Methods: A retrospective, single centre study was conducted at a Madhavbaug clinic in Maharashtra from February 2022 to December 2023. Patients aged 20-75 years diagnosed with ischemic heart disease were included in the study. Follow-up was conducted weekly, for total duration of 90 days. Day 1 and day 90 data were compared

Results: A total of 22 patients with mean age of 58.64±9.81 years were included in this study. VO_2max(day 1: 16.34±5.35 mL/kg/min and day 90: 28.11±7.39 mL/kg/min, p=0.00), duke treadmill score (day 1: -6.77±4.38 and day 90: 3.77±15.83, p=0.00), and MET value (day 1: 4.66±1.53 and day 90: 8.02±2.10, p=0.00) improved significantly at the 90-day follow-up.

Conclusions: Ischemia reversal therapy has proven to be effective in improving the cardiac capacity of heart, demonstrated by improvement in VO_2max. Also improved Duke’s treadmill score.

Experimental repurposing of metformin for Crohn’s disease in trinitrobenzene sulfonic acid induced colitis model in BALB/c mice

2024-10-31T16:12:58+0530

Background: Inflammatory bowel disease (IBD) is characterized by repetitive episodes of inflammation of the gastrointestinal tract caused by an abnormal immune response to gut microflora. It includes two types: Ulcerative colitis (UC), which causes widespread colon inflammation, and Crohn’s disease (CD). The current therapy focuses on symptom relief and provides inadequate maintenance of remission and quality of life improvement. Metformin has already been repurposed in few studies with dextran sulphate sodium (DSS) induced colitis. We aimed to evaluate the effect of metformin in TNBS induced acute on chronic colitis, to mimic the relapsing-remitting nature of CD in humans, which has not been done before.

Methods: Objectives were, phase I- evaluation of the effect of metformin in TNBS induced acute colitis in BALB/c mice. Phase II- evaluation of the effect of metformin in TNBS induced chronic colitis in BALB/c mice. Phase III- Evaluation of the effect of metformin in TNBS induced acute on chronic colitis in BALB/c mice. Materials And Methods: Trinitrobenzene sulfonic acid (TNBS) was used for inducing both acute, chronic and acute on chronic colitis in BALB/c mice. 36 BALB/c mice were divided into 4 groups i.e. normal control, disease control, positive control and test drug. Effect on DAI score, lower colon weight by length ratio, macroscopy and histopathology were assessed.

Results: Metformin showed significant improvement (p<0.05) in all the variables assessed i.e. reduction of (Disease Activity Index) DAI score, lower colon weight by length ratio, lower colon macroscopic score and lower histopathological score in comparison to the disease control group in all the phases i.e. acute (day 5), chronic (day 22) and acute on chronic (day 25). However, the effects were comparable to the positive control.

Conclusions: Metformin has potential to be repurposed for Crohn’s disease as it showed comparable efficacy in all three phases.

Evaluation of anti-anxiety activity of Garcinia indica using Vogel water lick conflict test in rats

2024-11-08T18:35:44+0530

Background: Anxiety is usually described as a psychological, physiological and behavioural state induced in animals and humans by a threat to well-being or survival, either actual or potential. In modern medicine, benzodiazepines are still commonly used anti-anxiety agents in spite of their unfavourable adverse effect profile. Traditional herbs like Garcinia indica (Kokum) known to have possible therapeutic relevance in treatment of anxiety as a potential anxiolytic herb. So, this study was conducted to evaluate anti-anxiety effect of Garcinia indica in both, low and high doses, using Vogel’s conflict test which is of broad significance to clinical anxiety.

Methods: Wistar albino rats of either sex (150-250 g) were divided into four groups with eight rats in each group. Different groups were given distilled water (0.5 ml p.o.), Diazepam (1 mg/kg p.o.), Garcinia indica (1.75 gm/kg p.o.) and Garcinia indica (3.5 gm/kg p.o.) respectively. Effect of test drugs on anxiety was evaluated using Vogel’s water lick conflict test. Parameters such as number of water licks, total number of shocks tolerated were assessed. Results expressed in mean and standard deviation were analysed using one-way analysis of variance (ANOVA) test followed by Tukey’s test.

