Role of nutritional supplements in the management of tendinopathies: focus on combination of type 1 collagen, vitamin C and mucopolysaccharides

Tendinopathy is a common disease that is difficult to manage due to its recurrent nature. It is associated with increased healthcare costs and significantly impacts quality of life of patients. Also, according to recent studies patients with high cholesterol and diabetes are at a higher risk of developing tendinopathy. There has been rise in the incidence of tendinopathies due to increase in sport activities, life expectancy and some other factors (environment, diet and some drug therapies). Approximately 30% of visits for musculoskeletal pain in general practice are related to tendon injury. Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids remain the mainstay of treatment. Despite the use of current therapies, there is need of a supportive therapy that can help in the healing process towards development of physiologically normal tendons. Nutraceuticals have been used as supportive therapy for management of tendinopathies. This review focuses on the management of tendinopathy with special attention on role of nutraceuticals such as type I collagen, mucopolysaccharides and vitamin C in the management of tendinopathy. Clinical data suggests that this combination (type I collagen, mucopolysaccharides and vitamin C) promotes the endogenous synthesis of collagen type I, avoiding the accumulation of collagen type III and aggrecan, thus interfering with the degeneration of tendon tissue. Based on the available clinical data, combination of type I collagen, mucopolysaccharides and vitamin C not only reduce the clinical symptoms but also improve structural evolution of different types of tendinopathies as well as plantar fascitis

Darbepoetin alfa: review in the management of anemia in patients with chronic kidney disease

Chronic kidney disease (CKD) is a significant clinical problem across the world including India. The SEEK (Screening and Early Evaluation of Kidney Disease) study from India reported the prevalence of CKD as 17.2%. Diabetic nephropathy, undetermined etiology, chronic glomerulonephritis and hypertensive nephrosclerosis are the common causes of CKD in India. Rising rates of diabetes and hypertension, late presentation of patients to nephrologists and limited number of nephrologists in India adds to the concerns related to management of CKD. Considering the pathophysiology of CKD, anemia is almost an inevitable complication in these patients. Untreated anemia significantly contributes to the morbidity and mortality associated with CKD. Early recognition, timely management with appropriate therapy helps to reduce the complications of anemia. Erythropoiesis-stimulating agents (ESAs) are one of the important measures for correction of anemia in CKD patients. Darbepoetin, an ESA is a valuable therapeutic option for the treatment of anemia in CKD patients and has played a vital role in enhancing anemia management. In this article we reviewed the efficacy and safety data along with key benefits and place of darbepoetin alfa in the management of anemia in CKD patients

Pharmacological management of neuropathic pain in India: A consensus statement from Indian experts

Neuropathic pain (NeP) constitutes a major pain-related disorder, which is often underdiagnosed and undertreated. Adverse physical, psychological, and economic consequences associated with NeP lead to poor quality of life. Burden of NeP in developing countries like India is colossal. Various international guidelines provide effective approaches to diagnose and manage NeP. However, differences in the genetic makeup of Indian population can result in subtle differences in clinical response, considering their low body weight, drug metabolism ability, and pain perception. Similarly, treatment-related adverse effects may also vary. Practice of Indian physicians may also differ for choice of drugs based on their availability and affordability. In the absence of country-specific guidelines, this document could serve as a guiding tool for health-care providers, ensuring uniformity in the treatment of NeP. Thus, applicability of all recommendations from any of these guidelines in Indian setting demands careful evaluation. Clinical experience of Indian physicians suggests that there are lot many challenges (e.g., busy outpatient departments, nonavailability of screening questionnaires in regional languages, and availability and affordability of medications) faced by them when managing NeP. In addition, in India, there are no country-specific guidelines that would help them to address these challenges. The objective for this consensus was to develop an expert opinion guideline to harmonize the management of NeP in India. The expert panel consisted of experts from various specialties such as pain medicine, anesthesiology, diabetology, neurology, and orthopedics. The panel critically reviewed the existing literature evidence and guideline recommendations to provide India-specific consensus on the management of NeP. The final consensus document was reviewed and approved by all the experts. This expert opinion consensus will help health-care professionals as a guiding tool for effective management of NeP in India. Use of Douleur Neuropathique 4 (DN4) questionnaire for NeP screening should be routine in day-to-day clinical practice. For effective utilization of DN4 questionnaire, it should be converted to regional language. If DN4 questionnaire screening fails to identify NeP, it should not be disregarded and should not replace the sound clinical judgment from the treating physician. Diagnostic tests may be considered as a supplement to clinical judgment. Cost-effective treatment should be the initial choice. Dosing should be individualized based on efficacy and tolerability. Tricyclic antidepressants (TCAs), gabapentinoids, and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be considered among initial choices. Tramadol can be considered as a second-line add-on treatment for NeP if there is partial response to the first-line agent either alone or in combination. Fixed-dose combination (FDC) of gabapentinoids such as pregabalin (75 mg) with TCA such as nortriptyline (10 mg) is synergistic and improves treatment adherence. Among other treatments, Vitamin B12 (methylcobalamin) can be used either alone or in combination for the management of NeP. Use of Vitamin D and steroids should be limited to specific NeP in individual cases. Referral to pain specialists can be considered if two drugs fail to provide relief in NeP