A retrospective study to evaluate the pattern of spontaneously reported antiretroviral induced adverse drug reactions in a tertiary care hospital

Background: To evaluate the adverse effect profile of spontaneously reported cases of adverse drug reactions due to antiretroviral (ART) drugs in a tertiary care teaching hospital.Methods: A descriptive retrospective study of pattern of ART induced adverse drug reactions (ADRs) spontaneously reported to the Pharmacology department at a tertiary care hospital from January 2011 to December 2016. The details of suspected ADRs including drugs involved, treatment given for ADRs, and the outcome were also documented. These ADRs were analyzed for causality (WHO scale), severity (Hartwig et al. scale), seriousness (ICH E 2A guidelines), preventability (Schumock and Thornton scale) and type based on Edwards and Aronson classification system.Results: Of the 75 cases of ART induced ADRs, reactions were slightly more common in males (52%) and had median age and duration of ART as 36 years and 109 days respectively. Drug induced anemia was the most common presentation followed by cutaneous ADR and zidovudine being the commonest offender. Severity was moderate in 85.3% and causality was probable in 16% and possible in 84% cases. The type reaction was augmented type in 41.3% and not preventable in 76%.Conclusions: Zidovudine is the commonest drug implicated in causing anemia amongst the antiretrovirals. Spontaneous reporting method for antiretroviral pharmacovigilance is insufficient. Targeted spontaneous reporting or cohort event monitoring need to be studied for antiretroviral pharmacovigilance

Evaluation of antidepressant activity of tramadol in comparison with imipramine in Swiss albino mice

Background: The aim of the study was to evaluate the antidepressant effect of opioid analgesic tramadol using forced swim test and tail suspension test models.Methods: The antidepressant effect was assessed by recording the immobility time in Forced swim test (FST) and Tail suspension test (TST). The mice were randomly divided into five groups. Mice belonging to group I was given normal saline (0.1ml/kg) which acted as control. Group II received imipramine (15mg/kg) considered as the standard drug tramadol was given in graded dose (10, 20 and 40 mg/kg) to mice of groups III, IV, V respectively. All drugs were administered intraperitoneally for seven successive days; test was done on 7th day.Results: Tramadol and Imipramine showed antidepressant activity when compared to control. There is dose dependent increase in antidepressant activity of tramadol. The antidepressant activity of imipramine was significantly (P<0.05) more than tramadol at dose 10 and 20 mg/kg but antidepressant activity with tramadol 40mg/kg was comparable to imipramine treated mice.Conclusions: The results of this study indicated the presence of antidepressant activity of tramadol at 40mg/kg

Evaluation of knowledge, attitude and practice of pharmacovigilance among interns and nursing students in a tertiary care teaching hospital

Background: Even though the role of spontaneous reporting of adverse drug reactions (ADRs) is well established in pharmacovigilance, it is not followed in the practice and a large number of ADRs goes unreported. In our institute, almost all of the ADR reported to the department of pharmacology are through either the faculty members or the residents and very few by the nurses and interns.Methods: The current survey was thus conducted to assess the knowledge, attitude and practice (KAP) of nursing students and interns. It is expected that the results should help us to designs specific activities to improve ADR reporting. The study was a questionnaire based survey to assess the knowledge, attitude and practices (KAP) of the interns (n=74) and nursing students (n=108) regarding ADR reporting and pharmacovigilance in this tertiary care centre.Results: More interns gave correct responses to knowledge based and attitude based questions of pharmacovigilance compared to the nursing students. On the other hand, more nursing students came across ADRs in the patients compared to interns. Even though 93.24% interns responded to have got training on “how to report ADRs”, only 6.76% ever reported ADR to pharmacovigilance centre.Conclusions: Proper training on pharmacovigilance, with easy way for reporting ADRs would be a useful step in improving pharmacovigilance status in nursing students and interns

Knowledge, attitude and practice of pharmacovigilance among medical professionals at a tertiary care hospital in Mumbai, Maharashtra, India

