International Journal of Basic & Clinical Pharmacology
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A competency-based medical education on personal drug selection among medical students: a prospective, cross-sectional study
Get PDFBackground: This study was conducted to know the students’ views regarding the personal drug (P-drug) concept in the rational prescription of drugs and also to give them training on creating and using personal drug concepts. Methods: The 60 medical students (5th semester) divided into four groups were involved voluntarily three-phase, questionnaire-based, and prospective study. In the first and second phases, students were taught and asked to derive P-drug using different standard textbooks and CIMS by analyzing the efficacy, safety, cost, and convenience of drugs used for stable angina pectoris. The third phase was designed to know the student’s perceptions regarding the exercise and difficulties faced in the process of P-drug selection. It contained demographic and 12 questions with the answer using the Likert scale.Results: Students selected tab. isosorbide dinitrate sublingual as a P-drug in terms of efficacy, safety, cost, and convenience. The 96.6% (58 out of 60) responded to the questionnaire. The overall median score was 2 and interquartile range was 2-5 (IQR 2-5). The majority (73% or 44) of students were in favour of introducing the process of selection of P-drug in the undergraduate pharmacology curriculum.Conclusions: The P-drug selection exercise helped students to understand the differences among various drugs used for the treatment of stable angina pectoris and gave them a strong foundation for developing rational use of the medicine in their future careers as a doctor
Evaluation of management in acute coronary syndrome and extent of adherence to standard treatment guidelines
Get PDFBackground: India has the highest burden of acute coronary syndrome (ACS) in the world. This research is to evaluate prescriptions pattern and extent of adherence to American College of Cardiology (ACC)\American Heart Association (AHA) guidelines in the management of ACS with patient outcome.Methods: Case record form containing patient’s demographic, clinical profile, diagnosis, prescription drugs (with dose, duration and frequency) were noted. Pharmacotherapy was compared to ACC/AHA guidelines, to evaluate adherence, guideline adherence index (GAI-5) was used for 5 major drug groups for ACS. GAI was calculated as: number of patients using the prescribed medications/number of eligible patients multiplied by 100.Results: A total of 172 patients diagnosed with ACS. 64 (37.20%) Patients with the highest preponderance to ACS belonged to 51-60 years age group with a 4.73:1 male to female ratio. ST-elevation myocardial infarction (STEMI) (44.77%) was the most common diagnosis and an average of 14.66±4.34 drugs were prescribed. Majority of the patients opted for percutaneous coronary intervention (PCI) with or without having received fibrinolytic therapy at onset. Adherence to the ACC/AHA guidelines being 93.75% and 118 prescriptions being 100% adherent to the guidelines. A positive correlation between adherence and number of drugs was statistically significant.Conclusions: The success of evidence-based medicine (EBM) was well noted with a 0% in hospital mortality rate i.e. all of the 172 patients were discharged with therapeutic success. Despite the concept of EBM and its proven effectiveness, there is a paucity of availability of such guidelines in India, so this study, a first of its kind can serve as a starting point of generating national as well as local guidelines
DRESS syndrome by sulfonamides, about a case
Get PDFAmong the most feared toxico-dermas is drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, a rare drug dermatitis that occurs after acute exposure to drugs whose clinical impact is based on multiple organs (skin, liver, kidneys, lungs, heart) and cell lines (eosinophils and lymphocytes). It is an entity with high mortality if it is not identified early, its treatment consists of the immediate suspension of the responsible drug and the administration of steroids, these being the therapeutic protagonists. A 64-year-old male patient with clinical, biochemical and histopathological criteria compatible with DRESS syndrome. It is essential to suspect the clinical course of DRESS syndrome before the appearance of dermatosis with multisystem involvement associated with the use of drugs, emphasis is placed on its early identification and the establishment of timely treatment to modify its prognosis.
Role of tocilizumab therapy in COVID-19 patients: a systematic review
Get PDFCoronavirus disease 2019 (COVID-19) caused by the Severe acute respiratory syndrome coronavirus-2 (SARS CoV 2) virus has created a global threat to the entire human population. The medical and scientific community are striving hard to find an effective therapeutic strategy to overcome this crisis. There are few studies showing the efficacy of tocilizumab against COVID-19, but they many of them lack reliability due to their small sample size or sample population not representative of the general population. This meta-analysis aims to elucidate the role of tocilizumab in the management of COVID-19, its efficacy and safety profile. A comprehensive search of databases including PubMed, Medline, Cochrane, Lancet, Google Scholar, WHO, Embase, Elsevier and other modalities of search like website searching and citation tracking was carried out through which 1061 articles were identified. Among them, 10 articles that fitted the inclusion criteria and qualitatively good were taken up for the meta-analysis. Out of the 10 studies selected, the results of 9 studies were in favour of the efficacy of tocilizumab therapy, while 1 study was against the efficacy of tocilizumab. The result of our statistical analysis was that OR=0.5569 (95% CI; 0.2289 to 0.9332) for the effect of tocilizumab on mortality reduction in COVID-19 patients. Among critically ill patients with COVID-19, the in-hospital mortality was significantly reduced in patients treated with tocilizumab during the first 2 days of ICU admission compared to patients those who were not administered with tocilizumab in the early phase. Treatment with tocilizumab significantly reduces the mortality rate, increases the survival rate and lowers the risk of requiring invasive mechanical ventilation.
