International Journal of Basic & Clinical Pharmacology

Phocomelia: is it time to retrospect, regulate and rescue? a case report

Thu, 09 Feb 2023 00:00:00 +0000

Phocomelia is an extremely rare congenital anomaly which presents as, the proximal part of the limb (humerus or femur, radius or tibia, ulna or fibula) being absent or markedly hypoplastic, with normal or near normal hand or foot. True phocomelia presents as the total absence of the intermediate segments of the limb, with the hand or foot directly attached to the trunk. Presented here is a case of phocomelia in an aborted foetus, with no maternal history of thalidomide exposure in her pregnancy and for whom evaluation of other family members/ siblings failed to reveal any substantial abnormality. The differential diagnosis and the significance of reporting of serious adverse drug reactions are discussed.

A case of drug induced dizziness in a patient on anti-Parkinson drugs

Wed, 22 Feb 2023 00:00:00 +0000

Parkinson’s disease (PD) is the second most common age-related neurodegenerative disease, exceeded only by Alzheimer’s disease. Clinically, PD is characterized by resting tremor, rigidity (stiffness), bradykinesia (slowing), and gait dysfunction with postural instability. These are known as the classical or “cardinal” features of the disease. Levodopa remains the most effective symptomatic treatment for PD and the gold standard against which new therapies are compared. Levodopa is routinely administered in combination with a peripheral decarboxylase inhibitor to prevent its peripheral metabolism to dopamine and the development of nausea, vomiting, and orthostatic hypotension. The major concern with levodopa is that chronic levodopa treatment is associated with the development of motor complications, nausea and dizziness in the large majority of patients. We are here reporting a case of Syndopa plus (Levodopa+Carbidopa) induced dizziness in a 76 years old male patient on anti- parkinsonism treatment. The causality assessment was done by Naranjo scale. The causality of Syndopa plus in the case was “probable” as per Naranjo scale. The patient was managed by reducing the dose of Syndopa plus to the half of it’s initial dose. The case was recorded properly in adverse drug reaction reporting form and was sent to nearby ADR (adverse drug reaction) monitoring centre.

Takayasu arteritis associated with tuberculosis: a case report

Wed, 22 Feb 2023 00:00:00 +0000

Takayasu arteritis, also called pulseless disease, is the chronic inflammation of the vessels, mainly the aorta and large vessels. It mainly affects females more than males with the ratio of 2.15:1 and in the second and third decade of life. Mechanism may be transmural fibrous thickening of the arterial walls. Takayasu’s is characterized by granulomatous inflammation of the vessel wall, leading to occlusion of the vessel wall. It is represented with claudication, fever, arthralgia. Clinical features are chest pain, vascular bruits, Hypertension. Investigation is based on angiography and CT scan. Medical treatment prednisolone is the first line agent 1mg/kg/day maximum dose is 60mg/day with gradual tapering as per European league against rheumatism guidelines, methotrexate and azathioprine are for inducing remission of arterial lesions, tumour necrosis factor-a antagonists, anti-IL-6 receptor monoclonal antibody like tocilizumab. Surgical treatment is angioplasty and stenting renal artery stenosis but less invasive and safest method is percutaneous transluminal angioplasty (PTA). Takayasu arteritis might be associated with Tuberculosis, yet, the relationship and mechanism are not clearly understood. Here we report a case of Takayasu arteritis associated with tuberculosis.

A case of drug induced oral erythema multiforme

Wed, 22 Feb 2023 00:00:00 +0000

Erythema multiforme (EM) is an acute, self-limited, usually mild, and often relapsing mucocutaneous syndrome. It occurs predominantly in younger age group with slight male preponderance. The classical cutaneous target lesions and mucosal bullae or erosions are clinical manifestations of EM. Drug induced oral EM a rare clinical entity which involves only the lips and oral mucosa without skin involvement. These lesions are difficult in diagnosing with other oral ulcerative lesions with similar clinical manifestations. Here we are reporting a case of phenylbutazone induced oral EM. The causality of phenylbutazone in the reaction was “probable” as per Naranjo scale and seriousness of the reaction was “prolonged hospitalization”. The patient was managed by immediate withdrawal of the suspected drug along with conservative managements to prevent secondary infections. The patient was discharged successfully after 15 days of admission.

Comparison of microvascular endothelial function as measured by laser Doppler flowmeter among non-smoker and smoker males

Thu, 09 Feb 2023 00:00:00 +0000

Background: To understand the role of smoking in influencing endothelial function as assessed by LDF among non-smoker and smoker males.

Methods: The LDF measurement for a total of 35 non-smokers and 16 smokers was done in the central research laboratory after written informed consent. The change in LDF signal in response to acetylcholine 100 µl, which was delivered to the forearm skin by iontophoresis, was measured as perfusion units (PU).

Results: The pre-ACh LDF signal were statistically not significant between the groups. The increase in LDF signal was more prominent in non-smoker group. The LDF signal parameters such as differences in minimal response pre and post-ACh; difference in mean response pre and post ACh; the difference in maximal response pre and post ACh was not statistically significant between groups. However, the difference in the area under curve (AUC) pre and post-ACh (PU.min) (non-smoker 20089.34 (3438.92) vs smoker 13220.72 (3379.52); p=0.16) showed a trend towards statistical significance.

Conclusions: Microvascular endothelial function as assessed by LDF signal among smokers (pack-years;1.9±1.44) and non-smokers is statistically insignificant. However, lower microvascular endothelial function is observed among smokers.

