Long term carbamazepine therapy induced acute lymphoblastic leukemia

Carbamazepine is a commonly used antiepileptic drug. Apart from the neurological side-effects, hematological side-effects in form of aplastic anemia and agranulocytosis are well-documented. We report an unusual case of Acute Lymphoblastic Leukemia (ALL) associated with the long term use of carbamazepine. On hospitalization, the drug carbamazepine was stopped and after confirmation of the diagnosis, patient was started on standard treatment for ALL

Drug utilization pattern of antihypertensive drugs in chronic kidney disease stage 5 patients in a tertiary care hospital of central India

Background: India is experiencing a rapid health transition and is projected to become a major reservoir of chronic diseases like Diabetes and Hypertension and 25 to 40% of these subjects may develop chronic kidney disease and end stage renal disease. Aim and objective of the study was to analyze utilization pattern of antihypertensive drugs in chronic kidney disease patients in a tertiary care hospital.Methods: The present observational cross-sectional study was conducted in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.) from 01.01.2018 to 31.03.2018 on patients with chronic kidney disease stage 5. The drug utilization pattern was studied with respect to age, sex, basic disease, duration of dialysis, type of antihypertensive used, etc. Comparison of mean between gender and dialysis / not on dialysis was done using unpaired ‘t’ test. A p value of < 0.05 was taken as statistically significant.Results: Of 198 patients, 63 (31.8%) were females and 135 (68.2%) were males, showing a male preponderance. Majority of the patients (54%) belonged to the age group 41-60 years. Majority of the patients were having diabetic nephropathy (40.9%), followed by CGN-CKD 5d (18.7%) and CIN-CKD 5d (17.2%). 11.6% patients were not on dialysis, while 88.4% were on dialysis with a mean duration of dialysis of 31.45±34.57 months. Calcium channel blockers were given in 87.4% patients, followed by centrally acting drugs in 56.1% patients, beta blockers in 51.0% and alpha blockers in 39.9%. 93.9% patients were on multidrug antihypertensive therapy. Mean number of antihypertensives required in patients on dialysis was lower than those not on dialysis (2.69±1.44 vs. 3.48±1.16, p <0.05), similarly mean number of antihypertensives use in males was higher than females (2.99±1.41 vs. 2.32±1.37, p <0.05).Conclusions: In order to treat CKD, it is important to treat hypertension as hypertension and CKD are related to each other. Treatment of hypertension will help in controlling future development of comorbidities. Calcium channel blockers and centrally acting drugs are the treatment of choice in patients with CKD stage 5D with hypertension. Multi-drug antihypertensive therapy is a better choice than mono/single-drug antihypertensive therapy

Efficacy and tolerability of milnacipran and escitalopram: a comparative study among patients of depression

Background: The present prospective, open labelled study was designed to evaluate the efficacy and tolerability of escitalopram, selective serotonin reuptake inhibitors (SSRI) in comparison with milnacipran, dual serotonin and noradrenaline reuptake inhibitors (SNRI) in the treatment of major depressive disorder.Methods: Outpatients (N=120) with an ongoing/newly diagnosed ICD-10 major depressive episode and having a minimum score of 8 on the 21-item Hamilton Depression Rating Scale (HDRS) were assigned to escitalopram, 10–20 mg/day (54 patients) and milnacipran 50-100mg (66 patients), for an 8 week treatment period with follow up at 2nd, 4th and 8th week. The parameters for efficacy were improvement (decrease in HDRS scores at 8 weeks from baseline values), response (decrease of ≥50% in the HDRS scores) and remission (HDRS score of ≤7). Tolerability was assessed by comparing the frequency of adverse effects and drop out rate due to the same at the end of 2nd, 4th and 8th week in both the groups.Results: Improvement, Response rate and Remission rates at the end of eight weeks were 71.11%, 83.33% and58.33% for escitalopram and 59.35%, 34.14% and75.6% for milnacipran respectively. Adverse experiences were reported by 14% of patients in escitalopram group and 79.2% patients in milnacipran group at 8 weeks. Additionally, there were significantly lesser dropouts due to adverse events in escitalopram (3.70%) than in milnacipran group (30%).Conclusions: Escitalopram, the Senantiomer of citalopram, is a safe and effective antidepressant with potentially superior tolerability and comparable efficacy to the dual reuptake inhibitor, Milnacipran

Antibiotic susceptibility pattern of bacteria isolated from patients of respiratory tract infection in a tertiary care hospital of Central India

Background: Respiratory tract infections are one of the commonest types of infections affecting the Indian population and are a significant cause of morbidity and mortality. To deal with multidrug resistance one should be armed with region specific data about the susceptibility patterns of antimicrobials. This study was planned to identify the common pathogens responsible for the respiratory tract infection and their antibiotic susceptibility patterns.Methods: Smears were prepared from the specimens and gram stains of all clinical samples were done. The organisms were grown on various media and identified according to the standard procedures. The susceptibility patterns of the bacterial pathogens were determined following the panel of antimicrobial agents. Descriptive statistics were used for data analysis.Results: Out of 513 samples 471 samples were further processed. Klebsiella (30.42%) was found to be commonest pathogen followed by Pseudomonas (28.36%). Ampicillin and piperacillin /tazobactam combination were found to be highly efficient against Pseudomonas (83% and 58.8% respectively), E. coli (68% and 50.7% respectively), and Klebsiella (43% and 30.3% respectively). Conclusions: In our study, we found penicillins as the most efficacious antimicrobials to treat respiratory pathogens. The study reveals that the antibiotic susceptibility pattern varies across regions. The prescription of a right antibiotic, for a right patient will help to minimize the menace of emergence of antimicrobial resistance

