Price variation in different brands of anticancer drugs available in Indian pharmaceutical market: a cost analysis study

Background: Cancer is one of the most expensive and lethal noncommunicable diseases globally. Availability and affordability of anticancer drugs are the most important factors on which management of cancer depends. The objective of the study was to evaluate the variation of cost among different brands of anti-cancer drugs available in the Indian market.Methods: “Current Index of Medical Specialties” July-October 2018 and “Drug Update” Sept - 2018 were used to obtain cost in INR* (Indian National Rupees) of anticancer drugs manufactured by different pharmaceutical companies in India, in the same strength and dosage form. Percentage cost variations were calculated by minimum and maximum costs of anticancer drug of different brands.Results: Percentage variation in cost was analyzed for 41 different formulations of 27 anticancer drugs. Highest cost variability seen with Alkylating agent Carboplatin 150 mg injection (1100%) and lowest with Antimetabolite anticancer agent Cytarabine 500 mg injection (6.56%). Three formulations showed more than 500% cost variation, largest with Carboplatin 150 mg injection (1100%) followed by Anastrozole 1 mg tablet (870%) and Letrozole 1 mg tablet (508.42%).Conclusions: Present study finding showed significant cost variation in different brand of many anticancer drugs in India. These results indicated that greater price transparencies required. This price variation issue requires a much more in-depth analysis of the health care system

Analytical Tool for Determination of traces of Cu (II)

Heavy metals are widely existent in the contaminated environments. Copper is an essential metal for plants, microorganisms, animals and human beings to perform specific biological functions. As a toxicant at elevated levels of biologically available form, it produces a physiological response. Hence there is a need for rapid and sensitive methods for the analytical determination of copper. The aim of this article is to propose a rapid, selective and sensitive method for the determination of trace amounts copper (II). We aim to develop paptodes based on RGB analysis for copper determination and removal. A new optical analytical method, “digital RGB Analysis” is proposed instead of the conventional optical method, “spectrophotometry”. MATLAB image processing tool can transform the color information into digital RGB values that can be treated as analytical information. The Paper optode has been prepared by immobilizing resorcinol and oxalic acid 1:1 solution on chromatographic (TLC) strip and heating for 15min at 80-900C. The obtained color pattern was analyzed using image processing tool of MATLAB software to determine copper (II). All parameters affecting intensity on optode have been optimized. The proposed sensor was linear in the range 0.012-8.4µg mL-1 {12 µL of 1-700 µg mL-1). The minimum detection limit was found 15ng mL-1.The proportionality in intensity of the spot color on the optodes loaded with varying amounts of copper suggests its potential applications for environmental monitoring. The paptode can also be used for pollutant check at home. Thus the paper optode has great potential for this purpose. Key Words: MATLAB, RGB analysis, Heavy metals, optical analytical method, TLC strip

Prescribing pattern and drug utilization study in inpatients of department of Orthopaedics in a rural teaching hospital of Ujjain, Madhya Pradesh, India

Background: Drug utilization study can increase our understanding of how drugs are being used. This study was done to evaluate the current drug prescribing trend in management of indoor patient of orthopaedic department and to comment on rationality of the prescribed medicines.Methods: This is a prospective observational study conducted for 12 months, in Chandrikaben Rashmikant Gardi Hospital, a 600 bedded tertiary care rural based, teaching hospital. Total 611 patients were included in this study.Results: Total 5416 drugs were prescribed in 611 prescriptions. Average number of drugs per prescription was 8.86. Average duration of prescription was 10.7 days. Percentage of drugs prescribed by generic name was 28.8%. Percentage of encounter with an Antibiotic prescribed was 60.23% i.e. out of 611 prescriptions antibiotics were prescribed in 368. Percentage of encounter with an Injection prescribed was 63% which means out of 611 prescriptions, injectables were prescribed in 385. Percentage of drugs prescribed from National Essential Medicine List was 52.63%. Percentage of drugs prescribed from WHO model List was 32.46%. Diclofenac (14.25%) was most commonly prescribed drug. Incidence of polypharmacy was quite high in context of Analgesics. Almost 40% of prescriptions had 2 drugs. Orally prescribed Analgesics were 62.6%, Injectables 34.38% and Topical 3.02%.Conclusions: This study reveals that the pattern of prescription in terms of rationality is poor. Special attention needs to be given to the irrational prescribing in terms of polypharmacy and long duration. Continuing medical education regarding appropriate use of drugs, knowledge of adverse effects and standard prescription guidelines will play pivotal role in rational prescription of drugs

