Adverse events of albendazole due to mass drug administration

Background: Soil-transmitted helminths are mostly prevalent in developing countries due to poor sanitation and lack of adequate clean water. The present study examines adverse events (AEs) experienced following administration of albendazole to children (2-19 Years) at Uttarakhand on national de-worming day.Methods: Children were given single doses of albendazole on national de-worming day. Some of children experienced adverse events and were admitted in hospital of Govt Medical college Haldwani (Uttarakhand). Data were collected and analyzed.Results: Total twenty five children were admitted due to albendazole adverse events. Out of these 92% were female. Mean age of admitted children was 14.14 years with standard deviation 3.45. Mean onset of adverse events was 5.6 hours with standard deviation of 1.5 hours. All children were treated symptomatically and were discharged once they recovered. No fatality due to adverse events was observed. Average duration of stay in hospital was 3.4 days. Out of twenty five children 12% children reported four or more adverse events, 40% children reported three adverse events and 48% reported two adverse events. Out AEs, 33% AEs were mild, 19% AEs were moderate, 31% AEs were severe and 17% AEs were serious. Abdominal pain was reported by 76%, headache by 44%, loss of consciousness by 32%, vomiting by 28%, nausea by 16%, convulsions by 12%, rashes by 8%, fever by 8%, and breathlessness by 14% and vertigo by 4%.Conclusions: The adverse events were mild to serious but transient, but all of them recovered after hospitalization. Therefore, it is imperative that mass drug administration programmes put in place surveillance measures in order to ensure timely detection, management and reporting of potential life threatening AEs

STEVENS-JOHNSON SYNDROME DUE TO ADVERSE DRUG REACTIONS: A CASE SERIES

Stevens-Johnson syndrome (SJS) is a rare, serious disorder affecting skin and mucous membranes. It is one of the few serious dermatological adverse effects of drugs encountered in clinical practice which is characterized by blisters and rash on skin, mucous membranes, swelling over face and lips, and hyperpigmentation. After that, the outer layer of affected skin becomes dead, sheds, and starts to heal after several days of inflicting injury. Here, we present a case series of ofloxacin and chloroquine induced SJS after the consent given by patients. First case is a 62 years old male received Ofloxacin and second patient is a 40 years old male received chloroquine. Both patients experienced a severe skin reaction which was diagnosed as SJS. The above-mentioned medications will be implicated in cases of SJS. We should prescribe these medications with extreme caution

TRIMETHOPRIM-SULFAMETHOXAZOLE AND SODIUM VALPROATE-INDUCED TOXIC EPIDERMAL NECROLYSIS: A CASE SERIES

Toxic epidermal necrolysis (TEN) is a rare and serious but life-threatening dermolytic cutaneous reaction characterized by diffuse and severe exfoliation and destruction of the epidermis of skin and mucosa due to immunological damage of the epidermis which can bring about sepsis and respiratory distress. Drugs are the most common inflicting agents in the generation of TEN. Among drugs, antiepileptics, antipsychotics, and sulfa-drugs are common causes of TEN. Valproate is one of the most common drugs prescribed for epilepsy, was found as causative agent in TEN in very few cases. Among sulfonamides, sulfamethoxazole is commonly used antibiotic which can cause TEN. The evidence-based treatment guidelines are lacking, so the best approach is to recognize and evade potential risk factors and to deliver intensive supportive care immediately to reduce morbidity and mortality. The aim of this case series is to focus on valproate and trimethoprim-sulfamethoxazole (TMP-SMX)-induced TEN, which are commonly used drugs. Here, we present a case series of TEN inflicted by TMP-SMX and sodium valproate in a 23-year-old female and 10-year-old boy, respectively, with successful recovery

Prescribing pattern of drugs in sick newborn care unit in a tertiary care hospital, Haldwani, Uttarakhand, India

Background: Sick Newborn Care Unit (SNCU) is meant to reduce the case fatality among sick newborns. Although it has been shown that patterns of drug utilization in SNCU are changing dynamically, current data on drug utilization patterns in SNCU is limited. This study was done to find out drug utilization pattern in newborn admitted at SNCU.Methods: This prospective observational drug utilization study was carried out in SNCU of Government Medical College and Hospital, Haldwani (Uttrakhand). The pattern of drug use in 206 sick newborn admitted at SNCU was assessed.Results: 75.25% sick newborns were in early neonatal period and 63.11% sick newborns were male. 33.98% sick newborn were preterm and mean±SD of weight of sick newborn was 2.16±0.6kg. Neonatal sepsis was commonest reason for admission followed by birth asphyxia . Three or more drugs (average 2.35drug/ Range 3-9 drug) were given to 52.91% new born and two drugs were given to 40.78% new born. Commonest route of drug administration was intravenous (97.08%), followed by intramuscular (72.82%), followed by orally (13.59%) and 11.65% new born received drug by inhalation. Most frequently used drugs in SNCU were antibiotics (Ampicillin, Gentamicin, Amikacin, Cefotaxime). Only two adverse drug reactions (mild rash by ampicillin and fever) were reported during study period. Out of 206 sick newborn, 18.93% died. Most common causes for death were respiratory distress syndrome (41.03%) followed by sepsis (23.08%) and hypoxic ischemic encephalopathy (17.95%).Conclusions: Antibiotics were of major concern in SNCU. The uncertainty regarding the choice of antibiotic can be minimized by periodic survey of etiological agent and their antibiotic susceptibility pattern

