Comparison of microvascular endothelial function as measured by laser Doppler flowmeter among non-smoker and smoker males

Background: To understand the role of smoking in influencing endothelial function as assessed by LDF among non-smoker and smoker males. Methods: The LDF measurement for a total of 35 non-smokers and 16 smokers was done in the central research laboratory after written informed consent. The change in LDF signal in response to acetylcholine 100 µl, which was delivered to the forearm skin by iontophoresis, was measured as perfusion units (PU). Results: The pre-ACh LDF signal were statistically not significant between the groups. The increase in LDF signal was more prominent in non-smoker group. The LDF signal parameters such as differences in minimal response pre and post-ACh; difference in mean response pre and post ACh; the difference in maximal response pre and post ACh was not statistically significant between groups. However, the difference in the area under curve (AUC) pre and post-ACh (PU.min) (non-smoker 20089.34 (3438.92) vs smoker 13220.72 (3379.52); p=0.16) showed a trend towards statistical significance. Conclusions: Microvascular endothelial function as assessed by LDF signal among smokers (pack-years;1.9±1.44) and non-smokers is statistically insignificant. However, lower microvascular endothelial function is observed among smokers

Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital

Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit.Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, antimicrobial use, culture and sensitivity reports, concomitant disease, concomitantly administered drugs, as well as clinical response were collected. The prescribed antimicrobials were correlated with the patient’s culture and sensitivity report. The number of defined daily doses (DDDs) administered per patient was calculated for each antimicrobial prescribed as per WHO anatomical therapeutic chemical classification. The ADR observed during the study were assessed using WHO causality analysis. The economic burden of the antimicrobial used was analyzed using average cost of antimicrobial per patient. The study was approved by the Institute Ethics Committee.Results: The antimicrobials that are commonly used as per total drug use (DDDs) are ceftriaxone followed by doxycycline and metronidazole. The antimicrobials account for 58.6% of cost spent on drugs for inpatients. Four antimicrobial related ADR were reported during the study period.Conclusion: Ceftriaxone, doxycycline, and metronidazole are commonly used antibiotics and significant proportion of the cost of drugs is spent for antimicrobials in a medicine unit

Effect of vitamin D on vascular health in hypertensive patients with vitamin D deficiency

Background: Many observational studies have shown association of cardiovascular disease and vitamin D deficiency. However, there is a need for prospective studies to show causal effect of vitamin D and cardiovascular diseases in India. Hence the present study was designed to study the effect of vitamin D on markers of vascular health in hypertensive patients with vitamin D deficiency. The objective of the study was to assess the effect of vitamin D supplementation on markers of vascular health in hypertensive patients with vitamin D deficiency.Methods: Hypertensive patients were screened for vitamin D deficiency defined as 25 OH vitamin D less than 20 ng/mL after written informed consent. Hypertensives deficient with 25 OH vitamin D were recruited for the study to receive cholecalciferol 60000 IU/ week for 8 weeks. The vascular parameters such as blood pressure, pulse wave velocity, arterial stiffness index, malondialdehyde and total antioxidant status were assessed at baseline and after 8 weeks of cholecalciferol. The results were analysed using paired‘t’ test.Results: A total of 119 hypertensive patients were screened for vitamin D status. Among them 57 patients were found to be vitamin D deficient (48.7%). Thirty two patients completed the study. The baseline serum 25 OH vitamin D3 was 12.55 ± 5.7 ng/mL and it increased to 40.06 ± 10.53 ng /mL after 8 weeks.Conclusions: The vascular parameters didn’t show any statistically significant difference between baseline and at 8 weeks. However trend for decline was observed for malondialdehyde, right brachial pulse wave velocity

Effect of vitamin D on vascular health in hypertensive patients with vitamin D deficiency

