ABSTRACT
Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory autoimmune disease that affects small joints. RA has a population prevalence of 0.5% to 1% in the U.S. The annual cost of care for chronic treatment of RA in the United States is estimated at $12,509. Pharmaceutical companies have developed drugs to treat RA using Janus kinase (JAK) inhibitors. These drugs can have potential adverse effects. Forecasting a better output to JAK inhibitors (JAKI’s). Therapy duration of JAKI’s and Problems regarding to strategies of dose reduction or if the discontinuation of therapy takes place in case of low disease activity. The accurate pharmacological profile and interactions of other drugs with JAKI’s have to establish. Proper safety, efficacy profile of JAKI’s and when administered in combination with DMARD’s. The safety, efficacy data of JAKI’s when compared to non-anti-TNF biologics. Obtaining of experience on JAKI’s that were already existed in the market and further experimental findings on newer compounds and which may clarify many of the aspects which are to be solved in nearer future as these JAKI will have greater application in treatment of RA. Regardless of significant developments in latest years in the pharmacotherapy of RA in the use of JAK inhibitors, yet the adverse effects of JAK inhibitors are unanswered. Therefore, one of the main concerns associated with JAK inhibitor is the potential adverse effects. The challenges can be addressed by clinical pharmacist mediated interventions related to dosing of JAK inhibitors and proper management of adverse drug reactions (ADRs).
ABSTRACT
Non-steroidal anti-inflammatory drugs (NSAIDS) are used in a wide range but may cause harm to the gastrointestinal mucosa, which leads to various complications. This study shows the impact of long term NSAID use on small and large intestine and presents 2 cases of patients with NSAID induced perforations. The first case involves a 62-year-old male patient with RA on long term Ibuprofen use, presented with abdominal pain, vomiting, and lower limbs pain. Laparotomy revealed a 5 mm perforation in the proximal jejunum. The second case, a male patient of 65 years of age using diclofenac without a prescription, which lead to a 4×4 cm sigmoid colon perforation. The comparison of both the cases presents a difference in examination and laboratory findings. Long-term NSAID use has been associated with various GI complications, including perforations. The case presents the importance of considering NSAID related complications, mainly in older patients and the persons with ulcers. Combining NSAIDS with other drugs, like misoprostol may minimize the risk of the GI complications. NSAIDs are also linked with cardiovascular events, and heart related issues. This study shows the need of careful NSAID prescription, with their association with preventable adverse effects. 30% of hospitalizations for adverse drug reactions are only by the NSAIDs. PPIs and H2 receptor antagonist are commonly used to protect the gastrointestinal mucosa which minimizes the occurrence of ulcers. Healthcare professionals should be careful particularly in case of high risk patients to minimize the NSAID related complications.
ABSTRACT
Background: The pandemic of COVID-19 infection has almost paralyzed the world since the first infection was reported in December 2019. We have seen 3 waves of infection in the country, out of which the second wave caused by the delta variant was the most severe. Along with the preventive measures of masking, maintaining social distance, and handwashing, the vaccines seemed to be the most logical next step. Many vaccines received emergency use approvals with hardly any efficacy and adverse effects data available with the process inducing a significant amount of anxiety among the public. This survey was aimed at understanding the attitude and perception of our hospital employees towards COVID-19 vaccination. Methods: This is a cross-sectional study conducted among health care workers (HCW) at CMC, Vellore between March 2021 to July 2021. The HCWs who are willing to participate in this study were recruited and collected the quantitative data on their attitude and perception towards COVID vaccine. In-depth interviews were conducted among those who did not take vaccine to understand the reasons for not taking vaccine. The data were analyzed using statistical package for the social sciences (SPSS). Results: The survey results were analyzed on 435 HCWs. 58.4 percent of the HCWs trust the institutional protocols as the trusted source of information about vaccine. Most of the HCWs agreed that vaccines are the only protective way, and they are safe and effective. Conclusions: Sensitization and awareness programs with transparency of vaccine development processes, safety and efficacy will help remove barriers.