Journal of Pharmacology and Pharmacotherapeutics

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https://imsear.searo.who.int/handle/123456789/150269

Editor: Mr R Raveendran

Language: English

Open Access Peer-reviewed journal

Web site: https://www.jpharmacol.com/>

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An Update on the Pharmacological Aspects of Vaccines and Antivirals for the Management of Monkeypox
(SAGE Publications, 2023-03) James, J; A, P; P, K; Rani, J; V, S.
Monkeypox is a self-limiting zoonotic disease caused by the monkeypox virus belonging to the genus of orthopox viruses. Initially considered an ‘African disease’, this infection has crossed the boundaries to affect other continents and it has raised tremendous concerns among the general public as well as the medical fraternity all over the world, particularly because of the lack of specific vaccinations and drugs for the management of the illness. Epidemiological evaluation of the current infection has reported that it is mainly transmitted through sexual contact in bisexual men, mostly whites, and in those with pre-existing human immunodeficiency virus infection. The most common presentations were skin rash, anogenital lesions, or mucosal lesions along with systemic symptoms. It has been established that the vaccines and drugs approved for the management of smallpox could be used for the management of the current monkeypox outbreak. Vaccinia Immune Globulin (VIG) and vaccines like JYNNEOS and ACAM2000 and antiviral drugs like tecovirimat, cidofovir (CDV), and brincidofovir are being considered for those patients with serious diseases. It is imperative for physicians to understand the pharmacological aspects of these drugs for delivering better care to patients with monkeypox, which is eventually essential for the containment of this infection. This review covers updates on vaccines as well as drugs for the prevention and management of monkeypox.
Targeting TLR-4 Signaling to Treat COVID-19-induced Acute Kidney Injury
(SAGE Publications, 2023-01) Almazmomi, MA; Alsieni, M.,
The newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has turned into a potentially fatal pandemic illness. Numerous acute kidney injury (AKI) cases have been reported, although diffuse alveolar destruction and acute respiratory failure are the major symptoms of SARS-CoV-2 infection. The AKI, often known as a sudden loss of kidney function, carries a greater risk of mortality and morbidity. AKI was the second most frequent cause of death after acute respiratory distress syndrome (ARDS) in critically ill patients with coronavirus disease 2019 (COVID-19). While most patients with COVID-19 have moderate symptoms, some have severe symptoms, such as septic shock and ARDS. Also, it has been proven that some patients have severe symptoms, such as the failure of several organs. The kidneys are often affected either directly or indirectly. The major signs of kidney involvement are proteinuria and AKI. It is hypothesized that multiple mechanisms contribute to kidney injury in COVID-19. Direct infection of podocytes and proximal tubular cells in the kidneys may lead to acute tubular necrosis and collapsing glomerulopathy. SARS-CoV2 may also trigger a cascade of immunological responses that lead to AKI, including cytokine storm (CS), macrophage activation syndrome, and Toll-like receptor type 4 activation (TLR-4). Other proposed processes of AKI include interactions between organs, endothelial failure, hypercoagulability, rhabdomyolysis, and sepsis. Furthermore, ischemic damage to the kidney might result from the decreased oxygen supply. This article focuses on kidney injury’s epidemiology, etiology, and pathophysiological processes. Specifically, it focuses on the CS and the role of TLR-4 in this process. To effectively manage and treat acute kidney damage and AKI in COVID-19, it is crucial to understand the underlying molecular pathways and pathophysiology.
Comparative Study Between Intravenous Clonidine and Preservative Free Intravenous Lignocaine in Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation
(SAGE Publications, 2023-01) Vazhakalayil, STJ; Haroon, S.
