Current status of calcitonin gene-related peptide-based therapies in migraine: a scoping review

A significant proportion of patients exhibit sub-optimal response to the standard treatment of acute migraine such as triptans and NSAIDs. Even the conventional preventive therapies (e.g. beta-blockers) indicated for patients with frequent migraine attacks have varying responses. Moreover, evidence from animal studies elucidated the role of calcitonin gene-related peptide (CGRP) in the pathophysiology of migraine. Currently two classes are drug, the small molecule CGRP receptor antagonist or the ‘gepants’ (Ubrogepant, Rimegepant, Atogepant, Zavegepant) and CGRP monoclonal antibodies (Erenumab, Galcanezumab, Fremanezumab, Eptinezumab) have been found efficacious and safe in various clinical trials for the treatment and prevention of migraine. While the small molecule CGRP receptor antagonists are given orally, the monoclonal antibodies are injectable drugs. Ubrogepant and Rimegepant are the second-generation gepants approved for treatment of migraine. Zavegepant is a third generation gepant which has proven efficacy for acute treatment of migraine in a phase III trial. Atogepant has been approved for prevention of migraine. Rimegepant has also proven to be efficacious for preventing migraine attacks but has not yet been approved for this indication. Erenumab is the only monoclonal antibody which neutralizes the CGRP receptor. The latter three monoclonal antibodies target the CGRP peptide. The monoclonal antibodies have been approved for the prevention of migraine as a subcutaneously or intravenous infusion (Eptinezumab) given once a month or quarterly. Both the classes of drugs were well-tolerated in the clinical trials. Nausea was the most common adverse effect with gepants while injection-site pain was commonly reported with the antibodies

Is remdesivir the therapeutic answer for COVID-19: a review of current knowledge

As the world races to find the solution to the COVID-19 pandemic, an investigational agent which has triggered worldwide interest is remdesivir. Though failing clinical trials for treatment of Ebola virus disease, remdesivir has shown efficacy in numerous viral studies involving SARS-CoV-2. Reports from compassionate use of remdesivir in hospitalized patients of COVID-19 have been promising. But the real picture about the safety and efficacy of remdesivir can only be known after completion of randomized clinical trials. In this review, we aim to highlight the salient features of pharmacokinetics and pharmacodynamics of remdesivir known so far and its plausible role in management of COVID-19. We searched the PubMed database and Google Scholar for published literature using the key words: remdesivir, human coronavirus, novel coronavirus, COVID-19, SARS-CoV 2, mechanism of action, pharmacokinetics, pharmacodynamics and compassionate use till 1st May 2020. The U. S. national library of medical trials registry was searched for ongoing trials with remdesivir among patients of COVID-19. Remdesivir is a prodrug of a nucleoside Analog that inhibits RNA replication by binding to viral RNA dependent RNA polymerase. It is being employed in many global phase-3 clinical trials for evaluating the efficacy and safety of the drug in patients of COVID-19

Factors influencing the knowledge and attitude of nurses towards adverse drug reaction reporting in a teaching hospital

Background: Adverse Drug Reactions (ADR) are common in hospitalized patients. Nursing staff spends most time in patient care placing them at a key it position to recognize ADRs at the earliest. However, ADR reporting practices among nurses is very poor. We conducted this study to identify the factors affecting knowledge and attitude of nurses in a teaching hospital towards ADR reporting.Methods: A pre-tested and validated questionnaire was used. Correct responses in the knowledge section were awarded one mark and incorrect responses were given zero. Based on responses to attitude questions on a 5-point Likert scale, best attitude was scored five and least preferred attitude was given one point. Total knowledge and attitude scores were analyzed with regards to age, gender, educational qualification, average weekly working hours, total working experience in years and past experience with ADRs and ADR reporting. Knowledge scores were also correlated with attitude scores.Results: Knowledge level was poor with 48.29±23.85% average score while attitude of the respondents was reasonable with 65.69±10.05% average scores. The knowledge scores and attitude scores of BSc degree holders was higher than GNMs and ANMs (p<0.001). Those who had independently identified an ADR had higher knowledge scores (p<0.01) and more positive attitude (p<0.001). Attitude scores also had a significantly strong correlation with knowledge level of the respondents (r=0.72).Conclusions: Knowledge about ADR reporting is the most important factor determining the attitude towards ADR reporting. Increasing awareness would be pivotal in changing attitude and thus, improving reporting rates

Comparison of efficacy and safety of oral azithromycin and oral doxycycline in acne vulgaris

Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit with considerable psychosocial impact. Oral azithromycin or oral doxycycline can be used for the management of moderate and severe acne vulgaris. However, there is no consensus on which antibiotic is superior and the optimal dose for management.Methods: A prospective randomized interventional study was carried out among 120 patients of moderate to severe acne vulgaris. The patients were randomized into group A and B. While group A was prescribed oral azithromycin 500 mg three times a week, group B was given oral doxycycline 100 mg daily for 12 weeks. Topical clindamycin twice daily application was also given. Global Acne Grading Scale (GAGS) score was recorded at baseline and at 2nd, 4th, 8th and 12th weeks.Results: GAGS score at baseline in azithromycin (n = 53) and doxycycline (n = 55) group was 31.98±4.49 and 30.63±3.78 respectively (p value >0.05). 83.91±6.83% (p 0.05). 15.09% patients in azithromycin group and 20% patients in doxycycline group reported adverse effects. The most commonly reported adverse effect was diarrhoea. All adverse effects were of ‘mild’ category and causality assessment was ‘possible’.Conclusions: Oral azithromycin is equally efficacious but safer alternative to oral doxycycline for the management of acne vulgaris

A correlation study of lipid profile with body mass index and waist hip ratio in Rohilkhand region

Background: Central or abdominal obesity is associated with metabolic disorders such as hypertension, diabetes mellitus and cardio vascular disease (CVD). Anthropometric tools especially BMI is commonly used to categorize obesity. BMI, calculated from the weight and height of an individual, represents generalized fat distribution. Waist hip ratio (WHR) is more reliable anthropometric tool for measuring abdominal obesity as it takes waist circumference into consideration. Therefore, this study was undertaken to study the correlation of dyslipidemia with BMI and WHR and conclude if WHR could be used as a reliable tool for identifying high risk patients. Materials and Methods: Two hundred participants aged between35 to 45 years were randomly chosen. Lipid profile of all the participants was determined. These participants were divided into three groups based on their BMI. Same participants were also divided based on their WHR into two groups – Low risk and high risk. Mean of lipid profile was analyzed for significance by ANOVA and independent t test using SPSS 23.0. Correlation of dyslipidemia and BMI and WHR was analyzed using Pearson Coefficient. P&lt;0.05 was considered significant. Result: Participants with WHR in the high-risk category had TC/HDL ratio of 3.8±0.5 which was similar to those with BMI&gt;30 Kg/m2. Pearson correlation coefficient of Total cholesterol, LDL-C and TC/HDL with WHR was 0.505, 0.484 and 0.528 respectively which was stronger than that with BMI. Conclusion: WHR is a reliable tool to identify patients who are at high risk to develop CVD and other metabolic diseases

Study of Lipid Profile during Late Reproductive Phase, Perimenopause and Postmenopause in North Indian Women

Background: Perimenopause or menopausal transition is the phase which preceeds menopause and is characterized with fluctuation in estrogen levels. Several studies have been done to investigate the changes in lipid profile in premenopausal and postmenopausal women. Studies regarding the changes in lipid profile during perimenopause is scanty. This study was done to study the lipid profile in reproductive or premenopausal, perimenopausal and postmenopausal women. Materials and method: A case control study was done on 60 late reproductive phase, 60 perimenopausal and 60 postmenopausal women. Total cholesterol (TC), serum triglyceride and High Density Lipoprotein – Cholesterol (HDL-C) were determined with a fasting venous blood sample. Low Density Lipoprotein – Cholesterol (LDL-C) was calculated by Friedwald’s formula. TC/HDL cholesterol ratio and LDL/HDL cholesterol ratio were calculated and compared. Data was analyzed using Statistical Package for Social Sciences (SPSS) 17.0 version (SPSS Inc., Chicago, IL, USA). Results: Statistically significant increase in the total cholesterol, serum triglyceride and HDL-C levels and LDL/HDL cholesterol ratio in the perimenopausal was observed when compared with women in late reproductive age group. LDL- C and the TC/HDL-C ratio although increased was statistically not significant. Postmenopausal women showed statistically significant increase in TC, serum TG, LDL-C, TC/HDL-C ratio and LDL/HDL-C ratio. Conclusion: Adverse changes seen in the lipid profile during postmenopause begins during the perimenopause. As the perimenopause phase is a period of varied length, it is the optimal time for lifestyle style modification and preventive intervention in order to prevent cardiovascular risk in future

Prescription auditing based on World Health Organization (WHO) prescribing indicators in a teaching hospital in North India

