National Journal of Physiology, Pharmacy and Pharmacology

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https://imsear.searo.who.int/handle/123456789/149612

Editor: Dr. Jay Charan

ISSN: 2320–4672 (Print)

Frequency: 2 issues a year

Language: English

Open Access Peer-reviewed journal

Web site: https://www.njppp.com/

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0.25% Bupivacaine with 8 mg Dexamethasone and 50 mcg Clonidine as adjuvant on fascia iliaca compartment block in open reduction and internal fixation surgeries to femoral fractures-a prospective randomized study
(Mrs Dipika Charan of MedScience (India) Publications, 2022-03) Prasad, DS; Damarla, R.
Background: Fascia iliaca compartment nerve block (FICB) is commonly preferred pain management technique in femoral fractures. Dexamethasone and clonidine as adjuvants to local anesthetics have good analgesic effect with limited adverse effect. Aim and Objectives: To assess the efficacy of bupivacaine with clonidine, bupivacaine with dexamethasone, and bupivacaine alone in fascia iliaca compartment block in cases with femoral fractures. Materials and Methods: The present prospective randomized study included a total of 120 cases undergoing proximal femoral surgeries under subarachnoid block above 21 years. The study cases were randomly divided into three study groups, i.e. 40 participants in each group. Group 1 received 0.25% bupivacaine with 2 ml normal saline, Group 2 received 0.25% bupivacaine with 50mcg clonidine, and Group 3 received with 0.25% bupivacaine with 8mg dexamethasone. Parameters such as heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation levels, and visual analog scale (VAS) score was monitored and recorded. Results: The mean difference of HR between the study groups was statistically not significant (P > 0.005). The mean SBP, DBP, and VAS score was comparable between study groups. The mean analgesic duration in Group 1 was 6.01 h, in Group 2 was 13.58 h, and in Group 3 was 14.44 h. The mean difference of rescue analgesia requirement and duration of rescue analgesia was statistically significant. No adverse effects toward drugs were noticed. Conclusion: About 0.25% bupivacaine with 8 mg Dexamethasone had better analgesic duration and require minimal rescue analgesia in the first postoperative day than 0.25% bupivacaine with 50 mcg clonidine in cases undergoing femoral surgeries under FICB.
Abdominal fat distribution and its relationship to sagittal abdominal diameter (SAD) and SAD-height ratio – An analytical cross-sectional study in the South Indian population
(Mrs Dipika Charan of MedScience (India) Publications, 2022-08) Catherine, P; Devanand, V; Chelladurai, A; Balasubramaniam, S; S, S; Nazarene, A; Vivekkumar, P.
Background: The prevalence of obesity is increasing in developing countries like India. This will place a great burden on the health infrastructure of the country. Early identification and intervention are the keys to managing this important problem. Since Asians tend to have more visceral body fat for any given body mass index (BMI), lower cut-off values have been suggested for different anthropometric parameters. Studies determining the correlation of Sagittal abdominal diameter (SAD) and SAD-height ratio (SADHtR) with total visceral fat volumes measured by computed tomography (CT) scan abdomen quantification are limited in the South Indian population. Aims and Objectives: This study was conducted with the objectives of measuring BMI, SAD, SADHtR, and comparing the correlation of the measured anthropometric parameters with visceral and subcutaneous abdominal fat volumes measured using CT scan abdomen in both the genders in South Indian population. Materials and Methods: This analytical cross-sectional study was done in a hospital setting with a sample size of 566 (276 men and 290 women-aged 30–70 years). Weight, height, and BMI were measured. SAD was measured electronically from a CT image at the L4–L5 level. SADHtR was derived. Total abdominal fat volumes, subcutaneous abdominal fat volumes, and visceral abdominal fat volumes were measured in cm3 from the dome of the liver to the pubic symphysis using software for CT-based quantification of fat volumes between ?190 and ?30 Hounsfield units threshold limits. The data were tabulated and analyzed to compare mean values between men and women and to find the correlation between the anthropometric parameters and visceral fat volume using Pearson’s correlation test. Results: The difference in mean values of BMI, SAD, and SADHtR between the sexes was statistically significant. SAD showed the highest correlation with visceral fat volume in both genders. BMI showed a higher correlation with subcutaneous adipose tissue volume than with visceral adipose tissue volume. Conclusion: Both SAD and SADHtR can be used as simple and reproducible anthropometric tools to identify the presence of increased visceral fat volume in both genders in our population.
Academic stress affecting the mental health of budding medical professionals
(?Eldaghayes Publisher, 2024-06) Garg, R; Kaur, R; Bansal, N; Kaur, G.
