Grade 4 oral mucositis and prolonged pancytopenia with high dose intravenous methotrexate in a patient of philadelphia positive acute lymphoblastic leukemia

Antimetabolite drugs are rarely associated with grade 3 or 4 mucositis. However specific side effects such as bone marrow suppression, pancytopenia, hospitalization, high cost limit the use of intravenous methotrexate. Here we report a case of 25-year-old girl patient with Acute Lymphoblastic Leukemia (ALL) treated with 24 hour methotrexate in her continuous phase of chemotherapy. After 12 hours of completing the treatment she developed oral mucosal pain & she was not able to speak. After a week, her White Blood Cell (WBC) count was 600/cumm with fever and she could not speak and eat or drink. So she was hospitalized for few days till she can drink something. We report high grade mucositis with methotrexate. Hematologists should be aware of this possible side effect to undertake early intervention

Digoxin toxicity: crucial to diagnose

Digoxin is mainly used for heart failure and arrhythmias like atrial flutter and fibrillation. Digoxin is like double edged sword because of its potency to cause life threatening complications like various arrhythmias. Furthermore, it is difficult and important to recognize cardio toxicity caused by digoxin to prevent threat to life. We report a case which was initially diagnosed as arrhythmia and later turned as digoxin toxicity

Drug utilization study-pattern of use of anti-microbial drugs among post operative patients in department of general surgery at a tertiary care hospital

Background: The objective of this study was to assess the current trends of prescribing antibiotics amongst the patients of General surgery postoperative unit of C. U. Shah Medical College and Hospital, Surendranagar, Gujarat.Methods: An observational study was done amongst 200 patients admitted in the General surgery postoperative ward of a C. U. Shah Medical College and Hospital, Surendranagar over a period of 6 months in accordance with the ethical principles of the ethics committee guidelines. Data were analyzed using Microsoft Office Excel 2007 and values were presented descriptively in percentiles.Results: The average number of antimicrobials per encounter was 1.78. The most common surgeries in the postsurgical unit were urological procedures 61 (30.35%) followed by incision and drainage 40 (20%). Most of the patients were in the age group of 35-60 yrs. Higher utilization of cephalosporins (62.91%) and fluoroquinolones (20.27%). The most preferred route of administration of antibiotics in post operative period was oral (55.58%).Conclusions: The present study provides valuable insight about the overall pattern of anti-microbials used in postoperative patients in a tertiary care hospital. It is intended to be a step in broader evaluation of safety and efficacy of drug as well as for improving prescribing habits among the fraternity and minimizing incidence of resistance to antimicrobials in surgical wards of a teaching hospital

Prevalence of G6PD deficiency versus oxidizing drugs: a survey in the tertiary care hospital

Background: G6PD deficiency is distributed worldwide including India and is involved in accidental hemolysis and anemia by inadvertent use of oxidizing drugs. Awareness of community wise occurrence of G6PD deficiency can help in screening beforehand.Methods: On 150 community wise classified, non-anemic, non- hemolysed (in recent past) visitors of pathological laboratory attached to C U Shah Medical College, Surendranagar, Gujarat, Crayman’s hemoglobin colorimetric kit (item no 700540) was used to estimate normal or below normal status of G6PD.Results: 10 people (6.6% of population) were found deficient – 7 (4 male + 3 female) from Harijan community, 2 (1 male + 1 female) from Rabbari community and 1 (1 male + 0 female) from Lohana community.Conclusions: While applying oxidizing drugs in a person of Harijan community (prevalence 7 out of total 26, i.e. 27%), extra caution is required, esp. if a person otherwise vulnerable (e.g. alcoholic). For other less represented communities, larger stratified sampling is required

An analytical survey of promotional drug literatures at C. U. Shah Medical College and Hospital, Surendranagar

Background: The research and marketing of a new drug requires a lot of money by the pharmaceutical companies. Promotion through advertising brochures and leaflets is widely used to influence the physicians. Most of the times, this information is the only source of new drug information for the physicians. Hence, this study to analyze the appropriateness, accuracy, and validity of promotional drug literatures was undertaken.Methods: Promotional materials were collected from outpatient departments of C. U. Shah Medical College and Hospital, Surendranagr. They were evaluated according to the “WHO criteria, 1988,” and the references cited to support the claims were checked for their validity and authenticity. The images and the pictorial content were evaluated to find out any biased nature of gender representation.Results: Evaluation of the total 486 brochures showed that none of them fulfilled all the nine criteria. Of the 308 claims, only 208 (42.79%) gave references to support the claims. Only 27 (39.13%) of the research articles among the 125 journal article cited were of high methodological quality. Among the 218 human figures, 144 were patients, and 103 were doctors. Female patients (62.5%) were depicted more than male patients (37.5%).Conclusion: The present study showed that pharmaceutical companies do not strictly follow the WHO guidelines and majority of the research were sponsored by companies. Hence, more stringent regulations need to be implemented for the proper promotion and dissemination of information about the new drugs

Ivermectin: pharmacology and therapeutic applications

Ivermectin is an antiparasitic drug with a broad spectrum of activity, high efficacy as well as a wide margin of safety. It belongs to the family of avermectins. It binds to glutamate-gated chloride iron channels, which are present in invertebrate nerve and muscle cells, and causes the paralysis and death of the parasite. Ivermectin is approved by the US Food and Drug Administration, and used worldwide to treat patients with onchocerciasis and strongyloidiasis. It is also used against a wide range of endoparasites (nematodes) and ectoparasites (insects, acarine) of animals and humans