Objectives To compare the attenuation of pressor responses by intravenous clonidine and preservative-free lignocaine to laryngoscopy and endotracheal intubation. Materials and Methods A randomized, prospective, comparative, double-blinded study was conducted in 80 adult patients who were randomized into two groups of 40 each, group clonidine (Group C) and group lignocaine (Group L). Group C patients were given 2 µg/kg clonidine in 20 ml of normal saline as a slow infusion over 10 min prior to intubation. Group L patients were given 1.5 mg/kg of preservative-free 2% lignocaine in 20 ml of normal saline as a single-dose infusion over 3 min prior to intubation. Baseline vital and hemodynamic parameters were monitored during the perioperative period at 1-, 5-, and 10-min post-intubation. Results The attenuation of heart rate (HR) after intubation was much better with clonidine than lignocaine as there is statistically significant difference in the mean HR between the two groups at 1, 5, and 10 min after intubation with the HR significantly lesser in the Group C than the Group L at all times after intubation. Both clonidine and lignocaine were effective in attenuating systolic blood pressure response after intubation, but clonidine was more effective than lignocaine as systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in the Group C remained much lower than the Group L and the difference between the two groups was statistically significant at all times after intubation. Conclusion Premedicating with a single slow infusion of 2 µg/kg i.v. clonidine has been proven to be effective in maintaining perioperative hemodynamic stability at 1, 5, and 10 min post-intubation than lignocaine.
Self-assumed Neurologic Related Condition Deviated Metoclopramide-Induced Acute Dystonic of Oculogyric Crisis in a Woman of Childbearing Age: A Case Report
(SAGE Publications, 2023-01) Ismail, Nahlah Elkudssiah; Jha, Ambika Nand; Goh, Khang Wen; Ming, Long Chiau; Wahab, Mohd Shahezwan, Abd.; Shah Nehal, J.; Shah, Akshay H.; Hermansyah, Andi.
A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.
Patterns of Medication Use and Their Determinants in Pregnancy among Women Admitted to the Obstetrics Wards of a Tertiary Care Hospital: A Cross-Sectional Study: Patterns of Medication Use and Their Determinants in Pregnancy
(SAGE Publications, 2023-01) Rajan, B; Pasangha, E; Devi, P; George, S.
Objective To assess the patterns and factors affecting medication use during antenatal and perinatal periods and to examine maternal and fetal outcomes among pregnant women admitted to a tertiary care hospital in a developing country. Methods A cross-sectional study was conducted in the obstetrics wards from 2017 to 2019. Data on patient demographics, co-existent medical conditions, medications, and patient outcomes were collected. Descriptive statistics were used to analyze baseline data, chi-square test was used for categorical variables, and multivariate logistic regression was used for factors influencing drug prescription. Results Out of 442 pregnant women, 56% were primigravida with a mean age of 24.7 ± 3.9 years. Approximately 32% experienced at least one disease condition during pregnancy; hypothyroidism (9.7%) was the commonest. The mean number of medications was 2.7 and 38.9% received drugs for a disease condition. Antimicrobials (24.5%) were the commonest drug class. Maternal age of over 25 [(OR (CI): 1.508 (1.191–2.716) (p = .005)] and maternal illness [OR (CI) 2.934 (1.8–4.7) (p = .00)] were identified as factors affecting drug prescription. Approximately 39.8% of deliveries were cesarean. Of the newborns, 12.6% had low birth weight, 9.2% were admitted to the newborn intensive care unit, and 14.9% were premature. Conclusions Most patients were primigravida and under 25 years. Antimicrobials were the most prescribed drug class. Maternal age over 25 years and maternal illness were identified as the factors affecting medication use. The prevalence of cesareans and prematurity was similar to previous studies.
Delayed Extensive Local Reaction to the mRNA-1273 Vaccine against SARS-CoV-2: A Case Report
(SAGE Publications, 2023-01) Ferreira-da-Silva, Renato; Ribeiro-Vaz Inês; Silva, Ana Marta; Nunes, Fernando; Morato, Manuela; Polónia, Jorge Junqueira; Guedes, Paulo.
In response to the COVID-19 pandemic, two mRNA vaccines (Comirnaty and Spikevax) received emergency use authorization from the European Medicines Agency. This case report aimed to report a delayed adverse reaction to the mRNA-1273 vaccine against COVID-19 from a Portuguese vaccination center. A case report was performed with medical observation and reported to the Portuguese Pharmacovigilance System, then investigated based on the WHO-UMC Causality Categories. A 66-year-old female patient with a clinical history of dyslipidemia, essential arterial hypertension, obesity, multinodular goitre and cholecystectomy, who presented delayed large cutaneous hypersensitivity reaction following Spikevax COVID-19 mRNA (mRNA-1273) vaccine administration. Our clinical findings (time and clinical appearance), along with evidence of previously reported histological findings, are strongly suggestive of T-cell-mediated hypersensitivity. There is no contraindication to the inoculation of subsequent doses in patients developing these clinical conditions, and vaccination should continue to be strongly encouraged.
