International Journal of Basic & Clinical Pharmacology

Evaluation of the protective role of antioxidants: α-tocopherol, vitamin C, and quercetin, against ibuprofen-induced renal damage in male Wistar rats

Fri, 25 Aug 2023 00:00:00 +0000

Background: Ibuprofen, commonly used in management of pains and inflammatory conditions, has been associated with renal damage. The protective role of antioxidants against Ibuprofen-induced renal damage in wistar rats were investigated in this study.

Methods: The study was designed in two parts; first, to induce kidney damage and secondly, to determine protective role of antioxidants against ibuprofen-induced kidney injury. In the first phase, two groups of animals were used; one group treated with 120mg/kg ibuprofen daily for 14 days, while the other served as control and had distilled water. Serum malondialdehyde and kidney parameters were estimated after treatment and kidneys harvested for histology. In the protection study, animals were divided into five groups, with groups 1-4 having three sub-groups treated with 120mg/kg Ibuprofen and graded doses of vitamin E, vitamin C and quercetin respectively, while group five served as control. After 14days, antioxidant enzymes and kidney parameters were estimated, and the kidneys harvested for histology.

Results: Showed significant (p<0.05) increase in malondialdehyde, urea, creatinine, and uric-acid levels after ibuprofen administration. Conversely, there was significant (p<0.05) reduction in kidney parameters after co-administration of antioxidants with ibuprofen, with significant increase in antioxidant enzymes. Estimated antioxidant’s percentage protection showed vitamin E gave highest protection on the kidneys against ibuprofen-induced damage amongst others. Histology revealed atrophied glomeruli with widened capsular space, desquamated tubular epithelial cells and infiltrating lymphocytes after ibuprofen administration, but showed normal histo-architecture after co-administration with antioxidants.

Conclusion: Antioxidants such as α-tocopherol, vitamin C, quercetin, protected against ibuprofen-induced renal damage in Wistar rats.

Investigating the possible neurological side effects follow the COVID-19 vaccine

Abolfazl Atalu, Saeed Sadeghieh-Ahari, Haleh Khademmasjedi — Fri, 25 Aug 2023 00:00:00 +0000

Background: With the widespread of COVID-19 vaccination around the world, there are many case reports which referred to the neurological complications following vaccination. However, due to the lack of more information about this, especially in our country Iran, the aim of this study was to investigate the possible neurological side effects of the COVID-19 vaccine in patients.

Methods: This cross-sectional study was conducted on 1046 people injecting various types of COVID-19 vaccines, including Sinopharm, AstraZeneca, Sputnik V, CovIran-Barekat, Covaxin, SpikoGen, and PastoCovac plus, who were registered in the health system due to vaccine complications. These people were evaluated in terms of the overall incidence rate of neurological complications, types of neurological complications, and the relationship between the occurrence of neurological complications and the type of vaccine.

Results: Of all patients, 589 (56.3%) were female and 457 (43.7%) were male, and most of them were from the age group of 60 years and older (43.8%). 247 people (23.6%) had neurological complications that most of them related to the headache (16.6%).

Conclusions: The results of this study showed that the neurological side effects associated with the covid-19 vaccination were in mild level and most of them were seen in AstraZeneca vaccine and so, in line with the recommendation of the European medicines agency, the injection of this vaccine should be done with caution.

Effect of combining estradiol valerate with sildenafil in increasing the thickness of the endometrium in infertile women before intrauterine insemination: a randomized clinical trial

Faranak Jalilvand, Maryam Sadat-Razavi, Firouz Amani, Nasrin Mirzaei — Fri, 25 Aug 2023 00:00:00 +0000

Background: Therapies available for thin endometrium are limited and are mostly performed experimentally which most of these treatments have a similar function and increase blood flow to the endometrium, causing it to thicken and develop. The aim of the study was to compare the effect of estradiol valerate in combination with sildenafil on endometrial thickness in infertile women before intrauterine insemination.

Methods: In this randomized clinical trial 100 infertile women referred to Reyhaneh Infertility Center in Ardabil were randomly divided into two groups. Patients' endometrial thickness was assessed by vaginal ultrasound before treatment and then on day 9 of the cycle. The intervention group received one tablet of estradiol valerate every 12 h from the ninth day of menstruation for 4 days and sildenafil as 25 mg orally daily from day 9 to 12, but in the control group, patients received placebo tablets orally in addition to estradiol.

Results: There was no statistically significant difference between the intervention and control groups before and after the intervention in term of endometrial thickness. The rate of increase in endometrial thickness was 1.35 mm in the intervention group and 1.37 mm in the control group, but the difference was not statistically significant.

