Prescribing pattern and adverse drug effects monitoring of anti-rheumatoid drugs in rheumatoid arthritis patients in a tertiary care hospital

Background: Rheumatoid arthritis (RA) is a common disease that causes substantial morbidity in most patients and premature mortality in many. All the drugs used in the treatment of rheumatoid arthritis show significant toxicity and hence it is important to monitor the drugs for adverse drug reaction. This study will estimate the prescribing pattern and bring out the possible adverse drug reactions in patients with rheumatoid arthritis.Methods: This study included 200 patients with rheumatoid arthritis who fulfilled the study criteria were observed for three months. Their prescriptions were collected and analysed. The symptoms of adverse drug reaction were documented through questionnaire. The causality assessment was done by WHO-UMC assessment scale and severity by using modified Hartwig-Seigel severity assessment scale.Results: This study showed most of the patients were female (86%). Majority of them were in age group of 51-60 years. Average number of drugs per prescription was 10.57. Out of 200 patients, 2% were on single DMARD and 50.5% were on two DMARDs. 40% and 7.5% were taking three and four DMARDs respectively. A total of 450 adverse drug reactions were reported, out of which 68.4% due to steroid,12.5% due to DMARDs and 19.1 due to use of NSAIDs, DMARDs and glucocortisteroids. Chloroquine maculopathy occurred in 3 patients and elevated liver enzymes due to methotrexate in 3 patients, which necessitated DMARD withdrawal. Most patients had 1-3 ADRs. 6% of ADRs were severe and 54% belongs to probable category of causality assessment.Conclusions: Treatment of rheumatoid arthritis is mainly based on DMARDs, glucocorticosteroids and NSAIDs. So, occurrence of ADR is much common. Proper monitoring of therapy and timely modification of drugs and lifestyle can reduce the ADR occurrence

Evaluation of anticonvulsant activity of aqueous extract of Adhatoda vasica leaves by MES model in rats

Background: Epilepsy is the commonest neurological condition affecting people of all ages, race and social class. The present study was taken up to evaluate the anticonvulsant effect of aqueous extract of leaves of Adhatoda vasica in rats. To evaluate the effect of aqueous extract of Adhatoda vasica leaves on maximal electroshock model in albino rats and to compare the effect of aqueous extract of Adhatoda vasica leaves with standard dose of Phenytoin on Maximal electro shock model.Methods: Anticonvulsant activity of aqueous extract of Adhatoda vasica was analysed using MES (Maximal electroshock) model. Phenytoin (25mg/kg) as standard for Maximal electroshock, and two doses of aqueous extract of Adhatoda vasica (100mg/kg and 200mg/kg) were used as test drugs. Parameters observed in MES were abolition of hind limb tonic extension (HLTE) and time taken to regain righting reflex.Results: In MES model, control group showed 0% protection and standard phenytoin group showed 100% protection. Aqueous extract of Adhatoda vasica at 100mg/kg and 200mg/kg showed 33.33% and 50% protection from seizures respectively. The mean duration of time to regain righting reflex was significantly reduced in Adhatoda vasica groups when compared to control group (p 0.05) were obtained.Conclusions: Aqueous extract of leaves of Adhatoda vasica has shown significant anticonvulsant action in MES model

Anticonvulsant activity of Adhatoda vasica leaves by pentylenetetrazol model: preliminary evaluation in rats

Background: Epilepsy is a disorder characterised by recurrent seizures of cerebral origin with episodes of sensory, motor phenomenon with or without loss of consciousness. The present study was taken up to evaluate the anticonvulsant effect of aqueous extract of leaves of Adhatoda vasica in rats. Objectives of this study is to evaluate the effect of aqueous extract of Adhatoda vasica leaves on Pentylenetetrazol induced seizures in albino rats and to compare the effect of aqueous extract of Adhatoda vasica leaves with standard dose of sodium valproate on Pentylenetetrazol induced seizures in albino rats.Methods: Anticonvulsant activity of aqueous extract of Adhatoda vasica was analysed using PTZ (Pentylenetetrazol) model. Groups used were distilled water as control group, Sodium valproate as standard for Pentylenetetrazol and two doses of aqueous extract of Adhatoda vasica (100mg/kg and 200 mg/kg) for this screening model. Parameters observed for PTZ models were abolition of clonic seizures and time duration between injection of PTZ and onset of seizures.Results: In PTZ model, test group at 200 mg/kg showed 33.33% protection for abolition of clonic seizures, though not comparable to standard group. There was significant increase in the duration of onset of clonic seizures after PTZ injection in both test groups (at 100 mg/kg and 200 mg/kg) when compared to control group.Conclusions: Aqueous extract of leaves of Adhatoda vasica has shown significant anticonvulsant action in PTZ model

Effect of vitamin A supplementation in category-I Pulmonary Tuberculosis patients in a Medical College in India: a rapid assessment analysis

Background: Tuberculosis is one of the major health problems affecting the global population causing immense morbidity and mortality. Studies have shown that a good antioxidant status of the body has immune protective role against tuberculosis and may be associated with a decreased risk of the disease and slower rate of progression. Objective of the study was planned to evaluate the beneficial effects of Vitamin A as add on therapy to the standard drug therapy in patients with sputum positive pulmonary tuberculosis.Methods: The study was done in a Tuberculosis clinic, Department of Internal Medicine, Stanley Medical College for duration of 6 months. All the newly diagnosed sputum positive pulmonary tuberculosis patients (18-55 years) attending the outpatient were taken for the study purpose. A Phase III, prospective, open, two arm parallel group, outpatient, randomized, active controlled study was done.Results: After two weeks of therapy, the number of patients with negative sputum smear was higher in the study group than the control group. Vitamin A supplementation resulted in an earlier elimination of tubercle bacilli from the sputum.Conclusions: This study shows that vitamin A as add on therapy to the existing standard therapy improves the clinical response and decreases the disease activity to a greater extent than with routine standard therapy alone

