Drug induced liver injury is associated with high mortality- A study from a tertiary care hospital in Pakistan

Background and aim: In light of few established drug induced liver injury (DILI) registries, this study aims to evaluate the clinical spectrum and predictors of mortality and morbidity of hospitalized patients with suspected DILI.Patients and methods: DILI cases were identified and categorized on basis of COIMS/RUCAM score and the exclusion of other liver diseases. Clinical and laboratory parameters were analyzed to identify the predictors of morbidity (prolonged hospital stay \u3e 5 days) and mortality.Results: Out of 462 patients, there were 264 (57.6%) males and the mean age of the cohort was 50.83 years (range: 20-94 years). DILI was classified as definite or highly probable in 31.1%, probable in 62.5%, and possible in 7.4% of cases. Pattern of liver injury was hepatocellular in 25.1%, cholestatic in 56.17%, and mixed in 18.72% of patients. Anti-tuberculosis drugs (ATDs) were found to be the most common category of drugs causing DILI, in 295 (63.9%) patients. Clinically, encephalopathy was present in 21.6% patients; other presenting symptoms included abdominal pain (57.1%), vomiting (57.1%), jaundice (54.1%) and pruritus (42.3%). In-hospital mortality was 26.5% and prolonged hospital stay (\u3e 5 days) was observed in 35.93% of patients. Mortality was significantly greater in patients with encephalopathy, male gender, hepatocellular pattern of DILI, increased INR and use of ventilator support.Conclusion: In our study, the most frequent cause of DILI in hospitalized patients was ATDs. More than a quarter of patients died during hospital stay. A close control of clinical and biochemical parameters are required to prevent and monitor DILI, especially in patients taking ATDs in our region

A study of serious adverse drug reactions with antiepileptic drugs: a pharmacovigilance study

Background: Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally. There are currently more than 25 drugs in the market for the treatment of epilepsy, many of which have similar efficacy but differ in their tolerability profile. Besides unmatched beneficial potential of antiepileptic drugs, it is associated with many adverse reactions too. This study aims to identify the serious adverse reactions caused by prescribed antiepileptics, reported at the pharmacovigilance centre of government tertiary care centre.Methods: This is a retrospective, pharmacovigilance study of the antiepileptic drugs adverse reactions reported over a period of 1 year at a tertiary care centre.Results: A total of 120 ADRs of antiepileptic drugs were reported and collected at the pharmacovigilance centre. According to the WHO-ART system organ classification of ADRs, 78% of ADRs belonged to skin and appendages disorder. Based on the modified Hartwig and Siegel scale of severity, 60.8% ADRs were mild, 18.5% were moderate and 20.8 % were severe ADRs. The severe ADRs included: Steven-Johnson syndrome, Toxic epidermal necrolysis, Erythroderma, DRESS syndrome and Acute pancreatitis. Phenytoin has been found to be the antiepileptic drug causing the most number of severe ADRs amongst the prescribed antiepileptics. According to the modified Schumock and Thornton criteria most of the severe ADRs were not preventable.Conclusions: This study analyses the ADRs associated with antiepileptics reported at the pharmacovigilance centre. 20.8% ADRS were severe, this indicates that the epileptic patients should be closely monitored for ADRs, to avoid clinically significant harmful consequences. The awareness of ADRs would help physicians to identify patients with greater risk of ADRs and therefore, might benefit from ADRs monitoring and reporting programmes

Characterization of cowpea to harvest rainwater for wheat in semiarid conditions

Aim of study: A field experiment was executed, under rainfed conditions from 2014-15 to 2017-18, to study the role of cowpea (Vigna unguiculata L.) in rainwater harvesting to enhance the wheat (Triticum aestivum L.) yield.Area of study: Rain-fed area of Pothwar region, Punjab, Pakistan.Material and methods: We designed three treatments (T1: control; T2: cowpea grown after conventional tillage and incorporated into soil to act as “green manure”; and T3: grown without any tillage practice, cut with sickle and spread as “mulch”). The effect of these treatments on soil moisture conservation was studied against conventional farmer’s practice, wherein no host crop is grown before wheat sowing.Main results: Available soil water remained highest in T2 during first three years when sufficient rainfall was received contrary to fourth year with low rainfall. The results revealed that cowpea biomass of 15.2 t/ha and 13.72 t/ha, from T2 and T3 respectively, were produced during 2015 corresponding to 213 mm rainfall. Whereas, these quantities increased to 25.69 t/ha and 24.29 t/ha during 2017 with 387 mm of rainfall. The study revealed that net income from wheat crop under T2 was Rs 13000 and Rs 9000 per hectare higher than that of control during the first two years respectively. Contrarily, net income from T2 was found negative and benefit-cost ratio reduced to 0.79 when very low rainfall was received during the last year.Research highlights: Use of cowpea as green manure gave maximum net return if sufficient rainfall is received during decomposition of cowpea and hence recommended for in-situ rainwater harvesting

A study of serious adverse drug reactions with antiepileptic drugs: a pharmacovigilance study