Conclusions: Estradiol valerate alone or in combination with sildenafil resulted in a significant increase in endometrial thickness and increasing oral sildenafil supplementation with oral estradiol valerate had no significant effect on increasing endometrial thickness.

A comparative study on the dependence potential of thienorphine and buprenorphine

Zheng Yong, Yu-Lei Li, Pei-Lan Zhou, Ze-Hui Gong, Rui-Bin Su — Fri, 25 Aug 2023 00:00:00 +0000

Background: As part of research to discover partial opioid agonists for new treatments of opioid abuse and dependency, thienorphine, a buprenorphine analogue, was synthesised and reported to be a potent, long-acting oripavine in multiple mammalian models. Thienorphine binds non-selectively to μ-, δ-, and κ-opioid receptors, and partially stimulates μ- and/or κ-opioid receptors in vitro. Compared with buprenorphine, thienorphine exhibits better analgesic effects and has higher oral bioavailability. Poor oral absorption and dependence have hindered the use of buprenorphine for detoxification therapy and relapse prevention in the clinic. The addiction potential of thienorphine is unknown, and is worthy of in-depth investigation.

Methods: In the present study, we conducted a comparison of thienorphine and buprenorphine with respect to their physical and psychological dependence liabilities, using a naloxone-induced withdrawal test, a conditioned place preference test, and a self-administration experiment in rats.

Results: In contrast to chronic buprenorphine administration, we failed to observe any severe abstinence syndromes in mice or rats treated with thienorphine after naloxone challenge in a physical dependence model. Compared with the dependence potentials of buprenorphine, rats treated with chronic thienorphine did not show a place conditioning response, self-administration, or psychological dependence.

Conclusions: We demonstrated that thienorphine has a lower potential than buprenorphine for physical and psychological dependence. Our results indicate that thienorphine might be a good candidate to treat opioid addiction.

Catastrophic consequences of the enormous use of hydroxychloroquine during COVID era on liver and kidney of male albino rats: an in-vivo study

Tanushree Samanta, Sagarika Mukhopadhyay, Suman K. Khanra, Anup Jana — Mon, 31 Jul 2023 00:00:00 +0000

Background: Hydroxychloroquine (HCQ) is mainly used for the treatment of malaria but during COVID trial, it was used against coronavirus though no history of the drug is known against SARS COV 2 or any other respiratory ailment. Many case studies showed the adverse effects on liver and kidney in many patients after the exposure of HCQ. The main aim of this study is to know the effect of HCQ drug on the liver and kidney of male albino rat at a range of human equivalent dose that was given during COVID period.

Methods: After institutional animal ethics committee (IAEC) approval, ten male albino rats were obtained and divided into two groups-control and treated. Treated groups receives HCQ through oral gavage for six days and then serum, tissue enzymes and total serum bilirubin were measured. Histopathological study was done from liver and kidney tissue. After that statistical analysis was done.

Results: We found significant increase in enzymes glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT) and alkaline phosphatase (ALP) in the HCQ-treated rats than in control and this signifies that there might be damages that occurred in liver and kidney. Increased level of bilirubin in HCQ-treated rats indicate hyperbilirubinemia and may be a sign of jaundice or any other hepatic disorder. From histopathological identification we also found liver and kidney tissues got damaged due to exposure of HCQ.

Conclusions: From this study, we can conclude that the exposure of this drug might have led to the impaired function of organs that could have potentiated their ill fate.

Comparative efficacy of fixed dose combination of brinzolamide 1% and timolol 0.5% without versus with benzalkonium chloride following single ocular instillation in New Zealand white rabbits

Fri, 25 Aug 2023 00:00:00 +0000

Background: Benzalkonium chloride (BAK) is the most used preservative in topical ophthalmic formulations. BAK causes dry eye and trabecular meshwork degeneration. Hence, BAK-free formulations are desirable for chronic conditions like glaucoma. The objective of this study was to compare the efficacy of BAK-free versus BAK-containing ophthalmic suspension of fixed dose combination (FDC) of brinzolamide and timolol on their intraocular pressure (IOP) lowering effect following a single ocular instillation in New Zealand White (NZW) rabbits.

