Teaching of Critical Analysis of Drug Advertisements to Medical Students

Background: Medical practitioners utilize drug promotional materials from pharmaceutical companies as a major source of information especially in developing countries. These promotional materials can be highly informative as long as they are critically appraised but when they are accepted without question, they lead to irrational prescribing. Aim: To sensitize the students regarding WHO criteria for medicinal drug promotion and to determine the impact of teaching critical appraisal of medicinal drug promotion to medical students. Design: The medical students of second year were given a pre test questionnaire to identify the violations in generic labeling, pharmacological information, claims, relevance and references cited in the drug advertisements. Later they were sensitized about the WHO criteria for medicinal drug promotion and how to critically appraise a drug advertisement. This was followed by a post test questionnaire with the same drug advertisement. Result: The number of students answering the post test correctly was significantly (p<0.05) more than that of pre test. Conclusion: Education of medical students regarding critical analysis of drug advertisements should be a part of the medical curriculum

A CASE REPORT OF NADROPARIN INDUCED HYPERKALEMIA

ABSTRACTNadroparin, a low molecular weight heparin, has prophylactic and therapeutic use in thromboembolic disorder. In a patient with carcinoma ovarystage 3 B, nadroparin was given prophylactically for deep vein thrombosis (DVT) before and after interval cytoreduction surgery. Nadroparin 0.3 mlwas given subcutaneously once daily for 1 day preoperatively and 8 days postoperatively. Rise in serum potassium was observed on the third postoperativedaysuggestiveof hyperkalemia.Intravenousfluids weregiven,and thedrug wasstoppedon the 9 post-operative day and hyperkalemiaresolved after 2 days. Monitoring of serum potassium level is essential when Nadroparin is administered prophylactically for more than 7 days forDVT. As this case illustrates a causal relationship between nadroparin and hyperkalemia, caution must be exercised with nadroparin.Keywords: Nadroparin, Hyperkalemia, Thrombosis.t

ADVERSE REACTION DUE TO CLINDAMYCIN

ABSTRACTA 43-year-old patient was diagnosed of left sided empyema. He was started on injectable piperacillin-tazobactam combination and clindamycin.After 11 days, he developed itchy red lesions over different parts of the body. Both the drugs were immediately stopped in view of drug allergy.However, oral clindamycin with a lower dose was restarted, and patient tolerated the drug without any skin related episodes. Postdischarge he wasprescribed oral clindamycin for 2 more weeks. 2 days postdischarge he started developing rash. The patient continued the drug for next 10 daysand as a severity of rashes increased he reported to the hospital. He had itchy red lesions throughout the body. Clindamycin was stopped, and hewas prescribed clonate lotion and tablet cetirizine for 10 days. The lesions resolved. A patient was informed that he is allergic to beta-lactams andclindamycin.Keywords: Clindamycin, Skin rashes, Beta-lactams

EVALUATION OF EFFICACY AND TOXICITY OF DIFFERENT TREATMENT REGIMENS IN PLASMODIUM FALCIPARUM MALARIA

The efficacy and toxicity of four commonly used antimalarials was evaluated. Thecombinations evaluated were Artesunate and Doxycycline, Quinine and Doxycycline, Artesunateand Quinine, Artesunate and Mefloquine. The four combinations did not show any statisticallysignificant difference in terms of days of defervescence, parasite clearance and hospital stay. Allthe four combinations were well tolerated

Effect of statins on chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials.

BACKGROUND: Much controversy persists regarding the place of statins in the treatment of patients with chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis sought to determine the clinical efficacy of statin therapy in COPD. METHODS: We searched Medline, Embase, Cochrane databases, and Pubmed for relevant clinical studies. Randomized controlled trials comparing the effects of statins to placebo in COPD populations were included. Pooled estimates were calculated using a random-effects model. Heterogeneity was determined using the I(2) statistic. RESULTS: Ten trials with a total of 1471 patients were included. Statin treatment was associated with a larger improvement in exercise capacity, lung function, and St. George's Respiratory Questionnaire score compared with placebo, but there were no statistically significant differences in inflammatory markers, all-cause mortality, and safety outcomes; however, subgroup analysis indicated that statins improved clinical outcomes in the subjects from trials enrolling patients with overt cardiovascular disease, elevated baseline C-reactive protein, or high level of cholesterol. CONCLUSIONS: The findings from this systematic review suggest a role for statins in COPD patients with coexisting cardiovascular disease, evidence of increased systemic inflammation, or hyperlipidemia, in terms of improving exercise tolerance and pulmonary function. These findings need to be confirmed by randomized controlled trials specifically designed to test this hypothesis and identify appropriate patients for statin use

Assessment of adverse drug reactions to antituberculosis regimen in a tertiary care hospital

