International Journal of Basic & Clinical Pharmacology
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Methotrexate-induced multi-organ chronic toxicity in a rheumatoid arthritis patient: a case report
Get PDFThis case report highlights the clinical presentation, diagnosis, and management of a 48-year-old female diagnosed with rheumatoid arthritis (RA) who developed toxicity due to prolonged use of methotrexate (MTX) in combination with other immunomodulatory drugs. The patient exhibited erythematous rashes, skin peeling, angular stomatitis, oral candidiasis, symptoms of acute gastroenteritis and pancytopenia. This report discusses the importance of monitoring, managing polypharmacy in patients with chronic diseases, to prevent adverse events and management of drug-induced toxicity in RA patients and improve patient outcomes
Inhaled theophylline: old drug new tricks?
Get PDFTheophylline and aminophylline (i.e., the soluble complex of theophylline with ethylenediamine) have been used in the treatment of respiratory diseases such as asthma and chronic obstructive pulmonary disease for more than 90 years. Theophylline’s narrow therapeutic index and side effects, as well as the discovery of more potent and safer bronchodilators, made it to fall out of favour with healthcare professionals and patients. New scientific knowledge on the molecular mechanism of action of theophylline, along with increasing clinical evidence suggest that theophylline should be exploited as an anti-inflammatory agent rather than a bronchodilator. This review covers the journey of theophylline from rise to fall and back to its potential re-emergence as a combination formulation with inhaled corticosteroids in the management of chronic inflammatory lung diseases. Several approaches to formulate theophylline either as a monotherapy or as a combination therapy for delivery to the lungs are presented
Quality of life in COVID survivors and post COVID manifestations in a tertiary care hospital, Nalanda, Bihar
Get PDFBackground: 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
Assessment of students’ perception on self-directed learning, alignment and integration in competency-based medical education curriculum among first year medical undergraduate students
Get PDFBackground: 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
Anti-diabetic potential and safety profiles of Tephrosia purpurea on streptozotocin-nicotinamide induced diabetes in rats
Get PDFBackground: 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
Case series on anti-melanoma differentiation-associated gene 5+ dermatomyositis associated with interstitial lung disease
Get PDFDermatomyositis (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
A case of drug induced dizziness in a patient on anti-Parkinson drugs
Get PDFParkinson’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
Pantoprazole induced black hairy tongue: a case report
Get PDFBlack 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
Effect of saroglitazar in South Indian patients with diabetic dyslipidemia uncontrolled on a moderate-intensity statin and the association of PPAR α and γ gene polymorphisms with its response
Get PDFBackground: Diabetic dyslipidemia is associated with atherosclerosis risk factors and cardiovascular disease. Saroglitazar is a dual PPAR α and γ agonist approved initially for diabetic dyslipidemia and later for managing non-alcoholic steatohepatitis and hyperglycemia in T2DM. This study was conducted to estimate the association of studied PPAR α and γ gene polymorphisms among patients with diabetic dyslipidemia at baseline and with triglyceride response to saroglitazar administration.
Methods: A total of 54 diabetic dyslipidemia patients who are not controlled i.e., triglycerides (TG)>200 mg/dl with moderate intensity of atorvastatin (≥10 mg) were recruited to the study. All the patients were given saroglitazar 4 mg once daily for 12 weeks. PPARα single nucleotide polymorphisms (SNPs) rs1800206, rs4253778, rs135542 and those of PPARγ gene rs3856806, rs10865710, rs1805192 were genotyped by real-time PCR.
Results: 54 patients (67% female) with a mean age of 48.01±6.73 years were given saroglitazar 4 mg once daily for 12 weeks. There was a significant decrease in TG (36.9%) from baseline of 292.33±83.81mg/dl (mean±SD) to 184.46±95.90 mg/dl (<0.001) and in HbA1c (0.66%) from baseline of 8.5% to 7.8% (<0.001). PPAR α and PPAR γ gene variants did not show any association with TG lowering response.
Conclusions: Saroglitazar 4mg once daily effectively decreases the TG, non-HDL-C levels, and HbA1c with no major adverse events, and TG lowering response is not associated with the studied polymorphisms.
Evaluating the efficacy and safety of simple combination of analgesics with and without low dose opioid for perioperative analgesia, hemodynamic and recovery profile in various surgeries posted under general anaesthesia: a prospective randomised controlled study
Get PDFBackground: Multimodal analgesia is an emerging technique.It has been consistently demonstrated to minimise opioid consumption, related side effects and vital component of enhanced recovery after surgery pathways. The current study presents use of combination of readily available medication as a part of multimodal analgesia. Balanced anaesthesia with multimodal analgesia is harmonious use of combination of agents to produce desired effects with minimal side effects of individual agents.
Methods: This study was done in a tertiary health care centre, Government General Hospital, Kakinada over a duration of two months from August 2022 to September 2022. 60 adult patients of either sex of physical status ASA grade 1and 2 undergoing elective surgery under general anaesthesia were randomly allocated into Group A and Group B of 30 patients. Group 1: received Inj. Lignocaine+Inj. Paracetamol+Inj. Magnesium sulphate+Inj. Fentanyl. Group 2:received Inj. Lignocaine+Inj. Paracetamol+Inj. Magnesium sulphate+Normal saline (control group) as premedication for perioperative analgesia.
Results: All patients were hemodynamically stable for first 30 minutes period of observation in Group A compared to Group B. There is clinically and statistically significant difference in the duration of analgesia in Group A compared to Group B. There is no statistically significant difference in the Numerical Rating Scale (NRS) for pain in both the groups.
Conclusions: This study concluded that simple analgesia combination of multimodal analgesia regimen comprising of Inj. Lignocaine, Inj. Paracetamol and Inj. Magnesium sulphate produces safe and effective analgesia with good recovery profiles and no adverse opioid related side effects for ASA 1 and 2 patients posted under general anaesthesia