Neuroprotective Effects of P-Coumaric Acid on Haloperidol-Induced Catalepsy Through Ameliorating Oxidative Stress and Brain Dopamine Level
(SAGE Publications, 2023-02) Pathan, AS; Jain, PG; Kumawat, VS; Katolkar, UN; Surana, SJ.
Objective To evaluate the effect of p-coumaric acid (p-CA) on haloperidol-induced catalepsy in Swiss albino male mice. Method To induce catalepsy, haloperidol (1 mg/kg i.p.) was administered for 21 consecutive days. p-CA (50, 75, and 100 mg/kg, PO) was administered 30 min before haloperidol injection for 21 consecutive days. For catalepsy, locomotor activity and motor coordination scores were recorded on the 17, 14, and 21 days of drug treatment, while the gait analysis score was recorded on day 21. After behavioral testing, animals were sacrificed, and various biochemical and histopathology tests of the brain were conducted. Dopamine, malondialdehyde, reduced glutathione (GSH), superoxide dismutase (SOD), and catalase activity were examined in the brain. Results Chronic administration of haloperidol significantly increased catalepsy in mice. It also produced hypolocomotion, motor coordination, and gait disturbance in mice. p-CA significantly inhibited haloperidol-induced catalepsy. Haloperidol significantly increased malondialdehyde levels in the brain. While dopamine levels in the brain dropped along with GSH, SOD, and catalase activity levels, which also had an impact on the histology of the brain. p-CA significantly reduced haloperidol-induced increases in brain oxidative stress, dopamine levels in the brain, and brain histology in mice. Discussion p-CA significantly reduced haloperidol-induced catalepsy, possibly through reducing oxidative stress and increasing brain dopamine levels. It can be a good candidate drug for extrapyramidal symptoms in Parkinson’s disease and adjuvant therapy with antipsychotic drugs.
Antimicrobial Resistance, Phenotypic Characteristics, and Biofilm Production in Citrobacter freundii Isolates Obtained from Urinary Tract Infections
(SAGE Publications, 2023-01) Shinu, P.
Objective To evaluate the link between phenotypic traits, antimicrobial resistance, and biofilm-producing capacity of urinary isolates of Citrobacter freundii (C. Freundii). Methods Both pan-antibiotic-susceptible and -resistant C. freundii isolates (n = 120) obtained from laboratory-confirmed urinary tract infections were analyzed for their link between antimicrobial resistance, phenotypic characteristics, and biofilm production. Results Of the total C. freundii isolates (n = 120), 30% (37/120) of them formed large colonies. Among the total large colonies produced (n = 37), they were present in 21.62%, 10.81%, 13.5%, 16.2%, 21.62%, and 16.21% in the control group, CIP-group, FOS-group, COT-group, Gent-group, and ESBL groups, respectively. Compared to the pan-susceptible isolates, the occurrence of large-sized-colony-forming strains was relatively reduced in most of the drug-resistant groups. The overall distribution of mucoid colonies produced (n = 54) includes 9.25%, 18.51%, 16.66%, 18.51%, 20.3%, and 16.66% in the control group, CIP-group, FOS-group, COT-group, Gent-group, and ESBL groups, respectively. Of the total isolates that produced biofilm (n = 51), 11.76% of isolates showed biofilm formation in the control group. Alternatively, the rate was found to be 15.68%, 11.76%, 25.49%, 19.6%, and 15.68% in the CIP-group, FOS-group, SXT-group, Gen-group, and ESBL-groups, respectively. Conclusion This study correlates the association between phenotypic characteristics, antimicrobial resistance, and biofilm production, the three main characteristics of C. Freundii.
Australia’s Pharmacology Research: A Scientometric Assessment of High-Cited Papers During 2002–2021
(SAGE Publications, 2023-02) Ahmed, KKM; Gupta, BM; Mamdapur, GM.