Results: Diazepam and high dose Garcinia indica (3.5 gm/kg) showed statistically significant increase in number of water licks and number of shocks tolerated but low dose Garcinia indica (1.75 gm/kg) did not show any significant increase in these parameters.

Conclusions: This study shows that high dose Garcinia indica possess significant anti-anxiety effect comparable to that of diazepam.

A prospective observational study on iv compatibility, dose adjustment and ADR of chemotherapy drugs in oncology department at tertiary care hospital

2024-11-09T23:15:45+0530

Background: Cancer is the second leading cause of death worldwide. Chemotherapy is a standard modality of cancer treatment that uses chemical agents or drugs to destroy cancer cells in the cell cycles or use chemicals or drugs to inhibit cancerous cells growth and spread. The objective of this study was to assess the IV compatibility of chemotherapy drug in different solution, assess the frequency of ADR, classify ADR according to the class of drug and dose adjustment.

Methods: In this study, cancer patients of either gender (aged 21-90) admitted on the oncology department of Bangalore Baptist Hospital were included in the study. Assessment of IV compatibility was done based on the prescription pattern, dose adjustment was done on the basis of body weight, BSA and hepatic and renal parameters. Adverse reactions reported by the patients, assessed by the doctors and nurses and changes in the laboratory parameters were analysed for the assessment of ADR.

Results: A total of 43 patients met the inclusion criteria; among which 44% were male and 56% were female. The mean age of the study was 57.49. Breast cancer, stomach cancer and lung cancer were more prevalent. In the study 24 chemotherapy drugs were used among them 20 drugs were compatible in 0.9% normal saline and 4 drugs were compatible in 5% dextrose. Dose adjustment were done for 4 drugs which were Carboplatin, Paclitaxel, Trastuzumab and Ifosfamide. The average dose adjusted for Carboplatin, Paclitaxel, Trastuzumab and Ifosfamide were -0.46±3.3, 0.5±10.6, -10±0 and -50±0 respectively. Total of 25 adverse drug reaction were seen where vomiting, gastritis and anemia were more frequently seen. Alkylating agents showed more number of ADRs.

Conclusions: From the study, it can be concluded that most of the chemotherapy drugs were compatible either in 5% dextrose or 0.9% normal saline. Dose adjustments were done on the basis of body weight and BSA. Alkylating agents showed ADR most frequently and least frequent was topoisomerase inhibitor. Vomiting was the most reported ADR.

A prospective and observational study on rationale use of noradrenalin and vasopressin in critically ill patients

2024-11-09T23:23:45+0530

Background: Shock, particularly septic shock, is a critical medical condition characterized by inadequate blood flow, leading to multi-organ failure and high mortality rates. Traditional treatment includes fluid resuscitation and antibiotic therapy, but advancements in understanding and management are needed. This study aims to evaluate the rationale use of noradrenalin and vasopressin in patients with shock, specifically focusing on their effects on blood pressure.

Methods: Conducted as a prospective observational study at a tertiary care hospital, the study involved 50 critically ill patients diagnosed with septic, cardiogenic or hypovolemic shock. Patients were treated with either noradrenalin, vasopressin or both and data were collected from ICU, HICU and CCU admissions. Inclusive criteria included critically ill patients with shock on noradrenalin or vasopressin. Exclusion criteria included pregnant or breastfeeding women and dialysis patients.

Results: Among the patients, septic shock was the most common type (68%). Age distribution showed a majority (24%) aged 61-70 years, while a minority (2%) was 11-20 years old. Significant contributors to septic shock were lower respiratory tract infections (23.4%) and urosepsis (19.4%). The study noted fluctuations in systolic and diastolic blood pressures in response to the medications.

Conclusions: The study result demonstrated that the change in the blood pressure were significant. Changes in the diastolic pressure when used vasopressin along with norepinephrine was more prominent. Drug interactions didn’t cause any adverse effects in the course of treatment as there is no significant fluctuation in the K levels. Not much difference was seen in blood cells count, ABG but significant decrease in serum lactate, CRP and troponin were seen.

