A prospective study of the pattern of morbidity and medication use during antenatal and perinatal period in mothers of neonates admitted to neonatal intensive care unit of a tertiary care hospital

Background: Most drugs taken by pregnant women can cross the placenta (except high molecular weight drugs like heparin) and expose the foetus to pharmacologic and teratogenic effects. The drugs used in the late antenatal and intranatal period may have a potential perinatal and neonatal outcome.Methods: The pattern of maternal morbidity and drug use was assessed prospectively in 150 consecutive mothers of neonates admitted to NICU. The number of drugs used, therapeutic class, dose, route, frequency and purpose of use were recorded. The efficacy and safety of medications was assessed by neonatal outcome.Results: The most common maternal morbidity during pregnancy was PIH, eclampsia, hypothyroidism, GDM, PROM, oligohydromnias, anemiaorpolyhydromnias, and 4% (n=6) had more than one complication. Different therapeutic classes of drugs were used as per the prevailing clinical conditions or complications. The total number of drugs used was 26, with an average of 3.68 per subject. AMAs were the most commonly used drugs, chosen empirically and used in combination for prophylaxis or control of infections. Other classes of drugs were used for specific indications. None of the NICU admissions in the present study seem to be related to antenatal or perinatal drug exposure. The treatment outcome was very good in most of the subjects and no drug related adverse events or interactions were observed.Conclusions: Maternal morbidity and drugs administered to mother play an important role in improving the neonatal outcome

A prospective study of the pattern of non-antimicrobial drug use in neonatal intensive care management in a tertiary care hospital

Background: Neonatal intensive care management (NICM) may be required for high risk or critically ill neonates for survival or stabilization. NICM involves the use of different classes of drugs, and the pattern of use mainly determined by the prevailing clinical conditions and complications, and the desired therapeutic objectives. The objective of this study was to study the pattern of drug use in NICM, criteria for drug selection and dose individualization, to assess the efficacy and safety of medications and record drug interactions.Methods: The pattern of drug use was assessed prospectively in 150 consecutive subjects admitted to NICU. The number of drugs used, therapeutic class, dose, route, frequency and duration of administration, criteria for selection were recorded. The efficacy and safety of the medications was assessed by the treatment outcome and by observing for any adverse events or drug interactions.Results: Different therapeutic classes of drugs were used as per the prevailing clinical conditions or complications. The total number of drugs used was 23. Different classes of drugs were used for specific indications. The treatment outcome was very good in most of the subjects and no drug related adverse events or interactions were observed.Conclusions: Most of the problems and complications in high risk and critically ill neonates can be prevented or controlled by judicious use of several classes of drugs, properly chosen and individualised to the given situation, without producing serious adverse events and interactions. Drugs play an important role in improving the outcome

Correlation of lipid profile and anthropometry with aortic intima-media thickness in newborns of diabetic and non-diabetic mothers

Background: Exposure to diabetes in utero has been established as a significant factor for certain component of the clinical syndrome. Although complications of atherosclerosis occur in adult life, the process begins in early childhood. Hence, measuring aortic intima-media thickness (AIMT) in the newborn is a feasible, accurate, and sensitive marker of atherosclerotic risk. Objective: The objective of the study was to find an association of AIMT with cord blood lipid levels and anthropometric factors. Methods: Babies born to diabetic mothers (gestational diabetes mellitus/type 2 diabetes mellitus (34 weeks–42 weeks) who were taken as one group and babies born to non-diabetic mothers (34 weeks–42 weeks) who were taken as the other group were enrolled in this study. Lipid values were measured of umbilical cord blood, collected immediately after delivery. Atherogenic-indices were calculated; neonatal anthropometric measurements were taken within 24 h after delivery. Abdominal AIMT (aAIMT) was measured within 4 days of delivery using a high-resolution ultrasound B mode by a trained radiologist. Maternal age, parity, height, pre-pregnancy weight, gestational age, and other investigations were taken from maternal records. Results: In this study, birth weight (BW) was positively correlated with triglycerides (TG), cholesterol, high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and atherogenic-indices, whereas, it was negatively correlated with low-density lipoprotein (LDL) (p<0.01). A positive correlation was found between aAIMT and BW, abdominal circumference, TG, cholesterol, HDL, LDL, VLDL, and atherogenic-indices (p<0.001). Conclusions: In this study, infants born to diabetic mothers had higher anthropometry, lipid values, aAIMT compared to babies born to non-diabetic mothers without risk factors