Background: Adverse drug reactions are common with multidrug therapy in tuberculosis, if detected early can improve patient compliance and prevent emergence of resistance.Methods: A prospective observational study as a part of Pharmacovigilance Program under Central Drugs Standard Control Organisation was conducted in Kasturba hospital, Manipal to collect adverse drug reactions (ADR). Data of patients reported with antitubercular treatment (ATT) related ADRs from September 2012 to August 2013 was evaluated for patient demography, type of tuberculosis, ATT regimen, organ/ system affected and time of onset of ADR. ADRs were then subjected to causality assessment as per WHO scale.Results: A total of 65 ADRs were reported in 60 patients during the study period, of which 46.7% were in males and 53.3% in females. 85% of ADRs were reported in patients with pulmonary tuberculosis. 77% of ADRs were observed with daily regimen. Common ADRs were hepatitis (40%), gastritis (15%), skin reactions (15%), peripheral neuropathy (14%), gout (6%) and nephritis (3%). Median duration for the onset of ADR was 31 days each for hepatitis, gout, nephritis and 20, 11, 9 days for gastritis, peripheral neuropathy and skin reactions respectively. As per causality assessment, 80% of ADRs were assigned “possible”, 11% “probable” and 9% “certain”. As per severity scale 27.7% of ADR were severe, 36.9% were moderate.Conclusions: Early detection and management of ADRs is vital for the success of ATT and patient adherence

Comparing the effect of statins on hepatic fibrosis induced by carbon tetrachloride in Wistar rats

Background: The clinical studies have shown contrary results regarding hepatoprotective effect of statins. However, antifibrotic properties of statins in in vitro and in vivo experimental models have been demonstrated. The purpose of this study was to assess and compare the effect of statins on serum liver enzymes and their antifibrotic effects.Methods: Forty two rats were divided into 7 groups (I to VII) (n=6). Liver toxicity was induced by injecting carbon tetrachloride (1 ml/kg). Control groups received corn oil (0.1 ml/100 gm) and carboxy methyl cellulose (0.50%) respectively. Group III to VII received carbon tetrachloride (CCl4) for 6 weeks and then groups IV, V, VI and VII received simvastatin (10 mg/kg), atorvastatin (15 mg/kg), rosuvastatin (2 mg/kg) and silymarin (50 mg/kg) for another 8 weeks respectively. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels were estimated in all the groups at baseline, 6 weeks and 14 weeks. At 14 weeks, histopathology of liver was done in all groups.Results: At 14 weeks, all the test groups (IV, V and VI) showed a significant decrease in serum ALT, AST and ALP levels as compared to control (p<0.05) and group III (p<0.05). On intergroup comparison, liver enzymes in rats in group VI (rosuvastatin) and group V (atorvastatin) were decreased more in comparison to group IV (simvastatin) but the difference was not statistically significant except for AST levels where the difference was significant between the statins. There was decrease in hepatic fibrosis by statins with rosuvastatin being superior followed by atorvastatin and simvastatin.Conclusions: In the present study statins decreased the serum AST, ALT and ALP levels and histopathological changes were reversed by statins in CCl4 induced hepatotoxic models

CLOZAPINE INDUCED PARALYTIC ILEUS

Clozapine is an atypical antipsychotic drug used for the treatment of schizophrenia in patient not responding to other antipsychotics. Dry mouth, constipation, loss of accommodation and urinary retention are the common side effects encountered with this drug. Here we are reporting a case of paralytic ileus secondary to clozapin

Statins in Asthma: Potential Beneficial Effects and Limitations

Asthma’s sustenance as a global pandemic, across centuries, can be attributed to the lack of an understanding of its workings and the inability of the existing treatment modalities to provide a long lasting cure without major adverse effects. The discovery of statins boosted by a better comprehension of the pathophysiology of asthma in the past few decades has opened up a potentially alternative line of treatment that promises to be a big boon for the asthmatics globally. However, the initial excellent results from the preclinical and animal studies have not borne the results in clinical trials that the scientific world was hoping for. In light of this, this review analyzes the ways by which statins could benefit in asthma via their pleiotropic anti-inflammatory properties and explain some of the queries raised in the previous studies and provide recommendations for future studies in this field

EFFECT OF FUCITHALMIC AND SOFINOX EYE DROPS ON EXPERIMENTAL ALLERGIC CONJUNCTIVITIS IN RATS

Objective: To investigate the therapeutic effect of Fucithalmic 1%, Sofinox 0.5% and 1% eye drops against an IgE-mediated allergic conjunctivitis model in Wistar rats. Methods: IgE-mediated allergic conjunctivitis was induced by ovalbumin antigen challenge. Allergic conjunctivitis induced control rats (Group I) received normal saline (0.9% NaCl; 10 µl/eye) whereas Fucithalmic 1% (Group II), Sofinox 0.5% (Group III) and 1% (Group IV) were administered as 10, 20 and 10 µl/eye respectively to the treatment group animals (n=6) for 15 days. Eye scratching behavior, hypothermia and edema was evaluated after topical antigen challenge. Results: Sofinox 1% eye drops (10 µl/eye) significantly attenuated eye scratching behavior, hyperemia and edema in comparison with allergic conjunctivitis induced control (p &lt; 0.001) and Fucithalmic 1% treated rats (p &lt; 0.05). Eye scratching behavior and edema was also significantly decreased in Sofinox 0.5% eye drops (20 µl/eye) treatment group as compared to allergic conjunctivitis induced control rats (p &lt; 0.05). Conclusion: The present study revealed that the Sofinox eye drop is the potential agent that could offer a novel therapeutic opportunity against IgE-mediated allergic conjunctivitis in Wistar rats