Background: The prevalence of stress among medical students has been reported to be different. Medical undergraduates especially in MBBS first phase are more likely to develop psychological distress than in later phases. It may affect their physical and mental health leading to anxiety, depression, and poor academic performance. Aim and Objectives: The objectives of this study are as follows: (1) To assess the prevalence of stress and its effects among Medical undergraduates, that is, MBBS 1st Phase students at the time of their joining to the course (baseline) and after about 8 months of their joining (repeat testing). (2) To compare any difference in levels of stress and its physical and psychological effects among male and female students. Materials and Methods: A cross-sectional study was conducted with the help of Hamilton Anxiety Rating Scale (HAM-A) on 141 students of MBBS first Phase in the Department of Physiology. The data were collected only after taking informed consent. Results: Among our male and female students at the time of baseline scoring, mild anxiety was observed in (95% of males and 91% of females) and mild-to-moderate anxiety (4% of males and 8% of females). At the time of repeat scoring mild anxiety (93% of males and 85% of females), mild-to-moderate anxiety (7% of males and 10% of females) was observed. Anxiety was observed to be more in our female students as compared to male students. Comparative analysis of each variable of HAM-A (baseline and repeat score) showed a significant difference (P < 0.0001) in eight HAM-A variables in repeat score as compared to four variables in baseline score. Conclusion: Early screening of MBBS first phase students should be planned for the presence of stress and its negative and lethal health consequences. Academic and psychological counseling should be provided to them.
Acceptance of face masks use during A 5-week training of healthcare professionals in the context of COVID-19 pandemic in Sub-saharan Africa
(?Eldaghayes Publisher, 2024-11) Ouedraogo, N; Sanou, BS; Sempore, WY; Michodigni, F; Sangare, I; Poda, A; Ouedraogo, AS; Sombie, I; Salou, M.
Background: The use of face masks may be difficult for accessibility reasons related to commodity, their cost, their availability, and the misinformation, or for medical reasons such as adverse effects. However, it is one of the affordable measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic. Although compliance with this barrier measure may be uncomfortable for the general population, there are other reasons related to the refusal of face masks wearing by healthcare professionals. Objectives: The objective of our study was to evaluate the acceptance of face masks use by healthcare professionals (HCPs) during the 5-week training course on Antimicrobial Resistance (AMR) in Sub-Saharan Africa. Materials and methods: A descriptive cross-sectional study was conducted from September 13 to October 15, 2021, in Bobo-Dioulasso, Burkina Faso. The survey was the method of the study, while individual interviews and observa- tion were the study techniques. During the individual interview, a semi-structured questionnaire was administered to participants, including some points related to observation. Results: In this study, fifty-eight (58) HCP of ten (10) countries of Sub-Saharan Africa were interviewed. The mean age was 35 ± 0.83 years. Male gender represented 75.86%. The most represented labor classes were medical special- ists 31.03%, biologists 29.31%, and general practitioners 18.27%. Participants wore the face masks systematically in 56.90% of cases, 34.48% made frequent use of them with an average of 7 hours and 24 minutes of daily wearing, and 58.6% made proper use of the face masks. The breathing difficulty was indicated as the main discomfort of wearing a face mask in this study (46.55%). Conclusion: Face mask wearing is generally accepted by HCP during the 5-week training course in the context of the COVID-19 pandemic. The participants had a fairly good knowledge of the importance of this preventive measure. Acceptance of face mask wearing appears to be crucial in the fight against the spread of the COVID-19 pandemic. HCPs have an important mission to inform and educate patients by showing a good example.
Acid base disturbances in leptospirosis patients: Comparison of conventional and Stewart method
(?Eldaghayes Publisher, 2024-06) Priya, PV; Jayakumar, KP; Kurien, A; Thomas, PC.