Study of interaction of nifedipine with haloperidol on conditioned avoidance response and catalepsy in rats

Background: To study the interaction of calcium channel blocker (Nifedipine) with Antipsychotic drug (Haloperidol) on Conditioned avoidance Response and catalepsy in Rats.Methods: Every group consisted of 10 healthy albino rats of either sex. Different groups received Nifedipine (5, 10 & 20 mg/kg, i.p.), Haloperidol (ED50 -0.2mg/kg for CAR & 0.4mg/kg for catalepsy) alone and combined doses of both drugs. The Antipsychotic effect of drugs was measured by Conditioned avoidance response (CAR) using Cook’s Pole climbing apparatus and Adverse drug effect (Extra pyramidal syndrome) was measured by Catalepsy.Results: 5 mg/kg i.p. of Nifedipine inhibited CAR in 50 % of Rats (compared to control, p<0.001). 10mg/kg i.p. of Nifedipine inhibited CAR in 60% of Rats (p<0.001) & 20 mg/kg i.p. inhibited CAR in 70% of Rats (p<0.001). When Nifedipine (5 mg/kg i.p) was combined with Haloperidol ED50-0.2mg/kg  the CAR was inhibited in 70% of the rats (p<0.01) and after combining Nifedipine (10mg/kg) with Haloperidol ED50-0.2mg/kg the CAR was inhibited in 80% Rats (p<0.001). Nifedipine at the dose of 5 mg/kg and 10 mg/kg (i.p.) did not induce catalepsy in the rats at any testing time interval.  At 20 mg/kg i.p., it produced catalepsy in 2 rats at half hour and in 4 rats at 1 hour and 2 hour testing interval each (p<0.01). In the dose of 5, 10 and 20 mg/kg, pretreatment with Nifedipine significantly increased Haloperidol induced cataleptic scores at all testing intervals (p<0.05).Conclusions: Nifedipine blocked CAR. Its higher doses induced catalepsy and it is synergistic with haloperidol in blockade of CAR and catalepsy

Dermatological adverse drug reactions in tertiary care hospital: an analysis of causality and severity

Background: Dermatological adverse drug reactions (ADRs) are easily detected by patients and that precludes further usage of drugs. So, decided to study the pattern, causative drugs, severity of adverse drug reactions and their causality in tertiary care hospital.Methods: It was prospective non inventional cross sectional study. Patients attending OPD or admitted to IPD of all age group and both gender with suspected dermatological ADRs following drug intake were included and the ADRS were recorded on CDSCO’s Pharmacovigilance form. Collected data was analyzed for assessment of causality using WHO-UMC scale, for severity by using Modified Hartwig and Siegel. Morphological pattern, drug groups, gender and age distribution was analyzed.Results: 231 dermatological ADRs were recorded and analyzed. Maximum cases were found in 21-30 years age group (74 cases). Dermatological ADRs were found in 143 females and in 88 males. Three major classes of drugs found responsible for causing dermatological ADRs were -oral Antimicrobials-41 (17.75%) and Injectable Antimicrobials-40 (17.32%), NSAID's-40 (17.32%.) and Topical Betnovate-36 (15.58%.). Regarding the type, 95 cases were of maculopapular rashes (41.12%), steroid damaged face in 42 (18.18%) andacute urticaria in 20 (8.65%). In terms of Severity assessment, authors found 23 cases (9.95%) as Mild, 176 cases (76.19%) of moderate severity and 32 cases (13.85%) of Severe category. In terms of causality assessment: 3 cases as Certain, 68 cases as Probable and 160 cases as Possible.Conclusions: From this study, it was found maximum Dermatological ADRs of moderate severity and few cases of causality category as “Certain”

Type of antihypertensive medications in CKD-stage V patients on hemodialysis and its relationship with demographic variables: an observational study