Background: Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally. There are currently more than 25 drugs in the market for the treatment of epilepsy, many of which have similar efficacy but differ in their tolerability profile. Besides unmatched beneficial potential of antiepileptic drugs, it is associated with many adverse reactions too. This study aims to identify the serious adverse reactions caused by prescribed antiepileptics, reported at the pharmacovigilance centre of government tertiary care centre.Methods: This is a retrospective, pharmacovigilance study of the antiepileptic drugs adverse reactions reported over a period of 1 year at a tertiary care centre.Results: A total of 120 ADRs of antiepileptic drugs were reported and collected at the pharmacovigilance centre. According to the WHO-ART system organ classification of ADRs, 78% of ADRs belonged to skin and appendages disorder. Based on the modified Hartwig and Siegel scale of severity, 60.8% ADRs were mild, 18.5% were moderate and 20.8 % were severe ADRs. The severe ADRs included: Steven-Johnson syndrome, Toxic epidermal necrolysis, Erythroderma, DRESS syndrome and Acute pancreatitis. Phenytoin has been found to be the antiepileptic drug causing the most number of severe ADRs amongst the prescribed antiepileptics. According to the modified Schumock and Thornton criteria most of the severe ADRs were not preventable.Conclusions: This study analyses the ADRs associated with antiepileptics reported at the pharmacovigilance centre. 20.8% ADRS were severe, this indicates that the epileptic patients should be closely monitored for ADRs, to avoid clinically significant harmful consequences. The awareness of ADRs would help physicians to identify patients with greater risk of ADRs and therefore, might benefit from ADRs monitoring and reporting programmes

Role of Soil Moisture in Fertilizer Use Efficiency for Rainfed Areas-A Review

The balanced dose of fertilizer used for any crop to get the desirable yield is very much important in crop production and is dependent upon different factors like soil type, soil texture, soil structure, organic matter and especially soil moisture availability is the main and crucial factor in predicting optimum use of fertilizers. The areas where proper irrigation practices are available and the moisture level differences are minimum, there the prediction of fertilizer is simple and depends upon soil type, availability of different nutrients and organic matter in the soil which helps to estimate nutrient deficiencies to be supplemented by different fertilizers with optimum dose. Commendable job has been done by scientists of University of Agriculture, Faisalabad to design a model to predict fertilizer doses for all districts of Punjab for different cropping pattern with the help of some basic soil fertility status (organic matter, available phosphorus) assuming no water shortage during crop growth period.  Rainfed/barani tract comprises 3.10 million hectare (mha) out of total 11.83 mha under cultivation in Punjab. Therefore, the areas where irrigation practices are not present and the crop production is entirely dependent upon uncertain and uneven distribution of rainfall which makes the agriculture risky and the farmers are reluctant to incur expenditure on expensive inputs especially fertilizers, so one cannot rely only on basic soil fertility status. The fertilizer doses vary according to moisture available at the specific site besides other factors and one cannot use only soil type and nutrient levels for fertilizer dose prediction to get maximum and desired yields. In order to address this issue work done by different scientists is reviewed to establish the relationship or role of soil water contents in fertilizer use efficiency in rainfed areas to design a future study to predict different fertilizer doses under different prevailing soil water contents to achieve desired yield targets

Characterization of cowpea to harvest rainwater for wheat in semiarid conditions

Aim of study: A field experiment was executed, under rainfed conditions from 2014-15 to 2017-18, to study the role of cowpea (Vigna unguiculata L.) in rainwater harvesting to enhance the wheat (Triticum aestivum L.) yield.Area of study: Rain-fed area of Pothwar region, Punjab, Pakistan.Material and methods: We designed three treatments (T1: control; T2: cowpea grown after conventional tillage and incorporated into soil to act as “green manure”; and T3: grown without any tillage practice, cut with sickle and spread as “mulch”). The effect of these treatments on soil moisture conservation was studied against conventional farmer’s practice, wherein no host crop is grown before wheat sowing.Main results: Available soil water remained highest in T2 during first three years when sufficient rainfall was received contrary to fourth year with low rainfall. The results revealed that cowpea biomass of 15.2 t/ha and 13.72 t/ha, from T2 and T3 respectively, were produced during 2015 corresponding to 213 mm rainfall. Whereas, these quantities increased to 25.69 t/ha and 24.29 t/ha during 2017 with 387 mm of rainfall. The study revealed that net income from wheat crop under T2 was Rs 13000 and Rs 9000 per hectare higher than that of control during the first two years respectively. Contrarily, net income from T2 was found negative and benefit-cost ratio reduced to 0.79 when very low rainfall was received during the last year.Research highlights: Use of cowpea as green manure gave maximum net return if sufficient rainfall is received during decomposition of cowpea and hence recommended for in-situ rainwater harvesting

Genetic gain and G × E interaction in bread wheat cultivars representing 105 years of breeding in Pakistan

It is important to understand the genetic gain achieved through selection of key yield traits for planning future breeding strategies in high yielding wheat cultivars. The aim of the present study was to characterize the genetic changes in morphological, physiological, and yield component traits under five irrigated and rain-fed environments using 24 wheat cultivars released from 1911 to 2016 in Pakistan. We evaluated these cultivars for genotype-by-environment (G×E) interaction by additive main effect and multiplicative interactions (AMMI) in five environments. There was a significant increase in grain yield (9.03 kg ha–1 year–1, 0.37%). Plant height was reduced linearly (-0.26 cm year−1, -0.33%). The traits waxiness, leaf rolling, harvest index, spike length and grains per spike significantly increased but the gain was only 0.16-2% per year. Analysis of variance (ANOVA) revealed that genotype, environment, and G×E interaction were highly significant (P 40% and >20% of the G×E interaction, respectively. Gene-specific markers identified the durable resistance gene Lr67/Yr46/Sr55/Pm46 in obsolete cultivars as early as 1910, whereas the photoperiod-insensitive allele Ppd-D1a and reduced height alleles Rht-B1b and Rht-D1b were present only in the post-1965 cultivars. Diversity analysis based on a 50 K SNP genotyping array clearly differentiated temporal patterns in 24 cultivars, which was correlated with the agronomic performance of the cultivars. This dataset provided detailed insight about the performance of historical wheat cultivars and could help in devising future wheat breeding strategies to focus on the traits contributing to grain yield and have slower rate of genetic progress