Treatment of Anaphylaxis in Adults: A Questionnaire Survey

Objective: To identify the medications that medical students, interns and casualty medical officers are likely to prescribe when treating an adult patient with anaphylaxis, and to ascertain the dose and route of administration of adrenaline they would use. Design: A questionnaire study survey. Setting: Kasturba medical college hospital, Manipal (Udupi District) and public health centers of Udupi district, Karnataka. Subjects: Data collected from 39 second year medical students, 35 interns and 35 casualty medical officers. Main outcome measure: To determine the percentage of use of adrenaline for the treatment of anaphylaxis in the correct dose, strength and route. Results: Majority (73 .3%) of participants correctly opted to use adrenaline. Only 9 participants have written the correct dose, route and concentration of adrenaline. 41.28% and 66.05% participants preferred to use antihistamines and corticosteroids respectively. Conclusion: This study has shown that confusion exists regarding the correct route of administration and dose of adrenaline to be used when treating anaphylaxis. This confusion applied to medical students, interns and medical officers. Therefore doctors must be made aware of the guidelines to treat anaphylaxis effectively

Teaching of Critical Analysis of Drug Advertisements to Medical Students

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

MANAGEMENT OF DEPRESSION IN TERMINALLY ILL PATIENTS – A CRITICAL REVIEW

Depression is a well-recognized risk factor for shortened life span from cancer. Depression is among the main causes of disability in the world leadingto increased suffering and mortality. As per research surveys over the years, prevalence among cancer patients varies widely from 3% to 38% formajor depression and 1.5-52% for depression spectrum syndromes. The need of the hour is to effectively treat depression in cancer patients so thatthe quality of life can be improved and thereby patient survival. Both psychological and pharmacological interventions and the combination of bothvery much effective in treating depression in cancer patients. A broad range of therapies now exist, and the art of such therapy is the strategic selectionof components from several models to best respond to the needs of the individual patient and his/her family in the specific circumstances, whetherclinical, psychological, spiritual, or social.Â

A COMPLETE REVIEW OF MIGRAINE

Migraine characterized by recurrent headaches present with aura or without aura. Various treatment modalities ranging from 5-hydroxytryptamine 1B/1D agonists, non-steroidal anti-inflammatory drugs to steroids are available for acute treatment of migraine. Prophylaxis for chronic cases is usually with β blockers, calcium channel blockers, and antiepileptics. Even many nutraceutical preparations are helpful in migraine including riboflavin, vitamin b12. This review focuses on the newer agents available for treatment of migraine with some sight into their clinical trials

ORPHAN DRUGS: THE CURRENT GLOBAL AND INDIAN SCENARIO

ABSTRACTIt was not until a few decades ago that orphan drugs, still enjoyed†the status of pharmaceutical touch-me-not entities. However, the past two decadeshave witnessed a radical shift in the approach of global pharmaceutical industry toward orphan drugs. This has stemmed from an apparent innovationcrisis in the domain of common diseases, progressively increasing stringency in the regulations, and the decline of the blockbuster business model.Further, the success stories of a few orphan drugs, for instance, eculizumab has gone a long way in breaking the myth of non-profitability associatedwith orphan drug development endeavor. This combined with the high degree of incentivization attached with orphan drug development makes it avery lucrative avenue for further investment by the pharmaceutical industry. Sadly, the Indian scenario with respect to orphan drugs is a throwbackto the dark ages.†The progress seen across the developed nations, for instance, the United States of America has not permeated into the Indianmarket. India, with its huge population base, stands to provide a hugely lucrative market for orphan drug development. However, this point seemsto have escaped the notice of the Indian authorities and the pharmaceutical sector in India. Thus, with the various patient advocacy groups and nongovernmentorganizationschampioning the cause of orphan diseased patientsin India, the time is ripe forthe concerned authoritiesand the pharmasectorin India totakecognizance of this gapinglacuna in the health-careservices and undertakemeasurestoaddressthis situation.Keywords: Pharmaceutical touch-me-not, Orphan, Indian scenario.Â

A FATAL CASE OF BILATERAL INTERSTITIAL PNEUMONIA (BLIP): INTERFERON ALPHA 2 A INDUCED.

  Adult T-cell leukemia/lymphoma (ATLL) is a rare lymph proliferative disorder of mature CD4 T-cells caused by the human T-lymph tropic type 1 (HTLV 1) of retrovirus family. Combination of zidovudine and interferon Alfa combination is one of most commonly used regimen. Many drugs are implicated in causing interstitial lung disease. Hence, we report a case of interferon Alfa-induced bilateral interstitial pneumonia in a 32-year-old female patient diagnosed with ATLL with HTLV 1 positivity

The reproductive toxicity of the organophosphate pesticide 0, 0-dimethyl 0-4-nitrophenyl phosphorothioate (methyl parathion) in the male rat