Background: The Henderson-Hasselbalch equation is used in the conventional assessment of acid-base status. In 1983, P. Stewart put up an alternate strategy. The Henderson-Hasselbalch equation uses variations in PCO2 and bicarbonate to explain the acid-base state. On the other hand, the Stewart theory states that albumin, inorganic phosphate, PCO2, Strong Ion Difference (SID), and SID dictate acid-base status. Therefore, these variables have an important role in clinical management. The metabolic acidosis caused by unmeasured anions is accurately identified by the Stewart physiochemical approach, and it is a predictor of mortality in patients with leptospirosis. Aims and Objectives: Comparison of the leptospirosis patient’s S. albumin (requiring ABG analysis) and arterial blood gas (ABG) analysis parameters (pH, PO2, PCO2, HCO3-, BE, SaO2, S.Na+, S.K+, S.Cl, S.PO4 3-, and anion gap) to compare the conventional and Stewart methods and determine the type of acid-base disturbances present in leptospirosis patients in the intensive care unit. Materials and Methods: Following approval by the ethics committee, ABG and S. Albumin were taken from the clinical notes of fifty patients. The Henderson-Hasselbalch equation, in its conventional form, was unable to identify complex acid-base problems. Thus, we integrated this with the Stewart method. Results: The majority of leptospirosis patients had a mixed disorder characterized by respiratory alkalosis, metabolic acidosis, and metabolic alkalosis. The most prevalent conditions were metabolic acidosis, respiratory alkalosis, and metabolic alkalosis. Stewart’s method can help explain the cause of metabolic disorders. Stewart’s approach also made occult acid-base disorders visible. Conclusion: Stewart’s approach emphasizes the significance of Na+, K+, Cl-, Alb, and PO4 3- and clarifies their part in the development of metabolic abnormalities, particularly those involving Alb and PO4 3-. This demonstrates unequivocally that the cause of the metabolic abnormalities can be explained by Stewart’s method, which is highly helpful in planning the management.
Acneiform eruptions associated with nintedanib – A case report
(?Eldaghayes Publisher, 2024-09) Bhure, AS; Joshi, AD; Ade, A; Agashe, A.
Interstitial lung diseases (ILDs) these are a group of diffuse parenchymal lung disorders present with increased risk of morbidity and mortality. The patient presents with symptoms of gradual onset of dyspnea, dry cough, chest discomfort, and extreme tiredness, which causes decreased quality of life. Treatment of ILD includes the use of immunomodulatory therapies such as corticosteroids, azathioprine, cyclophosphamide, and monoclonal antibodies. Antifibrotic therapies include the use of pirfenidone and nintedanib. The most common adverse effects associated with tyrosine kinase inhibitors include hepatotoxicity, hypertension, Steven–Johnson syndrome, acne-like skin rash, and pruritus. The patient presented to the dermatology outpatient department with complaints of acneiform eruptions over the forehead and cheeks. Lesions started within 7–15 days of starting nintedanib for ILD. Post-dermatology consultation and local examination, acneiform eruptions due to the drug are the probable diagnosis made, and therefore, capsule nintedanib was withheld and prescribed Vitamin C tablets, tretinoin 0.05% with azelaic acid 10% and sunscreen. At the time of discharge tapering doses of prednisolone, tablet deriphylline 150 mg BD and tablet n-acetyl-cysteine 600 mg BD for 14 days were prescribed. Detailed history of the patient was taken and the relevant medical documents were scrutinized. This case was assessed as per the pharmacovigilance program of India. A very rare adverse reaction was seen with the use of nintedanib. After discontinuation of capsule nintedanib and acne management, patient experienced an improvement in the acne lesions. The case reported is a very rare adverse reaction seen with the use of nintedanib for the management of ILD. Our study is supported by temporal association, biological plausibility, and successful de-challenge.
Acquaintance of medical students with the National List of Essential Medicines
(?Eldaghayes Publisher, 2024-09) Jani, CK; Agrawal, A.
Background: Undergraduate medical students are future prescribers of medicines, and they must understand the concept of essential medicines and their importance in healthcare. Regulations on Graduate Medical Education Amendment 2019, has revolutionized Indian medical education by introducing competency-based medical education which states that the major goals for an Indian medical graduate are to acquire the competency of a “clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.” The National List of Essential Medicines (NLEM) has been included as a core topic in the curriculum of undergraduate medical students. This research attempted to understand the level of knowledge regarding the NLEM among undergraduate medical students. Aim and Objective: To assess the baseline level of knowledge regarding the NLEM among undergraduate medical students. Materials and Methods: A questionnaire- based study was done among medical students of a government tertiary care teaching hospital in India. 1st year students were excluded as they were not taught about Essential Medicines and NLEM. A pre-validated multiple-choice questionnaire was distributed to medical students and information was collected related to knowledge regarding NLEM significance, criteria for inclusion in NLEM, terminologies, and drugs in NLEM that are used for common conditions. Results: Out of 600 students 237 (39.50%) students responded. 98 (41.35%) students were aware of recent NLEM-2022, 91 (38.40%) students were aware of terminologies used in NLEM, and 71 (29.96%) students were aware of the criteria for inclusion of any drug in NLEM. 175 (73.84%) students were unaware of updates in NLEM-2022. 165 (69.62%) students were unaware of the number of medicines added and deleted in NLEM-2022.155 (65.40%) students were not able to answer the questions regarding drugs for anaphylaxis and new antihypertensive drugs included in recent NLEM-2022. Conclusion: Knowledge regarding NLEM is limited among undergraduate medical students. To sensitize medical students to rational drug therapy, there is an urgent need to improve their knowledge related to NLEM via educational interventions.