Prescription pattern in ischemic heart disease inpatients at B. P. Koirala Institute of Health Sciences: a cross sectional study

Wed, 25 Jan 2023 00:00:00 +0000

Background: Drug utilization pattern studies seek to screen, evaluate and suggest appropriate modifications in prescription practices. It would help to make patient care rational and cost effective. Objective was to analyze the drug prescribing pattern for treatment of ischemic heart disease (IHD).

Methods: A prospective cross-sectional observational study was conducted in patients of IHD admitted in intensive coronary care unit and medicine ward for the period of six months. Data were collected in preformed case record form. The data were analyzed for drug use indicators, demographic parameters, morbidities, pattern of drug use using Microsoft excel 2010.

Results: A total of 145 patients were enrolled out of that 89 (61.38%) were males. The mean age was 60.01±12.71 years and majority (26.89%) belonged to age group of 61-70 years. A total of 1208 drugs were prescribed in 145 patients. Most frequently prescribed drugs were antiplatelet group of drugs 100% encounters, followed by hypo-lipidemics (98.62%). Average number of drugs per encounter was 8.33 and percentage of drugs prescribed by generic name was 5.04%.

Conclusions: IHD was more common in males than females. The most commonly prescribed drug classes were anti-platelet drugs followed by hypolipidemic agents.

Improving an online higher education pharmacology course based on students’ perception

Marianela E. Traetta, María S. Viola, Juan Mauricio Minoia — Wed, 22 Feb 2023 00:00:00 +0000

Background: The COVID-19 pandemic outbreak transformed education thoroughly. Our in-classroom Pharmacology course had to be adapted precipitously into a completely online modality. Hence, we aimed to evaluate its efficacy for learning and improve it based on our students’ perception.

Methods: Semi-open questionnaires were designed and applied at the end of the 2020 and 2021 courses to assess students’ satisfaction on the following fields: eLearning platform, lectures, synchronous discussion section, asynchronous collaborative work, and assessments. Data from the first online course was analyzed and evidence-based improvements were performed for the 2021 course. Quantitative comparison of cohorts was carried out. Furthermore, students’ perception from the last in-person course (2019) was analyzed.

Results: The 2019-course questionnaire demonstrated a good acceptance towards an incipient use of the virtual campus. Comparison of the complete online cohorts revealed a significant increase in positive answers in six items: complementarity of lectures with discussion sections (85% vs. 100%), teaching strategy (30% vs. 84%), adequacy of faculty’s role (47% vs. 79%), pre- and post-class activities (30% vs. 55%), wording of exercises (30% vs. 55%) and assessments (50% vs. 97%). Moreover, a modification of the students’ requests expressed in the comment section was observed.

Conclusions: Custom-designed semi-open questionnaires used to evaluate students’ perception and receiving feedback on the Pharmacology course provided high quality information to promote student-oriented changes that allowed for an improvement in the teaching-learning process.

Evaluation of the antiulcer and antimicrobial activities of methanol leaf extract of Helianthus annuus

Wed, 22 Feb 2023 00:00:00 +0000

Background: Medicinal plants are widely used in treating and preventing specific diseases and are known to play an important role in health care. Helianthus annuus is one of such plants whose therapeutic applications no doubt have numerous folkloric background. This study aimed at assessing Helianthus annuus methanol leaf extract for antiulcer and antimicrobial potentials

Methods: The antiulcer activity was evaluated using aspirin, ethanol and histamine methods in Wistar rats, while the antimicrobial activity was carried out on selected microorganisms. The acute toxicity test and phytochemical screening of the extract were also conducted.

Results: The methanol leaf extract exhibited significant (p<0.05 and p<0.01) antiulcer effect in both model. The ulcer protection effect of the extract is comparable to omeprazole. The extract also significantly inhibited the growth of test organisms. The acute toxicity test produced no lethality in rats, whereas the phytochemical analysis revealed the presence of alkaloids, saponins, tannins, flavonoids, terpenoids and steroids.

Conclusions: The findings confirm the ethnomedicinal use of H. annuus leaf as a valuable natural agent for the treatment of ulcer and microbial infections.

Prescription pattern of non-steroidal anti-inflammatory drugs among patients admitted with fever in a tertiary hospital

Sat, 18 Feb 2023 00:00:00 +0000

Background: WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately. Nonsteroidal anti-inflammatory drugs are a group of drugs that are commonly prescribed for the treatment of fever associated with pain and inflammation. The objective was to assess the prescribing pattern of NSAIDs in fever patients. Along with this, we looked at the clinical indications for prescribing and the pattern of prescribing with respect to use of generic or trade names.

Methods: This observational study was conducted in a tertiary care teaching hospital in Malappuram district of Kerala, India by extracting data of inpatients retrospectively from medical records for a six-month period. The reported prevalence of NSAID use in previous study was 20%, with a relative precision of 18% the sample size required was 500. The data was analyzed and expressed as absolute numbers and/or percentages.

Results: Out of these 500 patients, Dengue fever was the most common diagnosis (86.6%) followed by Typhoid (2.8%) and Leptospirosis (2.4%). Among these, 392 (78.4%) received any of the NSAIDs. The most commonly prescribed drug was Paracetamol (77.04%). Among to the prescriptions, 91.7% were prescribed with generic names. As concomitant medications, antibiotics were prescribed at 21.2% cases, gastro protective agents were prescribed to 24.23% and vitamins were prescribed in 72.6% cases.