Methods: Twelve normotensive NZW rabbits (male) between 9-12 months of age (3.4-4.4 kg) received a single ocular instillation (35 ml) in left eye of either ophthalmic suspension containing FDC of brinzolamide (1% w/v)/timolol (0.5% w/v) without BAK (n=6, test) or with BAK 0.01% w/v (n=6, reference). IOP was measured before ocular instillation (baseline) and at 2, 4, 6, 8 and 24 hours after instillation using a pneumatonometer. Change in IOP from baseline were calculated and analysed using repeated measures analysis of variance (ANOVA) followed by Bonferroni post-test for pairwise comparisons.

Results: Significant IOP reduction (p<0.05) from baseline was seen in both test and reference groups, up to 6 hours after instillation. Maximum IOP reduction was 25.5% and 22.6% at 2 hours in the test and reference group respectively. No significant differences (p>0.05) were observed between the test and reference group for the change in IOP at all time points.

Conclusions: BAK-free and BAK-containing ophthalmic suspension of FDC of brinzolamide 1% and timolol 0.5% after a single ocular instillation in normotensive NZW rabbits produces similar reductions in IOP.

Evaluation of drug treatment awareness among caregivers and patients of chronic kidney disease: unexplored determinant in patient care

Fri, 25 Aug 2023 00:00:00 +0000

Background: Chronic kidney disease (CKD) patients are prescribed multiple drugs to slow disease progression and prevent complications mandating adherence to therapy. Lack of awareness about drug treatment is one of the contributors to nonadherence. Hence the study was conducted to explore the awareness of patients and caregivers towards CKD treatment.

Methods: The study was a cross sectional questionnaire-based study conducted among 300 CKD patients (150 dialysis/150 non-dialysis) and 100 caregivers (50 of dialysis / 50 of non-dialysis patients) attending nephrology OPD at a tertiary care hospital.Patient /caregiver awareness about drug treatment was assessed usinga prevalidated drug awareness questionnaire (8 items). The items were scored as correct response=2, no response=0 and incomplete response = -1, accounting the total awareness score as +20 to - 6

Results: The mean awareness score of patients / caregivers was 8.16±3.41 and 8.3±1.6 respectively. Majority (>70%) patients/ caregivers gave accurate responses for the items -specifying number of medicines, medication frequency and regular intake of drugs but awareness regarding action plan for skipped (27% patients, 11% caregivers) or missed doses (22% patients, 15% caregivers) and adverse effects (17% patients, 5% caregivers) was poor. Patients/ caregivers belonging to dialysis group had statistically better awareness then non-dialysis group.

Conclusions: Patient /caregiver awareness regarding drug treatment is less than 50% with strikingly low awareness about dose regimen, adverse effects, action plan for missed doses and co morbidities. Patient education programs to reinforce and retain this knowledge need to be implemented in CKD patients.

Pharmacoecomonic study of oral antidiabetic drugs available in Indian pharmaceutical market

Prashant Wadagbalkar, Sandeep Singh Bhadoriya — Fri, 25 Aug 2023 00:00:00 +0000

Background: Diabetes mellitus is a metabolic disorder requiring lifelong medication which further adds to comorbidity. Cost of the drug pays an important role in adherence and compliance to the treatment. There is a wide variation in prices of oral hypoglycemic drugs available in Indian pharmaceutical market. Aims and objectives of the study was planned to evaluate cost of oral antidiabetic drugs of various brands currently available in Indian market either as single drug or in combination.

Methods: Cost of antidiabetic medications manufactured by various pharmaceutical companies in the same strength and dosage form was obtained from the price list provided by various pharmaceutical companies in current index of medical specialties December 2022-March2023. The cost ratio and percentage price variation for each formulation was calculated and analyzed.

Results: Among single antidiabetic drugs, Tab. Metformin 500 mg shows highest percentage price variation (809%) and highest cost ratio (9.09). Among fixed dose combinations, Tab. Glibenclamide 5 mg + Tab. Metformin 500 mg shows highest percentage price variation 300.8% and highest cost ratio 4.

Conclusions: Our study shows that there is high price variation for oral anti diabetics. It is important to bring awareness about wide variation in prices so that drug cost can be reduced and made affordable to common man which plays major role in compliance of patient.

A prospective observational study of prescription pattern of antihypertensive drugs in general medicine outpatient department of associated hospital RUHS CMS, Jaipur

Vishal Sharma, Beena Sharma, Rajveer Singh Rathore, Lokendra Sharma — Fri, 25 Aug 2023 00:00:00 +0000

Background: The increasing prevalence of hypertension is attributed to population growth, ageing and behavioural risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress. The aim of study is the prescribing pattern and the consumption of antihypertensive drugs in isolated hypertensive patients and in hypertensive patients with different co-existing morbidities.

