International Journal of Basic & Clinical Pharmacology
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Brief remission of cardiac conduction defect under anaesthesia during trans-sphenoidal pituitary surgery
Get PDFAcromegaly 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
Effect of melatonin on hematological indices in cyclophosphamide induced hematotoxicity in mice
Get PDFBackground: Cyclophosphamide use is often limited by associated hematotoxicity. This study investigated the effects of melatonin on haematological indices in cyclophosphamide-induced hematotoxicity in mice.
Methods: Ninety mice weighing between 20-25 gm were randomly divided equally into nine groups (A-I). Group A (saline control) received 2 ml/kg intraperitoneal (i.p.) normal saline with 10 ml/kg distilled water orally, groups B, C and D (melatonin control) received i.p. normal saline with melatonin at 5, 10 and 20 mg/kg orally, respectively. Group E (cyclophosphamide control) received 150 mg/kg/day i.p. cyclophosphamide with 10 ml/kg distilled water orally, while group F received 150 mg/kg/day cyclophosphamide with standard drug, (erythropoietin control) at 100 IU/kg. Group G, H and I (treatment groups) received 150 mg/kg/day cyclophosphamide with melatonin at 5, 10 and 20 mg/kg/day orally. Cyclophosphamide was administered on days 1 and 2 only, oral administrations occur once daily for 14 days. On day 15, animals were sacrificed and blood collected by cardiac puncture for assessment of haematological parameters; white blood cell count (WBC), red blood cell count (RBC) and platelets (PLT).
Results: The results showed a significant increase in WBC in groups C D, G and H (melatonin control; 10 mg/kg. 20 mg/kg and melatonin treatment; 5 mg/kg and 10 mg/kg) and a significant (p=0.001) decrease in group E (cyclophosphamide control) compared to A (saline control). RBC increased significantly in groups B and D (melatonin control; 5 mg/kg and 20 mg/kg) and significantly decreased in group E (cyclophosphamide control) compared to group A (saline control). Compared to group E (cyclophosphamide control), RBC increased significantly in groups F-I (erythropoietin standard, melatonin treatment). PLT increased significantly in groups B, C, (melatonin control; 5mg/kg and 10 mg/kg) G, H and I (melatonin treatment) compared with groups A (saline control) and E (cyclophosphamide control) (p=0.001).
Conclusions: Melatonin has potential to attenuate cyclophosphamide-induced hematotoxicity in mice
Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra
Get PDFBackground: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra.
Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages.
Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination.
Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs
Meteoric effect of meropenem: an unrevealed case report on Jarisch Herxheimer reaction
Get PDFJarisch Herxheimer Reaction is an immune mediated, self- limited reaction that releases endotoxins from the spirochetes. It occurs due to an acute inflammatory response when lipoproteins, owing to their entry into the patient's bloodstream, cause an increase in inflammatory cytokines during the period of exacerbation, resulting in body aches, fevers, rashes, nausea and vomiting, and flushing, along with other symptoms. These symptoms usually begin within 2 hours after the administration of the antibiotics. We represent a 76-year-old male patient who has had a known case of recurrent urinary tract infections since 2017 and was recently diagnosed with urosepsis and syphilis after being administered an injection of Meropenem, wherein he developed a Jarisch Herxheimer Reaction. The causality assessment revealed a Naranjo score of 7, indicating a probable adverse drug reaction. This patient was treated with intravenous antihistamines and corticosteroids for its management. Benzathine penicillin was avoided owing to the previous suspected Jarisch Herxheimer Reaction. None of the studies reported that Meropenem could contribute to such a reaction. All healthcare professionals should maintain a high alert of suspicion and be aware of antibiotic induced Jarisch Herxheimer Reaction symptoms and their management to avoid life threatening conditions
A cross sectional observational study to evaluate utilization of antimicrobials in paediatric department of a tertiary care teaching hospital
Get PDFBackground: Antimicrobials play cardinal role in management of infectious disease. Paediatric age group forms significant part of developing countries and have high chances of acquiring infectious. Misuse and overuse of these antimicrobials are leading culprits in causing antimicrobials resistance. The purpose of this study was to analyse utilization of antimicrobials among paediatric department of a tertiary care teaching hospital.
Methods: A cross sectional observation study was conducted for three months in paediatric department of a tertiary care teaching hospital. The demographics and antimicrobials use details were observed daily from patients admitted to paediatric outpatient department, wards and intensive care unit to assess according to The World Health Organization-International Network of Rational Use of Drugs drug prescribing indicators and WHO antibiotics AWaRe (Access, Watch, Reserve) classification.
Results: In our study we found that mean antimicrobial use in OPD, wards and ICU was1.15±0.35, 1.12±0.33 and 2.25±1.01 respectively. Cephalosporins were most commonly prescribed in OPD (34.62%) and wards (65.26%) while piperacillin-tazobactam (29.93%) in ICU. Percent encounter with an antibiotic in OPD, Wards and ICU was 8.41%, 30.71% and 33.58% respectively. 56.69%, 81.35% and 55.80% antibiotics prescribed in OPD, Wards and ICU respectively were of Watch group. 5.66% Reserve group antibiotics were prescribed in the ICU.