Objectives To analyze Australia’s high-cited papers (HCPs) receiving ?100 citations in pharmacology during 2002–2021 and examine the research characteristics, study performance of the top 30 leading participating organizations and authors, and identification of top 30 journals publishing in this area and sub-fields of their research. Materials and Methods Australia’s HCPs on pharmacology research from the top 30 most productive organizations were identified and extracted from the Scopus database from 2002 to 2021 on 21 September 2022 using a search strategy. Select bibliometric measures were utilized to evaluate the publication productivity of important players in this area. The network analysis was performed to evaluate the collaborative interactions amongst the countries, organizations, authors, and keywords. Results -Of the 19,418 Australia’s publications (articles) in pharmacology from the top 30 most productive organizations during 2002–2022, only 685 (3.53%) were HCPs, which together received 1,14,623 citations, averaging 164.4 citations per paper (CPP) and the citations ranged from 100 to 1,230. Two papers had more than 1,000 citations and 16 papers had 500 citations. Of the 685 HCPs, 40.58% (278) and 11.39% (78) received external funding support and were international collaboratives. The most productive organizations were Monash University (n = 155), the University of Queensland (n = 111) and the University of Melbourne (n = 97). The most impactful organizations in terms of CPP and relative citation index (RCI) were James Cook University (203.22 and 1.21), Australian National University (196.67 and 1.18) and Queensland University of Technology (193.45 and 1.16). The most productive authors were J. Li (n = 24), C. J. H. Porter (n = 24) and R. L. Nation (n = 23) (Monash University, Melbourne); and the most impactful authors in terms of CPP were A. Christopoulos (Monash Institute of Pharmaceutical Sciences, Melbourne) (288.21), C.W. Pouton (Monash University, Melbourne) (241.50), and D.L. Peterson (University of Queensland, Brisbane) (225.58). The most productive journals were Antimicrobial Agents and Chemotherapy (n = 59), Environmental Pollution (n = 43) and Journal of Medicinal Chemistry (n = 42). The most impactful journals in terms of CPP were Nature Reviews Drug Discovery (371.8), Antiviral Research (286.86) and European Journal of Pharmaceutical Sciences (253.0). The most important keywords with their frequency of appearances were Animal Experiments (108), Metabolism (76), Drug Effects (67), Animal Models (65), Protein Expression (64), Anti-Bacterial Agents (62), Drug Delivery Systems (54), Drug Formulation (44), Signal Transduction (42), and so on. Conclusion There is an urgent need to increase national funding and expand international collaboration in priority areas, which will help to increase and diversify research output and improve research impact.
Rituximab, a Safer Option for Rheumatoid Arthritis: A Comparison of the Reported Adverse Events of Approved Monoclonal Antibodies
(SAGE Publications, 2023-02) Sharma, S; Basu, S; Goyal, RK; Sahoo, PK; Mathur, R.
Monoclonal antibodies (mAbs), which are commonly used to treat rheumatoid arthritis (RA), have been linked to a variety of adverse events (AEs). The objective of the study was to compare the safety profiles of six FDA approved mAbs (sarilumab, tocilizumab, adalimumab, golimumab, infliximab, and rituximab) marketed for the treatment of RA. A systematic review of the literature was conducted using the databases PubMed, Cochrane Library, and Science Direct. The manuscript comprised a total of 23 clinical studies. The percentage of patients who had AEs was calculated and presented using box-whisker and forest plots. Infections and infestations were found to be the most common AEs in RA patients treated with mAbs. Raised alanine aminotransferase (ALT), aspartate aminotransferase (AST), upper respiratory tract infection (URTI), and nasopharyngitis were frequently reported. The most common AEs were reported with adalimumab. The highest percentage of patients reporting AEs was associated with golimumab (52%), while rituximab had the fewest AEs (4.9%). In conclusion, rituximab appears to be a safer treatment option for RA as it is found to be associated with a lower risk of AEs, particularly respiratory infections.
A Deep Insight into the Correlation Between Gut Dysbiosis and Alzheimer’s Amyloidopathy
(SAGE Publications, 2023-02) Kondaveeti, Sreenivasulu Naidu; Thekkekkara, Dithu; T, Lakshmi Narayanan; Manjula, S. N.; Tausif, Y Mohammed; Babu, Amrita; Meheronnisha, SK.