Methyl parathion (MP) is a pesticide widely used to protect crops but also illegally used in many countries for spraying homes and businesses to contain insects. The present study was planned to investigate the effects of MP on the male reproductive organs in the rat. Male Wistar rats (13-14 weeks old) were treated with MP and sacrificed as follows. Experiment 1:0 (water vehicle), 1.75, 3.5 or 7 mg/kg (i.p.) for 5 days and sacrificed on day 14; experiment 2:0, 0.5 or 1 mg/kg (i.p.) for 12 days and sacrificed on day 130; experiment 3: 0, 0.5 or 1 mg/kg (i.p.) for 12 days and sacrificed on day 77; experiment 4: 0, 0.75 or 1.5 mg/kg (i.p.) for 25 days and sacrificed on day 17; experiment 5: 0 or 3.5 mg/kg (p.o.) for 25 days and sacrificed on day 17 after the last exposure. The reproductive organs were removed, weighed and processed for histopathological analysis. Structural changes, for example the morphology of the epithelium and the lumina of the organs, were observed in all animals. Biochemical estimates of acid phosphatase (ACP), cholesterol, total protein, uric acid, and vitamin C were conducted in the epididymes. The weight of the epididymes increased in experiment 2 in a dose-dependent pattern (p < 0.01) and decreased in experiments 4 and 5 (p < 0.01). The weight of the ductus deferens decreased in experiment 3 at 1 mg/kg dose level (p < 0.001) and increased in experiment 5 (p < 0.05). The weight of the seminal vesicle decreased in experiment 3 at both 0.5 mg/kg and 1 mg/kg dose levels (p < 0.001), and increased in experiment 5 (p < 0.01). The weight of the prostate decreased in experiments 4 (in a dose-dependent pattern) and 5 (p < 0.001). ACP levels decreased in experiment 4 (p < 0.001) with a greater effect at 0.5 mg/kg than at 1 mg/kg. In experiment 5 (p < 0.01) cholesterol levels decreased to less than 50% of the control level for this experiment (p < 0.01) and protein levels also decreased (p < 0.01). Vitamin C levels decreased in a dose-dependent pattern in experiments 4 (p < 0.001) and 5 (p < 0.01). There were no effects on uric acid level. Sperm density was decreased in the epididymes of the rats treated and the epithelium of the epididymis and ductus deferens showed cellular necrosis, brush-border disruption and nuclear pyknosis. Nuclei were haloed, except in experiment 2 and the 0.5 mg/kg group of experiment 3. Methyl parathion did not induce significant changes in the structure of the seminal vesicle and prostate, except that epithelial folding was shorter than in the control. In conclusion, MP is a reproductive toxicant in the male rat and causes deterioration in the structural integrity of the reproductive organs and also the biochemical parameters in the epididymis

Modulation of Serotonin Transporter Function during Fetal Development Causes Dilated Heart Cardiomyopathy and Lifelong Behavioral Abnormalities

BACKGROUND: Women are at great risk for mood and anxiety disorders during their childbearing years and may become pregnant while taking antidepressant drugs. In the treatment of depression and anxiety disorders, selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed drugs, while it is largely unknown whether this medication affects the development of the central nervous system of the fetus. The possible effects are the product of placental transfer efficiency, time of administration and dose of the respective SSRI. METHODOLOGY/PRINCIPAL FINDINGS: In order to attain this information we have setup a study in which these parameters were measured and the consequences in terms of physiology and behavior are mapped. The placental transfer of fluoxetine and fluvoxamine, two commonly used SSRIs, was similar between mouse and human, indicating that the fetal exposure of these SSRIs in mice is comparable with the human situation. Fluvoxamine displayed a relatively low placental transfer, while fluoxetine showed a relatively high placental transfer. Using clinical doses of fluoxetine the mortality of the offspring increased dramatically, whereas the mortality was unaffected after fluvoxamine exposure. The majority of the fluoxetine-exposed offspring died postnatally of severe heart failure caused by dilated cardiomyopathy. Molecular analysis of fluoxetine-exposed offspring showed long-term alterations in serotonin transporter levels in the raphe nucleus. Furthermore, prenatal fluoxetine exposure resulted in depressive- and anxiety-related behavior in adult mice. In contrast, fluvoxamine-exposed mice did not show alterations in behavior and serotonin transporter levels. Decreasing the dose of fluoxetine resulted in higher survival rates and less dramatic effects on the long-term behavior in the offspring. CONCLUSIONS: These results indicate that prenatal fluoxetine exposure affects fetal development, resulting in cardiomyopathy and a higher vulnerability to affective disorders in a dose-dependent manner

Fluoxetine during Development Reverses the Effects of Prenatal Stress on Depressive-Like Behavior and Hippocampal Neurogenesis in Adolescence

Depression during pregnancy and the postpartum period is a growing health problem, which affects up to 20% of women. Currently, selective serotonin reuptake inhibitor (SSRIs) medications are commonly used for treatment of maternal depression. Unfortunately, there is very little research on the long-term effect of maternal depression and perinatal SSRI exposure on offspring development. Therefore, the aim of this study was to determine the role of exposure to fluoxetine during development on affective-like behaviors and hippocampal neurogenesis in adolescent offspring in a rodent model of maternal depression. To do this, gestationally stressed and non-stressed Sprague-Dawley rat dams were treated with either fluoxetine (5 mg/kg/day) or vehicle beginning on postnatal day 1 (P1). Adolescent male and female offspring were divided into 4 groups: 1) prenatal stress+fluoxetine exposure, 2) prenatal stress+vehicle, 3) fluoxetine exposure alone, and 4) vehicle alone. Adolescent offspring were assessed for anxiety-like behavior using the Open Field Test and depressive-like behavior using the Forced Swim Test. Brains were analyzed for endogenous markers of hippocampal neurogenesis via immunohistochemistry. Results demonstrate that maternal fluoxetine exposure reverses the reduction in immobility evident in prenatally stressed adolescent offspring. In addition, maternal fluoxetine exposure reverses the decrease in hippocampal cell proliferation and neurogenesis in maternally stressed adolescent offspring. This research provides important evidence on the long-term effect of fluoxetine exposure during development in a model of maternal adversity