International Journal of Basic & Clinical Pharmacology
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Evaluation of hydroxychloroquine induced retinal toxicity in systemic lupus erythematosus patients
Get PDFBackground: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder, which affects the major organs in the human body. Pathophysiology of SLE is unknown. It mainly affects the joints, and restricts their movement. Hydroxychloroquine (HCQ) an anti-malarial drug is used as the first line of drugs used to treat SLE. The major adverse effect of this drug is irreversible retinopathy. The aim of the study was to evaluate the incidence and prevalence of retinopathy in patients with long-term usage of hydroxychloroquine (for more than 1 year).Methods: In patients with SLE, we recorded a review on HCQ induced toxicity among those taking it for longer period (>1 year). All the patients were above 18 years of age. A total data of 210 patients suffering from SLE and taking HCQ for more than one year was collected. Patients were categorized according to gender and dose pattern. Out of 210 patients, 0 patients were found to be retinal toxic induced by HCQ.Results: Suitable statistical tools were used and data was analysed which showed the incidence and prevalence of HCQ induced toxicity. With the results of our study we can understand that incidence and prevalence rates were very low among the subjects.Conclusions: HCQ is said to reduce the risk of disease remission, improves survival, minimizes the risks of vital organ damage, reduces the frequency of flares and has a protective effect on cardiovascular health. HCQ medication is usually well tolerated. But irreversible retinopathy is the major effect on long term use of HCQ. The present study concludes that in the nominal daily dose of 200mg did not reveal any signs of retinal toxicity in 100% of the population tested within 5 years of HCQ treatment suggesting that the toxicity is rare and can be prevented by reducing the dose of the drug
Drug prescribing pattern of antifungal drugs for local fungal infections in a tertiary care hospital: MAMC, Agroha
Get PDFBackground: Drug utilization research or studies are the powerful exploratory tools to ascertain the role of drugs in the society which refers to the marketing, distribution, prescription and use of drugs with special emphasis on the medical, social and economic consequences. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and promote rational prescribing.Methods: This was a prospective and an observational study. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sexes who attended dermatology OPD. Factors considered were sociodemographic parameters and WHO prescribing indicators.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. The average number of drugs per encounter was 3.68. The percentage of drugs prescribed by generic name was 50.33% and the percentage of drugs prescribed from NLEM was 20.93%.Conclusions: This study indicates that prescribing practices of drugs in tertiary care hospital can be improved by promoting generic name drug prescribing, prescribing drugs from NLEM and by reducing polypharmacy
Comparing dexmedetomidine and propofol for sedation and hemodynamic stability in cardio-thoracic intensive care unit for patients following off-pump coronary artery bypass graft surgery
Get PDFBackground: Most patients in intensive care unit (ICU) require both sedation and analgesia to encourage natural sleep, facilitate assisted ventilation and modulate physiologic response to stress. The ideal sedative after Coronary artery bypass grafting (CABG) should have rapid onset, immediate resolution of both pain and anxiety, promote cardiac and respiratory stability, maintain a reusability during sedation, allow rapid recovery after discontinuation, and attenuate the cardiovascular, neuroendocrine, and inflammatory response. All these properties may improve outcome in cardiac patients after CABG.Methods: Setting-cardiac ICU. A prospective, randomised, single blind study including 60 patients divided into 2 groups. Data collection tools-study proforma and Ramsay sedation scale (RSS). Data analysed using science and statistical packaged (SPSS) version 20, independent sample `t` test, chi-square test, analysis of variance (ANOVA) and p value ≤0.05 was considered statistically significant.Results: Sedation levels and length of stay of patients on ventilator were comparable in both groups, however, analgesic requirement was significantly less in dexmedetomidine group. Dexmedetomidine group showed significantly lower heart rates compared to propofol group.Conclusions: Dexmedetomidine and propofol are safe sedative agents during mechanical ventilation in ICU for patients undergoing off pump coronary artery bypass (OPCAB). There is more than 50% reduction in analgesic requirement and a significant reduction in heart rate in dexmedetomidine sedated patients.
