Comparison of efficacy of high dose inhaled corticosteroids with a combination of low dose inhaled corticosteroids and long acting β2 agonists in patients of moderate persistent asthma : a randomised prospective comparative study

Background: Asthma has global prevalence varying from 2-25%. Among various subtypes, moderate persistent asthma is a subtype currently managed by a combination therapy of low dose inhaled corticosteroids and LABA (long acting β2 agonists). Search is on for LABA free regime because of safety concerns and increased risk of exacerbations as reported in meta-analysis conducted by FDA in 2008.Methods: Patients (new and old) of either sex and age having moderate persistent asthma as per GINA 2004 guidelines were enrolled and allocated in two groups using block randomization. DPIs (dry powder inhalation) were used in the study. Budecort group subjects were treated with budesonide 400 µg rotacaps twice a day. Foracort group subjects were treated with combination rotacaps of formoterol 6 µg with budesonide 200 µg twice a day. Follow up period in study was nine months with quarterly spirometry assessment.Results: In 63 enrolled cases, there was no significant difference in intergroup spirometry comparison at baseline and at 9 months. The difference at 9 months in spirometry as compared from baseline in each group was also not statistically significant. Numerically, budecort group showed slightly better values.Conclusions: The therapy in each group was comparable in terms of efficacy. This is important due to the fact that therapy in current use for moderate persistent asthma is combination therapy. So use of high dose inhaled steroid therapy used as 400 µg rotacaps with matching revolizer twice a day (800µg daily) may be good alternative to use of combination therapy particularly in patients where LABA cannot be used

A study on the effectiveness of nicotine and counselling in tobacoo smoking cessation

Background: Effectiveness of pharmacotherapy and counselling has been suggested by various research workers in smoking cessation, but studies show variable results with pharmacotherapy. Also efficacy of counselling and pharmacological intervention differs from centre to centre. So we conducted this study, to observe the role of counselling and nicotine gums in our setup.Methods: 86 smokers willing to quit smoking were enrolled. Baseline counselling was provided at the time of enrolment, then at 1 week, 1 month, 3 months and at 6 months. Telephonic counselling was given to those who did not come for face to face counselling. Nicotine gums were prescribed for 3 months duration. At the end of 12 months, follow up outcome was measured.Results: At 1 week 24% smokers, at 1 month 23%, at 3 months 12% and at 6 months 33% smokers attended face to face counselling session. At 1 week 66%, at 1 month 57%, at 3 months 63% and at 6 months 59% smokers received telephonic counselling. Nicotine gums were used by only 76% smokers. Out of those who used nicotine gums, only 3% used gums for 3 months duration and 97% stopped prematurely. Among those who used gums, 29% experienced side effects. Total 22 (26%) smokers stopped smoking at 12 months.Conclusions: Less number of smokers coming for follow up counselling visits, suggest lack of motivation. Alternative counselling, like telephonic counselling, was much more accepted and was found to be helpful. Acceptance of nicotine gums was very less which also shows the lack of motivation. Abstinence rate of 26% shows that counselling and nicotine gums help in quitting smoking

Pharmacovigilance analysis in a rural tertiary care hospital in North India: a retrospective study

Background: The main motive of PvPI (Pharmacovigilance Programme of India) is to collect valuable data so that signals can be generated from reported adverse drug events (ADEs). It also tries to establish their causality so that ADEs can be labelled as adverse drug reactions (ADRs) beyond any doubt.Methods: This retrospective observational study done in rural set up tertiary care teaching hospital collected data through voluntary reporting in ADR form of PvPI for period of 6 month. Causality assessment was done using WHO causality assessment scale.Results: In 150 reported cases, majority ADRs were due to tuberculosis, cancer and HIV treatments. Gastrointestinal tract and central nervous system were the major organs involved. Most ADRs occurred within first day of drug intake. Around 15% required hospitalization. 55% ADRs were probable and 41% were possible in nature. Vertigo and depression was most frequent ADR in MDR therapy. Rashes, pruritis, fever and joint pain was frequent in antiretroviral therapy. Dysguesia, dizziness, nausea, vomiting and constipation was frequent in patients taking anticancer drugs. Platins and antibiotics used for cancer therapy cause most cancer treatment ADRs.Conclusions: ADRs add to hospitalization expenses, insurance costs and increase in work loss days besides addition to patient suffering. Prior knowledge can help in better prescriptions and prevent valuable resource loss. Reasons for under-reporting of ADRs can be complacency, ignorance, lack of financial incentives for reporting, fear of litigation, claims of compensation and lack of time in busy hospital schedules