Recent research has shown a strong correlation between gut dysbiosis and Alzheimer’s disease (AD). The purpose of this review is to investigate the relationship between gut dysbiosis, immune system activation, and the onset of AD and to examine current breakthroughs in microbiota-targeted AD therapeutics. A review of scientific literature was conducted to assess the correlation between gut dysbiosis and AD and the various factors associated. Gut dysbiosis produces an increase in harmful substances, such as bacterial amyloids, which makes the gut barrier and blood-brain barrier more permeable. This leads to the stimulation of immunological responses and an increase in cytokines such as interleukin-1? (IL-1?). As a result, gut dysbiosis accelerates the progression of AD. The review highlights the connection between gut dysbiosis and AD and the potential for microbiota-targeted therapies in AD treatment.
Exposure to Azathioprine Metabolites and Clinical Outcome in Indian Patients with Crohn’s Disease
(SAGE Publications, 2022-03) Prabha,R; Mathew,SK; Joseph,AJ; Mathew,BS.
Aim: To determine the concentration of 6-thioguanine nucleotide (6-TGN) and 6-methylmercaptopurine (6-MMP), the interpatient variability, and the relationship with disease activity in patients with Chron’s disease on long-term stable doses of azathioprine (AZA). Methods: This is a prospective, tertiary care single-center hospital study in adult Chron’s disease patients treated with AZA. The quantification of phenotypic thiopurine methyltransferase enzyme activity in red blood cells and the estimation of the concentration of 6-TGN and 6-MMP in whole blood was performed using the HPLC-UV detector method. A clinical response was categorized as remission (Harvey-Bradshaw Index [HBI] < 5) or improvement (drop from baseline of at least three points of HBI) based on HBI. Exposure to metabolite concentrations and the clinical response to AZA treatment was observed. Results: Study analysis included 30 patients who were initiated on AZA, and they were followed up with an estimation of metabolite concentrations to determine their clinical outcome. At six months, 93% of (n = 28) patients continued to be on AZA and had clinical improvement. All the patients achieved remission of Chron’s disease. Only two patients developed adverse effects such as joint pain and thrombocytopenia. Conclusion: AZA is a safe and effective therapy in managing Chron’s disease when administered after determining thiopurine methyltransferase phenotype and with dose optimization performed using therapeutic drug monitoring of 6-TGN and 6-MMP.
A Review on the Pharmacological Importance of PDE5 and Its Inhibition to Manage Biomedical Conditions
(SAGE Publications, 2022-11) Saikia,Q; Hazarika,A; Mishra,R.
Phosphodiesterase type 5 (PDE5) is a cyclic GMP (cGMP) specific protein. It hydrolyzes the phosphodiesterase linkage and catalyzes the conversion of cGMP to 5’ GMP, which controls different physiological activities of the body. PDE5 is associated with biomedical conditions like neurological disorders, pulmonary arterial hypertension, cardiomyopathy, cancer, erectile dysfunction, and lower urinary tract syndrome. Inhibition of PDE5 has now been proven pharmaceutically effective in a variety of therapeutic conditions. Avanafil, tadalafil, sildenafil, and vardenafil are the most commonly used PDE5 inhibitors (PDE5i) today which are often used for the management of erectile dysfunction, lower urinary tract syndromes, malignancy, and pulmonary arterial hypertension. However, these synthetic PDE5i come with a slew of negative effects. Some of the most common side effects include mild headaches, flushing, dyspepsia, altered color vision, back discomfort, priapism, melanoma, hypotension and dizziness, non-arteritic anterior ischemic optic neuropathy (NAION), and hearing loss. In light of the potential negative effects of this class of medications, there is a lot of room for new, selective PDE5 inhibitors to be discovered. We have found 25 plant botanical compounds effectively inhibiting PDE5 which might be useful in treating a variety of disorders with minimal or no adverse effects.
A Prospective, Observational Study of the Spontaneous Reporting Patterns of Adverse Drug Reactions in a Tertiary Care Teaching Hospital
(SAGE Publications, 2022-11) Raju,SK; S.,G; Kamble,S.