Analysis of the variations in price of anti-glaucoma eye preparations available in Indian pharmaceutical market
Get PDFBackground: The aim of the study was to analyze the percentage cost variations among different brands of the commonly prescribed anti–glaucoma drugs.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition Drug Today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of each eye drop was calculated. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for anti-glaucoma eye preparations marketed in india was found to be eye drop timolol maleate (0.5%) of 5 ml:263.63, eye drop dorzolamide (2%) of 5 ml:9.77, eye drop pilocarpine (2%) of 5 ml:160.40, eye drop Betaxolol (0.5%) of 5 ml:56.54, eye drop Latanoprost (50 mcg/ml) of 2.5ml:135.88, eye drop Brimonidine tartarate (0.15%) of 5 ml:183.9, eye drop Levobunolol (5 mg/ml) of 5 ml:32.38.Conclusions: Glaucoma is the most common ocular disease and eye drops are to be prescribed for prolonged period. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy
A randomized prospective study to compare the efficacy and safety of budesonide plus formoterol and tiotropium plus formoterol in patients having mild to moderate chronic obstructive pulmonary disease
Get PDFBackground: Chronic obstructive pulmonary disease (COPD) is a leading respiratory illness affecting the quality of lives around the world. The present study aims to compare the efficacy and safety of combination of inhaled corticosteroid (ICS) and long acting β2 agonist (LABA) with long acting β2 agonist and long acting muscarinic antagonist (LAMA) in treatment of mild to moderate COPD in a tertiary care hospital.Methods: Total 132 patients with COPD were recruited on the basis of inclusion and exclusion criteria for 8 weeks study from outpatient clinic. A complete pulmonary examination including spirometry examination was done to rule out severe and very severe forms of COPD. Spirometry was performed at the time of recruitment for evaluation of forced expiratory volume in one second (FEV1) and measurement of SpO2 at the time of recruitment at 2 weeks and 8 weeks. Appropriate statistical methods were used to compare the qualitative and quantitative primary and secondary efficacy end points, p value <0.05 was considered significant.Results: On analysis, there was a significant difference (p<0.05) was observed in FEV1 and SpO2 from baseline in ICS plus LABA group (n=66). A similarly significant difference (p<0.05) was observed in LABA and LAMA group (n=66). On comparison between ICS plus LABA and LABA plus LAMA no significant difference in FEV1 and SpO2 was observed between the two groups. More adverse drug reactions were observed in ICS plus LABA group than LAMA plus LABA group.Conclusions: Combination of ICS and LABA combination is as effective as combination of LABA and LAMA in patients having mild to moderate COPD. However, LABA and LAMA combination is preferable because it is associated with fewer side effects
Efficacy of intranasal olopatidine hydrochloride as an add on therapy in mild to moderate allergic rhinitis
Get PDFBackground: Treatment with intranasal olopatidine hydrochloride spray is proposed for patients with chronic perennial and seasonal rhinitis. Hence we compared the efficacy of intranasal mometasone furoate as an add-on therapy with existing standard treatment in a randomized, open label comparative study.Methods: A prospective, randomized, single blinded, comparative study in patients with chronic perennial and seasonal rhinitis. Patients were divided into two groups to receive intranasal olopatidine therapy and intranasal saline plus existing standard treatment with levocetrizine and vitamin C orally. Improvement in symptoms like nasal obstruction, nasal discharge, sneezing, nasal itching, itching of eyes, watering of eyes were assessed by a questionnaire at 2, 4, 6 and 8 weeks and by a reduction of eosinophil count in blood and nasal smear examination at baseline and 8 weeks.Results: At the end of 8 weeks the percentage reduction of nasal obstruction in olopatidine hydrochloride and saline were 93.1% and 36.07% respectively, rhinorrhoea was 90.34% and 36.42%, nasal itching was 85.76% and 41.37% sneezing symptoms were 89.6% and 37.86%, itching in the eyes was 94.6% and 44.05% and watering in the eyes were 87.1% in group A and 38.07% in group B. At the end of 8 weeks, there was reduction in absolute eosinophil count and it attributed to 57.5% in olopatidine hydrochloride and 11.9% in saline group and reduction in nasal smear count scoring was 60.7% and 18.2% respectively.Conclusions: Intranasal olopatidine hydrochloride is highly effective, in the treatment of allergic rhinitis
Assessment of knowledge, attitude and practice of insulin injection among subjects with diabetes mellitus