Background: Many adverse drug reactions (ADRs), interactions and specific toxicities are known once drug is exposed to a larger population. Spontaneous reporting adverse events (AEs) are fundamental to a robust pharmacovigilance (PhV). Increasing physician awareness about the pharmacovigilance and ADR reporting can significantly contribute the safety of medicines. Objective of the study was to assess the knowledge, attitude and practices related to PhV among medical professionals at a tertiary care teaching hospital.Methods: Postgraduate students (PGs) and medical teachers at a Medical College and tertiary care hospital were evaluated for their knowledge, attitude and practice of pharmacovigilance with the help of a structured questionnaire. Suggestions for improving the effectiveness of the pharmacovigilance practices were also sought.Results: One-hundred and fifty doctors [91 (60.7%) PGs and 59 (39.3%) medical teachers] participated. Overall, 48.7% were males. 96% believed that PhV is important in medical practice but only 79.3% knew the definition of pharmacovigilance. Only 24.7% were aware of the existing nationwide pharmacovigilance program whereas the international collaborating center was known to 26% of the participants. 96% believed that it is the duty of a treating physician to report an ADR while 36.7% felt that ADR reporting should be the responsibility of a separate team. Surprisingly, 54% felt that financial aid should be provided for ADR reporting. 42.7% have not reported any ADR whilst only 16% have reported more than 10 ADRs in their career. To create an ADR database (79.3%) was the common expectation from the PhV center. 98.7% suggested continued medical education (CME) and trainings to improve the effectiveness of PhV in Indian setting.Conclusions: Regardless of a fair attitude towards PhV, the practice of ADR reporting is poor probably because of lack of sufficient knowledge about PhV. Motivating the physicians through CMEs and trainings so as to improve and strengthen the pharmacovigilance practices is the current need in India

Supernumerary heads of sternocleidomastoid muscle and its clinical significance: A cadaveric study

Background: Sternocleidomastoid muscle is main muscle of neck region which is attached proximally to mastoid process and lateral half of the superior nuchal line and distally to the sternum and clavicle. It is related to numerous important neurovascular structures. Avariation in its anatomy is clinically important especially for neck surgeries and catheterization of internal jugular vein. Aim and Objectives: To establish the incidence, number and variations of supernumerary head of ternocleidomastoid muscle in cadavers. Material and Methods: We studied the variations in the heads of the ternocleidomastoid muscle in the 84 cadavers (n=168, Right= 84; Left=84) which were used for undergraduate teaching in our college. Muscle was exposed by doing meticulous dissection. Proximal and distal attachments were carefully cleaned and number of supernumerary heads with their origin and insertion were noted. Results: Present study observed supernumerary heads of sternocleidomastoid muscle in 32.73% cadavers. In majority of cases the supernumerary heads (which may be 2, 3, 4) was found to be arising from superior surface of medial 2/3 clavicle. Conclusion: Detailed knowledge of this variation is crucial for head and neck surgeons, radiologist, anesthetists and clinicians dealing with this region

EXPERIMENTAL STUDY TO EVALUATE THE ANTINOCICEPTIVE ACTIVITY OF FLUOXETINE AND ITS INTERACTION WITH NALOXONE AND ONDENSETRON IN MICE

Objectives: Evaluate antinociceptive activity of fluoxetine and the interaction of fluoxetine with naloxone and ondansetron. Methods: 32 albino mice of either sex were divided into 4 groups of 8 mice each: group I received normal saline, group II received fluoxetine; group III received fluoxetine + naloxone; group IV received  fluoxetine + ondansetron. Fluoxetine and naloxone were given subcutaneously whereas ondansetron was given intraperitoneally. Eddy’s hot plate analgesiometer was used. Latency of licking of paw or jumping from the hot plate was recorded at intervals  after giving study drugs in each group. Results: Fluoxetine produced a significant increase in the latency of licking of paw or jumping as compared to control at all time intervals except at 120 minutes with onset of antinociceptive effect within 30 min (p&lt;0.01) and maximum effect at 60 min time interval  (p&lt;0.001). There was no significant difference between the control group and the fluoxetine + naloxone or fluoxetine + ondansetron group at any time point. Pre-treatment with naloxone and ondansetron antagonized the antinociceptive effects of fluoxetine. Conclusion: Administration of naloxone and ondansetron in fluoxetine treated mice antagonized the antinociceptive activity of fluoxetine. Therefore, antinociceptive activity of fluoxetine may be mediated through µ-opiod and 5HT3 receptors. Keywords: anti-nociceptive, Eddy’s hot plate, fluoxetine, naloxone, ondansetron

COMPARATIVE STUDY OF TADAGJAL (ARTIFICIAL LAKE WATER) AND HANSODAKA (NATURALLY PURIFIED WATER IN SHARAD RITU) FROM THE SAME TADAG WITH RESPECT TO CHEMICAL PROPERTIES