Methods: The present study is a Prospective observational study. The study was conducted at Medicine Department of associated hospital of RUHS College of Medical Sciences, Jaipur.

Results: A total of 965 patients having hypertension were analyzed, in that 556 patients were male and 409 patients were female. In hypertension patients, angiotensin receptor blockers ARB, diuretics and β- blockers (29.90%) were mostly used classes in three drug therapy. Whereas telmisartan, hydrochlorothiazide and metoprolol (35.05%) were mostly prescribed. Drugs. In hypertension patients, angiotensin receptor blockers ARB, diuretics, β- blockers and calcium channel blockers (56.67%) and calcium channel blockers, angiotensin converting enzyme inhibitors, β-blockers and diuretics (43.33%) were used classes in four drug therapy. Whereas Telmisartan, Hydrochlorothiazide, Nebivolol and Amlodipine (62.5%) were mostly prescribed drugs. Hypertensive Patients with Comorbidity were found in higher prevalence with 276 hypertensive patients (28.60%) along with Diabetes Mellitus most commonly found and 389 hypertensive patients (40.31%) were found to be with No Comorbidity.

Conclusions: Present results reveal that antihypertensive medication adherence to JNC-8 recommendations is suboptimal. Therefore, physicians should follow JNC-8 guidelines to improve the patients care because suboptimal adherence leads to adverse clinical outcomes. The present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with co-morbid conditions.

Drug utilization pattern of analgesics after a surgical procedure in a tertiary care hospital: a prospective observational single centre cohort study

Christian S. Sharma, Rajan P. Nerurkar — Fri, 25 Aug 2023 00:00:00 +0000

Background: the study aimed to understand the prescription pattern of analgesics used in the post-operative period after a general surgical procedure in a tertiary care hospital in India and estimate the severity of post-operative pain up to 48 hours. Such a study was not done in this institute of recent hence it was carried out.

Methods: 266 adults of either gender were recruited and prescription pattern analyzed over a period of 1 year beginning January 2021 to December 2021 from the post-operative general surgery wards of a tertiary care hospital in India. Patient interview and records were used to collect data. Follow ups at 4, 24 and 48 hours were undertaken to assess pain according to the visual analogue scale (VAS) that was analyzed using the Friedman’s test followed by the post hoc Dunn’s test.

Results: an average of 1.52±0.58 analgesics were prescribed per patient. Paracetamol was most commonly used followed by tramadol and diclofenac. All analgesics prescribed were a part of the national list of essential medicines. Effective pain management is feasible as seen by the significant (p<0.0001) reduction in average pain score from 4.75±1.35 to 3.05±1.18 at 24 hours and further to 2.16±1.04 at 48 hours.

Conclusions: Use of analgesics prescribed from a standardized list is effective in majority of patients.

A study comparing the change in drug utilization pattern in medical intensive care unit of a tertiary care hospital in seven years

Ashwini V. Karve, Mayur M. Chaure — Fri, 25 Aug 2023 00:00:00 +0000

Background: Medical intensive care unit is a type of intensive care unit that takes care of a range of medical illnesses with patients who are seriously ill and/or suffer from severe chronic illnesses. These patients are usually prescribed multiple drugs. Use of antimicrobial agents and injectable medications in setting of MICU is high as compared with other class of drugs and other hospital settings respectively. Periodic evaluation of drug utilization pattern needs to be done to enable suitable modifications in prescription of drugs to increase the therapeutic benefit and decrease the adverse effects. There could be changes in drug utilization pattern due to changes in disease pattern, development of newer drugs, resistance to antimicrobial agents. Hence comparison of past and present data needs to be done to find out the changes that occurred in drug utilization pattern over the years.

Methods: Data was collected from June 2021 to Dec 2021 for prospective arm and June 2014 to December 2014 for retrospective arm was obtained from MICU of tertiary care hospital and Medical Record Department. Drug utilization pattern was analysed and compared with appropriate statistical tests.

Results: Most common cause of MICU admission was infective diseases (71% and 67% respectively in retrospective and prospective arm). The drug prescribed frequently was pantoprazole and antimicrobial was ceftriaxone in both the study arms. Half of the drugs were prescribed by generic names in both arms.

Conclusions: There was no change observed in drug utilization pattern and disease pattern in patients admitted to medical intensive care unit over the years in our institute.