Active monitoring for adverse drug reactions of microtubule-damaging anti-neoplastic drug in a tertiary care hospital
(?Eldaghayes Publisher, 2024-08) Rajapandian, N; Krishnan, SP.
Background: Cancer is a critical disease characterized by unhampered progress and metastasis of atypical aberrant cells. In India, cancer is a leading cause of increased mortality, and it is also the cause of 3 million deaths per year. Most of the anti-cancer medications originated from plants, and despite the promising anti-cancer effects of natural medications, researchers have encountered various adverse drug reactions (ADR) related to the drug. Aims and Objectives: The aims and objectives of the study are to analyze the ADR profile of cancer patients treated with microtubule-damaging anti-neoplastic and assess the preventability, severity, and causality of the documented ADR. Materials and Methods: All the cancer patients on treatment regimens containing taxanes undergoing treatment in the medical oncology department were included in this study. All the study participants were monitored for adverse effects, and any ADR reported by the patients that were diagnosed and documented in the case sheet form was recorded in the adverse reaction reporting form. The mean ± standard deviation was performed for continuous variables. Categorical variables were stated in numbers and percentages. Results: A total of sixty study participants with ADR to microtubule-damaging anticancer drugs were registered for the study and among them, 10% were males and 90% were females. The majority of adverse reactions developed in patients between 51 and 60 years of age with female dominance. A total of 114 adverse reactions were reported by the sixty study participants registered in this study, and nevertheless, more than one ADR was noticed in a greater number of patients. Conclusion: Early observation of ADR may help in either modifying the dose or changing the drug that produces adverse reactions so that damage to the organ system can be prevented.
Acute response to hematological biomarkers in athletes after a short-term high-intensity exercise: A cross-sectional study
(?Eldaghayes Publisher, 2024-09) Singh, J; Chahar, PS; Singh, SK; Mishra, SP; Meena, A; Kumar, R.
Background: Exercise offers significant health benefits, promoting normal body system functioning, healthy growth, development, and overall well-being. Aims and Objectives: Therefore, the objective of the present study was to determine the effect of short-term high-intensity exercise (HIE) on hematological biomarkers and acute responses in athletes, as well as changes in these biomarkers immediately after 10 and 20 min of HIE. Materials and Methods: This cross-sectional study was carried out in the Department of Physical Education, Banaras Hindu University, Varanasi (UP). A total of 20 healthy male athletes with an age range of 22 to 26 years were randomly selected. All participants performed HIE for 5 min with maximal effort. Blood samples for selected hematological biomarkers were collected before exercise, immediately after exercise, and 10 and 20 min after the HIE. Results: A repeated measures analysis of variance with a Greenhouse- Geisser correction revealed that red blood corpuscles (F = 58.447; P < 0.05.), white blood cells (F = 59.778; P < 0.05), platelets (F = 23.794; P < 0.05), and hemoglobin (F = 46.853; P < 0.05) responses differed statistically significantly between time points. Post hoc analysis with a Bonferroni adjustment revealed that their response was significantly increased immediately after the HIE, reduced 10 min after the exercise, and closely returned to baseline levels after 20 min of exercise. Conclusion: HIE causes an inflammatory response in the blood by elevating the hematological biomarkers. These findings can be taken into consideration to develop high-intensity training programs for athletes.
Acute toxicity study and phytochemical screening of Pterocarpus marsupium heartwood
(Mrs Dipika Charan of MedScience (India) Publications, 2022-05) Koyagura, N; Munge, B; Vedula, P.
Background: Conventionally, Ayurvedic herbs are being used to treat various diseases. These medicinal compounds have to be evaluated for their safety and presence of therapeutic compounds for the clinical application. Aims and Objectives: The present study was designed to obtain the scientific knowledge on the safety profile as well as to assess the presence of pharmacologically active principles in the Pterocarpus marsupium heartwood. Materials and methods: The aqueous extract of P. marsupium heartwood was subjected to an acute toxicity in albino rats. The animals were divided into four groups (n = 6) and fed with graded doses (1000, 2000, and 5000 mg/kg p.o.) of plant extract, respectively, whereas control group had received 2 ml distilled water orally. Animals were continuously observed for the toxicological symptoms for 2 h and intermittently for 48 h and latter once in a day for 14 days. The body weight of the animals was recorded. In addition, the qualitative phytochemical investigations were conducted to identify the presence of active principles. Results: The animals fed with aqueous extract of P. marsupium heartwood did not exhibit any toxic symptoms and the mortality. However, there was a significant (P < 0.05) dose-dependent change in the weight gain observed in comparison to the control group. The median lethal dose (LD50) of the plant extract was considered as >5000 mg/kg. Furthermore, the phytochemical investigations of the plant extract showed the presence of carbohydrates, flavonoids, triterpenoids, saponins, tannins and phenols. Conclusion: The aqueous extract of P. marsupium heartwood was found to be safe and well tolerated even at a large dose of 5000 mg/kg. Furthermore, the plant extract found to possess pharmacologically active principles having wide pharmacological spectrum. Hence, it can be preferred in various therapeutic conditions.