Background: Many observational studies have shown association of cardiovascular disease and vitamin D deficiency. However, there is a need for prospective studies to show causal effect of vitamin D and cardiovascular diseases in India. Hence the present study was designed to study the effect of vitamin D on markers of vascular health in hypertensive patients with vitamin D deficiency. The objective of the study was to assess the effect of vitamin D supplementation on markers of vascular health in hypertensive patients with vitamin D deficiency.Methods: Hypertensive patients were screened for vitamin D deficiency defined as 25 OH vitamin D less than 20 ng/mL after written informed consent. Hypertensives deficient with 25 OH vitamin D were recruited for the study to receive cholecalciferol 60000 IU/ week for 8 weeks. The vascular parameters such as blood pressure, pulse wave velocity, arterial stiffness index, malondialdehyde and total antioxidant status were assessed at baseline and after 8 weeks of cholecalciferol. The results were analysed using paired‘t’ test.Results: A total of 119 hypertensive patients were screened for vitamin D status. Among them 57 patients were found to be vitamin D deficient (48.7%). Thirty two patients completed the study. The baseline serum 25 OH vitamin D3 was 12.55 ± 5.7 ng/mL and it increased to 40.06 ± 10.53 ng /mL after 8 weeks.Conclusions: The vascular parameters didn’t show any statistically significant difference between baseline and at 8 weeks. However trend for decline was observed for malondialdehyde, right brachial pulse wave velocity

Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review

Purpose: Computerised prescriber (or physician) order entry (CPOE) implementation is one of the strategies to reduce medication errors. The extent to which CPOE influences the incidence of chemotherapy-related medication errors (CMEs) was not previously collated and systematically reviewed. Hence, this study was designed to collect, collate, and systematically review studies to evaluate the effect of CPOE on the incidence of CMEs. Methods: A search was performed of four databases from 1 January 1995 until 1 August 2019. English-language studies evaluating the effect of CPOE on CMEs were selected as per inclusion and exclusion criteria. The total CMEs normalised to total prescriptions pre- and post-CPOE were extracted and collated to perform a meta-analysis using the 'meta' package in R. The systematic review was registered with PROSPERO CRD42018104220. Results: The database search identified 1621 studies. After screening, 19 studies were selected for full-text review, of which 11 studies fulfilled the selection criteria. The meta-analysis of eight studies with a random effects model showed a risk ratio of 0.19 (95% confidence interval: 0.08-0.44) favouring CPOE (I2= 99%). Conclusion: The studies have shown consistent reduction in CMEs after CPOE implementation, except one study that showed an increase in CMEs. The random effects model in the meta-analysis of eight studies showed that CPOE implementation reduced CMEs by 81%.</p

Role of Drug Transporters in Elucidating Inter-Individual Variability in Pediatric Chemotherapy-Related Toxicities and Response

Pediatric cancer treatment has evolved significantly in recent decades. The implementation of risk stratification strategies and the selection of evidence-based chemotherapy combinations have improved survival outcomes. However, there is large interindividual variability in terms of chemotherapy-related toxicities and, sometimes, the response among this population. This variability is partly attributed to the functional variability of drug-metabolizing enzymes (DME) and drug transporters (DTS) involved in the process of absorption, distribution, metabolism and excretion (ADME). The DTS, being ubiquitous, affects drug disposition across membranes and has relevance in determining chemotherapy response in pediatric cancer patients. Among the factors affecting DTS function, ontogeny or maturation is important in the pediatric population. In this narrative review, we describe the role of drug uptake/efflux transporters in defining pediatric chemotherapy-treatment-related toxicities and responses. Developmental differences in DTS and the consequent implications are also briefly discussed for the most commonly used chemotherapeutic drugs in the pediatric population.</p

Role of Drug Transporters in Elucidating Inter-Individual Variability in Pediatric Chemotherapy-Related Toxicities and Response

Pediatric cancer treatment has evolved significantly in recent decades. The implementation of risk stratification strategies and the selection of evidence-based chemotherapy combinations have improved survival outcomes. However, there is large interindividual variability in terms of chemotherapy-related toxicities and, sometimes, the response among this population. This variability is partly attributed to the functional variability of drug-metabolizing enzymes (DME) and drug transporters (DTS) involved in the process of absorption, distribution, metabolism and excretion (ADME). The DTS, being ubiquitous, affects drug disposition across membranes and has relevance in determining chemotherapy response in pediatric cancer patients. Among the factors affecting DTS function, ontogeny or maturation is important in the pediatric population. In this narrative review, we describe the role of drug uptake/efflux transporters in defining pediatric chemotherapy-treatment-related toxicities and responses. Developmental differences in DTS and the consequent implications are also briefly discussed for the most commonly used chemotherapeutic drugs in the pediatric population