Conclusions: This study has shown that the prescribing, usage and preferences of NSAIDs practiced rationally. No over use, under use or misuse of drugs was noticed.

Extracts of Neptunia prostrata Linn. ameliorates progression of diabetes mellitus and hyperlipidemia in animal models

Wed, 22 Feb 2023 00:00:00 +0000

Background: The herb Neptunia prostrata Linn. belonging to the family Mimosaceae has been used in folkloric medicine in the North-eastern states of India of Assam, Tripura and Meghalaya by indigenous herbal healers since time immemorial but there is a scarcity of any background study documenting its use as an antimicrobial herb. For the same, plants were collected and authenticated.

Methods: Following identification of these herbs methanolic, ethanolic, pet ether and chloroform extracts were prepared using soxhlation. Acute toxicity study as per OECD guidelines 420 was assessed in wistar albino rats and in swiss albino mice (n=5) of both sexes at doses of 2000 mg/kg body weight and did not reveal any morbidity or mortality in the animals within the stipulated period. Phytochemical screening was performed on all four extracts of Neptunia prostrata.

Results: Phytochemical constituents depicted presence of glycoside, flavonoids in only ethanolic, methanolic and chloroform extracts. Alkaloids were present in the chloroform extract. The antidiabetic and antihyperlipidemic activity was performed by HFD-STZ models in rats. The herbs showed antioxidant activity comparable to standard antioxidants in-vitro such as Ascorbic acid (Vitamin C) with comparable IC₅₀ values.

Conclusions: Results of the antidiabetic shows immense potential in animal models and therapeutics and the antibacterial screening suggests conspicuous and potent putative role in the therapeutics of a vast plethora bacterial infections that need to be corroborated for the expansion of future prospective in vivo studies with larger sample size.

Celastrus paniculatus and memantine prevent alcohol dependence and improve decision making in alcohol dependent C57BL6 mice

Wed, 22 Feb 2023 00:00:00 +0000

Background: Alcohol use disorder poses a huge burden with only a handful of approved drugs. AUD is associated with impaired decision-making that leads to compulsive drinking despite negative consequences. A drug that decreases alcohol consumption as well as improves decision-making may thus prove more useful. This study was planned to evaluate the effect of two drugs, Celastrus paniculatus and memantine on alcohol preference and decision impairment in alcohol-dependent mice.

Methods: In part 1, the effect of both the study drugs on alcohol consumption was studied using intermittent access model in 70 male C57BL6 mice. In part 2, effect of drugs on decision making was studied using the rodent version of Iowa gambling task. Mice were divided in seven study groups: Group 1-3: Celastrus paniculatus (140, 280, and 560 mg/kg), Group 4: memantine (25 mg/kg), Group 5: vehicle control 1 (Milk), Group 6: vehicle control 2 (normal saline) and Group 7: naltrexone(1mg/kg).

Results: Percentage alcohol preference was lower in test groups i.e., Celastrus paniculatus at medium (40.90±15.18%) and high doses (31.79±7.46%) vs. milk (82.74±8.53%; p<0.05); and in memantine group (36.28±10.99%) vs. normal saline (83.27±5.51%; p<0.05). The results were not significantly different to Naltrexone (19.70±6.90%). Percentage preference to disadvantageous arms was also lower in Celastrus paniculatus, at medium (50.52±1.92%) and high doses (48.11±2.43%) compared to milk (54.47±2.73%; p<0.05) and memantine (47.45±1.67%) compared to normal saline (54.00±2.73%; p<0.05), indicating better decision-making ability in the test groups. The findings were comparable to Naltrexone group (45.43±2.52%).

Conclusions: These results indicate that Celastrus paniculatus and memantine reduce alcohol consumption and improve decision making in alcohol-dependent mice.

Comparing the antiepileptic effects of atorvastatin, celecoxib, ashwagandha, clove oil, and Sodium valproate on chemo-shock induced seizures in male Wistar albino rats

Wed, 22 Feb 2023 00:00:00 +0000

Background: Antiepileptic potential of statins, COX inhibitors and other herbal medications are to be evaluated in experimental animals so that the most efficacious can be translated for human use as an adjunct to the commonly used anti-epileptic drugs.

Methods: This experimental animal study grouped 30 male Wistar albino rats into 6 groups with each containing 5 rats of which one group was control, one was the standard drug and the other 4 were treatment groups which received Atorvastatin, Celecoxib, Ashwagandha and Clove oil. These drugs were administered 30 minutes prior to administering Pentylene-tetrazole which induced convulsions and the various seizure parameters were analysed. The blood samples of the animals were also assessed for anti-oxidant activity by measuring superoxide dismutase and catalase levels in the blood.

Results: The onset of seizure was significantly delayed by Ashwagandha (2.55±0.94), similar to the latency shown by the standard drug (2.09±1.21). The duration of convulsions was very significantly reduced in all the 5 drug groups in comparison to the control (p<0.001). The clonic jerk duration was not reduced as effectively as the standard drug. The duration of recovery time amongst the various groups was also significant (p<0.05). The SOD and Catalase levels of no groups showed any possible association between the anti-epileptic efficacy of these drugs and the anti-oxidant enzyme levels.

Conclusions: Ashwagandha has good anti-epileptic efficacy not less than the standard drug when the various drug groups were compared.

