Pharmacoeconomic exercise for undergraduate medical students

Pharmacoeconomics is defined as a description and analysis of the cost and consequences of drug therapy to healthcare systems and society. It is concerned with identifying healthcare therapies that represent an efficient use of scarce resources. Patients are affected by the high prices of medicines. In the era of therapeutic jungle, the prescriber can help the society by using generic names while prescribing. The doctors must be trained in the initial years of learning to develop a habit of prescribing drugs based on safety and efficacy. When the safety and efficacy are comparable, it is furthermore important to consider the cost of drug, and not get allured by the marketing gimmicks of the pharmaceutical companies. Understanding of pharmacoeconomic principles and evaluation methods will help the health care decision makers in reducing the economic burden on patients and society in India where the health care costs are mainly met out of pocket by the patients

PHARMACOTHERAPY OF HEART FAILURE

Abstract Heart failure is one of the major problems related to heart diseases in the modern era. Multiple comorbidities like coronary artery disease, hypertension, diabetes mellitus, anemia etc. have a great contribution in the development of heart failure.It is primarily two types systolic and diastolic heart failure. Insufficient or decreased pumping of the heart is Systolic heart failure whereas diastolic heart failure is because of lack of ability of the heart to relax or increased muscle inflexibility. The pathophysiology of heart failure is due to enhanced activity of sympathetic system, Renin Angiotensin system and structural changes in the wall of ventricle. The two definite targets of medical treatment in heart failure are: (1) Alleviation of obstructive (or) decreased output manifestations and replenishment of cardiac function. The drugs used are Frusemide, thiazides,ACE inhibitors/ARBs,Amrinone/Milrinone,Dopamine/ Dobutamine,Levosimendan,Digoxin, Hydralazine,Nitroprusside, Nitrate, Bisoprolol,Metoprolol, Nebivolol, Carvedilol (2) Prevention ofadvancementof heart failure and extension of patient survival - drugs used are β blockers,ACE inhibitors/ ARBs, Spironolactone andEplerenon

DAPSONE INDUCED DRESS: A CASE REPORT

Drug reaction with eosinophilia and systemic symptoms. is a very dangerous adverse drug effect causing rashes, eosinophilia, and multiple organ damage. Many drugs are implicated in causing DRESS with most common ones being antimicrobials and antiepileptics. Dapsone used in the treatment of Hansen's disease as a first-line agent is known for causing many side effects ranging from nausea, vomiting, insomnia, anaphylaxis, hypersensitivity reactions, rashes, muscle weakness, abdominal pain, and so on. Hence, we report a rare case of dapsone-induced DRESS in a tertiary care hospital in South India.Â

Effect of elevated CO2 and temperature on growth parameters of pea (Pisum sativum L.) crop

Global warming is predicted to have negative effect on plant growth due to the damaging effect of high temperature on plant development. The field experiment was conducted during 2014-15 to study effect of elevated CO2 and temperature on growth parameters of pea (Pisum sativum L.) crop in order to check the effect of climatechange on vegetable crops. Effect was studied under four conditions i.e. Open Top Chambers, T1: OTC - elevated CO2550±10 ppm; T2: OTC -elevated CO2 550±10 ppm and temperature 1°C; T3: OTC - ambient CO2 and temperature (reference) and T4: natural condition. Maximum plant height at 50 % flowering was recorded in T1 (84.29cm) at elevated CO2 which differed significantly with T2 (79.47cm) at elevated CO2 and temperature, T3 (73.60cm) at ambient CO2 and temperature and natural condition (70.73cm). Minimum days to 50 per cent flowering were recorded in plants growing under T2 (68.56 days). Maximum pollen viability was recorded in T1 (77.42%) followed by T3 (76.36%), T4 (74.65%) and T2 (69.97%). Internode length of plants grown under T1 was maximum (7.01cm) followed by T2 (6.68cm), T3 (6.00cm) and T4 (5.05cm). Elevated temperature and CO2 had significant effects on growth and development in vegetables. Overall, growth parameters of pea crop were affected positively by elevated CO2 whereas under interaction effect of elevated CO2 and temperature these positive effects of CO2 were offset by elevated temperature effect and hampered the growth of pea crop which interns can affect the yield and quality of crop under changing climate scenario

