International Journal of Basic & Clinical Pharmacology
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Retrospective analysis of a cohort of HIV-infected patients on antiretroviral therapy in Abidjan (2003 to 2017)
Get PDFBackground: Antiretroviral therapy (ART) has been successful in improving clinical outcomes for HIV-positive patients, but efforts are needed to improve life expectancy and quality of life. This study aimed to analyze a long-term ART cohort and assess patients' life expectancy.
Methods: A retrospective cohort study was conducted at the infectious and tropical diseases department of the University Teaching Hospital of Treichville from 2003 to 2017. Data analysis was done using VBA access and XLSTAT 2018 excel software. Patients on post-exposure chemoprophylaxis and prevention of mother-to-child transmission were excluded.
Results: Out of 19,567 patient records, 49.60% were included, 72.43% were in 1st line, and 50.10% were over 50 years old, mostly female 58.49%, 98.4% HIV1. 74.31% had a CD4/mm3 (Nadir) count <350. The patients were essentially on the 2IN+INN regimen (72.31%), TDF + XTC + EFV (20.57%). The average duration under treatment 6.15 [0-13.67] ±3.94 years, the average duration under a line of treatment 4.33 [0-14.04] ±2.96 years. Life expectancy was 10.37 years. It is higher in patients on 2IN+IPr (12.21 years) versus 10.12 years in patients on 2IN+INN. The comparison of duration on a line according to the CD4 counts and the line of treatment did not show a significant difference p>0.05.
Conclusions: The study concluded that ART significantly improved the life expectancy of patients, adherence could be improved to further enhance the benefits of ART. The use of new combinations of ART may reduce events related to non-compliance
Application of precision medicine in medical conditions
Get PDFThe idea of precision medicine came into existence that all patients who received the same therapy do not respond in the same manner and there exists an inter-individual variation. Researchers then found that precision medicine plays a vital role which may lead to treatment failure or toxicity. Precision medicine will provide the right medicine at the right time to the right patients with specific characteristics for a better clinical outcome. It utilizes the information related to a person’s genes, proteins and environment to cure disease. This breaks the model of “one fits for all” and it helps us to sequence DNA which is unique for everyone and to decide therapy based on the genetic information. The difference between the terms “precision medicine” and “personalized medicine” is to be understood since the former will classify people into subpopulations that have difference in their susceptibility to disease and the latter refers to a single drug for a single individual. It has its applications to detect any genetic alterations starting before birth and till old age. Due to this reason, precision medicine has taken over the personalized medicine and the word “precision” means accurate and precise
Pharmaco-ecomonic study of oral anti-hypertensive drugs available in Indian pharmaceutical market
Get PDFBackground: Hypertension is a global public health problem. To decrease its morbidity and mortality it needs life-long treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost.
Methods: The cost of different brands of commonly used anti-hypertensive drugs was sorted out by referring latest CIMS, MIMS and drug today. The cost of 10 dosage forms (tablets/capsules) in INR of each brand, cost ratio and percentage cost variation were calculated and evaluated.
Results: The cost of different anti-hypertensive drugs were analysed and minimum and maximum cost of the drugs in a particular dosage are tabulated. The cost variation is analysed with SPSS software 2.0 version with tools of median and interquartile range. The variation in cost of most of the anti-hypertensive drugs is more than 100%. It’s found maximum in amlodipine (5 mg) with cost variation of 625%, atenolol 100 mg with cost variation of 413%.
Conclusions: The average percentage cost variation of the same molecules of antihypertensive drugs manufactured by different pharmaceuticals company in India is very wide. So, government, pharmaceutical company, marketing manager and prescribing doctors should think about variation of cost and do needful for providing maximum benefits to the patients receiving antihypertensive drugs
Neuropsychological side effects of anti-epileptic drugs in epilepsy patients: a cross sectional study
Get PDFBackground: Epilepsy is the fourth most common neurological disorder in world. Managing an epilepsy with anti-epileptic drugs (AEDs) either as monotherapy or polytherapy is necessary to reduce the deleterious effect of the disease and to provide neuroprotection. AEDs exert their negative effects on cognition by suppressing neuronal excitability or enhancing inhibitory neurotransmission. These neuropsychological side effects are found to be modest when the drug level is within the therapeutic concentration and used as monotherapy. Objectives were to assess the prevalence of neuropsychological side effects among epilepsy patients who were on antiepileptic drug therapy.
Methods: An open label, cross-sectional, clinical study was conducted at a tertiary care hospital, 126 participants were recruited. Participants demographic data, detailed medical and seizure history followed by neuropsychological tests was performed. The prevalence was assessed based on the number of participants scoring <15th percentile in one or more tests.
Results: Out of 126 participants who were recruited, 82 participants were on monotherapy and 44 participants were on polytherapy. Levetiracetam was the most commonly prescribed drug as monotherapy, followed by phenytoin, carbamazepine and valproate; whereas in polytherapy levetiracetam, clobazam followed by phenytoin were the commonly prescribed AED. The most common adverse effect was drowsiness, followed by headache, hypersensitivity reaction, giddiness, tremors, anxiety etc. The prevalence of neuropsychological side effects was 77.8%. The prevalence of impairment between monotherapy and polytherapy was statistically insignificant (p=0.727).
Conclusions: In this study, levetiracetam was the most commonly prescribed drug and the most common adverse effect was drowsiness due to AEDs. The subgroup analyses between monotherapy and polytherapy did not show any statistically significant neuropsychological impairment when compared based on the gender, age groups, duration of epilepsy with medication and duration of current therapy
Woman and pregnancy: focus on depression and psychopharmacological therapy
Get PDFPerinatal 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
Knowledge attitude and practices of drug promotional literature: a clinician’s perspective
Get PDFBackground: Promotion of drugs by pharmaceutical industries is fully regulated by drug regulators. Doctors are focus of intense marketing by representatives of pharmaceutical companies (MR). It is reported that very few physicians are equipped with the necessary skills and knowledge to critically assess the information delivered in drug promotional literature (DPL). Hence this study was carried out with the objective to determine knowledge, attitude and practices of doctors about the DPL
Methods: This was a questionnaire-based study population included clinicians working in a government set up and others doing private practice. Questionnaire was circulated online on social media platforms via Google forms.
Results: The 32.11% participants were aware of regulations and guidelines of DPL in India 80.7% participants searched for cost of medicine on DPL, 54.12% respondents perceive that the product claims made on DPL are balanced and supported by good evidence, 56.88% participants opined that their integrity is compromised by accepting gift from MR, 43.1% participants are exposed to drug advertisement through social media and 51.06% of them opined that their prescribing habits are influenced through this. Writing brand names while prescribing is significantly more in private practitioners as compared to doctors employed in government set up.
Conclusions: DPL serves to update the knowledge of the busy clinicians of the latest developments in the medical field. Quality check of drug promotion on social media is the need of the hour as this is influential. Private practitioners need to be addressed regarding enforced laws for rational prescribing
Comparison of microvascular endothelial function as measured by laser Doppler flowmeter among non-smoker and smoker males
Get PDFBackground: 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
Evaluation of the protective role of antioxidants: α-tocopherol, vitamin C, and quercetin, against ibuprofen-induced renal damage in male Wistar rats
Get PDFBackground: 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
Drug utilization pattern of analgesics after a surgical procedure in a tertiary care hospital: a prospective observational single centre cohort study
Get PDFBackground: 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
Fiction contract: its importance in simulation-based medical education
Get PDFSimulation-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