A study on adverse drug reactions of oral anti-diabetic agents in patients with type II diabetes mellitus in Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India

Background: Diabetes mellitus is an emerging non communicable, life style disease & the use of anti-diabetics has been increasing. Adverse drug reactions (ADRs) are well known to occur with any class of drugs when used in normal doses for the management of diseases. Anti-diabetic agents are no exception to this. The study of ADRs is the concern of the field known as pharmacovigilance. The objective of the present study was to analyze and describe the patterns of adverse events associated with the use of oral Anti-diabetic agentsMethods: A hospital based prospective observational study at Hi-Tech Medical College and Hospital, Bhubaneswar, Orissa. Convenience samples of 266 adult patients, prescribed with oral anti-diabetic agents from October 2016 to November 2018 were selected, out of which 74 patients developed ADRs. Data collected from available prescriptions. The severity assessment is done using the Hartwig and Siegal scale and preventability assessment using modified Schumock and Thornton is done.Results: Study suggests that female predominance in 41 (55.40%) patients with maximum cases of 43.24% in age group of 61-70 years age group. Maximum ADRs reported related to endocrine system seen in 36 (48.67%) patient population. Sulfonylureas 38 (51.35%) shows the largest numbers of ADR. The maximum ADRs reported were probable (56.73%). The severity assessment using the Hartwig and Siegal scale indicated that the majority of the ADRs were 63 (81.63%) as mild cases respectively.Conclusions: This study has provided evidence of monitoring and detecting ADRs and their management through therapeutic interventions which is beneficial in the better patient outcome

The study of adverse drug reactions of antihypertensive medicines in essential hypertension patients in Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India

Background: Every drug has the potentiality to cause an adverse drug reaction (ADR). ADRs are a major problem in drug therapy .The aim of this study was to assess the incidence and causality of ADRs to antihypertensive agents used for the essential hypertensive patients attending at the general medicine out patients departments of Hi-Tech Medical College and Hospital, Bhubaneswar Odisha, during the time period of November 2016 to October 2018.Methods: This prospective-observational study was carried out in general medicine outpatient department of Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha.Results: Out of 254 patients, 78 (30.71%) patients were developed ADRs to antihypertensive drugs. 51 (65.38%) were female and 27 (34.62%) were male. Calcium channel blockers were the commonest therapeutic class of antihypertensive drugs associated with ADRs (n = 50, 64.10%). According to WHO causality assessment scale most of the ADRs were “probable” 41 (52.56%), followed by “possible” 21 (26.92%), unclassifiable 13 (16.67%) and unlikely 3 (3.85%).Conclusions: The results of this study concluded that antihypertensive drugs able to induce the development of adverse drug reactions, which were significant cause of increase burden on health care system and decrease the quality of life, the health care professionals should take care about the rational use of antihypertensive agents. Thus, to minimize the incidence of adverse drug reaction and to increase the quality of life

Utilisation of antimicrobial agents in intensive care unit at a tertiary care teaching hospital in eastern India

Background: Antimicrobial agents (AMAs) are the most frequently used drugs in the intensive care units (ICU) and regular auditing can prevent the development of resistance to AMAs, reduce the cost and incidence of adverse drug reactions. The present study was conducted to assess the drug utilisation pattern by measuring the defined daily dose (DDD) per 100 bed days for the AMAs used and their correlation with the APACHE score II.Methods: This was a prospective observational study, conducted in the Central ICU of SCB Medical College and Hospital, Cuttack, Odisha for 4 months. Data regarding demographic profile, diagnosis, APACHE II score, microbiologic investigation, length of stay, outcome and utilisation pattern of AMAs assessing anatomic therapeutic chemical (ATC) classification and measuring the antimicrobial consumption index (ACI) equal to DDD per 100 bed days were collected and subjected to descriptive analysis. Multinomial logistic regression model was used to predict probabilities of different possible outcomes of categorically distributed variables and independent variables.Results: Mean age of study population was 44.70±14.814 with male and female ratio of 1.63:1. Septicaemia was the most common cause of admission. AMAs were prescribed to 92.66% of patients during their stay which constitutes 37.32% of the total drugs used. The DDD per 100 bed days for the AMAs were 118.59 and ceftriaxone was found to be most frequently used. Patients having higher APACHE II score received more no of AMAs (4.20±1.30). Patients having low APACHE II Scores received less number of antibiotics as compared to patients having higher score.Conclusions: AMAs were prescribed to 92.66% patients in the central ICU and there is significant relation between the APACHE II score and number of AMAs prescribed

Exosomes and HIV-1 Association in AIDS-Defining Patients

Exosomes are membranous nanovesicles of endocytic origin that help to facilitate cell-to-cell communication by transporting cellular cargo locally or systemically to a recipient cell. These are subsequently fused and internalised by recipient cells. Exosomes are secreted from all cell types in HIV-1 infected patients. Recent studies reveal that exosomes from various sources modulate the pathophysiology of HIV-1, and conversely, exosomes are also targeted by HIV-1 factors. Semen or plasma exosomes could suppress/inhibit HIV-1 replication in humans and rodent models. Exosomal cargo components could be used as a biomarker in HIV-1patients and AIDS-defining patients. Exosome in semen and plasma is a useful tool for the diagnosis of HIV-1 and an alternative therapeutic tool for antiretroviral therapy