Antimicrobial and Radical Scavenging Activity of Memecylon malabaricum

The present study was conducted to determine antimicrobial and radical scavenging potential of extract of two species of the genus Memecylon (Melastomataceae) viz., M. malabaricum (C.B. Clarke) Cogn. and M. talboltianum Brandis. The shade dried leaf materials of both Memecylon species were extracted using methanol. Antibacterial activity of leaf extracts was evaluated against five drug resistant uropathogenic bacteria by Agar well diffusion assay. Antifungal activity of leaf extracts was tested on the basis of mycelial growth inhibition of Colletotrichum capsici (isolated from anthracnose of chilli). Radical scavenging activity of extracts was determined by performing DPPH free radical scavenging activity. Total phenolic content of extracts was estimated by Folin-Ciocalteau reagent method. The extracts were subjected to preliminary phytochemical analysis to detect the presence of phytoconstituents. Among extracts, extract of M. malabaricum inhibited all test bacteria and inhibitory potential was marked against Gram positive bacteria than Gram negative bacteria. C. capsici was highly susceptible to extract of M. malabaricum when compared to extract of M. talboltianum. Overall, extract of M. malabaricum displayed marked antimicrobial activity than extract of M. talboltianum. Extract of M. malabaricum scavenged DPPH radicals more efficiently (IC50 6.26μg/ml) when compared to extract of M. talboltianum (IC50 43.80μg/ml). The content of total phenolics was also high in leaf extract of M. malabaricum (112μg GAE/mg) than that of M. talboltianum (28μg GAE/mg). Preliminary phytochemical analysis of leaf extracts revealed the presence of flavonoids, tannins, saponins and glycosides in both extracts. The antimicrobial and radical scavenging activity of leaf extracts could be ascribed to the presence of phytochemicals mainly phenolic compounds. These plants appear to be potential candidates for control of anthracnose disease of chilli and for development of agents active against drug resistant uropathogens and oxidative damage.Keywords: Memecylon; Antimicrobial; Agar well diffusion; Poisoned food technique; Antioxidant; DPP

A possible case of exfoliative dermatitis due to ibuprofen in an Eleven-month-old infant

Ibuprofen is a NSAID belonging to the class of propionic acid derivatives which is widely used for its analgesic, antipyretic and anti-inflammatory action. Well-known adverse effects of ibuprofen include gastric irritability leading to nausea and vomiting as well as allergic manifestations such as urticaria and skin rashes. Severe ADRs include renal papillary necrosis, SJS/TEN, and thrombotic events leading to myocardial infarction and stroke. Authors present a case of exfoliative dermatitis in an 11-month-old infant possibly due to ibuprofen. An 11-month-old infant was prescribed syrup ibuprofen by a local medical practitioner for unclear reasons. Three days after ibuprofen therapy, the infant developed erythematous, crusting exfoliative lesions predominantly over the face with a few lesions over the lower abdomen. Subsequently, the infant was admitted to Kempegowda Institute of Medical Sciences and Research Center Hospital, Bangalore. A diagnosis of drug-induced exfoliative dermatitis was made after ruling out other causes. Treatment was initiated with intravenous and topical dexamethasone along with saline compressions and amoxicillin + clavulanic acid for secondary bacterial infection as well as topical emollient cream applied over the affected areas. The lesions improved significantly with the above management and the infant recovered enough to be discharged from the hospital after 3 days. The reaction was assessed to be “possible” as per Naranjo and WHO-UMC causality assessment scales, “moderately severe” on modified Hartwig’s severity assessment scale and “not preventable” according to Schumock and Thornton criteria. Severe and serious reactions such as exfoliative dermatitis can be caused by commonly used drugs like ibuprofen

Inhibitory Effect of Some Plants of Western Ghats of Karnataka against Colletotrichum capsici

Anthracnose is a serious disease of chilli which results in major crop loss. Species of Colletotrichum are the causative agents of chilli anthracnose. In the present study, we investigated the inhibitory effect of a total of 50 extracts from 35 plants (belonging to 23 botanical families) of Western Ghats of Shivamogga district, Karnataka, India. The powdered plant materials were extracted using methanol. The methanol extracts were screened for antifungal activity by Poisoned food technique against Colletotrichum capsici isolated from anthracnose of chilli. All extracts were effective in inhibiting the growth of C. capsici but to a varied extent (16 to 74% inhibition). The mycelial growth of fungus was found to be reduced on poisoned plates when compared to control plate. Marked inhibitory efficacy was observed in case of leaf extract of Maesa indica (74.19%) followed by leaf extract of Pimenta dioica (70.96%). Least inhibition of the fungus was shown by leaf extract of Persea macrantha (16.13%). The extent of inhibition of the fungus by other extracts ranged between 20 to 70%. In conclusion, the plants selected in this study appear promising as natural antifungal agents. Further field studies are to be conducted to determine the possible application of these plants in the control of chilli anthracnose.Keywords: Western Ghats; Antifungal activity; Poisoned food technique; Colletotrichum capsici; Anthracnose of chill