Background: Prescription writing is an important means of therapeutic intervention by the doctor and reflects his approach towards safe prescribing. Complacency in prescribing results in errors which can even cause adverse effects. These errors can be detected through a prescription audit. We undertook this study to audit the out-patient department (OPD) prescriptions for completeness of prescription format, legibility and against the World Health Organization (WHO) prescribing indicators recommended to investigate rational use of drugs. Methods: OPD prescriptions were photographed from the pharmacy of a teaching hospital over a period of three months and 1274 prescriptions were audited. Prescriptions were evaluated for completeness of prescription format while legibility was graded as grade 1, 2 and 3. Prescriptions were also analyzed on the five WHO prescribing indicators. Results: An average of 4.02 ± 2.23 drugs were prescribed per prescription of which 39.01% were antibiotics. Though 79.2% drugs were prescribed from the Essential Drug List, none was prescribed by the generic name. Rate of injection use was 7.54% in our study. Registration number of the doctor was absent in 100% of the prescriptions. Errors such as omitting the mention of allergy status, follow-up advice and directions of use were common. Almost 8% prescriptions were illegible (grade3) and 66.8% were legible with difficulty (grade 2). Conclusion: Majority of the prescriptions were incomplete and poly-pharmacy was evident in our study. Regular auditing and feedback is necessary for imbibing safe prescribing practices. Doctors need to be made aware about the errors and the recommended guidelines

A Cross-Sectional Study to Assess mRNA-COVID-19 Vaccine Safety among Indian Children (5–17 Years) Living in Saudi Arabia

The objective of this study is to assess the frequency and severity of adverse events following immunization (AEFI) in Indian children aged 5–17 years who received the Pfizer-BioNTech mRNA COVID-19 vaccine, as well as to investigate for predictors of AEFI. To examine AEFI following the first and second doses of Pfizer’s vaccine, semi-structured questionnaires were distributed as Google forms at Indian schools in Saudi Arabia. The 385 responses included 48.1% male and 51.9% female children, with 136 responses of children aged 5–11 years (group A) and 249 responses from children aged 12–17 years (group B). Overall, 84.4% of children had two shots. The frequency of AEFI was reported to be higher after the first dose than after the second (OR = 2.12, 95% CI = 1.57–2.86). The reported AEFIs included myalgia, rhinitis, local reaction with fever, a temperature of 102 °F or higher, and mild to moderate injection site reactions. While group B frequently reported multiple AEFIs, group A typically reported just one. Local reaction with low grade fever was more frequently reported in group B after the first dose (24.1%) and second dose (15.4%), while local reaction without low grade fever was most frequently observed in group A after the first (36.8%) and second dose (30%). Only prior COVID-19 infection (OR = 2.98, 95% CI = 1.44–6.2) was associated with AEFI after the second dose in the study sample, whereas male gender (OR = 1.71, 95% CI = 1.13–2.6) and prior COVID-19 infection (OR = 2.95, 95% CI = 1.38–6.3) were predictors of AEFI after the first dose. Non-serious myocarditis was reported by only one child. According to the analysis conducted, the Pfizer’s mRNA COVID-19 vaccination was found to be safe in Indian children

A Cross-Sectional Study to Assess mRNA-COVID-19 Vaccine Safety among Indian Children (5&ndash;17 Years) Living in Saudi Arabia

The objective of this study is to assess the frequency and severity of adverse events following immunization (AEFI) in Indian children aged 5&ndash;17 years who received the Pfizer-BioNTech mRNA COVID-19 vaccine, as well as to investigate for predictors of AEFI. To examine AEFI following the first and second doses of Pfizer&rsquo;s vaccine, semi-structured questionnaires were distributed as Google forms at Indian schools in Saudi Arabia. The 385 responses included 48.1% male and 51.9% female children, with 136 responses of children aged 5&ndash;11 years (group A) and 249 responses from children aged 12&ndash;17 years (group B). Overall, 84.4% of children had two shots. The frequency of AEFI was reported to be higher after the first dose than after the second (OR = 2.12, 95% CI = 1.57&ndash;2.86). The reported AEFIs included myalgia, rhinitis, local reaction with fever, a temperature of 102 &deg;F or higher, and mild to moderate injection site reactions. While group B frequently reported multiple AEFIs, group A typically reported just one. Local reaction with low grade fever was more frequently reported in group B after the first dose (24.1%) and second dose (15.4%), while local reaction without low grade fever was most frequently observed in group A after the first (36.8%) and second dose (30%). Only prior COVID-19 infection (OR = 2.98, 95% CI = 1.44&ndash;6.2) was associated with AEFI after the second dose in the study sample, whereas male gender (OR = 1.71, 95% CI = 1.13&ndash;2.6) and prior COVID-19 infection (OR = 2.95, 95% CI = 1.38&ndash;6.3) were predictors of AEFI after the first dose. Non-serious myocarditis was reported by only one child. According to the analysis conducted, the Pfizer&rsquo;s mRNA COVID-19 vaccination was found to be safe in Indian children