Additive antiproteinuric effect of pentoxifylline in patients with diabetic nephropathy under angiotensin receptor blockade: A short-term, randomized, and controlled trial
(Mrs Dipika Charan of MedScience (India) Publications, 2022-06) Thottol, R; George, A; G, L.
Background: The ever-increasing prevalence of diabetes has led to a higher incidence of progression into complications including nephropathy. Diabetic kidney disease (DKD) is a chronic condition that is managed with renin-angiotensin-aldosterone system blockers which retard its progression. Pentoxifylline as an add-on therapy has been tried for reducing DKD. Aims and Objectives: The aims of this study were to study the safety and efficacy of pentoxifylline added on to an angiotensin II receptor blocker (ARB) to reduce the progression of the disease condition in diabetic nephropathy (DN) patients over 1 year. Materials and Methods: It is a randomized open-label study conducted in the Department of Nephrology, of a tertiary care center for 1 year. Type 2 diabetes patients with DN who satisfied the eligibility criteria were randomized into pentoxifylline added on to ARB or ARB alone and followed up for urine albumin-creatinine ratio (ACR) and serum tumor necrosis factor (TNF)-alpha. Results: Twenty-six patients were recruited and completed the study. Urine ACR was significantly low in the pentoxifylline group compared to the ARB alone group (P = 0.021). Serum TNF-? was decreased in the pentoxifylline group in comparison to the ARB alone group (P = 0.06). Conclusion: Pentoxifylline caused significant lowering of urinary ACR and urine TNF-? for 4 months.
Adverse drug reaction profile of patients taking amantadine for traumatic brain injury in a tertiary care hospital
(Mrs Dipika Charan of MedScience (India) Publications, 2023-01) Thaha, F; Rao, SCS; Mohanan, LK; Jose, P.
Background: Amantadine is found to be effective for the treatment of complications associated with traumatic brain injury. Drug-related side effects are common with Amantadine especially when combined with other drugs. Comprehensive information about the incidence and severity of these adverse effects is not available. Aim and Objectives: The aim of the study was to analyze the pattern of occurrence of adverse drug reactions (ADRs) in patients receiving Amantadine for traumatic brain injury in a tertiary care hospital. We also assessed the causality, severity and preventability of ADRs. Materials and Methods: This prospective cohort study was conducted among patients taking Amantadine for a continuous period of 1 month for traumatic brain injury in neurosurgery department between June 2020 and December 2020. Tools used were ADR Reporting form of National Pharmacovigilance Centre, WHO causality scale, Hartwig and Siegel scale, and Schumock and Thornton scale. Descriptive statistics were used and the values were expressed in numbers and percentages. Results: ADRs were experienced in 55 patients (36.7%) out of 150 patients and all the patients were on combination therapy. ADR was present more in male patients (63.6%) compared to females (36.4%). The most common ADRs were headache, ankle edema and dry mouth. Majority of ADRs belonged to the possible category according to the WHO causality assessment scale. Majority of the ADRs (61.9%) were mild level 1 according to severity scale. All the ADRs came under the definitely or probably preventable category. Conclusion: ADRs with Amantadine are common but mild and preventable.
Adverse drug reactions seen in cancer patients undergoing palliative care treatment at a palliative care center in Alappuzha
(?Eldaghayes Publisher, 2024-02) Alex, A; Sai Nathan, R; George, D.