Objectives: To analyse the adverse drug reactions (ADRs) reported from clinical departments of a tertiary care hospital. Materials and Methods: A prospective, observational study to analyse the reported ADRs to the pharmacovigilance unit, Department of Pharmacology, East Point College of Medical Sciences and Research Centre, between 2019 and 2021. Institutional Ethics Committee approval was taken before doing the study. The data pertaining to various parameters were recorded in the Central Drugs Standard Control Organization (CDSCO) approved ADR reporting form and were analysed with respect to each reported data using descriptive statistics and expressed as numbers and percentages using Microsoft Excel. Results: Overall, 114 ADRs were reported during the study duration, and ADRs were most commonly reported amongst females (69) and 31–45 years (27.2%) age group. Causality assessment was done using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale, which showed 75 (66%) probable and 39 (34%) possible ADRs. The highest number of ADRs were reported by Medicine department (48.2%), emergency and intensive care unit (ICU) (16.6%) followed by Dermatology department (9.6%). The majority of them were due to antimicrobial agents (53.5%). The most commonly affected organ system was found to be dermatological (68.4%) followed by the body as a whole (15.7%) and gastrointestinal system (8.7%). The presentations of ADRs were diverse; itching and rashes (34 cases) were most commonly reported. Conclusion: This study gives an overall understanding of the current situation and trends in ADRs and their reporting status by health professionals in a tertiary care hospital, which would help to strengthen the pharmacovigilance activities at all levels of health care.
Transgenic Rodent Models in Toxicological and Environmental Research: Future Perspectives
(SAGE Publications, 2022-11) Christapher,PV; Ganeson,T; Chinni,SV; Parasuraman,S.
The coexistence of humans and animals has existed for centuries. Over the past decade, animal research has played a critical role in drug development and discovery. More and more diverse animals, including transgenic animals, are used in basic research than in applied research. Transgenic animals are generated using molecular genetic techniques to add functional genes, alter gene products, delete genes, insert reporter genes into regulatory sequences, replace or repair genes, and make changes in gene expression. These genetically engineered animals are unique tools for studying a wide range of biomedical issues, allowing the exhibition of specific genetic alterations in various biological systems. Over the past two decades, transgenic animal models have played a critical role in improving our understanding of gene regulation and function in biological systems and human disease. This review article aims to highlight the role of transgenic animals in pharmacological, toxicological, and environmental research. The review accounts for various types of transgenic animals and their appropriateness in multiple types of studies.
The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement
(SAGE Publications, 2022-07) Bagle,A; Pujari,S; Shah,K; Solanki,S; Singh,C.
Objective: To evaluate the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods: This was a prospective, randomized, double-blinded placebo-controlled study done over a period of two years. A total of 60 participants undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously for Group K and Inj. Normal Saline 10 mL was given intravenously for Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results: There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N (P value <.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP)) were statistically and clinically not significant in both the intraoperative and postoperative periods between the groups. Conclusion: Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.
Treatment Considerations and Pharmacist Collaborative Care in Diabetic Ketoacidosis Management
(SAGE Publications, 2022-10) Algarni; Alanood.
Diabetic ketoacidosis (DKA) is a medical emergency caused by the lack of insulin. Metabolic acidosis, hyperglycemia, and ketoacidosis are its defining features. Insulin deficiency can cause DKA either in the presence or absence of a triggering event causing a chain of pathophysiological changes. Normalizing volume status, hyperglycemia, electrolytes, and ketoacidosis are the objectivesof DKA treatment. While hospital pharmacists are involved in managing DKA, community or ambulatory care pharmacists can help to prevent DKA. Depending on the particular field of practice, a p harmacist’s engagement in DKA may involve a number of factors. Inpatient pharmacists are in a good position to help with the acute care of DKA. Because they can recognize patients who are at risk for DKA due to factors including medication nonadherence or insulin pump failure, pharmacists in the community or ambulatory-care environment play a crucial role in its prevention. When a patient finds it challenging to navigate prescription plan coverage or a lack of coverage, community pharmacists can help them obtain insulin. Regardless of the professional environment, patient education is essential. Every pharmacist has the ability to give DKA patients thorough medication education that emphasizes the value of adhering to their drug schedule, addresses any obstacles that may occur, and teaches patients how to correctly monitor their blood glucose levels. Studies showed that pharmacists’ medication counseling and treatment monitoring could improve adherence to insulin medication. The aim of this review is to provide evidence that pharmacists can contribute to optimizing medication adherence and decrease the incidence of DKA.
