Therapeutic drug targets for COVID-19

Covid 19, caused by Corona virus started in Wuhan, China on December 2019 and the disease has spread rapidly among 210 countries. Corona virus disease, a RNA virus infection affected millions of people and caused death in many patients. The symptoms include fever, sneezing, coughing and other respiratory symptoms. The disease can highly affect the elderly, immunocompromised and the fatality rate is increased among these people. There is no definitive treatment till now and patients are treated symptomatically. The steps involved in the pathogenesis including attachment of the virus to the host cell, replication, protease action, assembly of nucleocapsid, release by exocytosis and they are the potential targets for the drugs. There are various trials ongoing to evaluate the efficacy of antiviral drugs, chloroquine, hydroxychloroquine, convalescent plasma and monoclonal antibodies. This review gives a summary of the most important drugs and drug targets used in the management of Covid 19

Pharmacoeconomic analysis of drugs used for peptic ulcer in India

Background: Acid peptic disorders are common medical problems in daily clinical practice leading to a significant economic burden on healthcare expenses. Due to lack of information on comparative drug prices and quality, it becomes difficult for physicians to prescribe the most economical treatment. So the present study was planned to analyse the price variations of various anti-ulcer drugs available in India.Methods: The cost of a particular anti-ulcer drug being manufactured by different companies, in the same dose and dosage forms, was obtained from latest issue of ‘‘current index of medical specialties’’ January to April, 2016. The difference between the maximum and minimum prices of same drug was analysed and percentage variation in the prices was calculated.Results: Overall, the prices of a total of 12 anti-ulcer drugs belonging to four different categories available in 38 different formulations were analysed.  Among the proton pump inhibitors, pantoprazole (40 mg; EC tablet) showed the maximum price variation of 500.75%. With regard to H2 blockers, ranitidine (50 mg; injection) showed the maximum price variation of 989.92%. The maximum price variation among various formulations of ulcer protective was seen with sucralfate (1000 mg; tablet) of 166.00% while misoprostol (200µg; tablet) was the only drug present in prostaglandin analogues and it showed a price variability of 14.33%.Conclusions: The average percentage variations of different brands of the same anti-ulcer drugs in same dose and dosage form manufactured in India were very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-ulcer drugs and thereby minimizing the economic burden on the patients

STUDY OF PREVALENCE AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF BACTERIAL ISOLATES IN A TERTIARY CARE HOSPITAL

Objective: Many human illnesses are bacterial in origin which can be treated with appropriate antibiotics and selection of these is mostly based on culture and sensitivity. The problem of antimicrobial resistance has burgeoned throughout the world both in inpatients and outpatients. We must work together to preserve the power of antimicrobials so as to use these effectively in treating diseases. The aim of the study is to find out the prevalence of infection and sensitivity pattern among bacterial pathogens in a tertiary care hospital.Methods: This retrospective study was carried out in Vinayaka Missions Medical College and Hospital, Karaikal, Puducherry (U. T) to study the culture and sensitivity pattern of clinical isolates from blood, urine, sputum, wound, ear/throat swab for one year (June 2012- June 2013). The positive cultures and their antibiotic susceptibility testing were performed under the guidelines of Clinical and Laboratory Standard Institute (CLSI). The lab data from Microbiology department were utilized and filled in a proforma and analyzed.Results: Out of 788 samples, 296 were culture positive. Isolated bacteria were mostly Gram negative organisms (GNO) of which Klebsiella (41.55%) was commonly followed by Pseudomonas (15.20%), Escherichia coli(4.05%) and Proteus (3.71%). Among Gram positive organisms (GPO) Staphylococcus (35.47%) was common. Imipenem (100%), Gentamycin (90.20%), Amikacin (89.14%), were the antimicrobials most sensitive for GNO, while Ceftriaxone (100%), Cefotaxime(100%),Nitrofurantoin(96.15%) and Linezolid(92.13%) were most sensitive for GPO. Widespread resistance to Nalidixic acid (99%),Ampicillin (85.90%), Cefuroxime (75%) is seen in both groups, while Cefazolin(79.25%) and Norfloxacin(83%) was noted for GNO, resistance to Amoxicillin with clavulanic acid (81.66%) and Imipenem(55.55%) was noted for GPO.Conclusion: The technical abilities to detect novel, resistant mechanisms and to overcome the microbial resistance has to be improved. Antibiotic policies agreed among clinicians, microbiologists and pharmacologists will guide good prescribing, provide maximum coverage for treating infections and ensure antibiotic cycling.Â