Association of proton pump inhibitors with renal dysfunction: a cross-sectional study

Mamata Singh, Ritu Bala, Amit Jain, Harminder Singh, Ajay Prakash — Fri, 25 Aug 2023 00:00:00 +0000

Background: Proton pump inhibitors are the most frequently prescribed class of medications for prescription and over-the-counter, and the data suggest that comorbidities, polypharmacy, self-medication, no clear indications and duration beyond the recommended guidelines PPIs use are associated with renal dysfunction. Aim was to study the proportion of renal dysfunction among patients using oral PPIs and determine the association between the duration of oral PPIs use and the severity of renal dysfunction.

Methods: The data collection of 250 patients was done at the time of contact, which included demographic profiles, complete medical history, physical examination, and laboratory investigation in this study. For analysis, name of oral PPIs used, duration and dosage of oral PPIs therapy, laboratory values of serum blood urea, serum creatinine, eGFR, and serum electrolytes parameters have been considered.

Results: Amongst 250 patients with PPIs used for a week, 23 patients showed mildly reduced kidney function (p=0.000), PPIs used for >1 to 2 weeks, 29 patients showed grade 2 kidney function (p=0.001), while PPIs used for >2-3 weeks only two patients showed grade 3 kidney function (p=0.44). Patients aged >50 years in all groups showed grade 2 renal function, regardless of the duration of PPIs use. Increasing age, males, rural, smoking, and alcoholics were the risk factors for renal dysfunction. PPIs use significantly impacts eGFR.

Conclusions: Collectively, this study found a significant association between PPIs use and renal dysfunction. PPIs used for >2 weeks in elderly patients have shown a 4−fold increased risk of developing renal dysfunction.

A prospective study on antibiotic resistance pattern in patients with urinary tract infection

Swastika Raj Singh, Shibi Mary Thomas, Balakeshwa Ramaiah — Fri, 25 Aug 2023 00:00:00 +0000

Background: Antibiotics are a blessing to the mankind in the realm of medical treatment. Quite contrary to that fact, they may cause risks in medical treatments of patients if these antibiotics are not taken under medical guidelines. In the current scenario it is a huge challenge for selecting appropriate antibacterial agents for the treatment of UTI. This study aims to evaluate the prescription & resistance pattern of antibiotics in patients with urinary tract infection.

Methods: A prospective observational study was carried out for a period of 1 year. Data on 100 research participants' reports and the results of their tests for antibiotic resistance were taken from the microbiology department's records, evaluated, and represented as percentages. Observations were made and meticulously recorded.

Results: Out of 100 study participants, Escherichia coli was the most common pathogen with a total of (35%) followed by Klebsiella (17%), Enterococcus with (16%). E. coli were highly resistant to Ampicillin (88.6%) and Cefazolin (88.6%), Ceftraixone (85.3%). Klebsiella were highly resistant to Ampicillin (100%) Cefazolin (93.3%), Cefuroxime (85.7%). Enterococcus were highly resistant to Tetracycline (92.9%) Ciprofloxacin (85.7%), Levofloxacin (81.8%). Where, E. coli were highly sensitive to Amikacin, Imipenem, Ertapenam. Klebsiella were highly sensitive to Meropenem, Cefoperazone/Sulbactam, Amikacin. Enterococcus was highly sensitive to Linezolid, Teicoplanin, Vancomycin.

Conclusions: Most of the identified bacteria were resistant to several of the popular antibiotics used in clinical settings. Consequently, it is vital to prescribe antibiotics rationally both before and after culture reports.

Long-COVID versus adverse event following COVID vaccination among students and staff of tertiary care teaching hospital

Fri, 25 Aug 2023 00:00:00 +0000

Background: Long COVID is an important public health concern requiring proper defining, quantifying and describing following SARS-CoV infection with differentiation from adverse events due to COVID vaccination. So, this study was planned to analyze adverse effect of COVID19 vaccination or drug for COVID treatment versus consequences of COVID19 infection.

Methods: Self-reported data was collected through questionnaire-based survey by voluntary participation of healthcare staff. Percentage of participant developing various events was analyzed by enlisting sign, symptom, co-morbidity and medication history. Association between COVID-19 infection with number of doses of COVID-19 vaccine taken was analyzed by Chi Square Test with p value <0.05. Association between presence of specific sign, symptom after COVID infection or side effect after COVID vaccination was analyzed by Chi-Square Test with p value <0.05.

Results: Overall total 985 (59.58%) participants were analyzed and among them maximum number of participants (60.30%) reported as COVID-19 positive during the third wave with history of diagnosed COVID positive twice (57.87%). Participants with presence of co-morbidity were more likely to develop symptoms (p<0.001). On analysis, fever, body ache, headache, sore throat and fatigue were significantly more likely to develop after COVID infection as compared to after COVID vaccination (p<0.001).

