Rapid-Acting Antidepressants and Underlying Mechanisms

Loss of glial cells with resulting atrophy of the medial prefrontal cortex (mPFC) as well as the hippocampal area is demonstrated in depressed patients by brain imaging and postmortem studies. The mPFC is the master control of mood and emotional response. The hippocampus is part of the limbic system, the main function of which is to regulate emotions. The mPFC depends on the hippocampus for rapid learning and memory consolidation. Unlike monoamine reuptake inhibitor antidepressants, which take 6 to 8 weeks to exert their full effects, and with 30 - 40% unresponsive rate, ketamine acts rapidly, within a couple of hours, and has higher responsive rates. It suggests that in theory, due to its rapid effect, Ketamine could well serve as a bridging remedy to lower the rate of suicidal risk before Selective serotonin re-uptake inhibitors (SSRIs) reach their full effect for long-term depression management. Yet, ketamine has long been linked with abusive potential and possible neurotoxicity if used in large doses over a prolonged period. Even though there are no collected data to prove the associated adverse effects, awareness of this negative aspect of ketamine is sufficiently widespread to propel the psychiatric community to look for other rapidly acting antidepressant alternatives. Recent studies have shown that scopolamine, the Yueju pill, and magnesium are rapid-onset antidepressants that have mechanisms comparable to that of ketamine. These rapid-acting antidepressant agents promise to be effective and safer choices for depression management in the future, providing that further studies and investigations to produce a better and fuller understanding of their effects and limitations

An intensive monitoring of adverse drug reaction in indoor patients of medicine department at tertiary care teaching hospital

Background: Use of drugs itself may result into illness and death due to their adverse effects. In India 10-20% of inpatients developed adverse drug reactions. Most of these problems can be overcome by undertaking hospital based intensive monitoring. Objective of this study was to estimate the incidence and document the spectrum of ADRs in studied patients in terms of causality, severity, frequency, type and preventability. A prospective, observational, single centre study conducted among the indoor patients of the department of general medicine, Guru Gobind singh government hospital, Jamnagar over a period of 12 months.Methods: Admitted patients who either had developed a clinically suspected ADR after admission (group A) or were admitted primarily because of an ADR (group B) were included. In all ADR related patients the necessary data was recorded on a pre-designed case record form, NCC-PvPI form and analysis was done.Results: Total 3566 patients were screened. 87 patients had 101 ADRs, among them 62 from group A and 25 from group B with 2.44% incidence. In causality, by WHO-UMC and by naranjo scale most common ‘probable’ category in group A (54.7%) and group B (50%) and 89.9% group A and 84.6% in group B respectively.95.05% ADRs were ‘Not preventable’. Hartwig seigle’s scale maximum ADRs 65.4% ADRs in group A and 73.1% in group B were ‘moderate’ in severity.Conclusions: Intercurrent illness, longer hospital stay and poly pharmacy was playing a major role in occurrence of multiple ADRs with 2.44% incidence in our setup

Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college

Background: A number of antimicrobial drugs are prescribed to the patients in Intensive Care Unit (ICU). Drug utilization research was defined by WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. There is lack of information about the use of antimicrobial agents in the ICU at GGGH till date. So we decided to conduct this type of study.Methods: A prospective observational study was carried out for 12 months. Patients of age >18 of both sexes who was admitted in ICU were included in the study while pregnant and lactating women excluded. The prescribing pattern was analyzed by using World Health Organization basic drug indicators. Results: Among 611 patients, 373 (61.04%) were male and 238 (38.95%) were female. The most common emergency was post-operative 204 (33.38%).The most common prescribed antimicrobial drug group and drug was antiamoebic drugs and metronidazole respectively in 437 (24.04%) out of total drugs prescribed. The numbers of antimicrobial drugs prescribed per patient were 2.97. 68% drugs were prescribed from WHO and national EML list. Total 57.26% drugs were prescribed by generic name. Average antimicrobial drug cost per patient was 1805.34 rs.Conclusions: Despite of limitations of present study it gives important conclusion about how antimicrobial drugs are used in GGGH ICU. This information can be used for improvement of current treatment strategies

Drug utilization study of psychotropic drugs in outdoor patients in a tertiary care hospital attached with a medical college