ZOLEDRONIC ACID: A MISCHIEVOUS SUSPECT FOR LIVER INJURY

ABSTRACTA 47-year-old male diagnosed as adenocarcinoma of the lung and received 8 cycles of chemotherapy comprising intravenous administration ofcisplatin 125 mg, pemetrexed 850 mg along with zoledronic acid 4 mg. After the completion of the 8 cycle, the liver enzymes were found to bemarkedly elevated, evincing zoledronic acid as the cause for hepatotoxicity. The case details were taken from the patient's medical record along withthe biochemical test reports and radiographic images. The causal association was confirmed using Naranjo's algorithm and Roussel Uclaf CausalityAssessment Method (RUCAM). After the uneventful chemotherapy, patient's liver function tests (LFT) were abnormal. There was an elevation in theaspartate aminotransferase, alanine transaminase, alkaline phosphatase, and direct bilirubin. The causal relationship was established using Naranjo'salgorithm (score-6) and RUCAM (score-5), displayed a probable†and possible†association. Hartwig's severity scale and Thornton's preventabilityscale displayed the adverse drug reaction to being moderately severe and not preventable, respectively. The zoledronic acid was stopped and neverreadministered. The LFTs assumed normal after a span of 2 months. The mechanism underlying hepatotoxicity due to zoledronic acid remains elusive.Zoledronic acid can induce acute phase response mediated by active production of interleukin-6, tumor necrosis factor alpha, and pro-inflammatorycytokines from the T-cells and macrophages. Vigilant monitoring along with timely assessment and management can prevent the occurrence ofirreversible liver damage. Henceforth, we would like to report the rare incidence of drug induced hepatic damage due to zoledronic acid. Henceforth,we would like to report the rare incidence of drug induced hepatic damage due to zoledronic acid.Keywords: Bisphosphonate, Dechallenge, Hepatotoxicity, Rechallenge.t

Numerical Study of Wind Loads on Y Plan-Shaped Tall Building Using CFD

The increase in the population is at an exponential rate, and the available land is in the form of irregular shapes. That is why irregular shapes are very commonly built. Wind load increases with respect to height, so wind load evolution is necessary for such high-rise structures. Wind forces majorly depend on the plan's cross-sectional shape. Therefore, for an irregular shape, an investigation is needed for tall buildings. This paper demonstrates a detailed study on velocity stream line, external pressure coefficients, pressure distribution on the surfaces of the building and the turbulence kinetic energy for the Y-shaped plan for tall buildings under wind excitation for wind incidence angles of 0o to 180o. k-  turbulence model is utilized to solve the problem using computational fluid dynamics techniques in ANSYS for terrain category II as per IS: 875 (Part3), 2015. Wind ward faces in all building models show positive pressure distribution, while the leeward faces are under the effect of negative pressure distribution. Wind load can be reduced on building models by modifying the corners, such as chamfering, rounding, and double recessed. The variation of pressure distribution on different faces of a "Y" plan shaped tall building for 0° and 180° is investigated using ANSYS CFX, and the pressure contours are plotted for all the faces of different "Y" shaped buildings to compute the effect of corner modification on pressure distribution. In this research, it was found that building models with rounded corners are highly efficient in resisting the wind load. Doi: 10.28991/CEJ-2022-08-02-06 Full Text: PD

Genetic variability studies in ajwain (Trachyspermum ammi L.)

In Ajwain (Trachyspermum ammi L.) extent of variability was assessed in eighty four genotypes using augmented design. The analysis of variance indicated presence of considerable amount of variability. Genetic coefficient of variation (GCV) was high for plant height, seed yield plant-1, length of internodes, and number of secondary branches, test weight, number of umbels plant-1 and number of seeds umbel-1. High heritability and genetic advance was found for number of seed umbel-1, number of secondary branches and seed yield plant-1. Hence, in ajwain ample amount of variability exists for the important component traits like number of secondary branches, harvest index, number of seed umbel-1 and number of umbellate umbel-1 thus the scope of improving the crop by selection in the available variability is high. &nbsp

Six senses while considering hydatid cyst as a differential for a swelling at nape of the neck: a case report

