International Journal of Basic & Clinical Pharmacology
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Prevalence of anemia among chronic kidney disease patients in India: a single-centre study
Get PDFBackground: Chronic kidney disease is defined as abnormalities in kidney structure or function with a decreased glomerular filtration rate <60 ml/min for three months or more, irrespective of the cause. CKD has many complications that usually develop throughout disease progression. Anemia is among these complications. The prevalence of anemia is very high among CKD patients and it is an important parameter to be monitored and addressed. This research study aimed to find out the prevalence of anemia among CKD patients and investigate the relationship between anemia and other predictive factors.Methods: This was a unicenter, cross-sectional, prospective observational study conducted for six months between December 2020 and May 2021 at a tertiary care hospital to assess the prevalence of anemia among CKD patients. Data were collected, coded, and analyzed using SPSS software. A descriptive analysis was performed, and significance tests were applied where applicable. Multiple regression analysis and Pearson tests were applied to determine the relationship between variables, p>0.05 was considered statistically significant.Results: A total of 715 patients were enrolled in the study, out of which 432 (59.2%) and 292 (40.8%) were male and female, respectively. The mean age was 56.4±15 SD. Out of 715 patients, 531 (74.3%) patients were anemic and 58 (8.1%) were severely anemic. Thus, the prevalence of anemia was 82.4% among study participants. Hypertension, diabetes, and CKD stage were associated with a high prevalence of anemia.Conclusions: This study reported a high prevalence of anemia compared to previous studies. Assessing the anemic status of patients in earlier stages of the disease will contribute greatly to managing this complication
Transient adrenal insufficiency following treatment of rheumatoid arthritis with intramuscular methylprednisolone acetate
Get PDFAn 82-year-old woman presented with dizziness, a fall, and pubic fractures. She had resting severe hypertension, with marked orthostatic hypotension. She was recently diagnosed with cyclic citrullinated peptide (+) rheumatoid arthritis. She had received 120 mg intramuscular methylprednisolone (Depo-Medrone®) eight months prior, and a second dose a day preceding hospitalisation. Two days into the admission, her Glasgow coma scale (GCS) score dropped acutely from 15/15 (E4;V5;M6) to 3/15 (E1;V1;M1). The initial differential diagnoses were: an acute stroke (a total anterior circulation syndrome-TACS or brainstem stroke), opiate toxicity (fracture pains), and possible unwitnessed seizure (in a post-ictal state). Urgent computerised tomography (CT) brain was unremarkable. She had an acute-on-chronic hyponatraemia (nadir 121 mmol/L) while on long-term proton pump inhibitor therapy, and hyperkalaemia (peak 5.8 mmol/L). Initial management included intravenous (IV) naloxone, fluids and diazepam with poor clinical response. Due to persistent low GCS, the admitting team were concerned about a potentially guarded prognosis. However, based on the history of recent high dose steroid injections, plus the evolving clinical picture and abnormal biochemistry, empirical treatment was started (IV hydrocortisone 100 mg QDS and 0.9% saline infusion) for possible adrenal insufficiency. An ‘add-on’ request for random serum cortisol was made to her admission bloods, and returned low (33 nmol/L). With treatment, her GCS improved rapidly from 3/15 to 15/15. A subsequent planned short synacthen test was abnormal (cortisol level pre-synacthen 100; 30min post-synacthen 340), suggestive of adrenal insufficiency. Following consultation with endocrinology, she was maintained on oral hydrocortisone 10 mg (am)/5 mg(teatime) with sustained clinical improvement.