Opportunistic screening of at risk asymptomatic adolescent children for prediabetes

Background: Type 2 diabetes mellitus (T2DM) once considered an adult disease is now being reported in children and adolescents all over the world due to a parallel increase in obesity. Prediabetes is an intermediate stage between no diabetes and diagnosis of DM. Objective: To screen at risk asymptomatic adolescent children for prediabetes state. Methods: A prospective descriptive study was conducted in the outpatient department of a tertiary care hospital in South India. All adolescent children between the age group of 10 and 18 years with evidence of overweight as per the World Health Organization age and sex specific centile charts for body mass index (BMI) were enrolled. The study period was 18-month. Anthropometric and demographic data were collected among these subjects and investigated for oral glucose tolerance test (OGTT), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) as per the designed protocol. Results: Prediabetes was diagnosed in 13% of the study population with a combination of OGTT, FBG, and HbA1c tests. Prediction of prediabetes by OGTT was 10%, HbA1c 5% and by FBS was 3%. Combination of impaired glucose tolerance test with HbA1c had high sensitivity (92%) and specificity (100%). Conclusions: Our study had 13% population with increasing risk of developing T2DM. Further longitudinal studies are required to screen at risk asymptomatic adolescent children for prediabetes

Cure from the rhizomes: the medicine behind the Indian saffron Curcumin

Indian system of medicine has always focused on cure from the nature. Plant products from the Indian household have been used as medicine to cure myriad of ailments since ancestral times. Curcumin is a polyphenol, an active ingredient found in turmeric. In Southeast Asia, turmeric has been used as a coloring, flavoring and as a therapeutic agent. The use of turmeric to treat ailments dates back to the times of Charaka and Shushrutha. It has been widely used as an antiseptic for cuts, burns, and bruises, and as an antibacterial agent. Modern medicine has begun to understand its importance in recent times. Unfortunately its poor solubility, limited absorption and enhanced metabolism limits its bioavailability for its extended therapeutic use. Integration of nanotechnology in drug design and development has led the way to development of nanocurcumin with improved pharmacological properties. A precise understanding of effective dose, safety, and mechanism of action is required for the rational use of turmeric in the treatment of human diseases. This review focuses on the molecular actions of curcumin and its possibility to be used as a therapeutic agent in conditions affecting oral mucosa

Adverse drug reactions in paediatric patients in a tertiary care hospital in India: a prospective observational single centre study

Background: Adverse drug reactions (ADRs) are a major source of concern in adult and paediatric population. Monitoring ADRs in children is vital as they differ from adults in pharmacokinetic and pharmacodynamics responses. Strict ethical guidelines in clinical trials result in extrapolation of data from studies done in adults. Further, ADRs reported in adults do not predict those in children. Incidence of ADRs in children is 2.9% emphasizing the need for systematic monitoring. Studies at institutional level can generate valuable data among paediatric population. Hence, the current study was taken up to assess the clinical pattern of ADRs, their causality, severity and preventability.Methods: This is a prospective observational single centre study. Suspected cases of ADRs were collected and assessed for the clinical pattern, causality, severity and preventability factors along with gender-wise distribution.Results: A total of 118 ADRs were reported in our study. Most of the ADRs (46.67%) occurred below 1 year of age with male preponderance (53.4%). Skin was the most common organ involved (91.5%). Majority (78.8%) of ADRs were due to anti-infectives for systemic use (J). Vaccines were the most commonly implicated agents (55.9%) followed by antibiotics (22.9%). Severe reaction like DRESS syndrome was reported due to antiepileptics (including levetiracetam) requiring hospitalisation. Majority of ADRs were probable (92.4%), moderate (73.7%) and definitely preventable (61%).Conclusions: A wide range of ADRs are possible in paediatric population. Adequate knowledge about ADRs is essential and caution has to be exercised even while prescribing drugs which are considered safe in children