Bibliometric analysis on the publications of the statins-associated autoimmune myopathy: a comprehensive review

2024-09-16T18:56:24+0530

This bibliometric analysis aimed to assess the landscape of research on statin-associated autoimmune myopathy (SAAM), focusing on publication trends, contributors, and implications for further investigation. Access to the Scopus and Web of Science databases was obtained through institutional login credentials. An advanced search using keywords "statin associated autoimmune myopathy" or "SAAM" was conducted. Data were collected from 2003 to 2022 and analysed using the Biblioshiny package in R-Studio. A total of 110 publications were identified, involving 418 authors. The analysis revealed a steady increase in publication activity on SAAM, particularly notable in 2017, 2020, 2021, and 2022, with a peak of 13 publications in certain years. However, no publications were recorded in 2014. The accumulated citations from 2003 to 2022 totalled approximately 3,000, indicating a sustained interest in the topic. Statins, being first-line drugs for conditions like hyperlipidemia, diabetes mellitus, cardiovascular diseases, obesity, and cancer, underscore the importance of vigilant monitoring for associated adverse events. The analysis highlights the need for further research on SAAM, a drug-related adverse reaction, due to the widespread use of statins and their association with comorbidities. Understanding and monitoring SAAM is crucial for patient safety, and further investigation is needed to understand its mechanisms and risk factors.

New perspectives on markers implicated in signalling pathways that advance diabetic nephropathy and its therapeutic approaches

2024-10-04T13:24:35+0530

Diabetic nephropathy is the chronic loss of kidney function occurring due to diabetes mellitus. Due to increased sugar levels, there is disfunctioning of glomeruli, loss of protein in urine, and decrease in the levels of serum albumin that mainly leads to edema. The progression of renal disfunctioning starts when glomerular filtration rate is greater than 90ml/min. A large body of evidence indicates that oxidative stress is the main attributor involved in the progression of macro-vascular complications of diabetes. (ROS), NAD(P)H oxidase, advanced glycation end products (AGE), polyol pathway, uncoupled nitric oxide synthase (NOS), mitochondrial respiratory chain via oxidative phosphorylation, protein kinase C, mitogen-activated protein kinases, cytokines and transcription factors eventually cause increased expression of extracellular matrix (EC) genes with progression to fibrosis and end stage renal disease. Apart from these well-established pathways, major markers in the kidney disease which could work as potential targets has been explored like MCP-1, BMP-7, p38 MAPK, MiR-130b, HSP-27, AKT which further needs more research as they have shown promising results in their early level of studies. The present review aims to investigate the molecular targets involved in diabetic nephropathy, and to comprehend the intricate signalling pathways, such as JAK/STAT, BMP-7–Smad1/5/8 pathway, RhoA/ROCK, caspases, to which the aforementioned markers have either an independent or dependent relationship. If these signalling pathways are properly studied, these markers may aid in the treatment of the disease and its associated secondary effects such as nephropathy.

An overview of biosimilars

2024-10-09T11:16:15+0530

The paradigm of pharmacological therapy in diseases is shifting from conventional small molecule drugs to biological drugs produced by living systems. Biological drugs have extensively ramified into therapies of various conditions such as autoimmune disorders, haematological conditions, cancers and others. Biological drugs are currently the diamond mine of the pharmaceutical drug market. Due to the enormous market value, other pharmaceutical companies are keen in producing and marketing generic versions of these innovator (reference) biologic companies, once the patents start to expire. These generic versions of the biological drugs are called as biosimilars. However, biosimilars are not exactly generics of the originator biological drugs like in the case of conventional small molecule drugs. Various controversies and perplexities exist in their production, approval, marketing, and prescription. The reason for the mere existence of biosimilars or generics drugs for that matter is their reduced cost with preserved clinical effectiveness. Biosimilar drugs are subject to rigorous scrutiny by a thorough comparative evaluation with the reference biological product for marketing approval. It is also equally important for the physicians and pharmacists to have a sound body of knowledge about biosimilar drugs to optimally avail the benefits offered by them. This review highlights how biosimilar drugs differ from the conventional drugs, their development process, issues, and challenges associated with their use.