Effects of Salacia oblonga on aluminium induced changes in membrane ATPases in brain cortex and hematological parameters in Wistar albino rats

Background: The current study was done to evaluate the effect of hydro alcoholic extract of Salacia oblonga on aluminum induced toxicity in brain cortex and blood in Wistar albino rats.Methods: The experimental animals were divided into four groups, each group comprising of six animals for 36 days of experimental duration. We investigated Na+/K+, Mg2+, Ca2+ ATPases enzyme activity in brain cortex and hematological changes if any, upon administration of aluminum chloride (Alcl3) (300 mg/kg b.w), hydro alcoholic extract  of Salacia oblonga (67 mg/kg b.w) and Alcl3+ Salacia oblanga with control (distilled water).Results: In brain cortex, Salacia caused an increased in activity of ATPases. Combined administration of Salacia suppressed the influence of aluminum on the ATPases in the brain cortex (p<0.05). Both aluminum as well as Salacia did not cause any alteration in the hemoglobin content of blood in Wistar albino rats. The erythrocytes count was also not altered by treatment with either aluminum or Salacia. Combined treatment with Salacia suppressed the influence of aluminum with reference to neutrophil count and significant increases in monocyte as well as lymphocyte count were seen. Thus, repeated administration of aluminum causes a decrease in neutrophil and increase in lymphocyte count.Conclusions: All the ATPases in brain cortex were found to be affected by aluminum administration and Salacia is found to counteract the ATPase effect to a particular extent implying the presence of an active principle that can counteract the aluminium toxicity indicating its possible usefulness in aluminum toxicity

Study on drug utilization pattern of antibiotics among dermatology in-patients of a tertiary care teaching hospital, Karaikal, Puducherry

Background: Skin diseases of microbial etiology are caused by bacteria, fungi, viruses and ectoparasites of which bacterial infections are most common than others. Although many bacteria reside on skin, they are unable to establish infection because of the natural defense mechanisms. Most of the bacterial infections are caused by Staphylococcus and Streptococcus. Antibiotic resistance among the micro-organisms is developing due to indiscriminate use of antibiotics and irrational prescription of drugs. Periodic study on drug utilization research and analysis of prescription pattern of antibiotics followed in recent past will guide physicians to prescribe the antibiotics judicially and with a rational approach.Methods: A prospective analysis of 291 in-patients admitted in the Department of Dermatology, Karaikal, over a period of 1-year (January 2013-December 2013) was carried out to analyze the usage of antibiotics through various routes to treat infections associated with dermatological disorders.Results: Among the study population, 60.48% were male and 39.51% were female. We found that out of 29 diseases observed, most common skin disease diagnosed was psoriasis (24.82%), followed by eczema (24.82%). The average number of drugs per prescription was 6.37±2.06. Oral antibiotics were mostly prescribed than parenteral and topical formulations among the study population. Among the oral antibiotics, amoxicillin with clavulanic acid (29.6%) was widely prescribed. In the context of parenteral formulations, cefotaxime (38.92%) was majorly prescribed. Among the topical antibiotics, mupirocin (60.71%) was mostly used.Conclusion: Our study provided an idea about the prevalence of dermatological disorders in a coastal area of Karaikal, Puducherry, the drug utilization strategy of antibiotics, the rationality behind usage and has given useful suggestions to achieve treatment success through judicious use of antibiotics

Prevalence, severity, causes and drugs used for depression, stress and anxiety among junior doctors in a tertiary care teaching hospital in South India

Background: Due to various reasons, junior doctors experience high level of stress in their workplace. However, very few studies have been done to analyze the stress levels and pertinent causative factors among junior doctors in India. So the present study was done to investigate the prevalence, severity and causes of depression, stress and anxiety among junior doctors along with the drugs used to mitigate them.Methods: A cross sectional, questionnaire based study was conducted on a total of 114 junior doctors who include 80 interns and 34 post graduates belonging to  2013-14 batch, utilizing the 21-item depression, anxiety and stress scale (DASS 21). A personal interview was also conducted to enquire into the causes responsible for the stress and the medications employed by them to overcome it.Results: Among the interns, the mean depression score was 5.64±3.85, mean anxiety score was 6.69±3.86 and mean stress score was 7.33±3.22. Among the post graduates, the mean depression score was 4.73±2.15, mean anxiety score was 5.18±3.19 and mean stress score was 7.82±2.68. The percentage of junior doctors who had severe or extremely severe scores of depression was 11.40%, anxiety was 40.35% and stress was 9.65%. Alcohol was the most commonly used psychotropic drug (60.87%). Frequent calls during night duties and late working hours were the leading causes for stress among junior doctors.Conclusions: Overall higher stress was observed among post graduates compared to interns and females compared to males. Anxiety was more severe compared to depression and stress among junior doctors. Reducing working hours and increasing workplace flexibility are some measures to reduce stress among the junior doctors

Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute.Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed.Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation.Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription

WHO core prescribing indicators in patients with allergic contact dermatitis in a coastal town of South India

Background: Prescribing pattern analysis utilizing WHO core drug prescribing indicators can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs.Even though many drugs are commonly used in treatment of Allergic contact dermatitis (ACD) they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and study the WHO core prescribing indicators in patients with ACD in our institute.Methods: A prospective observational study was carried out with prescriptions of 81 outpatients who attended the dermatology OPD with the diagnosis of ACD over a period of six months. Details such as basic demographics, specific drugs prescribed with their dose and dosage forms were recorded and WHO core prescription indicators analysed.Results: Overall, corticosteroids both topical and systemic were the most commonly prescribed drugs (45.54%) followed by antihistamines (30.69%) and antimicrobials (13.86%). The most commonly prescribed topical corticosteroid was desonide (58.82%), systemic corticosteroid was prednisolone (47.61%), antihistamine was cetirizine (54, 83%) and antimicrobials were cephalosporins (42.86%). Average drugs per prescription for patients of ACD were 6.8. Percentage of drugs prescribed by generic name was 22.77%. Percentage of encounters with antibiotic prescribed was 13.86% whereas injection prescribed was 9.90%. Percentage of drugs prescribed from National list of essential medicines (NLEM) was 53.57%.Conclusions: Corticosteroids remain the mainstay of treatment in ACD. The percentage of encounters with an injection and the use of systemic steroids were low and were according to the guidelines. But drugs prescribed by generic name and those prescribed from NELM were found to be satisfactory but can further be improved

Prevalence, severity, causes and drugs used for depression, stress and anxiety among junior doctors in a tertiary care teaching hospital in South India

Background: Due to various reasons, junior doctors experience high level of stress in their workplace. However, very few studies have been done to analyze the stress levels and pertinent causative factors among junior doctors in India. So the present study was done to investigate the prevalence, severity and causes of depression, stress and anxiety among junior doctors along with the drugs used to mitigate them.Methods: A cross sectional, questionnaire based study was conducted on a total of 114 junior doctors who include 80 interns and 34 post graduates belonging to  2013-14 batch, utilizing the 21-item depression, anxiety and stress scale (DASS 21). A personal interview was also conducted to enquire into the causes responsible for the stress and the medications employed by them to overcome it.Results: Among the interns, the mean depression score was 5.64±3.85, mean anxiety score was 6.69±3.86 and mean stress score was 7.33±3.22. Among the post graduates, the mean depression score was 4.73±2.15, mean anxiety score was 5.18±3.19 and mean stress score was 7.82±2.68. The percentage of junior doctors who had severe or extremely severe scores of depression was 11.40%, anxiety was 40.35% and stress was 9.65%. Alcohol was the most commonly used psychotropic drug (60.87%). Frequent calls during night duties and late working hours were the leading causes for stress among junior doctors.Conclusions: Overall higher stress was observed among post graduates compared to interns and females compared to males. Anxiety was more severe compared to depression and stress among junior doctors. Reducing working hours and increasing workplace flexibility are some measures to reduce stress among the junior doctors

Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a Tertiary Care Teaching Hospital

Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute.Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed.Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52%) were the most commonly prescribed category followed by analgesics (19.60%) and Intravenous fluids (13.53%). Metronidazole (27.02%) was the most commonly prescribed antimicrobial, Diclofenac (68.04%) was the commonly prescribed analgesics and Ringer lactate (38.81%) was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%), antiemetic was Ondansetron (76.39%). Majority of drugs (72.54%) were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM) was 82.16%. Injection (57.78%) was the most common drug formulation.Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial agents. Prescribing according to the national essential list of medicines was high, which indicates rational prescription