A prospective, randomised, open label study to compare efficacy and safety of hydroxychloroquine and teneligliptin in patients of type 2 diabetes mellitus refractory to concomitant metformin and glimepiride

Manisha Anand, Gurpreet Kaur Randhawa, Surinder Kumar Salwan — Wed, 22 Feb 2023 00:00:00 +0000

Background: Diabetes mellitus is chronic, metabolic disease characterized by hyperglycemia, which over time causes both microvascular and macrovascular complications. If HbA₁c target is not achieved with dual therapy then 3^rd drug is added. Aims of present study were to compare efficacy and safety of Hydroxychloroquine (HCQ) and Teneligliptin in patients of T2DM who are refractory to concomitant Metformin and Glimepiride.

Methods: It was interventional, randomized, prospective, parallel and open-label study. Patients were randomly divided into 2 groups either HCQ 400mg OD or Teneligliptin 20mg OD were added to their current treatment using Metformin 1gm BD and Glimepiride 4 mg OD as 3^rd drug. Follow up was done every 15 days for 12 weeks and underwent assessment of glycaemic parameters (FBS, PPG, HbA₁c), LFT, RFT, CBC, ADRs and VAS in addition to anthropometric parameters.

Results: After 12 weeks of treatment, HCQ group showed statistically (p<0.05) better improvement in BMI than Teneligliptin group. Both groups showed comparable improvement (p>0.05) from baseline in FBS, HbA₁c, PPG and VAS score. In HCQ group there was significant number (p<0.05) of patients who achieved target glycaemic control (HbA₁c ≤7.5%) i.e., 56.6%, compared to 37% with Teneligliptin group. Both groups had comparable (p>0.05) safety profile with no serious adverse effects and no significant change (p>0.05) in hepatic, renal and complete blood profiles.

Conclusions: On the basis of effects of HCQ on the glycaemic parameters and BMI, HCQ may be preferred over Teneligliptin in patients of T2DM who are refractory to concomitant Metformin and Glimepiride.

Quality of life in COVID survivors and post COVID manifestations in a tertiary care hospital, Nalanda, Bihar

Shreya Shekhar, Aman Kishor, Zaki Anwar Zaman — Wed, 22 Feb 2023 00:00:00 +0000

Background: COVID-19 pandemic had affected majority of the population across the world. Majority of the cases still complaining of post COVID symptoms. This study was undertaken to study the various pattern of post COVID-19 manifestations in this region in a group of patients attending hospital.

Methods: An observational study was undertaken in a group of 120 patients attending a tertiary care hospital. The patients were subjected for a detailed history and thorough physical examination and the details were entered in to a proforma. The data thus obtained was compiled and analysed.

Results: This study had shown than majority of cases were aged more than 50 years and most of them were females. The common post COVID-19 manifestations included joint pain, continued loss of taste and smell, dyspnoea, Anxiety/ depression and sleep disturbances in this study.

Conclusions: This study had observed continued symptoms from the episode of disease varying from mild to severe manifestations. This study urges for a comprehensive rehabilitation program for all COVID-19 patients.

A prospective observational study of demographic profile in patients of amoebic and pyogenic liver abscesses in a tertiary care hospital

Arun Walwekar, Mrutyunjay Mirje, Namrata Balaraddiyavar, Rekha Walwekar — Wed, 22 Feb 2023 00:00:00 +0000

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. Pyogenic liver abscess is a serious, life-threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. In India, due to poor sanitary condition and a lower socioeconomic status, amoebiasis is endemic and amoebic liver abscess accounts for 3-9% of all cases of amoebiasis. Aim and objectives of current study was to study demographic profile in patients of amoebic and pyogenic liver abscesses.

Methods: A detailed history was taken from each of these patients and all of them were subjected to a through clinical examination.

Results: The highest incidence occurred in the age group 31-50 years; males were more commonly affected than females. Fever and pain abdomen were the most consistently occurring symptoms. All the patients with liver abscess had abdominal tenderness. 17 patients (74%) with liver abscess were alcoholics. 8 patients (80%) with amoebic liver abscess were alcoholic as compared to 9 patients (69%) in pyogenic liver abscess.

Conclusions: Pyogenic organisms were most common cause of liver abscess.

Assessment of students’ perception on self-directed learning, alignment and integration in competency-based medical education curriculum among first year medical undergraduate students

Netravathi B. Angadi, Vidya Mahalmani, Jayasheela Bagi, Nayana Hashilkar — Wed, 22 Feb 2023 00:00:00 +0000

Background: The introduction of competency-based medical education curriculum in India has endorsed many new concepts, like foundation course, self-directed learning, early clinical exposure, etc. There has been paradigm shift from teacher centered to student centered learning. Integration of the curriculum has been evolved as an important strategy in the current system of Competency based medical education and SDL is essential to enable medical students to develop independent learning skills, increased responsibility, assertiveness and accountability which are key attributes to a medical professional’s career. Literature search could not retrieve many studies in Indian context, hence this study was conducted to determine the perception of students’ on self-directed learning, alignment and integration in CBME curriculum among first year medical undergraduate students.

Methods: It was a cross sectional study conducted among first year medical students. After obtaining informed consent, data was collected using a pre-validated questionnaire having SDL instrument and proforma to assess the students’ perception on alignment and integration. Students were asked to rate on a 5-point Likert scale. A total of 174 students completed the questionnaire. The data is expressed as means and percentages.