A comparative study of mebeverine and synbiotic combination in patients with diarrhoea predominant Irritable Bowel Syndrome in a Medical College in South India

Background: Irritable bowel syndrome (IBS) is a chronic, episodic functional gastrointestinal disorder characterized by abdominal pain / discomfort and altered bowel habits. Though it is considered as a functional disorder, the burden of the disease to the patients is very high and the quality of life becomes miserable. Currently available IBS therapies are mainly symptom oriented and have limited efficacy. Various studies had done so far which provide a clear rationale for the use of Synbiotic in this disorder. The objective of the study includes, this study was planned to compare the efficacy of Mebeverine + Synbiotic combination with Mebeverine and Synbiotic monotherapy in patients with diarrhoea predominant irritable bowel syndrome.Methods: The study was done in Department of Medical Gastroenterology, Rajiv Gandhi Government Hospital, Chennai for duration of one year. Patients with Irritable Bowel Syndrome (diarrhea predominant type), diagnosed within 1 year and attending outpatient department were taken. A randomized, Phase III, prospective, interventional, open label, outpatient, comparative study design was done. A total of 60 patients divided into 3 groups were finally selected for the study purpose.Results: Twelve weeks after completion of active drug therapy, the Mebeverine + Synbiotic combination improved all the symptoms of IBS except abdominal pain. Further it was evident that combination therapy had significant remission in stool frequency and consistency when compared with other groups.Conclusions: Combination of Mebeverine + Synbiotic is more effective in improving most of the troublesome symptoms in patients with diarrhea predominant irritable bowel syndrome than other therapies and also in maintaining remission, in terms of frequency and consistency of stools

Effect of in situ soil moisture conservation practices on maize and its crop residue incorporation on yield and economics of succeeding transplanted rice Var. ADT 46

Crop residue incorporation is a key component of sustainable cropping systems. It reduces the adverse effects of residue burning and enhances soil fertility. Effective usage of crop residue in the field and proper management are required. With this background, a field experiment was conducted during 2020 – 21 in the maize-rice cropping sequence at Annamalai University Experimental Farm, Department of Agronomy, Faculty of Agriculture, Annamalai University, Annamalai Nagar, Tamil Nadu to find out the residual effect of different mulching practices adopted in preceding maize crop and maize stubble incorporation on the growth, yield and economics of transplanted rice Var. ADT 46. The field experiment was conducted in Factorial Randomized Block Design with three replications. In factor I, soil moisture conservation in preceding maize crop viz., mulching of sugarcane trash, water hyacinth, hydrogel and control were allotted. In factor II, different levels of maize crop stubble incorporation on rice viz., 0, 33, 66 and 100% were provided. Water hyacinth mulched plot (M3) to the preceding crop registered significantly (þ <0.05) higher yield parameters, yield and economic returns of succeeding rice. The lower values were observed in unmulched (M1) plot. With respect to maize crop stubble incorporation on rice crop, the incorporation of 66% (SI3) of maize stubble registered higher yield parameters, yield and economic returns. In the interaction effects, mulching with water hyacinth to preceding maize + maize crop stubble incorporation at 66% in rice crop (M3SI3) recorded significantly (þ <0.05) higher yield parameters, yield and economic returns than other treatments. The lowest values were recorded with an unmulched + 100% crop residue incorporated (M1SI4) plot. Mulching the preceding maize crop with water hyacinth at a rate of 12 t ha-1 and incorporating 66% maize stubble into the transplanted rice (M3SI3) had a remarkable yield advantage and financial rewards

Assessment of Safety and Interference Issues of Radio Frequency Identification Devices in 0.3 Tesla Magnetic Resonance Imaging and Computed Tomography

The objective of this study was to evaluate two issues regarding magnetic resonance imaging (MRI) including device functionality and image artifacts for the presence of radio frequency identification devices (RFID) in association with 0.3 Tesla at 12.7 MHz MRI and computed tomography (CT) scanning. Fifteen samples of RFID tags with two different sizes (wristband and ID card types) were tested. The tags were exposed to several MR-imaging conditions during MRI examination and X-rays of CT scan. Throughout the test, the tags were oriented in three different directions (axial, coronal, and sagittal) relative to MRI system in order to cover all possible situations with respect to the patient undergoing MRI and CT scanning, wearing a RFID tag on wrist. We observed that the tags did not sustain physical damage with their functionality remaining unaffected even after MRI and CT scanning, and there was no alternation in previously stored data as well. In addition, no evidence of either signal loss or artifact was seen in the acquired MR and CT images. Therefore, we can conclude that the use of this passive RFID tag is safe for a patient undergoing MRI at 0.3 T/12.7 MHz and CT Scanning

Urothelial Cancer With Occult Bone Marrow Metastases and Isolated Thrombocytopenia

AbstractBladder cancer rarely presents clinically with a myelophthisic picture from diffuse bone marrow infiltration especially in the absence of detectable skeletal metastases. A 75-year old man presented with newly diagnosed urothelial cell carcinoma of the bladder. Pathology from transurethral resection of bladder tumor demonstrated muscle-invasive disease. Pre-therapy imaging including CT abdomen/pelvis, CXR and bone scan demonstrated liver lesions concerning for metastatic disease but no skeletal metastases. Labs were notable for isolated thrombocytopenia, hypercalcemia and acute kidney injury prompting hospitalization. Hematologic work-up including bone marrow aspiration and biopsy revealed diffuse infiltration of the bone marrow by urothelial cancer. The case illustrates the importance of fully investigating otherwise unexplained clinical findings in patients with clinically localized urothelial cancer prior to curative intent surgery