Background: Adverse drug reactions are a major contributor to morbidity and hospitalization in patients and have been held responsible for as much as 5% of hospital admissions. This is especially relevant in cancer patients undergoing palliative care because they often suffer from advanced/terminal cancer and the adverse drug reactions from the palliative care drugs can affect their remaining quality of life. Aim and Objectives: The aim of this study was to study the adverse drug reaction profile of palliative drugs used in cancer patients undergoing palliative care at the Pain and Palliative Care OPD and their association with gender, age, dose, and duration of opioid intake. Materials and Methods: After receiving permission from the Institutional Ethics Committee, TDMC Alappuzha, 138 eligible cancer patients receiving palliative care from the pain and palliative care OPD were included in the study. The necessary data were obtained through interviews with the patients, who had given their consent to the study and the information was used to fill a questionnaire. Results: Out of the 138 study participants, 96 were male and 42 were female. The age composition ranged from 35 years to 88 years of age. There were 30 diabetic patients, 28 hypertensive patients, and 13 patients with CAD. The most frequent adverse effects, seen within 2 weeks of a 5 mg dose oral morphine regimen, were nausea (58.26%), constipation (51.18%), vomiting (43.30%), insomnia (33.07%), sedation (31.49%), dry mouth (25.19%), abdominal discomfort (24.04%), edema (20.47%) and tremors (19.68%). Using the modified Naranjo algorithm, 12% of ADRs were doubtful, 40% of ADRs were possible, 32% of ADRs were probable, and 16% of ADRs were definite. Among male patients taking 5 mg oral morphine, the most frequent ADRs were nausea (56.25%), constipation (45.31%), vomiting (40.62%), insomnia (34.37%), sedation (26.56%), dry mouth (21.87%), abdominal discomfort (18.75%), and edema (17.18%). Among female patients, the most frequent ADRs were vomiting (58.62%), nausea (55.17%), constipation (55.17%), abdominal discomfort (34.48%), dry mouth (31.03%), insomnia (31.03%), tremors (31.03%), sedation (24.13%), edema (20.68%), and pruritus (20.68%). Almost no significant associations were seen w.r.t to age, dose, and duration of opioid intake. Conclusion: The study identified the adverse effects associated with palliative care and their relative incidence. It also attempted to derive a correlation between the incidence of adverse effects and the age and gender of patient, the dose, and duration of opioid use.
Adverse effect profile with low-dose methotrexate therapy in patients suffering with rheumatic diseases
(?Eldaghayes Publisher, 2024-05) Parimi, VP; Mirza, MA; Bandaru, RK; Surapareddy, B; Bala, S; Rakesh, S.
Background: Methotrexate (MTX) is the anchor drug for the management of many systemic inflammatory diseases. High-dose MTX is associated with various toxicities which may lead to drug discontinuation or interruption of therapy. Low-dose MTX is widely used for treating various systemic autoimmune diseases and is considered relatively safe. Aims and Objectives: In this study, we describe the clinical features and factors affecting adverse effects of low-dose MTX in a large cohort of patients with autoimmune rheumatic diseases (AIRDs) from a tertiary health center in South India. Materials and Methods: This was a retrospective analysis wherein we aimed to characterize the clinical features seen in and factors associated with adverse effects due to low-dose MTX. We reviewed the medical records of patients who were receiving MTX for their underlying AIRD from the Department of Clinical Immunology and Rheumatology and General Medicine. Inclusion: Patients with AIRDs being treated with MTX, who suffered from adverse events. Excluded: Patients on other csDMARDs and bDMARDs. Clinical profile, indications of therapy, dose of MTX, adverse effects, and deranged laboratory parameters were noted. Results: A total of 815 subjects using MTX were identified over a period of 6 months duration (n = 713 (87%) females). Underlying autoimmune conditions included rheumatoid arthritis (n = 675, 82.8%). The most common adverse event noted was hair loss (7.7%), followed by nausea (3.9%). Cytopenia and transaminitis were noted in 1.6% and 2.2%, respectively. Higher incidence of adverse events was seen in those without folic acid intake (81.2%; P = 0.0001). Conclusion: Low-dose MTX, although causes mild adverse effects and has the potential to cause life-threatening adverse events like cytopenia, is usually well tolerated. Identification of toxicities early improves the outcomes of patient care. Folate supplementation ameliorates side effects.
Adverse events following COVID-19 vaccination: An online survey
(?Eldaghayes Publisher, 2024-03) Arunnair, V; Bhuvaneshwari, S; Umamageswari, MS; Sathiya Vinotha, AT; Velarul, S; Jeevithan, S.
Background: Considering the overwhelming medical, economic, and social consequences of coronavirus disease 2019 (COVID-19), safe and effective prophylactic vaccines were rolled out in India on January 16, 2021. Although the discussions surrounding the efficacy of the vaccines are greatly explored, safety concerns regarding post-marketing surveillance have not been studied in detail. Aims and Objectives: The study aims to assess the post-vaccination events to the first and second doses of COVID-19 vaccine and to evaluate the adverse effects (AEs) profile of the individual COVID-19 vaccines among COVID-19 vaccinated participants. Materials and Methods: Retrospective, cross-sectional online survey, was conducted among COVID-19 vaccinated participants from June 2021 to December 2021 at a tertiary care hospital, in Coimbatore. Data obtained through Google forms were analyzed using statistical package for the social sciences version 26. Results: Of the 95 responses received, 93.2% had adverse events following immunization (AEFI). Pain at the injection site (74.74%), general unwell feeling (51.58%), and fever/chills (44.21%) were the commonly reported AEs. AEFI was higher with the first dose (53.5%) compared to the second dose (39.7%). Among the factors associated with AEFI, except the history of (H/O) medication for acute/chronic illnesses, there were no statistically significant differences between gender, COVID- 19 infection in the past, H/O drug/food allergy, type of vaccine, and comorbidities. Conclusion: Most of the AEFIs were mild, and both the viral vector and inactivated vaccine were found to be safe. Hence, the COVID-19 vaccination should be recommended to counteract the severity of the disease.