Background: The majority of the patients with chronic kidney disease stage V on hemodialysis have been found to have hypertension and many studies have recommended that hypertension should be essentially controlled in these patients for better clinical outcome. But till now no study analyzing the relationship between antihypertensive medication and the demographics of the patient has been done, so with this objective in mind the present study was carried out. Aim and objectives were to analyse the types of antihypertensive being used in CKD stage V patients on hemodialysis and their relationship with the demographic variables.Methods: The present observational cross-sectional study was conducted in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.) from 01 January 2018 to 31 March 2018 on patients with chronic kidney disease stage V on hemodialysis. The demographic variables evaluated were age, sex, basic disease and duration of dialysis. The relationship with type of antihypertensive being used and these demographic variables was calculated using Pearson Chi-square test. A p value of<0.05 was taken as statistically significant.Results: Diabetic nephropathy, CIN-CKD 5d, CGN-CKD 5d and hypertensive nephropathy were the commonest basic diseases in our study. Calcium channel blockers, beta blockers, ATRB, centrally acting antihypertensive, ACE inhibitors were the commonest antihypertensive used. Statistically significant relationship was seen between antihypertensive and basic disease (p<0.05).Conclusions: The study revealed that all the antihypertensive medications are prescribed on the basis of basic disease while other demographic variables do not play a vital role prescribing antihypertensive in patients with CKD stage V on haemodialysis. And the prescription of antihypertensive medications also matches with the actual clinical practice

Prescription of antihypertensive agents in the treatment of hypertension in diabetic nephropathy patients on hemodialysis

Background: All the patients with diabetic nephropathy have inherent hypertension and uncontrolled hypertension leads to deterioration in the kidney disease speedily. Aims and objectives were to analyze the prescription of antihypertensive agents in the treatment of hypertension in diabetic nephropathy patients on hemodialysis.Methods: The study was conducted on diabetic nephropathy patients on maintenance hemodialysis, in Sri Aurobindo Institute of Medical Sciences, Indore (M.P.). We had included 73 diabetic nephropathy patients on maintenance hemodialysis, who provided their consent for participation in the study. Pearson coefficient of correlation was used for finding the correlation. Unpaired ‘t’ test was applied for intergroup mean comparison. A p value of0.05). An inverse and statistically not significant correlation was seen between duration of dialysis; age and use of multiple antihypertensive medications (p>0.05).Conclusions: A strong association has been reported by many between hypertension and diabetic nephropathy. It is imperative that hypertension is well controlled in all the patients of diabetic nephropathy. This will slow down the progression of kidney disease and improve the quality of life in patients with diabetic nephropathy

Knowledge, attitude and practices of pharmacovigilance among the postgraduate and undergraduate medical students in a tertiary care hospital in Central India

Background: Adverse Drug Reactions (ADRs) are one of the underestimated causes of morbidity and mortality. Monitoring of these ADRs is at the core of any pharmacovigilance program. ADR monitoring suffers from lack of reporting from health care personnels. Unless we know the current knowledge, attitude and practices of the budding doctors it’s difficult to design corrective measures to improve reporting. The present study was designed to assess the knowledge, attitude and practices of pharmacovigilance and ADR reporting among undergraduate and postgraduate medical students.Methods: This was a questionnaire-based, observational study. The questionnaire had six questions each pertaining to knowledge, attitude and practices of pharmacovigilance and ADR reporting. Factors discouraging ADR reporting were also studied. Descriptive statistics were carried out and one-way ANOVA was applied to find the statistical difference between the groups.Results: A total of 288 subjects were approached for the study of which 229 agreed to participate. It was observed that the knowledge of the participants regarding ADR reporting and pharmacovigilance was satisfactory. 68% of respondents felt that educational programmes have a positive effect on ADR reporting. 15% of respondents admitted of having reported an ADR. The mean scores of knowledge, attitude and practices of ADR reporting were considerably higher in postgraduates as compared to undergraduates (p-value <0.05).Conclusions: The study concluded that participants of study were aware of the importance of ADR reporting but it did not reflect in their practices. There is a need to create awareness and to educate these future physicians about Pharmacovigilance

Efficacy and tolerability of milnacipran and escitalopram: a comparative study among patients of depression

Background: The present prospective, open labelled study was designed to evaluate the efficacy and tolerability of escitalopram, selective serotonin reuptake inhibitors (SSRI) in comparison with milnacipran, dual serotonin and noradrenaline reuptake inhibitors (SNRI) in the treatment of major depressive disorder.Methods: Outpatients (N=120) with an ongoing/newly diagnosed ICD-10 major depressive episode and having a minimum score of 8 on the 21-item Hamilton Depression Rating Scale (HDRS) were assigned to escitalopram, 10–20 mg/day (54 patients) and milnacipran 50-100mg (66 patients), for an 8 week treatment period with follow up at 2nd, 4th and 8th week. The parameters for efficacy were improvement (decrease in HDRS scores at 8 weeks from baseline values), response (decrease of ≥50% in the HDRS scores) and remission (HDRS score of ≤7). Tolerability was assessed by comparing the frequency of adverse effects and drop out rate due to the same at the end of 2nd, 4th and 8th week in both the groups.Results: Improvement, Response rate and Remission rates at the end of eight weeks were 71.11%, 83.33% and58.33% for escitalopram and 59.35%, 34.14% and75.6% for milnacipran respectively. Adverse experiences were reported by 14% of patients in escitalopram group and 79.2% patients in milnacipran group at 8 weeks. Additionally, there were significantly lesser dropouts due to adverse events in escitalopram (3.70%) than in milnacipran group (30%).Conclusions: Escitalopram, the Senantiomer of citalopram, is a safe and effective antidepressant with potentially superior tolerability and comparable efficacy to the dual reuptake inhibitor, Milnacipran