Profile of adverse drug reactions in patients on anti-tubercular drugs in a sub Himalayan rural tertiary care teaching hospital

Background: Tuberculosis is a major public health problem, with one out of three people in the world are infected with Mycobacterium tuberculosis. The prevalence of MDR TB in India is 2-3% among new cases and 12-17% in reinfection cases. One of the reasons for MDR may be noncompliance to treatment due to adverse drug reactions. The present study was conducted to find out ADRs in patients on antitubercular treatment (ATT) under pharmacovigilance programme of India (PvPI).Methods: This was a retrospective observational study. Data was collected through voluntary reporting by health-care professionals (HCP) in standard IPC-PvPI prescribed suspected ADR reporting form and analyzed for 100 patients on ATT. Causality assessment was done using WHO causality assessment scale.Results: The maximum ADRs were reported in adults with a mean age of 40.79±16.79 years. Males (n=66) outnumbered females (n=34). There were 62% MDR-TB on DOTS-plus regimen, followed by 35% on Cat1 ATT for pulmonary and extrapulmonary tuberculosis cases and XDR-TB accounted for 3% of the total cases. The commonest ADRs in patients on MDR treatment were related to CNS 44 (27.5%), followed by Gastrointestinal system 31 (19%), psychiatric 20 (12.5%) otovestibular 13 (8%) and ophthalmic ADRs being the least in frequency 1 (0.6%). In contrast patients on Cat 1 ATT the ADRs involving Gastrointestinal system 44 (44%) followed by CNS 12 (12%), psychiatric 0% and ADRs related to otovestibular manifestations being the least 1 (1%) frequency.Conclusions: ADRs involving different organ systems were seen in both categories with varied frequency. Adverse drug reactions add to hospitalization expenses, insurance costs and increase in work loss days besides addition to patient suffering and loss of compliance. Prior knowledge can help in better prescriptions and prevent valuable resource loss

Pattern of adverse drug reactions in new smear positive patients of pulmonary tuberculosis treated under directly observed treatment short course

Background: Directly observed treatment short course (DOTS), a combination therapy, drugs are administered for six to eight months in patients diagnosed with tuberculosis, increases the risk of adverse drug reactions. The objective of this study was to study the adverse drug reaction profile of new sputum smear positive (NSP) patients of pulmonary tuberculosis (PTB) treated under DOTS. A prospective observational study was carried out in Dr. RPGMC Kangra at Tanda, Himachal Pradesh, India over a period of six months.Methods: The study included 130 newly diagnosed TB patients on anti‑TB treatment under DOTS. A symptom based approach was followed for monitoring ADRs. The severity was assessed by Modified Hartwig scale and causality by WHO-UMC probability scale. Data was expressed as percentages for discrete variables using Microsoft excel.Results: Out of the total 130, 84 patients experienced ADRs with an overall incidence of 64.6%. 45 (34.6%) patients showed single ADR whereas 39 (30%) patients had two or more ADRs. Gastritis alone was present in 36 (27.8%) patients followed by itching 2 (1.5%), hypersensitivity 2 (1.5%), arthralgia 2 (1.5%), generalized weakness 2 (1.5%) and jaundice in 1 (0.8%) patients. Vomiting was present in 29 (22.2%) patients, neuropathy in 4 (3.1%) patients, arthralgia in 2(1.5%) patients, hypersensitivity, jaundice, itching and generalized weakness in 1 (0.8%) patient each. 21 (16.2%) patients experienced mild , 56 (43.1%) had moderate and only 7 (5.4%) had severe ADRs. All the ADRs were possible in nature.Conclusions: The incidence of ADRs was 64.6% and GI irritation was found to be most common ADR reported by 57.6% patients