Adverse reaction monitoring in drug resistance tuberculosis patients in a Northern Karnataka district
(?Eldaghayes Publisher, 2024-02) Latha, S; Somashekara, SC; Ghatage, S; Suraj, B.
Background: Drug resistance tuberculosis (DRTB) is an important concern in India as it accounts, one-fourth of global burden. DRTB regimen is associated with adverse drug reactions (ADRs) accounting for significant mortality, non-adherence, and treatment discontinuation. Hence, the present study emphasis to be vigilant about these ADRs. Aims and Objectives: The aim of the study was to estimate the incidence, various types, and risk factors associated with adverse reactions in DRTB in Northern Karnataka district. Materials and Methods: A Prospective observational cohort study was conducted at Nodal DRTB center. All diagnosed and treatment initiated pulmonary DRTB patients during January–March 2021 aged ?18 years of either sex were included, which constituted 70 patients. A pre-designed case report form was used to collect details like sociodemographic information, past history, personal history, and drug regimen along with their contact information of the DRTB patients. Results: Of 70 study participants, 64% were males and mean age was 36.7 ± 14.5 years with majority being resistant to rifampicin (52%). Incidence of ADR was 32 (46%) and commonly reported ADR were nausea (30%), gastritis (24%), vomiting (21%), arthralgia (9%), and peripheral neuropathy (9%). Causality assessment was done using “Naranjo algorithm,” majority were probable (79.01%) and as per the modified Hartwig and Siegel severity scale most ADR were mild (87.65%). The past history of TB and exposure to ATT was the major risk factor associated and was statistically significant (P = 0.009). Conclusion: ADRs are common in DRTB regimen early recognition and appropriate management might determine treatment adherence, prevent complications, and improve overall treatment outcome.
Aging effect on cardiac sympathovagal activity in healthy males over seven decades using short-term heart rate variability analysis
(Mrs Dipika Charan of MedScience (India) Publications, 2022-02) S, SJ; M, S.
Background: The autonomic nervous system (ANS), which governs practically all bodily processes, alters structurally and functionally as we age. Heart rate variability (HRV) studies are non-invasive, quantitative approaches to investigate the effects of ANS activity on the heart and also a marker to predict mortality. Aim and Objectives: This study was undertaken to assess the effect of aging on cardiac sympathovagal activity in healthy males over seven decades using short-term HRV analysis. Materials and Methods: This cross-sectional study was conducted on healthy in the age group of 10–69 years. Participants were divided into many age groups based on their decade of birth. Short-term HRV recording was done. In frequency domain analysis, spectral estimates of RR intervals was done by integrating the power as total power, low-frequency power (LF), high-frequency power (HF). In time-domain analysis, SDNN, RMSSD, and pNN50% were studied. Data were subjected to statistical analysis using ANOVA. Results: In the frequency domain analysis of HRV, all the components such as total power, HF in nu and msec2, LF in nu and msec2, LF/HF ratio decreased as the age advances. In the time domain analysis of HRV, all the components decrease as age advances. When the values were compared with other age ranges, a significant decrease with aging only with respect to the comparisons between the youngest (10–29 years) and oldest (50–69 years) groups. Conclusion: Our study found a global decrease in all the HRV indices. The decline in time domain indices was rapid in the early ages, stabilized out at the age of 40, and then declined gradually.
Airflow limitation in asymptomatic tobacco users and tobacco non-smokers
(?Eldaghayes Publisher, 2024-03) Michael, J; Mathew, S; Vincent, J.