Results: In the present study students opined that SDL helped them to establish their learning goals. Students also opined that alignment and integration is beneficial for in depth understanding of the subject and also to prepare for exams.

Conclusions: Incorporation of SDL and aligning and integrated curriculum has helped students in better understanding and correlation of subjects across the phase. The joint efforts by the facilitators and students themselves may be helpful to make students independent and lifelong learners.

A randomised comparative study of induction of labour with sublingual misoprostol 50 μg and oral misoprostol 50 μg in term patients

Neha Nimbark, Paramtap M. Joshi, Mittal I. Joshi — Wed, 22 Feb 2023 00:00:00 +0000

Background: Current study was conducted to compare the efficacy of tab Misoprostol 50 microgram by oral and sublingual routes for induction of labour.

Methods: A randomised comparative study of induction of labour in 200 cases of pregnant women at term and were divided into two groups of 100 each for 50 µg Misoprostol for oral and sublingual route repeated 4 hourly either by sublingual or oral route until an adequate contraction pattern set in (establishment of 3 uterine contractions in a period of 10 minutes) or once the cervical dilatation reaches 4 cm, maximum up to 6 doses. The patients were monitored for maternal vital signs, progress of labour and foetal heart rate.

Results: In this study, 86% women delivered vaginally with sublingual misoprostol while 76% were delivered vaginally with oral administration. In the present study, no significant maternal side effects were noted in either group. 4% cases of neonates in sublingual group and 6% cases of neonates in oral group required NICU admission. No still birth or neonatal deaths were seen.

Conclusions: Our study shows that sublingual Misoprostol has better efficacy, shorter induction to delivery interval, requirement of fewer doses of misoprostol when compared to oral route.

Effects of carbonated beverage and fruit juice on salivary pH among children in orphanage of Bareilly city: an in vivo study

Wed, 22 Feb 2023 00:00:00 +0000

Background: High degree of urbanization and economic development have resulted in rapid changes in diet and lifestyles, because of which there is a tremendous increase in prevalence of dental caries in developing countries. The aim of the study is to assess the acidogenic potential of commonly consumed carbonated beverage and commercially available fruit juice at various time intervals among orphan children.

Methods: This is an in vivo study in which 60 orphan children were included. Two beverage groups (carbonated beverage and fruit juice) were tested for salivary pH before having respective drinks (baseline) and after having drinks at specific time intervals (immediately after, after 15 min and 30 min). Intra-group and inter-group comparisons were done using Friedman test and Mann Whitney U test.

Results: Both the groups showed decrease in salivary pH after consumption and recovery of salivary pH to baseline value after 30 min.

Conclusions: Beverages produce a remarkable drop in the salivary pH as they contain organic acids and sugars but saliva by virtue of its buffering capacity nullifies this effect and after some time it comes to normal.

General population perceptions and attitudes toward COVID-19 booster vaccinations and the mask mandate as we approach the end of 2022: a pan India online survey

Wed, 22 Feb 2023 00:00:00 +0000

Background: The Coronavirus disease 2019 (COVID-19) exploded into a global pandemic, killing over 6.5 million people and forever changing the world. While many developed countries are well into their vaccination campaigns, India outperformed global expectations by providing over 2 billion doses to its citizens and assisting other countries worldwide. Following the emergence of various covid variants, it is critical to comprehend the willingness of Indians to receive additional doses of the newer generation of covid vaccination, as well as the fatigue associated with maintaining the most essential covid appropriate behaviour, masking. This study aimed to determine general public attitudes and perceptions of the COVID-19 vaccine in India.

Method: A pan-India cross-sectional analysis was conducted at RUHS college of medical sciences, Jaipur, between October 20, 2022, and December 15, 2022. Through web-based links, a self-administered and semi-structured questionnaire was used to collect data.

Results: Of the total responses received (n=391), 55.6% were males, and 43.8% were females. 63.2% have received two doses of the vaccine, while 33.8% have received three doses. 50.9% of respondents were willing to take the fourth dose of the vaccine, 20.5% were utterly unwilling, and 28.6% were undecided. 10.7% of our respondents were utterly reluctant to wear masks, whereas 26.6% always did.

Conclusions: Based on the findings, vaccination acceptance in India remains high with 50.9% of applicants willing to take the fourth dose. Furthermore, the pandemic has resulted in the incorporation of face masks into our lifestyles, with the majority of people using a face mask in at least one setting.

Evaluation of prescription pattern of antimicrobials in the treatment of respiratory tract infections in pediatric patients attending a tertiary care hospital

Wed, 22 Feb 2023 00:00:00 +0000

Background: Irrational use of antimicrobials is a complex and multifactorial problem in developing countries. Prescriptions not adhering to the treatment guidelines, self-medication, inappropriate use of drugs by patients can inadvertently lead to development of antimicrobial resistance. An observational study was designed to evaluate antimicrobial use in pediatric population with respiratory tract infections and its adherence to national treatment guidelines.

Methods: This was a cross sectional observational study initiated after taking institutional ethics committee permission. The prescriptions of children diagnosed with upper respiratory tract infections and lower respiratory tract infections (LRTI) were screened. Their demographic profile and details of drugs prescribed were recorded.