Conclusions: This study by exploratory survey highlights heterogeneity of Long COVID sign or symptom that’s seen predominantly in person with co-morbidity and a few of them were mimicking adverse events after COVID vaccinations.

Rationale use of drugs in pregnancy induced hypertension at a tertiary care hospital

Dwajani S., Samhitha Kulkarni , Andrea S. Vincent , Sanjana B. M. — Fri, 25 Aug 2023 00:00:00 +0000

Background: Pregnancy induced hypertension known as preeclampsia is considered to be the second cause of death next to anaemia. There are significant sources of maternal and foetal mortality and morbidity. Antihypertensive medication reduces the progression of the course of hypertensive disorders. However, its effect on the outcomes of pregnancy may include development of preeclampsia, preterm delivery, foetal /neonatal demise, IUGR, low birth weight. Whether such associations are casual or confounded is unknown. Hence, we intended to study the rationale use of drugs in pregnancy induced hypertensive patients.

Methods: Patients diagnosed with hypertensive disorders in pregnancy were recruited. Pregnant women in the age group of 18-45 years who consented to participate were included. Non pregnant women and women with PCOD, depression and on any medications were excluded. Details on drug treatment, type of drugs, combination, dose, dosage and duration were noted.

Results: 105 patients were enrolled. 51% belonged to 18-25 years. 98% mothers received monotherapy and 2% received dual therapy. Labetalol was the most commonly prescribed drug. 50% of the patients received a combination of Nifedipine and Methyldopa while another 50% received Nifedipine with Labetalol. The outcome of new born babies born in mothers receiving antihypertensive drugs had complications of low birth weight and malformations. The dose of the medications prescribed was well within the range.

Conclusions: Proper counselling to the patients regarding life style management, regular follow ups and monitoring of blood pressure is important to understand, resolve the burden and complication.

Drug utilization pattern in patients of upper respiratory tract infections in pediatrics outpatient department at a tertiary care hospital

Jitendra H. Hotwani, Ankita V. Tathe, Sushma Save — Fri, 25 Aug 2023 00:00:00 +0000

Background: Upper respiratory tract infections are the most common and frequently occurring infections in the pediatric population. These infections include conditions like common cold, laryngitis, pharyngitis, tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Young children have an average of 6-8 colds per year, however 10 -15% of children have at least 12 infections per year. This study concentrates on prescription pattern of Upper Respiratory Tract Infections in children. primary objective was to study the prescription pattern of drugs used in URTI in pediatric outpatient department and the secondary objective was to determine whether the drugs being prescribed comply with those listed in the National list of essential medicines.

Methods: This study was a Cross-sectional, observational study conducted at the Pediatric Outpatient Department in a tertiary care hospital, India. The data was collected from patients visiting Pediatrics OPD from June 2021 to December 2021 after taking written informed consent. Sample size was calculated to be 303.

Results: Total 943 drugs were prescribed for 303 patients with an average of 3.11±1.15 drugs per prescription. Most common class of drugs prescribed was Antipyretics of which Paracetamol was the most common drug. Antibiotics were prescribed for 19.80% patients & combination of Amoxicillin and Clavulanic acid was the most common antibiotic prescribed. 68.29% drugs were prescribed by generic name. 43.16% drugs were prescribed from National List of Essential Medicines 2015.

Conclusions: The study revealed that the majority of children suffering from URTI were below 5 years of age. Our study highlighted the prescribing.

Perception, knowledge and attitudinal assessment of drug promotional literature among second year, medical undergraduate students: a questionnaire-based study

Sweety Ramesh Deikar, Lois James Samuel — Fri, 25 Aug 2023 00:00:00 +0000

Background: WHO defines drug promotion literature (DPL) as “all informational and persuasive activities by manufacturers, the effect of which is to induce the prescription, supply, purchase and/or use of medicinal drugs”. Benefit driven marketing of new drugs by drug companies may lead to erroneous prescription due to insufficient understanding, knowledge of safety and therapeutic benefits of the drugs in the community. All these promotional activities influence the prescribing pattern of doctors. 2nd year of undergraduate medical course is the appropriate time to educate the medical undergraduate students about fundamentals of DPL and to train them accordingly for improving their prescribing behaviour eventually.

Methods: A prospective questionnaire-based study was conducted in Goa Medical College. The study participants consisted of 150 II-year undergraduate medical students. Approval from Institutional Ethics Committee was obtained. The feedback forms were collected from the students after they were completed and data was analysed and represented as counts and percentages.