PREVALENCE OF ASYMPTOMATIC PERIPHERAL ARTERIAL DISEASE AND ITS ASSSOCIATION WITH AGE AND GENDER IN TYPE 2 DIABETES MELLITUS IN A TERTIARY CARE TEACHING HOSPITAL: A CROSS-SECTIONAL STUDY

Objective: The true prevalence of peripheral arterial disease (PAD) in individuals with diabetes has been difficult to determine because of the lack of symptoms and insensitive diagnosis. We estimated the prevalence of PAD and its association with age and gender in Type 2 diabetes mellitus (DM) who were asymptomatic for PAD. Methods: Total 150 Type 2 DM patients were screened and examined for PAD using Ankle Brachial Index and Color Doppler. Prevalence of PAD was further studied and statistically analyzed to find its association with age and gender. Results: Prevalence of PAD in our study was 16%. Out of total 150 Type 2 DM patients, 24 patients were diagnosed to have PAD by Color Doppler. The prevalence was 12.0% in the fifth and sixth decade followed by 3.3% in seventh and eighth decade and 0.7% in <40 years age group. Out of total 150 cases, there were 83 males and among them 15 (18.1%) had PAD and out of 67 females, 9 (13.4%) had PAD. After application of Chi-square test to the above observations, there was no statistically significant association of age and gender with PAD in our study population. Conclusion: In the present study, the prevalence of PAD was 16%; 10% and 6% in males and in females, respectively. There was no statistically significant correlation of PAD with age and gender

Synergistic association of STX1A and VAMP2 with cryptogenic epilepsy in North Indian population

Introduction “Common epilepsies”, merely explored for genetics are the most frequent, nonfamilial, sporadic cases in hospitals. Because of their much debated molecular pathology, there is a need to focus on other neuronal pathways including the existing ion channels. Methods For this study, a total of 214 epilepsy cases of North Indian ethnicity comprising 59.81% generalized, 40.19% focal seizures, and based on epilepsy types, 17.29% idiopathic, 37.38% cryptogenic, and 45.33% symptomatic were enrolled. Additionally, 170 unrelated healthy individuals were also enrolled. Here, we hypothesize the involvement of epilepsy pathophysiology genes, that is, synaptic vesicle cycle, SVC genes (presynapse), ion channels and their functionally related genes (postsynapse). An interactive analysis was initially performed in SVC genes using multifactor dimensionality reduction (MDR). Further, in order to understand the influence of ion channels and their functionally related genes, their interaction analysis with SVC genes was also performed. Results A significant interactive two-locus model of STX1A_rs4363087|VAMP2_rs2278637 (presynaptic genes) was observed among SVC variants in all epilepsy cases (P1000-value = 0.054; CVC = 9/10; OR = 2.86, 95%CI = 1.88–4.35). Further, subgroup analysis revealed stronger interaction for the same model in cryptogenic epilepsy patients only (P1000-value = 0.012; CVC = 10/10; OR = 4.59, 95%CI = 2.57–8.22). However, interactive analysis of presynaptic and postsynaptic genes did not show any significant association. Conclusions Significant synergistic interaction of SVC genes revealed the possible functional relatedness of presynapse with pathophysiology of cryptogenic epilepsy. Further, to establish the clinical utility of the results, replication in a large and similar phenotypic group of patients is warranted

Metabolomics and transcriptomics based multi-omics integration reveals radiation-induced altered pathway networking and underlying mechanism