Comparative study of efficacy and safety of garenoxacin and moxifloxacin in acute exacerbation of chronic bronchitis in COPD patients

Background: Acute exacerbation of chronic bronchitis in COPD (AECB) is the major cause of morbidity, mortality and marked reduction in quality of life and imposes significant burden on both patients and healthcare systems. Bacterial infections causing AECB frequently require antibacterial treatment, so more evidences are needed to guide better antibiotic choice. Objective of the study was planned to compare efficacy and safety of Garenoxacin, a new fluoroquinolone versus moxifloxacin for treatment of Acute exacerbation of Chronic bronchitis in COPD patient.Methods: This was a prospective open label comparative study done in department of pharmacology and T.B & Chest of Government Medical College attached Dr Shusila Tiwari Hospital, Haldwani. 60 subjects with clinical symptoms suggestive of Anthonisen type II AECOPD (any two of following criteria: Increased dyspnea, cough, sputum purulence) were enrolled and randomized to receive either Moxifloxacin 400 mg once daily for 7 days or Garenoxacin 400mg once daily for 7 days. The primary outcome measure was clinical success rate at day 7 visit. Secondary outcome measures were changes in clinical global impression (CGI) scales and incidence of adverse events.Results: The mean age of patient was 60.98±9.9 years and 57.9±9.3 years in the Moxifloxacin and Garenoxacin groups. The clinical success rates were comparable with 86.2% in moxifloxacin group 84.6% and in garenoxacin group. Adverse effects were mild and self limiting. We observed two adverse effects in garenoxacin and three in moxifloxacin group.Conclusions: The result of study showed that garenoxacin is comparable to moxifloxacin in terms of efficacy and safety

Evaluation for substitution of stem bark with small branches of Myrica esculenta for medicinal use – A comparative phytochemical study

AbstractBackgroundOver exploitation of many traditional medicinal plants like Myrica esculenta has become a threat and in the near future, many medicinal plants may be unavailable for use of industry.ObjectivePresent study outlines the concept of plant part substitution. Stem bark and small branches of M. esculenta are compared on the basis of physicochemical analysis, phytochemical analysis, total phenolic contents, total flavonoid contents and high performance thin layer chromatography (HPTLC) to evaluate the possibilities of using small branches in place of stem bark.Material and methodsPhysicochemical parameters and preliminary phytochemical screening were carried out using standard methods. Total phenolic and total flavonoid contents were estimated spectrophotometrically using Folin-Ciocalteu and aluminum chloride method, respectively. CAMAG HPTLC system equipped with semi-automatic applicator was used for HPTLC profiling. n-Hexane, ethyl acetate and ethanol extracts of stem bark and small branches were developed in suitable mobile phase using standard procedures and visualized in UV 254 and 366 nm and in white light after derivatization within anisaldehyde-sulphuric acid reagent.ResultsPhytochemical analysis and HPTLC profile of different extracts showed the presence of almost similar phytochemicals in both stem bark and small branches.ConclusionSimilarities in phytochemical analysis and HPTLC profile of various extracts suggests that small branches may be used in place of stem bark. The study provides the base for further study to use small branches as a substitute of stem bark of M. esculenta

COMPARATIVE PHYSICOCHEMICAL, PHYTOCHEMICAL AND HIGH PERFORMANCE THIN LAYER CHROMATOGRAPHY EVALUATION OF HEART WOOD AND SMALL BRANCHES OF AQUILARIA AGALLOCHA ROXB.

Aquilaria agallocha Roxb. commonly called as Agaru is a medicinal plant. Heartwood of this tree is widely used in Ayurveda for various diseases. Removal of heart wood from trunk of this tree may make this plant weak and susceptible to damage due to which availability of this plant may be difficult in near future. Present study outlines the concept of plant part substitution. Heart wood and small branches of A. agallocha are compared on the basis of physicochemical analysis, phytochemical analysis, total phenolic contents, total flavonoid contents and high performance thin layer chromatography (HPTLC) to evaluate the possibilities of using small branches instead of heart wood. Physicochemical parameters of heartwood and small branches and phytochemical analysis of n-hexane, ethyl acetate and ethanol extract of both heart wood and small branches were carried out using standard methods. Total phenolics and total flavonoids were estimated spectrophotometrically using Folin-ciocalteu assayand aluminum chloride assaymethods, respectively. CAMAG HPTLC system equipped with semi-automatic applicator was used for HPTLC of n-hexane, ethyl acetate and ethanol extracts of stem bark and small braches using suitable mobile phases. Results of phytochemical analysis and HPTLC of n-hexane, ethyl acetate and ethanol extracts showed many similarities whichsuggest that small branches may have nearly similar active potency like heart wood and may be used as a substitute of heart wood after comparison and confirmation of same for pharmacological activities