Results: Among respondents 36% of students opined that the quality of details provided by medical representatives is biased and too commercial followed by others. 40.7% of students were of the view that the most important intervention needed to reduce the impact of drug promotion on prescribing was to formulate policies and guidelines for the health care authorities.

Conclusions: Promotional activities by manufacturers influence the attitude and prescribing pattern of doctors. So, it is of utmost importance to train medical graduates in order to enable them to develop the skill of critical analysis of DPL and consequently rational prescribing.

Ketamine but not glycine potentiates antidepressant like action of citalopram in mice exposed to chronic mild stress

Veena Verma, Pankaj P. Sanone, Ashish K. Mehta, Chakra D. Tripathi — Fri, 25 Aug 2023 00:00:00 +0000

Background: The present study was designed to investigate the effect of citalopram, ketamine, glycine and their combinations on animal models of depression.

Methods: Swiss Albino male mice were subjected to chronic mild stress for 6 weeks for inducing depression, and randomly divided into different groups: citalopram (5 and 10 mg/kg), ketamine (17.5 and 35 mg/kg), glycine (50 and 100 mg/kg), ketamine (17.5 mg/kg) + citalopram (5 mg/kg) and ketamine (17.5 mg/kg) + glycine (50 mg/kg). Two behavioural tests were utilized for the assessment of depression, namely tail suspension test (TST) and forced swim test (FST). Immobility time was recorded for 6 min, before and after administration of drug.

Results: Citalopram (10 mg/kg) administration caused significant decrease in the immobility time in TST model only but not in FST. Citalopram (5 mg/kg) and ketamine (17.5 mg/kg) caused insignificant decrease in immobility time in both the models. Moreover, ketamine in combination with Citalopram significantly reduced the immobility time in both the models. Glycine at a dose of 100 mg/kg (but not 50 mg/kg) significantly increased the immobility time in both the models as compared to control group. Further, ketamine when administered with glycine caused increase in the immobility time on both the paradigms, though insignificant.

Conclusions: Ketamine demonstrated antidepressant like action in both TST and FST models. Moreover, it potentiated the antidepressant effect of citalopram that might be due to the role of NMDA receptors.

Use of liraglutide in the patient with obesity and type 2 diabetes mellitus: a literature review

Jorge A. Diaz Cancino, Cristian J. Sosa Álvarez, Karen A. Zebadúa Ramírez — Fri, 25 Aug 2023 00:00:00 +0000

Obesity and type 2 diabetes mellitus represent two of the most pressing public health challenges globally. In recent decades, an alarming increase in the prevalence of both conditions has been observed, which has led to a significant increase in the burden of disease and an increased search for effective therapeutic strategies. As evidence accumulates on the efficacy and safety of Liraglutide in this patient population, a comprehensive review of the available scientific literature is necessary. The objective of this literature review is to analyze and synthesize relevant studies investigating the use of liraglutide in patients with obesity and type 2 diabetes mellitus, in order to provide a comprehensive view on its effectiveness, indications, complications and management. In conclusion, the use of liraglutide in patients with obesity and type 2 diabetes mellitus has been shown to be an effective therapeutic option to improve glycemic control, promote weight loss and reduce cardiovascular risk. This drug, as a GLP-1 receptor agonist, stimulates insulin secretion, suppresses excessive glucagon release and delays gastric emptying, which contributes to the improvement in glycemic control.

Formulation and evaluation of herbal hair serum-a review

Fri, 25 Aug 2023 00:00:00 +0000

In the mammalian system the hair follicle is known to the most significant organ that determine, appearance, gender distinction, provides intense temperature protection and plays a role in self-defence. The younger generations have begun to suffer extreme hair loss problem due to many reasons. The hair loss is not temporary in most cases. but it results in alopecia. Many people suffering from hair loss is in search of multiple treatments due to extreme anxiety and tension. To improve hair growth and to prevent hair loss, hair root activation is required. Citrus sinensis is used to antidandruff protection hair care. It’s had antibacterial and anti-inflammatory properties. Nigella sativa improves the shine, strength, volume, and texture of hair. Flax seed is full of fatty acids and antioxidants that tend to remove pollutants and dead cells from the scalp. Coconut oil may help to moisturise and seal hair. They can help to prevent dry, flaky scalp and dandruff. This review article focuses on the materials required for the formulation of hair serum and various evaluation tests to evaluate hair serum.