Results: Out of 230 pediatric prescriptions,155 (67%) were from outpatient department and 75 (33%) from those admitted in ward. Total 145 children were diagnosed with URTI whereas 85 had LRTI. In this study, 60 children with URTI received combination of amoxicillin and clavulanic acid (Co-amoxiclav) whereas 66 children with LRTI received Co-amoxiclav,18 ceftriaxone (N=18), 6 vancomycin (N=6) and 18 were prescribed oseltamivir (N=18), either alone or in combination. Other drugs prescribed included, paracetamol for fever and cough syrups. Out of 195 drugs prescribed by brand names, 138 (70.8%) were antimicrobials. Fixed dose combination amoxicillin and clavulanic acid, paracetamol and cough syrups were available from hospital pharmacy. None of the prescriptions had polypharmacy.

Conclusions: URTI was treated using single antimicrobial whereas LRTI was treated with more than one antimicrobials or combination of antimicrobial and antiviral agent. The prescriptions were in accordance with the national treatment guidelines.

An observational study on dapagliflozin as an add-on therapy in type-2 diabetes mellitus patients in a tertiary care teaching hospital

Wed, 22 Feb 2023 00:00:00 +0000

Background: Diabetes mellitus is one of the prevalent morbid conditions all over the world and no exception for India. Day by day, increase in its prevalence is attributed to lifestyle derangements. To treat this condition many drugs and treatment modalities are developed. Dapagliflozin is an oral antidiabetic drug which acts by sodium-glucose cotransport-2 (SGLT-2) inhibition. Its effectiveness seen in type-2 diabetes mellitus makes it an option for Add-On therapy.

Methods: This study is a retrospective observational study conducted at tertiary care hospital, GGH, Kurnool. The study proposal has been reviewed and approved by institutional ethics committee. All adult diabetic patients who were prescribed Dapagliflozin during the period of January 2021 to February 2022, total 45 were included in the study. FBG, HbA1c collected through hospital records from General Medicine and Endocrinology. Patients who stopped drug before 3 months period were excluded.

Results: Administration of dapagliflozin as an add-on therapy was found 26.63% decrease in base line mean FBG 184 mg/dl to 135 mg/dl after 3mnoths which is significant (p=0.001). Mean HbA1c significantly reduced by 0.96 percentage point after 3 months (p=0.001). Dapagliflozin effectively reduced the FBG and HbA1c when used in combination with other OHAs or insulin within 3 months.

Conclusions: Dapagliflozin as an add-on therapy significantly reduced the HbA1c level and fasting blood glucose of Type-2DM patients, in a 3-month treatment period. Due to the frequency of Genitourinary tract infections, caution is indicated while treating the patients.

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

Wed, 22 Feb 2023 00:00:00 +0000

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.

Anti-diabetic potential and safety profiles of Tephrosia purpurea on streptozotocin-nicotinamide induced diabetes in rats

Deepti V. D., Kavitha R., Seshathri E. — Wed, 22 Feb 2023 00:00:00 +0000

Background: Tephrosia purpurea was traditionally used for the management of diabetes mellitus. Since this claim has not been investigated scientifically, the aim of this study was to evaluate the antidiabetic activity of Tephrosia purpurea extracts against STZ-Nicotinamide induced diabetes in rat.

Methods: This preclinical study was done to evaluate the anti-hyperglycaemic activity of whole plant extract of Tephrosia purpurea in STZ- Nicotinamide induced diabetic rats, which produced a significant difference in blood glucose, lipid profile, renal and liver profile in comparison to untreated rats. In this study, the animals were divided into five groups and diabetes was induced by administering STZ-Nicotinamide and animals with blood sugar level >200 were enrolled in the study. Further the animals are grouped into Group I control (0.1% CMC), Group II, diabetic control and Group III reference control received glibenclamide. Group IV and V, diabetic rats treated with Tephrosia purpurea extract 200 mg/kg and 400 mg/kg respectively. All the test drugs were administered for 30 days.

Results: In diabetic rats, treated with 200 and 400 mg/kg of Tephrosia purpurea blood glucose level significantly lowered on 10th day (p<0.05) and 5th day (p<0.01) respectively as compared to untreated rats. At the end of 30th day there is significant reduction in blood glucose treated with TP 400 mg/kg (p<0.001). Safety assessment shows the protective effect of TP (400 mg/kg) on lipid profile TC, TG (p<0.001), HDL (p<0.001), LDL (p<0.001) and VLDL (p<0.01). It also shows protective activity against AST (p<0.001), ALT (p<0.01), ALP (p<0.001) and Renal functions BUN (p<0.001), Creatinine (p<0.001).

Conclusion: The anti-hyperglycaemic activity of Tephrosia purpurea is brought out in the study by its significant reduction in the blood glucose level. The safety and efficacy is established based on the protective effect of Tephrosia purpurea in lipid profile, renal and hepatic function of diabetic rats.

A study of assessment of knowledge, attitude and practice of antibiotic stewardship among healthcare providers in a tertiary care hospital of Sangli

Wed, 22 Feb 2023 00:00:00 +0000

Background: Antimicrobials are routinely used for variety of clinical conditions but are also misused leading to drug resistance bacteria in clinical practice. Consultants can gain the knowledge about it and can also have the depth of problem faced, their prescribing behavior mainly depends on their attitude and understanding of condition. Our aim of this study is to evaluate the knowledge and beliefs about antibiotics prescribing among health care workers in a tertiary care hospital of Sangli.