Ayurveda is an ancient science dealing with attaining health and curing diseases of ill. Good health makes our life happy. For that one has to take Wholesome of food which includes pure water also. We should always use the pure water to maintain health. Our Rishis have mentioned regarding Hansodaka in Samhitas. Hansodaka is purified water in Sharad ritu by natural resources like Sunrays, Moonrays and an additional effects of Agasti star rays at night and Kalprabhav of Sharad ritu. This Hansodaka is pure water and ideal for drinking purpose. So to check this statement of our Rishis, efforts are made here to compare such Hansodaka and simple Tadagjal in view of chemical properties, considering W.H.O. guideline in present era. Aims and Objective: To compare chemical properties of Simple Tadagjal and Hansodaka to check its suitability for drinking purpose. Materials and Methods: Total four samples were collected. Two were Simple Tadadjal and Two were Hansodaka. All Water samples were analyzed in standard laboratory for chemical properties. Reports were collected and analyzed. Results and Conclusion: Hansodaka is better than simple Tadagjal with respect to chemical properties. It may be due to combine effect of sunrays, moon rays and Agasti star rays in Sharad ritu. But Hansodaka is not suitable for drinking purpose as per W.H.O. guideline. it may be due to increased population, pollution, industrialization in present era as compared to ancient era. Hence we can say water purification by other methods is must in present era

Clinical challenges with excipients in insulin formulations and role of concentrated insulin

Most of the insulin formulations in clinical use contain phenol, meta-cresol or both as excipients. These excipients in insulin preparations provide stability and have antimicrobial properties. However, they are reported to be associated with undesirable side-effects especially localised allergic reactions. Amount of excipients injected per unit dose of insulin is a major determining factor in causation of these reactions. This review discusses the excipients in different insulin formulations available in India with potential of precipitating undesirable effects and the use of concentrated insulins to reduce these complications. To avoid the detrimental effects associated with excipients, removal of preservatives or use of insulin preparations devoid of excipients can be an option. Besides these approaches, one approach that can be considered is the use of concentrated insulin to reduce the volume of insulin dose and thereby the excipients. Concentrated insulins address the high insulin requirements of the growing population of patients with type 2 diabetes who require higher insulin doses. Concentrated insulins help in reduction of dose volume as well as amount of excipients injected per unit dose of insulin. U200 (concentrated r-DNA Human Insulin Premix 30/70-200 IU/ml) can be advantageous with better absorption from smaller quantity injected, lesser variability in absorption, lesser pain and discomfort due to smaller quantity, lesser chances of hypoglycaemia all of which can lead to better patient compliance. Thus, concentrated insulin U200 can be one of the alternatives to prevent/reduce clinical complications with excipients in insulins

Failures of crown and fixed partial dentures - A clinical survey

Failure of restorations is an important concern in dentistry. A clinical survey was conducted to assess the various failures associated with crowns and fixed partial dentures. The number of units involved and the type of materials used in fabrication of prosthesis were taken into consideration and the frequency of failures was analyzed. Out of 87 cases surveyed, 68 crowns and 19 fixed partial dentures demonstrated failure. The most common cause of failure in crown and fixed partial dentures was due to the lack of retention.Keywords: Crowns, fixed partial dentures, failure

Biocompatible implant surface treatments

Surface plays a crucial role in biological interactions. Surface treatments have been applied to metallic biomaterials in order to improve their wear properties, corrosion resistance, and biocompatibility. A systematic review was performed on studies investigating the effects of implant surface treatments on biocompatibility. We searched the literature using PubMed, electronic databases from 1990 to 2009. Key words such as implant surface topography, surface roughness, surface treatment, surface characteristics, and surface coatings were used. The search was restricted to English language articles published from 1990 to December 2009. Additionally, a manual search in the major dental implant journals was performed. When considering studies, clinical studies were preferred followed by histological human studies, animal studies, and in vitro studies. A total of 115 articles were selected after elimination: clinical studies, 24; human histomorphometric studies, 11; animal histomorphometric studies, 46; in vitro studies, 34. The following observations were made in this review: The focus has shifted from surface roughness to surface chemistry and a combination of chemical manipulations on the porous structure. More investigations are done regarding surface coatings.Bone response to almost all the surface treatments was favorable.Future trend is focused on the development of osteogenic implant surfaces. Limitation of this study is that we tried to give a broader overview related to implant surface treatments. It does not give any conclusion regarding the best biocompatible implant surface treatment investigated till date. Unfortunately, the eventually selected studies were too heterogeneous for inference of data