Fiction contract: its importance in simulation-based medical education

Hritika Sharma, Anant D. Patil, Ajit Baviskar — Fri, 25 Aug 2023 00:00:00 +0000

Simulation-based education has become an integral part of education and training in high-risk professions and disciplines such as aviation, aerospace, military, nuclear power plants, medicine and healthcare. In the last decade, medical simulation has globally emerged as a powerful instructional technique across various specialties and disciplines. Despite its increasing popularity and various advantages, simulation-based medical education (SBME) poses a unique challenge, that is, realism. This is where the concept of fiction contract or suspension of disbelief comes into the picture. In this article we provide an overview of fiction contract in SBME including how can it be effectively addressed during training.

Pantoprazole induced black hairy tongue: a case report

Divya G. Krishnan, Anukesh Vasu Keloth, Neethu P. — Fri, 25 Aug 2023 00:00:00 +0000

Black hairy tongue (BHT) is characterized by abnormally hypertrophied and elongated filiform papillae, appearing as blackish discoloration on the dorsal surface of the tongue. BHT has been reported as an adverse drug reaction to different categories of drugs. However, pantoprazole induced BHT has been rarely reported. We present the case of a 42-year-old female, admitted in the surgery ward with postoperative wound infection, for which she was prescribed oral clarithromycin and pantoprazole. On the third day of starting medications, she complained of blackish discoloration on the dorsal surface of the tongue with an alteration of taste sensation, which was clinically and microscopically diagnosed as BHT. Suspecting BHT as an adverse drug reaction to pantoprazole, it was stopped, while clarithromycin was continued for the full course. She was also advised to scrape her tongue thrice daily, drink adequate fluids and maintain good oral hygiene. On the third day after stopping pantoprazole, black discoloration and alteration of taste sensation resolved completely. WHO-UMC causality assessment scale showed a ‘probable’ association of the adverse drug reaction with pantoprazole. Physicians should be aware of the possibility of BHT with the use of pantoprazole and that it completely resolves on stoppage of the drug, mechanical debridement and good oral hygiene.

Case report on splenic abscess with pleural effusion caused by enteric fever

Fri, 25 Aug 2023 00:00:00 +0000

Splenic abscess is an infrequent complication of enteric fever caused by Salmonella typhi. The incidence rate ranges from 0.14-2%. Clinical manifestations are often nonspecific and may be presented as fever with left upper quadrant abdominal pain and a palpable tender mass. Diagnosis is often difficult and splenic abscess management is based on surgical interventions and antibiotic therapy. In this case report we would like to highlight splenic abscess with left reactive pleural effusion as a rare complication of Salmonella typhi infection.

Anaphylaxis to oral misoprostol in a term pregnant patient who is non-allergic to vaginal misoprostol-a case report

Vineeth V. K., Maria Jose — Fri, 25 Aug 2023 00:00:00 +0000

Misoprostol (PGE1) is a drug that is very commonly used in obstetrics for labour induction. Apart from its side effect of causing congenital malformations in offspring of users who have unsuccessfully used it as an abortifacient, it is considered a safe drug with few side effects. We here report a severe hypersensitivity reaction to misoprostol in a 33-year-old term pregnant patient who is non-allergic to vaginal misoprostol. The patient developed anaphylactic features like swelling of lips, low voice due to laryngeal oedema, and bradycardia. Prompt administration of adrenaline and emergent caesarean section allowed for the safe delivery of the neonate. When inducing labour, quick identification and treatment of anaphylaxis and hypersensitivity reactions are necessary to prevent maternal and neonatal morbidity and mortality.

How ‘pill for every ill’-alarming source of polypharmacy in elderly patient

Saumya Pandey, Reshma Choudhary — Fri, 25 Aug 2023 00:00:00 +0000

According to WHO there is one elderly person i.e., age 60 year or older in every nine people and this value is expected to increase by 2050 accounting for about half of the total growth of the world population. This demographic transition poses a significant challenge for health care authorities as the age advances multiple chronic disease such as hypertension, DM, arthritis, chronic heart disease, renal disease come in to scenario. For the above-mentioned disease an elderly patient has to take life-long medications this leads to polypharmacy.

Brief remission of cardiac conduction defect under anaesthesia during trans-sphenoidal pituitary surgery

Kirandeep Kaur, Manpreet Kaur, Shalvi Mahajan — Fri, 25 Aug 2023 00:00:00 +0000

Acromegaly can cause paroxysmal arrhythmia and bundle branch blocks, which may or may not be symptomatic. Physiological stress induced by anaesthesia can exacerbate cardiac problems; nevertheless, reversal of such problems can also occur despite being uncommonly reported. We describe temporary remission of left bundle branch block (LBBB) to normal sinus rhythm under general anaesthesia.