Abstract Recent advancement in integrated multi-omics has significantly contributed to many areas of the biomedical field. Radiation research has also grasped uprising omics technologies in biomarker identification to aid in triage management. Herein, we have used a combinatorial multi-omics approach based on transcriptomics together with metabolomics and lipidomics of blood from murine exposed to 1 Gy (LD) and 7.5 Gy (HD) of total-body irradiation (TBI) for a comprehensive understanding of biological processes through integrated pathways and networking. Both omics displayed demarcation of HD group from controls using multivariate analysis. Dysregulated amino acids, various PC, PE and carnitine were observed along with many dysregulated genes (Nos2, Hmgcs2, Oxct2a, etc.). Joint-Pathway Analysis and STITCH interaction showed radiation exposure resulted in changes in amino acid, carbohydrate, lipid, nucleotide, and fatty acid metabolism. Elicited immune response was also observed by Gene Ontology. BioPAN has predicted Elovl5, Elovl6 and Fads2 for fatty acid pathways, only in HD group. Collectively, the combined omics approach facilitated a better understanding of processes uncovering metabolic pathways. Presumably, this is the first in radiation metabolomics that utilized an integrated omics approach following TBI in mice. Our work showed that omics integration could be a valuable tool for better comprehending the mechanism as well as molecular interactions

Genetic Variations of <i>PIP4K2A</i> Confer Vulnerability to Poor Antipsychotic Response in Severely Ill Schizophrenia Patients

<div><p>Literature suggests that disease severity and neurotransmitter signaling pathway genes can accurately identify antipsychotic response in schizophrenia patients. However, putative role of signaling molecules has not been tested in schizophrenia patients based on severity of illness, despite its biological plausibility. In the present study we investigated the possible association of polymorphisms from five candidate genes <i>RGS4</i>, <i>SLC6A3</i>, <i>PIP4K2A</i>, <i>BDNF</i>, <i>PI4KA</i> with response to antipsychotic in variably ill schizophrenia patients. Thus in present study, a total 53 SNPs on the basis of previous reports and functional grounds were examined for their association with antipsychotic response in 423 schizophrenia patients segregated into low and high severity groups. Additionally, haplotype, diplotype, multivariate logistic regression and multifactor-dimensionality reduction (MDR) analyses were performed. Furthermore, observed associations were investigated in atypical monotherapy (n = 355) and risperidone (n = 260) treated subgroups. All associations were estimated as odds ratio (OR) and 95% confidence interval (CI) and test for multiple corrections was applied. Single locus analysis showed significant association of nine variants from <i>SLC6A3</i>, <i>PIP4K2A</i> and <i>BDNF</i> genes with incomplete antipsychotic response in schizophrenia patients with high severity. We identified significant association of six marker diplotype ATTGCT/ATTGCT (rs746203-rs10828317-rs7094131-rs2296624-rs11013052-rs1409396) of <i>PIP4K2A</i> gene in incomplete responders (corrected p-value = 0.001; adjusted-OR = 3.19, 95%-CI = 1.46–6.98) with high severity. These associations were further observed in atypical monotherapy and risperidone sub-groups. MDR approach identified gene-gene interaction among <i>BDNF</i>_rs7103411-<i>BDNF</i>_rs1491851-<i>SLC6A3</i>_rs40184 in severely ill incomplete responders (OR = 7.91, 95%-CI = 4.08–15.36). While <i>RGS4</i>_rs2842026-<i>SLC6A3</i>_rs2975226 interacted synergistically in incomplete responders with low severity (OR = 4.09, 95%-CI = 2.09–8.02). Our findings provide strong evidence that diplotype ATTGCT/ATTGCT of <i>PIP4K2A</i> gene conferred approximately three-times higher incomplete responsiveness towards antipsychotics in severely ill patients. These results are consistent with the known role of phosphatidyl-inositol-signaling elements in antipsychotic action and outcome. Findings have implication for future molecular genetic studies as well as personalized medicine. However more work is warranted to elucidate underlying causal biological pathway.</p></div

Multivariate logistic regression analysis with incomplete antipsychotic response in schizophrenia patients stratified by treatment.

<p>Footnote- OR, Odds ratio; ROC, Receiver operating characteristic; SE, Standard error; CI, Confidence interval.</p>a<p>Taken as continuous variable.</p>b<p>Significant p-value.</p