Single-stranded DNA binding protein from human malarial parasite Plasmodium falciparum is encoded in the nucleus and targeted to the apicoplast

Apicoplast, an essential organelle of human malaria parasite Plasmodium falciparum contains a ∼35 kb circular genome and is a possible target for therapy. Proteins required for the replication and maintenance of the apicoplast DNA are not clearly known. Here we report the presence of single–stranded DNA binding protein (SSB) in P falciparum. PfSSB is targeted to the apicoplast and it binds to apicoplast DNA. A strong ssDNA binding activity specific to SSB was also detected in P. falciparum lysate. Both the recombinant and endogenous proteins form tetramers and the homology modelling shows the presence of an oligosaccharide/oligonucleotide-binding fold responsible for ssDNA binding. Additionally, we used SSB as a tool to track the mechanism of delayed death phenomena shown by apicoplast targeted drugs ciprofloxacin and tetracycline. We find that the transport of PfSSB is severely affected during the second life cycle following drug treatment. Moreover, the translation of PfSSB protein and not the transcription of PfSSB seem to be down-regulated specifically during second life cycle although there is no considerable change in protein expression profile between drug-treated and untreated parasites. These results suggest dual control of translocation and translation of apicoplast targeted proteins behind the delayed death phenomena

Status of vitamin D level in newly diagnosed pemphigus vulgaris patients: A case–control study from tertiary care centre of Eastern India

Background: Pemphigus vulgaris (PV), one common type of pemphigus, that affects the skin and mucous membranes, produce keratinocyte acantholysis by desmoglein-3 autoantibodies. Many medical conditions, including autoimmune illnesses, have been linked to vitamin D deficiency. Aim of study: To measure vitamin D level of Pemphigus Vulgaris patients and compare that with healthy controls& severity of disease.  Material and Methods: Newly diagnosed PV patients (44) were compared to 50 healthy controls in this case-control study on vitamin D levels. At S.C.B. Medical College & Hospital, Odisha, the dermatology department chose all patients over a two-year period (2017-2019). Pemphigus vulgaris lesion severity ratings were used to measure the disease severity. The 25(OH) D levels in the blood were determined using the ECLIA method (Electro chemiluminescence immunoassay) in Cobas e411 analyzer. Analyses of the data included independent t-tests and pearson correlations. Results: Gender, age, and other characteristics of both groups were virtually identical. The study comprised 44 patients (27 females and 17 males) and 50 controls (including 19 men and 31 women). Eighty-six percent of patients had moderate to severe involvement, whereas 11% had minor lesions. Patients had Vitamin D levels of 14.44±9.03, compared to 32.88±15.66 for controls (p<0.05)

Drug Utilisation Pattern and Adverse Events in Patients with Chronic Kidney Disease Undergoing Maintenance Haemodialysis at a Tertiary Care Hospital of Odisha

Introduction: The number of patients receiving renal replacement therapy in the form of dialysis or transplant has been increasing in recent years. Increased frequency of monitoring due to complex therapeutic regimen and inappropriate use of drugs may lead to increased Adverse Events (AEs), hospital stay, cost of treatment as well as increased morbidity and mortality. Aim: To analyse utilisation pattern of drugs and AEs in Chronic Kidney Disease (CKD) patients undergoing maintenance haemodialysis. Materials and Methods: This prospective, observational study was conducted in the Department of Pharmacology in collaboration with Department of Nephrology, SCB Medical College and Hospital, Cuttack, from 1st June to 31st December, 2015. Demographic, clinical and medicine details were collected from patients’ case sheet, matched with nursing case records and tabulated in a predesigned case study form. The data were analysed in a descriptive manner using percentage calculation and Spearman’s correlation, multiple logistic regression using trial version SPSS v24. Results: A total number of 115 cases were included in this study. Average number of drugs used, per prescription was 12.8 during the dialysis and non-dialysis days. Most frequently used drugs were antihypertensives, 25% dextrose and heparin (before dialysis and on dialysis days) were prescribed to all patients followed by haematinics in 90.43% of the patients and proton pump inhibitors were prescribed in 70.43% of the patients. Among 1472 drugs prescribed, 40.96% of the drugs were prescribed in generic name. It was observed that 72.62% of the prescribed drugs were from National List of Essential Medicine. AEs were observed with varying severity in all the patients. Frequently observed AEs as per the laboratory investigations were hyperphosphataemia, hyponatraemia, metabolic acidosis, hyperkalemia, hypoglycaemia, hypocalcaemia and hypokalemia. AEs were statistically significant with age group >45 years (p<0.001). Conclusion: This study provides an insight regarding utilisation pattern of a wide variety of drug classes in CKD patients undergoing maintenance haemodialysis in a tertiary care teaching hospital setting and suggests a possible improvement in medicine practices among patients suffering from CKD which may probably affect adherence patterns positively. Certain areas like potential drug interactions, adverse drug reactions and adherence are required to be explored further