Topical corticosteroid misuse: observational study to evaluate pattern of abuse and adverse drug reactions

Background: Topical corticosteroids (TC) have a reputation as anti-acne, anti-blemish effects and popularly used as fairness creams. In India, there has been a rise in misuse of TC in last10 years. The present study was conducted to analyse the magnitude of adverse effects of topical corticosteroids abuse in dermatology outpatient department of a tertiary care hospital.Methods: A retrospective observational study was conducted on patients after categorizing them as a TC misuser by dermatologists. The socio-demographic data, chief complaints, details of drugs misuse and adverse drug reaction outcome was collected.Results: A total of 1240 patients was screened, out of which 80 patients misused TC without dermatologist prescription for their skin disease. TC was mainly misused by teenagers (43.8%). Misuse of topical corticosteroids was more common among females (76.3%). Betamethasone valerate (72.5%) was most common TC misused. Most common source of advice of TC misuse was friends (37.5%). Most common purpose of TC misuse was acne (55%) followed by cosmetic purposes (21.3%). The most common morphological varieties of adverse drug reactions were burning and itching sensation (53%) followed by increase severity of acne (44%).Conclusions: TC misuse was more common in teenage females. Most common adverse effect reported is burning and itch sensation followed by increase severity of acne. The study data indicates a significance of problem and requirement of urgent measures to control TC misuse

Comparative study to evaluate the anti-diabetic activity of commercially available extract of Tinospora cordifolia and Phyllanthus emblica in streptozocin induced diabetic rat

Background: Diabetes is a chronic metabolic disorder with significant socioeconomic impact on a developing country like India. Ayurvedic texts have mentioned Tinospora cordifolia (guduchi) and Phyllanthus emblica (amla) to possess antidiabetic properties. The study was conducted to evaluate the anti-diabetic activity of commercially available extract of these herbal plants in streptozocin induced diabetic rats and its comparison to standard antidiabetic drug glibenclamide.Methods: The study was carried out with albino rats of either sex weighing between 100-150 gm. All the rats were intraperitonially injected with 35 mg/kg of streptozocin in citrate buffer. Blood glucose was estimated after 1 week high fat diet and rats having blood glucose >200 mg/dl were considered diabetic and included in further study. They were divided into 6 groups of 6 rats each. Six groups were given different interventions as distilled water (which were control rats), Tinospora cordifolia extract low dose (200 mg/kg/day), Tinospora cordifolia extract high dose (400mg/kg/day), Phyllanthus emblica extract low dose (200 mg/kg/day), Phyllanthus emblica extract high dose (400 mg/kg/day) and standard drug glibenclamide (0.6 mg/kg/day). All the rats received allocated drugs for further 6 weeks. Blood glucose was measured every 2 weeks till the end of sixth weeks by glucose-oxidase method.Results: In both low as well as high dose groups, Tinospora cordifolia and Phyllanthus emblica showed significant reduction (P <0.01) in plasma glucose levels from fourth week onwards.Conclusions: Commercially available extract of Tinospora cordifolia and Phyllanthus emblica have significant anti-diabetic activity in streptozocin induced diabetic rats

Analysis of antimicrobial susceptibility pattern of ocular infections at Regional Ophthalmic Institute in India

Background: Ocular infections are a result of alteration in the normal microbial flora of eye. They are not only responsible for increase in morbidity varying from self-limiting trivial infection to sight threatening infection but also blindness.Methods: Patients with ocular infections were recruited at Regional Institute of Ophthalmology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh. Bacterial profile in ocular infections and susceptibility pattern to commonly used antibiotics were analyzed amongst these patients. The isolated organism was then identified by colony morphology, gram stain and biochemical test following which in vitro susceptibility test was performed by Kirby-Bauer disc diffusion method and interpreted clinically.Results: Staphylococcus aureus and coagulase negative Streptococcus were most common etiological agents of ocular infections in the present study.  It was observed that bacterial isolates were highly (in 100% of cases) susceptible to vancomycin and chloramphenicol among gram positive organisms. Gram negative organisms showed higher susceptibility to moxifloxacin, tobramycin and gentamycin. Pseudomonas was seen to have sensitivity towards ceftazidime and cefazolin.Conclusions: The present study gives an insight into use of ocular antimicrobials in northern India. These findings illustrate the need for constant bacterial surveillance before starting empirical treatment

Rimegepant: first novel oral calcitonin gene-related peptide inhibitor for migraine