Background: Psychotropic drugs have a great importance in psychiatric practice. Today many newer drug like selective serotonin reuptake inhibitors and atypical antipsychotic drugs has changed treatment protocol. Hence, the study was carried out to find morbidity pattern of psychiatric illness and prescribing pattern of psychiatric illness.Methods: A prospective cross-sectional study was carried out for 12 months. Patients of all ages and both sexes were included in the study while inpatients and referred patients were excluded. The prescribing pattern was analyzed by using World Health Organization (WHO) basic drug indicators.Results: Among 600 patients, male patient were 291 (48.50%) and female patient were 309 (51.50%). The most common disorder was depression 208 (34.66%) followed by schizophrenia 192 (32.00%). The numbers of psychotropic drugs prescribed a patient were 2.51. 39.39% drugs were prescribed from the WHO essential medicines list. Total 89.18% drugs were prescribed by generic name. Benzodiazepines were the most common prescribed drugs. Atypical antipsychotic drugs were commonly used than typical antipsychotic drugs. Central anticholinergic drug was used in 43.15% patients receiving antipsychotic drugs.Conclusion: Overall, the drugs were prescribed rationally. Benzodiazepine should be prescribed only for short-term duration. Use of central acting anticholinergic drugs with all antipsychotic drugs was not justified

Estimation of Serum Micronutrient Levels and The Possible Risk Of Oral Cancer And Premalignancy

Abstract; The oral cancer is one of the most prevalent type of cancer worldwide. It is invariably linked to lifestyle habits like alcohol consumption, cigarette smoking and poor nutritional status. This apart, the role of micronutrients in oral carcinogenesis still remains less understood. So the study was undertaken to assess the micronutrient levels of oral cancer and precancerous patients.The estimation of Haemoglobin showed there was no significant difference between controls, premalignancy cases and in cancerous conditions. Zinc and copper level levels were significantly lower in cases than in controls .There is a positive correlation between serum iron and selenium level and oral cancer patients, yet we didn't find significant increase in serum iron level either in precancerous or oral cancer patients. This study may indicate that very high or low levels of micronutrients associated with oral carcinoma. Yet moderate amount of micronutrients in diet may have protective effect on oral carcinoma which requires further research in these lines

An intensive monitoring of adverse drug reaction in indoor patients of medicine department at tertiary care teaching hospital

Background: Use of drugs itself may result into illness and death due to their adverse effects. In India 10-20% of inpatients developed adverse drug reactions. Most of these problems can be overcome by undertaking hospital based intensive monitoring. Objective of this study was to estimate the incidence and document the spectrum of ADRs in studied patients in terms of causality, severity, frequency, type and preventability. A prospective, observational, single centre study conducted among the indoor patients of the department of general medicine, Guru Gobind singh government hospital, Jamnagar over a period of 12 months. Methods: Admitted patients who either had developed a clinically suspected ADR after admission (group A) or were admitted primarily because of an ADR (group B) were included. In all ADR related patients the necessary data was recorded on a pre-designed case record form, NCC-PvPI form and analysis was done. Results: Total 3566 patients were screened. 87 patients had 101 ADRs, among them 62 from group A and 25 from group B with 2.44% incidence. In causality, by WHO-UMC and by naranjo scale most common and lsquo;probable' category in group A (54.7%) and group B (50%) and 89.9% group A and 84.6% in group B respectively.95.05% ADRs were and lsquo;Not preventable'. Hartwig seigle's scale maximum ADRs 65.4% ADRs in group A and 73.1% in group B were and lsquo;moderate' in severity. Conclusions: Intercurrent illness, longer hospital stay and poly pharmacy was playing a major role in occurrence of multiple ADRs with 2.44% incidence in our setup. [Int J Basic Clin Pharmacol 2016; 5(3.000): 742-747

Drug utilization pattern of antimicrobial drugs in intensive care unit of a tertiary care hospital attached with a medical college

Background: A number of antimicrobial drugs are prescribed to the patients in Intensive Care Unit (ICU). Drug utilization research was defined by WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. There is lack of information about the use of antimicrobial agents in the ICU at GGGH till date. So we decided to conduct this type of study.Methods: A prospective observational study was carried out for 12 months. Patients of age >18 of both sexes who was admitted in ICU were included in the study while pregnant and lactating women excluded. The prescribing pattern was analyzed by using World Health Organization basic drug indicators. Results: Among 611 patients, 373 (61.04%) were male and 238 (38.95%) were female. The most common emergency was post-operative 204 (33.38%).The most common prescribed antimicrobial drug group and drug was antiamoebic drugs and metronidazole respectively in 437 (24.04%) out of total drugs prescribed. The numbers of antimicrobial drugs prescribed per patient were 2.97. 68% drugs were prescribed from WHO and national EML list. Total 57.26% drugs were prescribed by generic name. Average antimicrobial drug cost per patient was 1805.34 rs.Conclusions: Despite of limitations of present study it gives important conclusion about how antimicrobial drugs are used in GGGH ICU. This information can be used for improvement of current treatment strategies