Homocysteine Levels and Clinical Outcomes in Schizophrenia—A Pilot Randomized Controlled Trial
(SAGE Publications, 2022-11) Vedam,VAV; Ghanta,MK; Kantipudi,SJ; David,DC; Vijayalakshmi,M; Nuthalapati,P.
Objectives: To find out the relation between homocysteine levels in peripheral blood and the effectiveness as well as the safety of haloperidol and olanzapine in schizophrenia treatment. Materials and Methods: A prospective randomized parallel-group open-label interventional clinical trial was conducted on 40 mild to moderate schizophrenia patients. To compare the efficacy of olanzapine and haloperidol Brief Psychiatric Rating Scale (BPRS) score was used. Homocysteine levels of peripheral blood and Abnormal Involuntary Movement Scale scores were evaluated. Results: BPRS score improved in both groups on day 14 and day 28. But significantly more with olanzapine (P value =.001). The olanzapine group showed a higher reduction (13.91±0.47 to 9.74±0.5) in homocysteine levels than the haloperidol group. Also, the BPRS scores negatively correlated (r = –0.66) to homocysteine levels. Conclusion: Therefore, our study shows that peripheral blood homocysteine levels can be used to predict and assess the treatment outcome in schizophrenia patients. Biomarker driven approach in schizophrenia will allow the patients to be treated promptly with the right drug. In this light, personalized treatment holds great potential in the future.
Progress Update on the Epidemiology of COVID-19 Variants and the Assessment Status of Developed Vaccines
(SAGE Publications, 2022-12) Venugopala,KN.
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread rapidly and diffused to more than 180 countries at varying severities. This pandemic has accounted for increased mortality and morbidity in developed as well as developing nations. The WHO has announced that there is a persistent need for the evaluation of the COVID-19 vaccine effectiveness (VE) against major outcomes, which include severe diseases, symptomatic COVID-19, and mortalities related to COVID-19. Therefore, mass vaccination programs using vaccines of high effectiveness are among the strategies that have been used by governments worldwide to impede the COVID-19 pandemic transmission. In this regard, massive efforts were made by governments, scientists, biomedical researchers, and healthcare professionals leading to the successful development of various vaccines to bring this pandemic under control. This editorial aims to shed light on the epidemiological status of COVID-19 variants, namely, Delta, Omicron, and Deltacron variants as well as discuss the effectiveness of the currently available COVID-19 vaccines.
Tapinarof: A Felicitous Discovery in Psoriasis Treatment
(SAGE Publications, 2022-11) Prabath,I; Subramanian,S; Rani,J.
Tapinarof is a novel topical formulation approved recently, in May 2022, by the United States Food and Drug Administration to treat plaque psoriasis. Existing topical therapies for psoriasis are limited by systemic and local adverse effects, medication cost and repeated administration, thus significantly hampering the compliance of patients to therapy. These limitations can be resolved by tapinarof owing to its better efficacy and favourable safety profile in psoriasis management. Tapinarof was developed with a unique mechanism targeting the aryl hydrocarbon receptor (AhR) involved in inflammation and modulation of skin barrier integrity in inflammatory dermatological disorders such as psoriasis and atopic dermatitis. The efficacy and safety outcomes of tapinarof in psoriasis were justified through the two pivotal clinical trials, namely, PSOARING 1 and PSOARING 2. The common adverse effects observed with tapinarof are folliculitis, contact dermatitis and headache. The literature search was conducted for efficacy and safety of tapinarof in the electronic databases of PubMed and Cochrane using a combination of keywords such as tapinarof, psoriasis and AhR. This review will delineate the molecular mechanisms underlying the action of tapinarof and also summarise the trial data supporting the claim that tapinarof is replacing the existing standard of care in psoriasis management.

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