While cervical swellings usually are located in anterior midline like thyroglossal cyst, thyroid swellings, or in antero-lateral aspect of neck like cold abscess, branchial cyst, lymphangioma, cervical lymphadenopathy etc. Nape of the neck swelling is even less common with differentials including lipoma, sebaceous cyst, lymphangioma, etc. Hydatid cyst (HC) is often missed as a differential resulting in intraoperative surprises. This case report might change the mind of the readers to keep HC in back of their minds while approaching a case of swelling of the neck. Here we report a case of 15 years’ female who presented with swelling of nape of neck which on evaluation was inclining towards lipoma/epidermal cyst. With an intention for surgical exploration and excision, the patient was taken for operation, where we discovered it to be HC and the same was later confirmed by histopathology as well. Because of its rare presentation the primary diagnosis of HC is often missed out in spite of having sensitive cytology and imaging modalities. Hence, by reporting this case we intend to emphasize six facts a clinician, a radiologist and also a pathologist must consider while keeping primary HC at an unusual site as a differential diagnosis.

Impact of a functional polymorphism in the PAR-1 gene promoter in COPD and COPD exacerbations

Proteinase-activated receptor-1 (PAR-1) plays a key role in mediating the interplay between coagulation and inflammation in response to injury. The aim of this study was to investigate the role of the promoter single-nucleotide polymorphism (SNP) rs2227744G&gt;A in modulating PAR-1/ F2R gene expression in the context of chronic obstructive pulmonary disease (COPD) and COPD exacerbations. The function of the rs2227744G&gt;A SNP was investigated by using reporter gene assays. The frequency of the polymorphism in the UK population was assessed by genotyping 8,579 healthy individuals from the Whitehall II and English Longitudinal Study of Ageing cohorts. The rs2227744G&gt;A SNP was genotyped in a carefully phenotyped cohort of 203 COPD cases and matched controls. The results were further replicated in two different COPD cohorts. The minor allele of the rs2227744G&gt;A polymorphism was found to increase F2R expression by 2.6-fold ( P &lt; 0.001). The rs2227744G&gt;A SNP was not significantly associated with COPD, or with lung function, in all cohorts. The minor allele of the SNP was found to be associated with protection from frequent exacerbations ( P = 0.04) in the cohort of COPD patients for which exacerbation frequency was available. Considering exacerbations as a continuous variable, the presence of the minor allele was associated with a significantly lower COPD exacerbation rate (3.03 vs. 1.98 exacerbations/year, Mann-Whitney U-test P = 0.04). Taken together, these data do not support a role for the rs2227744G&gt;A F2R polymorphism in the development of COPD but suggest a protective role for this polymorphism from frequent exacerbations. Studies in separate cohorts to replicate these findings are warranted. </jats:p

Socioeconomic Analysis on Problems and Prospects of Major Pulse Productions and Consumption in Bihar, India

The main objective of this paper is to appraise the existing situation of major pulse production and consumption with adoption of technologies and its impact on crop productivity, income, and other socio-economic issues. The average productivity of improved variety of chickpea in adopted villages was estimated at 9.5 quintal/ha & for local variety it was 8.5 q/ha. For pigeon pea the productivity was 18to 19 quintal/ha. The per capita income in the adopted village was more than that of control village accounted 54% of income from the crop enterprises and from pulses its share was estimated only10 to 12percent of total farm income. Human labor accounted highest cost in pulse cultivation (farm family contributed about52 percent of total labor). Comparative cost and benefit analysis indicated that pulse crop were more remunerative in Bihar. Constraints analysis indicates that the non-availability of seeds of high-yielding varieties in the desired quantities was perhaps one of the major constraints followed by moisture stress, high pod borer incidence, and shortage of labor during harvesting and threshing and some of variety found not suitable in flood affected area etc in pulse production. The share of consumption expenditure on pulses was only 15.60 percent of total food expenditure/household. It is suggested that major future expansion of area under pulse crops may take place in rice fallows, (1.2 million ha) where there is no other crop to compete with. Steps to reduce the temporal and spatial variation in price of pulses will definitely help in sustaining as well as enhancing the farmers' interest in pulses production. The government has never treated the MSP as an effective tool for increasing pulses production; High volatility in prices for long periods, low productivity, and stagnation in production technology has acted as disincentives for pulses production