Methods: Our present study was conducted in the Bharati hospital, BV (DU) medical college and hospital, Sangli. Ethical clearance from the institutional ethics committee was obtained and it was, cross-sectional questionnaire-based study carried out in the form of a survey in which a pretested, semi-structured, validated questionnaire was provided to junior residents, senior residents and faculty of different specialties and responses were recorded. Questionnaire comprises of 9 in knowledge, 10 in attitude and 10 in practice section.

Results: Out of all participants 84.5% believed that no need of antibiotics for running and blocked nose. Majority 89.6% were expressed that sample culture should be sent before starting antibiotics. 90.4% participants believed that education of patients will help. Only 76.8% strictly adhere to the antibiotic policy of our hospital.

Conclusions: The present study on antibiotic usage gives useful information about the knowledge, attitudes and practices of prescribers and help plan suitable educational modifications that aim at improving the antimicrobial prescribing and minimizing the development of drug resistance in our developing country.

Essential drug list for cardiovascular diseases in a tertiary health care centre

Wed, 22 Feb 2023 00:00:00 +0000

Background: Essential medicines are those that satisfy the priority health care needs of a population. The latest version of NLEM is the 23^rd list, published in September 2022, and contains 384 essential drugs, of which 29 are cardiovascular drugs. The drugs in the list may be huge or small according to the local needs. The objectives of our study are to prepare the essential drug list for cardiovascular disease in a tertiary care hospital and to confirm the essential drug list provided and its availability in the pharmacy.

Methods: We interviewed around 28 consultants from various departments who prescribe these cardiac drugs. The names, doses and dosage forms were noted. The list was verified with the NLEM 2022 and counterchecked in the hospital pharmacy.

Results: Most consultants adhered to NLEM, but an additional 42 drugs were prescribed, amounting to 71 drugs. There are four drugs Warfarin, Rivaroxaban, Furosemide and Torsemide which may be considered for the hospital pharmacy list.

Conclusions: Too many drugs other than those present in the NLEM list are prescribed, which can be reduced by adequately training the consultants to adhere to the prescribed list.

Appropriateness of antibiotic prescribing for upper respiratory tract infection in a tertiary care teaching hospital: a cross sectional study

Margi Shah, Niyati A. Trivedi, Janki Chauhan — Wed, 22 Feb 2023 00:00:00 +0000

Background: Overuse of antibiotics among the patients with upper respiratory tract infection (URTI) is a worldwide problem, leading to antimicrobial resistance. This study is aimed to evaluate the appropriateness of the antimicrobial prescribing for upper respiratory tract infections in a tertiary care teaching hospital.

Methods: This was a cross-sectional, observational study. Data was collected from outdoor adult patients who were clinically diagnosed to have URTIs from General Medicine and Otorhinolaryngology Department of a tertiary care teaching hospital. The appropriateness of antibiotics used in URTI was assessed. The data was analyzed using descriptive statistics.

Results: Total 100 cases, clinically diagnosed to have URTI were included in the study. Among these, common cold (46%) and acute otitis media (23%) were the most frequent encounters. 75% of the prescriptions contained at least one antibiotic. In fact, antibiotics were the most commonly prescribed agents (21.2%) followed by antihistaminic (19.8%) and NSAIDs. 57% of the antibiotics were prescribed inappropriately, either in terms of inappropriate choice (37%) or over use (20%) of antibiotic.

Conclusions: Inappropriate prescription of antibiotics for otherwise self-limiting URTI cases is a common practice even in a tertiary care teaching hospital. Implementation of multifaceted approach is needed to curtail the same.

Woman and pregnancy: focus on depression and psychopharmacological therapy

Davide Cristina — Wed, 22 Feb 2023 00:00:00 +0000

Perinatal depression is one of the most common complications of pregnancy: it affects about 10-15% of women; the object of clinical attentionis postpartum depression (PPD) because it involves a impairment of the social and personal functioning of affected women and can have repercussions on the partner on the quality of life, on mother-infant interaction and neurodevelopment of the product of conception. Selective serotonin reuptake inhibitors (SSRI) are generally consideredas first-line antidepressant treatment in pregnancy, as they are generally safe and effective. Studies concerning the adverse effects of exposure to SSRIs during pregnancy on the developing foetushaveindicated an increased risk of various congenital malformations and un toward effects such as poor neonatal adaptation syndrome or persistent pulmonary hypertension, but here still remain inconsistencies between various study results. PPD can be a preventable disorder, there fore it be comes important that integrated actions between different medical sectors (interdisciplinary), diagnosis and any interventions are effective.

Monoclonal antibody: a cell specific immunotherapy to treat cancer

Wed, 22 Feb 2023 00:00:00 +0000

Fundamentally, the therapy technique which is utilized in malignancy immunotherapy, monoclonal antibodies (mAb), is one of them, and it is used extensively as a treatment for the disease. To achieve more successful treatment, novel combination treatments and treatment procedures must be created. The purpose of this study is the improvement of mAb treatment and detail late advance and new limits, particularly in cancer therapy. With various keywords, we searched Google Scholar, PubMed, and Scopus for monoclonal antibody therapy as an alternate form of chemotherapy. The number of patients who received each therapy regimen, and the recovery rate are all displayed in this study, also a comparative study between monotherapy and chemotherapy. The result showed that rituximab had a greater overall response rate than other drugs, at 68%. In the combination treatment group (monotherapy+chemotherapy), 100% of patients had adverse events, compared to 84.2 percent in the monotherapy group. The pharmaceutical industry's fastest-growing medications, monoclonal antibodies are increasingly being examined in Clinical trials as stand-alone treatments or in conjunction with other therapies. It has a promising future since it will provide better tailored therapy and combination therapy for the treatment of cancer.