Conclusions: Prescribing trends of antimicrobials is near to WHO standard but according to AWaRe classification, watch group antibiotics were prescribed more than Access group
Metabolic syndrome: a comprehensive review
Get PDFMetabolic syndrome (syndrome X) includes several components like diabetes, hypertension, hyperlipidemia etc. Every patient should undergo detailed assessment for the silent presence of the components of metabolic syndrome. Genetic predisposition, increased nutrient- dense food, decreased physical activity and chronic stress are common in metabolic syndrome. Insulin resistance, obesity and hyperglycaemia are commonly seen which can later lead to serious consequences like cardiovascular complications, thrombotic events etc. Clinical features depend on the components of the metabolic syndrome in a patient. Some may present with complications and advanced disease. For non-diabetic individuals, oral glucose tolerance test is indicated. It is better to study serum uric acid level and to screen for silent kidney stones. Specific drugs are prescribed as indicated. Drugs for stress and insomnia are also prescribed. Thrombotic status of the patient should be considered, and antiplatelet drugs are prescribed if risk factors are present. Non-pharmacological measures like diet modification and increased physical activity should be given on a priority basis. Patient compliance of these two measures should be monitored regularly. Future deployment of “artificial intelligence – powered” predictive diagnostic tests will help in detecting and controlling metabolic syndrome. “At risk” individuals and patients showing some components of metabolic syndrome should undergo full investigations to detect other components of metabolic syndrome. Full range of therapeutic drugs, diet modification and increased physical activity should be prescribed
Antifungal activity testing of curry leaf ethanol extract on the growth of Pityrosporum ovale and Candida albicans fungus
Get PDFBackground: The curry leaf is an Indonesian plant commonly utilized as a spice. Curry leaves are abundant in secondary metabolites, which endow this plant with numerous advantages, including antibacterial and antifungal properties, as well as the ability to reduce blood sugar levels and blood pressure. The objective of this study is to assess the efficacy of an ethanol extract derived from curry leaves in suppressing the proliferation of Pityrosporum ovale and Candida albicans fungus.
Methods: The symbiotic properties and phytochemical composition of curry leaf simplisia were examined. The antifungal efficacy of the ethanol extract derived from curry leaves was evaluated against Pityrosporum ovale and Candida albicans using the disc diffusion method. Calculate the precise values of the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC).
Results: The simplisia of curry leaf fulfills the criteria for simplisia characterization. Curry leaves possess a variety of secondary metabolite chemicals, including alkaloids, flavonoids, tannins, saponins, glycosides, steroids, and triterpenoids. The activity against the inhibition of fungal growth of Pityrosporum ovale and Candida albicans can suppress fungal growth with inhibition zone diameters measuring 6.93±0.15 mm and 7.27±0.47 mm, respectively. The minimum lethal concentration of leaf ethanol extract for Pityrosporum ovale fungi is 8.75%, resulting in a decrease of 98.25%. For Candida albicans fungi, the minimum lethal concentration is 12.5%, resulting in a reduction of 98.37%.
Conclusions: The ethanol extract derived from curry leaves has the ability to hinder the proliferation of Pityrosporum ovale and Candida albicans fungus
A case study of an adverse drug reaction caused by long term use of proton pump inhibitors
Get PDFProton pump inhibitors (PPI) are the class of drugs used to treat a wide variety of disorders related to the stomach's acid production. Although it is considered safe for short term use, reports revealed that many serious life-threatening adverse reactions occurred from long term use. Here we report a case of hypomagnesemia and hypocalcemia induced by long-term use of PPIs in a patient with crest syndrome. From his past history, it was revealed that he was on pantoprazole 40 mg for more than 3 months. While he was admitted here for other complaints, we were able to discover that he had hypomagnesemia defined by low magnesium level of 1.3 mg/dL. As a consequence, he also showed signs of hypocalcemia with a low calcium level of 7 mg/dL. A peculiar complaint seen in this patient was three episodes of supraventricular tachycardia which is the most common cardiac manifestations of hypomagnesemia. As a conclusion, hypomagnesemia can sometimes be asymptomatic and cause unspecific and serious manifestations such as asthenia, paresthesia’s, seizures, arrhythmias, and cardiac arrest. Hence routine monitoring of serum magnesium and calcium levels should be made mandatory in practice for patients on long term use of PPI. Besides, it should be kept in mind that interchanging PPI class with histamine 2 receptor antagonist or fitful use of PPI may not cause hypomagnesemia
Maximizing learning efficiency: exploring the impact of ChatGPT in pharmacology assessment for undergraduates
Get PDFPharmacology, as a core discipline in healthcare education, plays a pivotal role in shaping competent and responsible healthcare professionals. The traditional methods of pharmacology assessment, such as written exams and multiple-choice questions, have long been the norm for evaluating students' understanding of drug interactions, mechanisms, and clinical applications. However, as technology continues to advance, integrating artificial intelligence (AI) into education has emerged as a transformative approach to enhance learning efficiency and improve student engagement
Immunosuppressive drugs in renal transplantation
Get PDFA 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