Knowledge, attitude and practicing behavior regarding antimicrobial use and awareness of antimicrobial resistance among interns and postgraduates in a tertiary care hospital
Get PDFBackground: Irrational use of antimicrobials and inaccurate practicing behavior leads to the issue of antibiotic resistance. This can be tackled by spreading awareness with the assistance of future medical practitioners. Hence, the present study was taken to determine the knowledge, attitude, and practicing behavior regarding antimicrobial use and awareness of antimicrobial resistance among interns and postgraduates.Methods: The study was conducted on interns and postgraduates in a tertiary care hospital. A standardized questionnaire was distributed to 120 participants and Ethical approval was taken before the study. Data was analyzed using SPSS software. For data comparisons, Chi-square tests were used, p≤0.05 is considered significant.Results: The study showed a majority in the 25 to 34 years of age group with female predominance. The subject of antibiotic resistance was moderately relevant to a majority, which highlighted a need for an increase in awareness workshops. The actual knowledge of respondents seems to be accurate in the study, a fair amount of attitude and practicing behavior was observed as well. A significant difference between the interns and postgraduates in knowledge (χ2=13.736, p=0.03), attitude (χ2=68.091, p=0.01), and practice (χ2=34.821, p=0.01) were noticed.Conclusions: Accurate knowledge and practicing behavior were observed in postgraduates and a fair attitude was observed in interns towards antimicrobial use and resistance. The awareness must be extended regarding this issue by conducting educational programs and by updating guidelines. Advancement in antibiotic prescribing pattern is required
Investigational synthetic neuroactive steroid zuranolone in treatment of major depressive disorder with peripartum onset
Get PDFMajor depressive disorder with peripartum onset or peripartum depression is a common condition experienced by a large proportion of women and to some extent even in men. The current treatment strategies involve the use of conventional pharmacotherapeutic classes of drugs like selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and psychotherapy methods in the management of this condition. In this article, we try to review and evaluate the pathophysiology of the condition along with the safety and efficacy of the novel investigational therapeutic drug zuranolone, which is a synthetic neuroactive steroid (NAS) that has shown promise in clinical trials for the management of conditions like major depressive disorder, peripartum depression and bipolar disorder. The synthetic NAS zuranolone is an orally bioavailable positive allosteric modulator of the gamma amino butyric acid (GABAA) receptor, which can regulate the action of the GABAergic pathway implicated in many depressive episodes and also affect the normal functioning of the hypothalmo pituitary-adrenal (HPA) axis which is the core pathophysiological cause behind major depressive disorder with peripartum onset
A questionnaire-based study to assess the awareness about package inserts amongst the resident doctors in a medical college of North India
Get PDFBackground: A package insert (PI) is a document certified by the administering licensing authority, provided along the package of a drug. They are a valuable source of knowledge and can be of tremendous help to doctors as doctors are evidence based. The objective of this study was to assess the awareness about package inserts among residents in a teaching hospital in north India.Methods: The present study was a cross-sectional, observational study carried out on residents in SKIMS Medical College, Srinagar (Jammu and Kashmir) to assess the awareness of participants regarding PIs. The questionnaire was pre-validated and then was used to elicit responses from the residents about their knowledge and opinion regarding the PIs.Results: A total of 96 residents participated in the study. About 67.7% of the participants agreed that PIs augment drug information but only 47.9% of the residents referred PIs as a source of knowledge for indication/contraindication/ adverse effects. 57.29% asserted it is important to tell the patient to read the package insert. Unfortunately, only 8.3% of the study participants had the knowledge of DRUG ACTS governing the information to be provided on PIs in India.Conclusions: The present study revealed that the residents have good attitude and knowledge towards PIs. However, the information provided on Package Inserts was not optimally used by them. The results of this study strongly suggest that there is a need to create awareness among resident doctors about PIs
Botulinum toxin: a boon or bane in dentistry
Get PDFBotulinum toxin is a neurotoxin which is produced by the Clostridium botulinum bacteria. It is an anaerobic, gram-positive, spore-forming rod-shaped bacteria which is commonly found in soil, on plants, in water and in the intestinal tracts of animals. All the serotypes of botulinum toxin interfere with neural transmission by blocking the release of acetylcholine. The use of botulinum toxins has revolutionised the treatment of various ophthalmic spastic disorders, Orofacial pain conditions, facial dystonia and periocular wrinkles. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice. This article is an effort to understand Botulinum toxin and its applications in head and neck
Effect of diuretics on sodium, potassium and chloride levels- a cross sectional study