Recent advancement in drugs of Alzheimer's disease
Get PDFAlzheimer's disease (AD), a multifaceted neurological ailment that progresses over time, is the most common cause of dementia in older people. Intracellular neurofibrillary tangles and extracellular amyloidal protein deposits contribute to senile plaques on a pathological level. AD symptoms vary depending on the stage of the disease. Depending on the severity of cognitive impairment, AD is classified as preclinical or presymptomatic, mild, or dementia-stage. In addition, the condition is influenced by a number of risk factors, including advancing age, hereditary factors, head injuries, vascular diseases, infections, and environmental variables. There are currently only two types of licenced medications to treat AD: inhibitors of the cholinesterase enzyme such as donepezil, rivastigmine, galantamine and antagonists of N-methyl d-aspartate (NMDA) such as memantine, both of which are only effective in treating the symptoms of the disease and do not cure or prevent it
A study of prescribing pattern of micronutrients in dermatology outpatient department at tertiary care teaching hospital
Get PDFBackground: Skin is the first line of defence for protecting our bodies against external perturbations, including ultraviolet (UV) irradiation mechanical/chemical stress, and bacterial infection. Different vitamins and trace elements are vital for skin health. The present study was planned to define the prescription pattern of micronutrients in the different skin diseases.Methods: An observational and cross-sectional conducted in the out-patient department of dermatology at a tertiary care teaching hospital in Rajkot, Gujarat over a period of two months. Prescriptions of 200 patients were analysed.Results: In our study, 200 prescriptions were evaluated. The average number of micronutrients per prescription was 1.95. In male average number of micronutrients per prescriptions was 2.01 while in female it was 1.91. Multivitamin B complex was the most commonly prescribed micronutrient.Conclusions: We observed that multivitamin B complex was the most commonly prescribed micronutrients followed by vitamin C in skin diseases. Though micronutrients play an important role in the body for healthy skin, it is overprescribed
Threat of multidrug resistant bacterial pathogens in COVID-19 pandemic
Get PDFCoronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease first emerged in Wuhan, China in December 2019 and since then, has been spreading worldwide.1 On March 11, 2020, the World Health Organization (WHO) declared the disease a pandemic.2 This pandemic has been described as the greatest threat to global health since the Spanish Influenza pandemic in the 20th century.
Life threatening acute kidney injury in a patient of rheumatoid arthritis, is it drug or disease related?
Get PDFEven low-dose MTX therapy for treatment of rheumatic diseases is claimed to cause impairment in renal function. We report an insidious and progressive deterioration of renal function of patient with RA on low-dose MTX in a 41-year-old woman. We suggest that patients on low-dose MTX therapy should be periodically monitored for creatinine levels
Tocilizumab induced immunosuppression in a case of adult-onset still’s disease: are these newer biologics double edged sword?
Get PDFAdult-onset still’s disease (AOSD) is a rare multisystemic inflammatory disorder of unknown etiology characterised by high spiking fever, evanescent skin rash, arthralgias, arthritis, neutrophilic leucocytosis. Initial treatment strategy includes use of hands-on drugs like non-steroidal anti-inflammatory drugs, low dose corticosteroids, conventional DMARDs. But as the disease progresses to severe form, targeted and biologic DMARDs could be the option for management. Interleukin-6 being one among the many cytokines involved in the pathogenesis of AOSD, has made itself a target for the treatment of refractory cases. Tocilizumab, a recombinant humanized anti IL-6 monoclonal antibody, is one such biologic drug available in the market that has proven its therapeutic efficacy in several clinical trials. We are presenting a case of 37-year-old female patient, known case of AOSD for 4 years. Patient was initially maintained on low dose corticosteroid and conventional DMARD like hydroxychloroquine and methotrexate. Flare ups of the disease warranted the use of tocilizumab and tofacitinib in this patient. After clinical as well as pathological improvement with tocilizumab 2 years before, signs of immunosuppression were observed when tocilizumab was reintroduced for the treatment. Patient suffered from acute pyelonephritis, septicemia, shock, oropharyngeal candidiasis and bronchitis which could be owned to immunosuppressive action of tocilizumab. One can reduce the chances of infection and other adverse effects by careful periodic monitoring of various laboratory parameters like total W.B.C., total platelet count and liver enzymes. Cautious selection of the patient is needed for the treatment with newer biologic agents
Relationship between oral cinacalcet therapy with CRP and anemia in hemodialysis patients with secondary hyperparathyroidism
Get PDFBackground: Cinacalcet is one of the newest calcium mimetic drugs in the treatment of patients with parathyroid cancer, secondary hyperparathyroidism in adults with chronic kidney disease. Due to the possible association between the effect of Cinacalcet on C-reactive protein and the pathophysiology of anemia in end-stage renal disease patients. The aim of this study was to evaluate the effect of oral Cinacalcet on rate of CRP and anemia in ESRD patients with secondary hyperparathyroidism. Methods: This descriptive cross-sectional study was done on all 40 hemodialysis patients over 18 years of age underwent hemodialysis for at least 6 months. The levels of C-reactive protein, phosphorus, calcium, parathyroid hormone, ferritin, Total iron binding capacity, iron, hemoglobin before the start of treatment and based on the routine dialysis ward were repeated once every three months and recorded in the, in the checklist. Also, age, sex, weight, underlying disease, duration of dialysis and duration of use and dose of Cinacalcet were entered. The results of these experiments were reviewed and analyzed before and after treatment with Cinacalcet.Results: In these patients, after treatment with Cinacalcet, the amount of hemoglobin increased and the amount of inflammation decreased and these changes were significant in hemoglobin rate but not significant in CRP rate. The relationship between patients' weight and inflammation was significant.Conclusions: Treatment with Cinacalcet in hemodialysis patients, at least in this study, could be increased hemoglobin and decreased CRP rate and can be a hypothesis for large analytical studies