DIMENSIONS OF CULINARY TOURISM AND HOSPITALITY IN GOLDEN TRIANGLE OF INDIA

Purpose: Delhi, Agra and Jaipur form the golden triangle of India. This tourist triangle is designed to up-sell in the market with lucrative offers. “Palace on Wheels” is a luxury train that runs on this route and is targeted for foreign clientele with its extravagance segment. These three destinations have their significance due to the presence of historical monuments and UNESCO world heritage sites i.e., Qutub Minar, India Gate, Tajmahal, and many more. These places also offer an enormous variety of food and beverage with warm hospitality to relieve the tired tourists. The gourmet dishes of Golden Triangle are a must to try as it dates to the traditional cooking combined with a spicy aroma and soothing beverages. The paper is structured to judge the culinary facet and warm hospitality of the Golden Triangle. The main objective is to find out the impact of traditional food in attracting travellers. It will also identify the food trail experiences in enhancing a niche segment of buyers for culinary tourism. Design/methodology/approach: The research is exploratory and draws on food and beverage culinary experience delivery in the Golden Triangle. The exploratory research will judge the effectiveness of food tours and the warm hospitality extended to food tourists. Findings: The research will examine how Culinary Tourism and Hospitality in the Golden Triangle of India can form a niche segment of food and beverage buyers. How it enhances the customer experience with hospitable conduct. The study will highlight the benefits of culinary tourism and hospitality. Practical implications: The paper recommends the concepts of food and beverage culinary tourism experience for creating a niche segment of buyers as well as attracting potential buyers with its approach. The research will synthesize the factors to improve customer interest in taking food and beverage tourism. Originality/value: The research sought to address the advantages of curating food and beverage tourists in the golden triangle of India. It will also address how food and beverage tours can influence culinary tourism. JEL Classification: L83, Z3

Assessment of pulmonary function in patients with type 2 diabetes mellitus: a case-control study

Background:As other microvascular complications, respiratory involvement is far less studied among patients with type-2 Diabetes Mellitus (DM). Objective: to study the extent of pulmonary function limitation among patients with type-2 DM.  Methods:Hospital based matched case-control study.Results:Total of 90 cases and 90 controls matched for age, sex, height and weight were recruited. Patients with DM had neuropathy [63.3% (57; male=27: Female: 30)], retinopathy [44.4% (40; male=22: Female: 18)], nephropathy [41.1% (37; male=17: Female: 20)] and microalbuminuria [14.4% (13; male=5: Female: 8)]. All cases and 88 controls observed with FEV1:FVC ratio of >70.0%, further assessment for delineation of normal and restrictive pattern patients with high level of predicted values of FEV1 as compare to FVC showed that significantly (P = 0.00) more (Cases: 76.6%; Controls: 42.2%) cases had FEV1 >FVC predicted levels as compare to controls, means among diabetics odds of restrictive pattern of lung abnormality is four times (OR: 4.4; CI: 2.3-8.5) more as compare to non-diabetics. In addition a long duration of DM was significantly (r: 0.39; P = 0.00) positively correlated with lung dysfunction.  Conclusion: Patients with type 2 DM patients as compare to its controls observed with restrictive pattern of lung dysfunction.

Host Antimicrobial Peptides: the promise of new treatment strategies against Tuberculosis

Tuberculosis (TB) continues to be a devastating infectious disease and remerges as a global health emergency due to an alarming rise of antimicrobial resistance to its treatment. Despite of the serious effort that has been applied to develop effective antitubercular chemotherapies, the potential of antimicrobial peptides (AMPs) remains underexploited. A large amount of literature is now accessible on the AMP mechanisms of action against a diversity of pathogens; nevertheless, research on their activity on mycobacteria is still scarce. In particular, there is an urgent need to integrate all available interdisciplinary strategies to eradicate extensively drug-resistant Mycobacterium tuberculosis strains. In this context, we should not underestimate our endogenous antimicrobial proteins and peptides as ancient players of the human host defense system. We are confident that novel antibiotics based on human AMPs displaying a rapid and multifaceted mechanism, with reduced toxicity, should significantly contribute to reverse the tide of antimycobacterial drug resistance. In this review, we have provided an up to date perspective of the current research on AMPs to be applied in the fight against TB. A better understanding on the mechanisms of action of human endogenous peptides should ensure the basis for the best guided design of novel antitubercular chemotherapeutics