Migraine is a neurological condition characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, numbness or tingling, sensitivity to light and sound. There are multitude of drugs available to treat migraine like triptans, non-steroidal anti-inflammatory drugs, ergots and opioids. But these drugs are associated with adverse effects especially triptans causing cardiovascular effects limiting its use. During last decade, calcitonin gene-related peptide (CGRP) has emerged as a possible mechanism for management of migraine. CGRP has been shown to release during episode of migraine attack and it may play a causative role in induction of migraine. Rimegepant is a novel CGRP antagonist has been approved by FDA for treatment of acute migraine. Rimegepant is a first oral CGRP antagonist compared to other gepants. The oral bioavailability of Rimegepant is 64% and high fat meal can decrease the Cmax, Tmax and area under the curve. This drug is mainly metabolized by CYP3A4 and to lesser extent by CYP2C9. Most common adverse reactions associated with this drug were nausea and urinary tract infection. Clinical trials for Rimegepant have been positive, and results suggest that the drug may be a new safe and effective option for treatment of acute migraine

Painful neuropathy: comparative observational analysis of safety profile of pregabalin and amitriptyline

Background: Chronic neuropathic pain, caused by a lesion or disease of the somatosensory nervous system is a common debilitating condition in clinical practice. Pregabalin and Amitriptyline are most commonly used drugs for its management. The aim of the study was to study the safety of Pregabalin and Amitriptyline in chronic neuropathic pain.Methods: Prospective observational study at Department of Medicine and Orthopaedics at All India Institute of Medical Sciences, Rishikesh. Newly diagnosed patients of neuropathic pain who were prescribed either Pregabalin or Amitriptyline were included in the study. Patients were followed up telephonically or during routine visits for a period of 3 months after initiation of any of these drugs. Appropriate measures of central tendency were used to describe demographic and clinical parameters and Correlation test was used between different variables and occurrence of adverse drug reactions.Results: 317 patients were prescribed these drugs. A total of 276 ADRs were observed (128 with Pregabalin and 148 with Amitriptyline). Central nervous system symptoms like sedation and dizziness were most commonly present in both the groups. Diabetes mellitus (47.1%) was most common etiology for neuropathic pain. Causality assessment showed probable association with Amitriptyline (n=140) and Pregabalin (n=118). Majority of ADRs with Amitriptyline group (49.32%) were moderate in severity whereas it was mild with Pregabalin (59.7%). A weak positive correlation (R=0.273) was seen with number of ADRs occurrence and total drug exposure in patients taking Pregabalin whereas a weak negative correlation (R=-0.623) was seen in Amitriptyline treated group.Conclusions: Safety profile of Pregabalin was better than Amitriptyline in the present study. The study findings must be replicated in larger patient population and for a prolonged duration for better understanding of the pattern of adverse drug reactions.

Comparative study to evaluate the anti-diabetic activity of commercially available extract of Tinospora cordifolia and Phyllanthus emblica in streptozocin induced diabetic rat

Background: Diabetes is a chronic metabolic disorder with significant socioeconomic impact on a developing country like India. Ayurvedic texts have mentioned Tinospora cordifolia (guduchi) and Phyllanthus emblica (amla) to possess antidiabetic properties. The study was conducted to evaluate the anti-diabetic activity of commercially available extract of these herbal plants in streptozocin induced diabetic rats and its comparison to standard antidiabetic drug glibenclamide. Methods: The study was carried out with albino rats of either sex weighing between 100-150 gm. All the rats were intraperitonially injected with 35 mg/kg of streptozocin in citrate buffer. Blood glucose was estimated after 1 week high fat diet and rats having blood glucose >200 mg/dl were considered diabetic and included in further study. They were divided into 6 groups of 6 rats each. Six groups were given different interventions as distilled water (which were control rats), Tinospora cordifolia extract low dose (200 mg/kg/day), Tinospora cordifolia extract high dose (400mg/kg/day), Phyllanthus emblica extract low dose (200 mg/kg/day), Phyllanthus emblica extract high dose (400 mg/kg/day) and standard drug glibenclamide (0.6 mg/kg/day). All the rats received allocated drugs for further 6 weeks. Blood glucose was measured every 2 weeks till the end of sixth weeks by glucose-oxidase method. Results: In both low as well as high dose groups, Tinospora cordifolia and Phyllanthus emblica showed significant reduction (P <0.01) in plasma glucose levels from fourth week onwards. Conclusions: Commercially available extract of Tinospora cordifolia and Phyllanthus emblica have significant anti-diabetic activity in streptozocin induced diabetic rats. [Int J Basic Clin Pharmacol 2016; 5(4.000): 1641-1646