SUBSTITUTION OF ROOTS WITH SMALL BRANCHES OF RAUWOLFIA SERPENTINA FOR THERAPEUTIC USES - A PHYTOCHEMICAL APPROACH

Rauwolfia serpentina commonly called Sarpagandha is a medicinal plant widely used in Ayurveda. As per the Ayurvedic literature, roots of this plant are used in cardiac disorder, cancer, mental illness and psychiatric disorder. To collect roots for medicinal purpose whole plant is uprooted on a mass scale from their natural habitat which is leading to depletion of resources, due to which plant may be difficult in near future for use in traditional systems of medicine. Present study was carried out to assess possibilities of using small branches of R. serpentina in place of its roots which will help in conservation of this plant and availability of raw material for therapeutic purposes. Roots and small branches of R. serpentina are compared on the basis of physicochemical analysis, phytochemical analysis, total phenolic contents, total flavonoid contents and high performance thin layer chromatography (HPTLC) to evaluate the possibilities of using small branches in place of its roots. Results of phytochemical analysis and HPTLC of n-hexane, ethyl acetate and ethanol extracts showed many similarities whichsuggest that small branches may have nearly similar active constituents like roots and may be used as a substitute of roots after comparison and confirmation of same for pharmacological activities

ADA3 regulates normal and tumor mammary epithelial cell proliferation through c-MYC

Background: We have established the critical role of ADA3 as a coactivator of estrogen receptor (ER), as well as its role in cell cycle progression. Furthermore, we showed that ADA3 is predominantly nuclear in mammary epithelium, and in ER+, but is cytoplasmic in ER- breast cancers, the latter correlating with poor survival. However, the role of nuclear ADA3 in human mammary epithelial cells (hMECs), and in ER+ breast cancer cells, as well as the importance of ADA3 expression in relation to patient prognosis and survival in ER+ breast cancer have remained uncharacterized.Methods: We overexpressed ADA3 in hMECs or in ER+ breast cancer cells and assessed the effect on cell proliferation. The expression of ADA3 was analyzed then correlated with the expression of various prognostic markers, as well as survival of breast cancer patients.Results: Overexpression of ADA3 in ER- hMECs as well as in ER+ breast cancer cell lines enhanced cell proliferation. These cells showed increased cyclin B and c-MYC, decreased p27 and increased SKP2 levels. This was accompanied by increased mRNA levels of early response genes c-FOS, EGR1, and c-MYC. Analysis of breast cancer tissue specimens showed a significant correlation of ADA3 nuclear expression with c-MYC expression. Furthermore, nuclear ADA3 andc-MYC expression together showed significant correlation with tumor grade, mitosis, pleomorphism, NPI, ER/PR status, Ki67 and p27 expression. Importantly, within ER+ cases, expression of nuclear ADA3 and c-MYC also significantly correlated with Ki67 and p27 expression. Univariate Kaplan Meier analysis of four groups in the whole, as well as the ER+ patients showed that c-MYC and ADA3 combinatorial phenotypes showed significantly different breast cancer specific survival with c-MYC-high and ADA3-Low subgroup had the worst outcome. Using multivariate analyses within the whole cohort and the ER+ subgroups, the significant association of ADA3 and c-MYC expression with patients’ outcome was independent of tumor grade, stage and size, and ER status.Conclusion: ADA3 overexpression enhances cell proliferation that is associated with increased expression of c-MYC. Expression patterns with respect to ADA3/c-MYC can divide patients into four significantly different subgroups, with c-MYC High and ADA3 Low status independently predicting poor survival in patients

Combination of system biology to probe the anti-viral activity of andrographolide and its derivative against COVID-19

The present study aimed to investigate the binding affinity of andrographolide and its derivative i.e., 14-deoxy-11,12-didehydroandrographolide with targets related to COVID-19 and their probable role in regulating multiple pathways in COVID-19 infection. SMILES of both compounds were retrieved from the PubChem database and predicted for probably regulated proteins. The predicted proteins were queried in STRING to evaluate the protein-protein interaction, and modulated pathways were identified concerning the KEGG database. Drug-likeness and ADMET profile of each compound was evaluated using MolSoft and admetSAR 2.0, respectively. Molecular docking was carried using Autodock 4.0. Andrographolide and its derivative were predicted to have a high binding affinity with papain-like protease, coronavirus main proteinase, and spike protein. Molecular dynamics simulation studies were performed for each complex which suggested the strong binding affinities of both compounds with targets. Network pharmacology analysis revealed that both compounds modulated the immune system by regulating chemokine signaling, Rap1 signaling, cytokine-cytokine receptor interaction, MAPK signaling, NF-kappa B signaling, RAS signaling, p53 signaling, HIF-1 signaling, and natural killer cell-mediated cytotoxicity. The study suggests strong interaction of andrographolide and 14-deoxy-11,12-didehydroandrographolide against COVID-19 associated target proteins and exhibited different immunoregulatory pathways. This journal i