Exploring the role of therapeutic drug monitoring and regular supervision in optimizing quality of life in patients of bipolar affective disorder receiving lithium therapy in a tertiary care teaching hospital: a prospective observational study

Background: Lithium is considered first line drug effective in treating manic and mixed episodes of bipolar affective disorders throughout the globe. But the chronic and heterogenous nature of disease, along with toxicity of lithium often make patients non-adherent to medication as well as diminished health related quality of life. Present study was done to find out the prospect of regular supervision and follow up with therapeutic drug monitoring in optimization of lithium therapy based on health-related quality of life outcomes.Methods: It was a prospective, non-randomized, observational study of a cohort of subjects who are suffering from bipolar affective disorders and on lithium therapy. Patients were regularly followed up with therapeutic drug monitoring and personalized interview with questionnaires like WHO Quality of Life Score (QOL-Bref), Montgomery-Asberg Depression Scale (MADRS) and Medication Adherence Rating Scale (MARS).Results: Results revealed there was significant improvement in health-related quality of life of patients who were monitored with therapeutic drug monitoring and prescribed lithium therapy.Conclusions: Hence to maintain patients’ quality of life improved throughout the cycle of bipolar disorder spectrum, regular follow-up visits with monitoring of serum levels of lithium is needed, so that adverse effects would be minimal and adherence to medication become optimal. These optimal dosing resulting in optimal benefit to patients can be achieved with the involvement of clinical pharmacological consultation

Chronic arsenicosis with varied pulmonary involvement – A case series

Arsenic is an element which occurs naturally in the earth’s crust and in small quantities in rock, soil, water and air. Chronic arsenic toxicity produces various dermal and systemic manifestations including cancer. It may also cause different pulmonary diseases. Here, we have described a case series of three chronic arsenicosis patients having varied pulmonary involvements ranging from bronchiectasis to chronic obstructive pulmonary diseases. They all had classic raindrop pigmentations with one patient developing squamous cell carcinoma. Pulmonary manifestations were severe with more cutaneous manifestations as well as more arsenic levels in hair and nail samples of patients. Manifestations also seemed severe with increased duration of exposure and more amount of arsenic in their drinking water

A Case of Self-treatment Induced Recurrent Fixed Drug Eruptions Associated with the Use of Different Fixed Dose Combinations of Fluoroquinolone-Nitroimidazole

A young male patient used fixed dose combinations of different fluoroquinolones and nitroimidazoles several times in the last few years for self-treating repeated episodes of diarrhea and loose motion. Each time, he experienced fixed drug eruptions that increased in number and severity on subsequent occasions. Suspecting association between the drug and the rashes, the patient each time discontinued the treatment prematurely, and preferred to switch to a similar formulation next time, but with different molecules of fluoroquinolone (ciprofloxacin or ofloxacin) and nitroimidazole (tinidazole or ornidazole).He could not however avoid the rash. This time the patient presented with multiple, round-to-oval, well-defined, hyperpigmented cutaneous patches of different dimensions, all over the body. He appeared to have run out of options and therefore consulted us seeking advice on how he should treat himself next time he suffered from diarrhea. Causality assessment by Naranjo’s algorithm revealed a definite relationship between the cutaneous adverse reaction and the offending drug. He was counselled regarding medication in general and advised, in particular, to avoid the tendency to self-treat any future episode of diarrhea

Convalescent Plasma - A Review of this Potential Therapeutic Strategy for Combating Novel Coronavirus Disease 2019

Coronavirus disease 2019 (COVID-19) poses a significant threat to global health and World Health Organization (WHO) has declared this outbreak as a “public health emergency of international concern” on January 31, 2020. Globally, there is currently no effective post-infection prophylaxis for the treatment of COVID-19, although some drugs are being repurposed. Some vaccines have been developed and vaccination in different countries are undergoing at present, but duration of such vaccination in the long term protection is still unknown to us. Many therapeutic drugs, including chloroquine or hydroxychloroquine with or without azithromycin, remdesivir, favipiravir, nitazoxanide, ribavirin, baricitinib, penciclovir, ritonavir, and arbidol, have been tried as experimental medicine as they are thought to be reducing the viral load by different mechanisms but only a few has shown slight promising viral impact in the initial study. There are no antibodies for the prevention of COVID-19. Immune (i.e., “convalescent”) plasma (CP) refers to plasma that is collected from individuals, following resolution of infection and development of antibodies. Antibody therapy can be used to treat patients who are already manifesting symptoms of varying severity. CP has shown limited and moderate success, previously for Severe Acute Respiratory Syndrome-1 and Middle East Respiratory Syndrome, and for COVID-19 in China, and could serve as a short-term solution to suppress mortality rates in India and worldwide. Based on the limited scientific data, convalescent plasma transfusion (CPT) therapy in COVID-19 patient appears safe, clinically effective, and reduces mortality. Well-designed large multicenter clinical trial studies should be conducted urgently to establish the efficacy of CPT to COVID-19 patients. At present, in India ICMR-CP trial (Placid Trial) on COVID-19 patients had been done. CP was not associated with a reduction in progression to severe COVID-19 or all-cause mortality. With this review, we have tried to highlight progress of CP on COVID-19 patients