Get PDFBackground: Diuretics are one of the widely used class of drugs used in various cardiovascular and other disorders. However, they can cause various metabolic adverse effects, electrolyte imbalance being among important changes.Methods: A cross sectional study was conducted in which patients diagnosed with hypertension for at least one month were included. Over a period of 6 months patients were enrolled irrespective of whether they were taking diuretics or not. Demographic details, drug therapy and electrolyte levels were recorded in a proforma. Data was analyzed for difference in serum electrolyte levels between diuretic and nondiuretic groups as well as between different diuretic groups.Results: Out of total 177 participants, 71 were on diuretic therapy. There was significant difference in mean serum sodium (S. Na), potassium (S. K) and chlorine (S. Cl) levels between diuretic and nondiuretic groups (P<0.05). Hyponatremia, hypokalemia and hyperkalemia were observed. Thiazide diuretic group showed significantly greater hyponatremia compared to other diuretics (P=0.028). Hyperkalemia was observed in participants receiving K sparing diuretic or combination of loop and K sparing diuretics. Old age and number of comorbidities showed negative association with S. Na. Females had significantly more hyponatremia than male participants.Conclusions: The study confirms that diuretics cause various abnormalities in electrolytes namely Na and K levels. Old age, comorbidities and female sex are risk factors for hyponatremia
Recent advances in the management of multiple sclerosis
Get PDFEvery 5 minutes, someone somewhere in the world is diagnosed with an inflammatory, demyelinating, neurodegenerative disorder known as multiple sclerosis (MS). MS was historically known as "La sclèrose en plaques" which involves the central nervous system (the brain and the spinal cord). It is always considered to be a disease of adulthood but nowadays pediatric MS is also gaining popularity. It is the most common non-traumatic chronic disabling disease of adults. MS is said to have etiology of multifactorial origin. of the myelin structure thereby producing a dysregulated immune system. MS is an ongoing disease with episodes of relapses and remissions whereas the basic pathophysiology remains increasing over time. Since the pathophysiology of MS is very complex, it makes the pharmacotherapy part bit difficult. MS therapy is disease subtype-specific. The drugs which were previously approved for MS lacks efficacy and sometimes possess serious adverse effects and thereby creating lacunae in treating MS patients include the need for a drug with better efficacy especially it should be evidence-based. There are several new drugs approved for the treatment of MS in recent times especially over the past 5-8 years and 'n' number of new molecules being tried in clinical trials. In this review, an effort was made to discuss MS epidemiology, potential etiological factors, pathophysiology, clinical aspects of MS before moving on to pharmacotherapy and other non-pharmacological management of MS. A special elaborative note on recently approved drugs and drugs under pipeline has been discussed in this review
Real-world utilization and acceptance of biosimilar bevacizumab in metastatic colorectal cancer in India
Get PDFBackground: To describe the patient characteristics and usage pattern of biosimilar bevacizumab for the treatment of metastatic colorectal cancer (mCRC) in India.Methods: This real-world, retrospective analysis included adult patients receiving biosimilar bevacizumab between April 2021 and March 2022.Results: A total of 1125 patients with mCRC who received biosimilar bevacizumab-based chemotherapy were included. The mean age at diagnosis was 57.8 years. Majority of the patients were males (71%) and belonged to the age groups of 41-76 years. The primary tumor site was right colon (52.6%) followed by left colon (29.2%) and rectum (17.3%), and tumor grade was reported as high in most (88.7%) of the patients. Majority of the patients received biosimilar bevacizumab-based chemotherapy as first-line therapy (61.3%), followed by second-line (31.9%) and third-line therapy (6.8%). In combination with biosimilar bevacizumab, FOLFOX (folinic acid, 5-fluorouracil, and oxaliplatin) was the most commonly administered chemotherapy regimen (42.9%), followed by CAPOX (capecitabine and oxaliplatin, 26.5%) and FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan, 22.8%).Conclusions: Biosimilar bevacizumab-based chemotherapy is being widely used in real‑world clinical setting in India for the management of patients with mCRC
Drug utilisation evaluation in patients with osteoarthritis in tertiary care hospital
Get PDFBackground: The principle aim of our study is to assess the prescribing pattern of drugs used in treatment of osteoarthritis patients. Methods: A prospective and empirical study was carried out at department of orthopaedics-Shadan teaching and general hospital, for 6 months.Results: During the study period, a total 120 patients were enrolled, of which 57% were females, 43% were males and common age group was ≥60 years. It was found that 56% of OA patient have history of trauma and 62% of obese individual contribute to occurrence of OA. It was found that subjects developed comorbidities like CV disorders which is 36%. It was found that 63% have OA for a duration of >2 years, 56% had no knowledge about their medications, 59% have co-morbidity, 61% have treatment complexity. NSAID’s, calcium, vitamin D3, glucosamine and chondroitin sulphate were the most frequently prescribed drugs in OA accounting for 50%. It was reported that 55% were adherent to OA medication, adherence to physical activity was 64%, adherence to weight loss was 62%.Conclusions: Our study manifest that majority of the patients had duration of >2 years of OA. The reasons for the uncontrolled pain was due to absence of awareness about osteoarthritis-related difficulties, drugs, low calcium diet, increased stress, obesity, and advanced age. Continuous health education, patient counselling, information about medication adherence and satisfaction at follow-ups is essential to avoid the problems