Background: The most frequent global contributor to avoidable fatalities is tobacco smoking. Cigarettes are a common way to consume tobacco. More hazardous chemicals are exposed, which causes more damage to the conduits and parenchyma of the lungs. Compared to non-smokers, cigarette smokers had a greater prevalence of FEV1 decline and a higher chronic obstructive pulmonary disease mortality rate. These disparities between smokers and non-smokers are inversely correlated with smoking frequency. Pulmonary function tests can detect an obstructive pattern early. Aims and Objective: The present study was done to assess the effect of tobacco smoking on pulmonary function and to evaluate the difference between smokers and non-smokers. Materials and Methods: The present study is a cross-sectional study conducted in the Department of Physiology, Sree Mookambika Institute of Medical Sciences for 1 year. The study participants were divided into two groups, Group I included 110 participants who were asymptomatic smokers, who smoke more than 5 cigarettes per day for more than 1 year and Group II included 110 participants who were non-smokers and not exposed to passive smoking. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1 to FVC ratio (FEV1/FVC), and peak expiratory flow rate (PEFR) were done after explaining the procedure to the participants. Data thus obtained were entered into Excel sheet. Results were analyzed using the SPSS 20.0 version and the association was tested using the unpaired “t” test and one-way analysis of variance test. Results: The spirometric variables (FVC, FEV1, and PEFR) were lower in smokers as compared to nonsmokers. This difference was statistically significant. The rate of reduction was also proportional to the number of years, the person had been smoking. Conclusion: Smoking tobacco in any kind has a serious negative impact on lung functions. Early detection and support for these asymptomatic smokers are crucial because early cessation is linked to improved survival. Being the initial point of contact, primary care doctors can play a significant contribution.
Alteration of liver function tests in various liver diseases
(?Eldaghayes Publisher, 2024-01) Patel, BR; Trivedi, N.
Background: The burden of liver diseases in India has witnessed a significant rise, spurred by factors such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, and a spectrum of metabolic and genetic disorders. Liver function tests (LFTs) serve as invaluable tools in the hands of clinicians, offering insights into the dynamic interplay between hepatic health and various disease processes. This study aims to provide a detailed exploration of the alterations in LFTs associated with various liver diseases prevalent in India. Aim and Objectives: (i) To Identify the various types of Liver diseases; (ii) To evaluate the various liver function tests in various liver diseases. Materials and Methods: The study involved the collection of samples from 100 liver disease patients who seek medical care at C. U. Shah Medical College and Hospital. Informed consent was obtained from all participants and the study protocol was approved by the institutional ethics committee. Results: Our study shows that the prevalence of cirrhosis of liver was 25% among study participants. Majority of liver disease were prevalent in male whereas, mostly affected age group was 51–60 years. Bilirubin was altered in cirrhosis of liver (88%), obstructive jaundice (100%), alcoholic liver disease (80%), viral hepatitis (75%), and in other liver disease (85%). Conclusion: Altered LFT is a useful tool to reach the Etiology of Liver disease. Alterations in liver enzymes as well as HbsAg reactivity are specific tests for cirrhosis of liver and viral hepatitis.
Altered circulating adipokines and heart rate variability: A biomarker for autonomic imbalance in obese individuals
(Mrs Dipika Charan of MedScience (India) Publications, 2022-01) Katuri, RB; Gaur, GS; Sahoo, JP; Bobby, Z; Shanmugavel, K.
Background: Evidences indicate altered circulating adipokine levels in obesity could increase the risk for cardiovascular disease (CVD). Hence, it is crucial to determine cardiovascular health by assessing heart rate variability (HRV) and its association with circulating adipokines. Aim and Objectives: The aim of the study was to assess the adipokines level and its association with HRV in obese population. Materials and Methods: A cross-sectional comparative study was conducted on 45 obese (body mass index [BMI] > 25–29.9 kg/m2) and 45 non-obese (BMI: 18.5–22.9 kg/m2) age-gender-matched participants. Lead-II electrocardiogram was recorded and HRV parameters were obtained. Biochemical parameters, that is, fasting blood glucose, fasting insulin, HOMA-IR, lipid profile, leptin, and adiponectin levels were estimated. Group comparisons were done by independent student’s t-test, whereas the association between the parameters was done by Pearson’s correlation using SPSS 20v. P < 0.05 was considered statistically significant. Results: There was a significant increase in low frequency: high frequency (LF: HF) ratio (<0.001), fasting insulin (<0.001), HOMA-IR (<0.001), leptin (<0.001), Leptin-Adiponectin ratio (L/A ratio) (<0.001), total cholesterol (<0.001), triglycerides (<0.001), and low-density lipoproteins (<0.001), whereas significant decrease in total power (TP) of HRV (TP) (<0.001), adiponectin (<0.001), and high-density lipoproteins. A significant positive correlation between leptin, L/A ratio with LF: HF ratio (r = 0.793, P < 0.001) and a negative correlation with TP (–0.463, P < 0.001) was observed. Conclusion: Altered adipokines and its association with HRV in obese individuals could be an indicator of CVD. Hence, the current study suggests that the L/A ratio might be considered as a biomarker for cardiovascular health in obese individuals.

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