Wound healing and anti-inflammatory activity of extract of Ficus racemosa linn. bark in albino rats

Background: F. racemosa is an indigenous plant having anti-secretory, anti-diabetic, anti-ulcer etc. properties. It is used widely in the ayurvedic medicines.Methods: The experimental models of wound and inflammation were used to assess the wound healing and anti-inflammatory properties of F. racemosa. The significance of differences was analyzed using students’ ‘t’ test.Results: In the strength of 10% local application it could apparently enhanced the process of healing. At the dose of 20 mg/100 gm intraperitoneally it could show inhibition of carageenan induced acute inflammation at 3rd, 5th and 7th hour and at the dose of 30 mg/100 gm intraperitoneally, formalin induced subacute inflammation was inhibited till 4th day. The results were found statistically significant.Conclusions: Aqueous extract of F. racemosa has got wound healing and anti-inflammatory activity. It is likely that the duration of action may be shorter

Approval of antineoplastic agents in India: comparison with the US and EU regions

Background: The antineoplastic drugs are prescribed for the treatment of cancer, which is an important cause of mortality in India; therefore, a drug lag in the availability of antineoplastic drugs is a direct threat to life. The present study was undertaken to assess the drug lag for new antineoplastic agents in India compared with that in the United States (US) or European Union (EU).Methods: The new antineoplastic agents approved in the United States, European Union and India between 1999 and 2011 were identified and information was gathered primarily from the websites of regulatory agencies of the three regions. We assessed absolute and relative drug lag for new antineoplastic agents approved in the three regions.Results: Of the 70 new antineoplastic agents, 64 (91.42%) were approved in the United States, 54 (77.14%) in the European Union and 44 (62.85%) in India. The US was the first to approve 59 (84.28%) out of the 70 new antineoplastic agents, the EU was the first to approve 9 (12.85%) and India was the first to approve 2 (2.85%). The median approval lag for India (26.35 months) was higher as compared to the United States (0 month) and European Union (7.3 months).Conclusions: This study confirms that India’s drug lag in the case of new antineoplastic agents is higher as compared to the US and EU. Further detailed analyses are necessary to find the reasons and impacts of drug lag for antineoplastic agents in India

Evaluation of the effect of topical cefadroxil on bacterial load of pathogenic staphylococci in anterior nares in human volunteers, comparative study between oral vs. topical cefadroxil and evaluation of effect of combination of oral plus topical cefadroxil in patients with staphylococcal superficial skin infections

Background: Cefadroxil has good tissue penetration & exerts more sustained action at the site of infection after oral absorption. Our aim of the study was to check topical cefadroxil has any efficacy over staphylococcal superficial skin infection or not.Methods: Pre-treatment nasal swabs were obtained from 25 healthy human volunteers and bacterial load was recorded. After single application of topical cefadroxil 3% in left anterior nare and placebo (vehicle) in right anterior nare nasal swabs were obtained and results were compared. 150 patients with staphylococcal superficial skin infections were distributed in 4 groups: Group A - oral cefadroxil 500 mg twice daily for 5 days, Group B - topical cefadroxil (0.5 % to 5%) twice daily, Group C - cefadroxil 500 mg orally plus placebo (vehicle) topically twice daily and Group D -cefadroxil 500 mg orally plus cefadroxil preparation topically twice daily. Bacterial load was measured before treatment, on follow up &after clinical cure and results were compared.Results: Topical cefadroxil significantly reduced bacterial load after single application in anterior nare. Topical cefadroxil cured and significantly reduced bacterial load in staphylococcal superficial skin infections within 3 days of treatment. Oral plus topical cefadroxil combination therapy significantly reduced bacterial load and cured infection within 3 days of treatment in patients with moderate to heavy bacterial growth. No any adverse effect was observed during entire study period in any of groups.Conclusions: Topical preparation of cefadroxil is safe and effective in treating staphylococcal superficial skin infections. Combination of oral plus topical cefadroxil showed synergistic effect in infections with moderate to heavy growth. This study is registered at CTRI [REG ID: CTRI/2013/02/003433 REF: REF/2013/02/004576]

To study cost effectiveness of topical permethrin versus oral ivermectin in patients of uncomplicated scabies

Background: The objective of this study was to compare the cost and effectiveness of topical permethrin and oral ivermectin in the treatment of uncomplicated scabies.Methods: This was an open label randomized comparative study conducted in 210 patients, randomly allocated to two groups. First group received permethrin 5% cream as single application, second group received tablet ivermectin 200mcg/kg as single dose. All the patients received antihistaminic for pruritus. The patients were followed up at intervals of one, two, three and four weeks. If there were no signs of cure, the same intervention was repeated at each follow up. The cost effectiveness was calculated on the basis of total expenditure incurred on therapy. Results: At the end of first week cure rate was 74.8% in permethrin group, 30% in oral ivermectin group. At the end of second week cure rate was 99% in permethrin group, 60% in oral ivermectin group. At the end of third week 100% cure rate was observed in permethrin while 99% in oral ivermectin group. The total cost of treatment shows that cost of tab. ivermectin was less compared to permethrin 5% but the cost to relieve itching and cost of transport was higher than permethrin 5%.Conclusions: Topical permethrin is more cost effective than oral ivermectin in treatment of uncomplicated scabies