Get PDFBackground: Diabetes mellitus (DM) is a spectrum of common metabolic disorders whose management mainly lies in treating the patients with oral hypoglycemic drugs and insulin along with the dietary and lifestyle modifications. Insulin is administered most subcutaneously. As the insulin injection sites are relatively painless, patients tend to inject in the same area repeatedly rather than moving to a newer site and increase risk for development of injection site reactions like lipodystrophy and impairment of glycemic control. Hence, it is utmost important for every diabetic patient and their relatives who would inject the insulin injection to be aware of appropriate manner of insulin injection. This helps in maintaining adequate glycemic control in diabetic patients. The main objective of this study was to assess the knowledge, attitude and practice of insulin injection technique among the diabetic patients.Methods: A cross-sectional study was conducted in the department of Endocrinology on 250 diabetic patients taking insulin injections based on inclusion and exclusion criteria. A validated questionnaire was administered to patients to answer in order to assess their knowledge, attitude and practice about technique of insulin injection.Results: In this study, it was found that 90% of the patients were aware of rotating the injection site, whereas only 40% of the patients were aware of appropriate time duration (5-10 sec for syringes/counting 1-15 for releasing the pen) required for resting the syringe/pen needle inside the skin. Only 48% of the patients used to remove the air bubble prior to injection, 57% pinched the injection site before injecting, 20% rubbed the injection site after injection and 30% used to wash hands prior to injection. Hypoglycemia was the most common adverse effect noted in 54% of patients.Conclusions: It can be concluded from the present study that every patient and his/her attendant needs to be educated and trained appropriately regarding technique of injecting insulin injection for betterment of their health.
A case report on penicillin/co-trimoxazole induced Jarisch Herxheimer reaction in secondary syphilis with human immunodeficiency virus
Get PDFThe Jarisch-Herxheimer reaction (JHR) typically occurs after the initiation of antibiotic treatment in syphilis. Although JHR was identified and looked at over many years, the prevention and management of JHR remain unclear. Previous reports have described the occurrence of JHR due to antibiotic treatment in syphilis, we presented a case of a young man with recurrence of JHR in syphilis, first due to penicillin which later was worsened due to co-trimoxazole
Clinical management and outcome of extreme preterm infant with respiratory distress syndrome, early onset sepsis and necrotizing enterocolitis stage 1: a case report
Get PDFRespiratory distress syndrome, although it is common in extreme preterm infants, early and effective management will aid in better outcome. Preterm also comes with multiple co- morbidities which has to be considered and stepwise treatment is utmost important in tackling them. Here, we report a case of an extreme preterm baby who experienced respiratory distress syndrome with early onset sepsis along with necrotizing enterocolitis. Early diagnosis and management helped in the discharge of the infant in stable condition
Olmesartan modulates proliferating cell nuclear antigen expression and improves dextran sulfate - induced ulcerative colitis in rats
Get PDFBackground: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by sudden attacks of remissions and exacerbations with increased incidence of cancer colon. The present study aims to determine the possible ameliorative mechanisms of Olmesartan in UC induced experimentally in rat.Methods: Adult albino rats were randomly grouped into control, UC model non treated group: Rats received dextran sodium (DSS) orally for 21 days with intra-colic administration of acetic acid (AA) for 3 consecutive days for induction of UC model, Olmesartan (1, 5, 10mg/kg/orally) and UC + Olmesartan in different doses (1 mg, 5 mg and 10 mg/kg/day orally).Results: DSS orally and AA intra-rectal produced sever colitis manifested by significant weight loss, watery and bloody diarrhea. Significant increase in serum and colonic tissue levels of tumor necrosis factor alpha and interleukine-1β. Pro-apoptotic Bax protein, myeloperoxidase (MPO) and expression of PCNA significantly increased in colonic tissue. Lipid peroxidation (MDA) significantly elevated while reduced glutathione (GSH) was depleted in UC non-treated group compared with normal control group. Treatment with Olmesartan (5 mg, 10 mg/kg/day, orally) ameliorated mucosal ulceration and improved inflammatory signs as confirmed by immunohistochemical and histopathological examination. Also, Olmesartan significantly attenuates overexpression of PCNA in colonic mucosa.Conclusions: Our results point out that Olmesartan had ameliorative effects on UC by its anti-inflammatory, antioxidant and anti-apoptotic effects and attenuates PCNA expression which is the main cause of dysplasia and colorectal cancer. Olmesartan may be a promising therapeutic drug for treating UC and protection of colorectal carcinoma.