Immunosuppressive drugs in renal transplantation

Wed, 22 Feb 2023 00:00:00 +0000

A kidney transplant, sometimes known as a renal transplant, is the treatment of choice for kidney failure at end stage renal disease (ESRD). The renal transplant surgery is followed by a lifetime course of immunosuppressive agents, divided into initial induction phase and later maintenance phase. It is seen that the risk of acute rejection is maximum in the initial months after transplantation (induction phase) and then reduces later (maintenance phase). In induction phase there is use of high-intensity immunosuppression immediately after transplantation, when the risk of rejection is maximum and then the dose reduced for long- term therapy. The main challenge in the renal transplantation community is long- term transplant survival. Long-term graft loss is mainly due to acute and chronic graft rejection, and also due to complications of immunosuppressive therapy. Currently, there is triple therapy as conventional immunosuppressive protocol: a calcineurin inhibitor, an antimetabolite agent, and a corticosteroid. The main aim of development of new immunosuppressive agents is not only improvement of short- term outcomes but also to increase the long- term graft survival by less nephrotoxicity, and minimal side-effects.

Does COVID-19 cause erectile dysfunction in males?

Anusha Manda, Are Anusha, Metikala Balaji — Wed, 22 Feb 2023 00:00:00 +0000

The COVID-19 pandemic brought on by the SARS-COV-2 is a novel healthcare problem. A cytokine storm caused by the hyper-inflammation present in this pandemic leads to serious consequences such micro thrombosis. There have been reports of some male genital organs being impacted by very severe illness instances, leading to erectile dysfunction (ED). Given the high rate of COVID-19 transmission, ED could also be a serious outcome for a sizable portion of the population. It is still little understood and is crucial given that the virus has been discovered in pensile tissue. In this account, we sought to compile potential explanations for the ED development driven by COVID-19. The psychological toll of COVID-19 and endothelial dysfunction, which are among the routes of ED, are now better understood according to recent research.

Review: recent trends in management of oral lichen planus

Shubhangi Garg, Sangeeta S. Malik, Nagaraju Kamarthi, Sumit Goel, Swati Gupta — Wed, 22 Feb 2023 00:00:00 +0000

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease, associated with altered cell‐mediated immunological function. It has been characterised by long‐term evolution, repeated exacerbations, sometimes painful and resistant to treatment, or even all of these. OLP significantly affects quality of patient's life. There is a higher risk of malignant transformation accompanied with OLP and similar appearing oral lichenoid lesions. Current OLP therapy aims at eliminating all mucosal‐related lesions reduce symptomatology and decrease the risk of oral cancer. This review summarizes recent treatment modalities used in the management of OLP which includes corticosteroids, immunomodulatory agents, retinoids, ultraviolet irradiation and/or laser therapy, herbal remedies. In addition, focus is also given upon adopting holistic approach in such patients by emphasizing on stress management.

Acute ischemic stroke: management approach

Wed, 22 Feb 2023 00:00:00 +0000

A stroke, or brain attack, happens when blood flow to the brain is stopped. It is an emergency situation. The brain needs a constant supply of oxygen and nutrients in order to work well. If blood supply is stopped even for a short time, this can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. Stroke is the second most common cause of death worldwide and the most important cause of physical weakness, with a growing occurrence in developing countries. Ischemic stroke is the most common type of stroke which occurs due to arterial block and managed by fast reperfusion with endovascular thrombectomy and intravenous thrombolysis. The first step in stroke management is initial identification of patients with stroke and triage to centers accomplished of transporting the suitable treatment, as fast as conceivable. Mobile stroke units, tele stroke and artificial intelligence are technologies playing an important role in recognizing and treating stroke. Stroke system-of-care models remain to streamline the distribution of definitive revascularization in the age of mechanical thrombectomy. Overall, in the present review, we emphasized the pathophysiology, diagnosis and management of acute ischemic stroke (AIS).

Case series on anti-melanoma differentiation-associated gene 5+ dermatomyositis associated with interstitial lung disease

Koya Pranathiya, Are Anusha, Kezia Sam, Anusha Manda — Wed, 22 Feb 2023 00:00:00 +0000

Dermatomyositis (DM) associated with anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody is a rare autoimmune disease. Anti-MDA5, also known as anti-CADM-140 antibodies. DM affects the skeletal muscle, skin, joints, and lungs and is a form of idiopathic inflammatory myopathy (IIM). All the 5 dermatomyositis MDA5+ positive patients had rapidly progressive interstitial lung disease (RP-ILD). DM is classified into 2 types, classic dermatomyositis (CDM) and clinically amyopathic dermatomyositis (CADM). Anti-MDA5 antibody-positive as RP-ILD without signs of DM or CADM. RP-ILD in patients with CADM associated with antibodies to MDA5 has a high mortality rate. MDA5+ DM is diagnosed by DM rashes (Gottron’s papules or Gottron’s sign and heliotrope rash) and a positive anti-MDA5. RP-ILD includes acute/subacute interstitial pneumonia, which is a progressive deterioration associated with ILD. Immunosuppressives are effective agents for the treatment of anti-MDA5-positive RP-ILD of CADM.