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It has been two years since the global outbreak of the highly contagious and deadly corona virus disease (COVID-19) caused by SARS-CoV-2 first emerged in China. Since then, various diagnostic, prognostic and treatment strategies undertaken to address the pandemic have been dynamically evolving. Predictive and prognostic role of various biomarkers in COVID-19 has been a subject of intense exploration. We aimed to determine the association of Carcinoembryonic antigen (CEA) and various surrogate inflammatory biomarkers with the severity of COVID-19 disease. This retrospective cohort study was carried out on 98 patients admitted in Jaypee Hospital, Noida with COVID-19 disease. Information regarding demographics, laboratory parameters and clinical history was collected from Hospital Information System. Serum levels of CEA and other biomarkers such as Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), Ferritin, and Procalcitonin (PCT) were assessed. Correlation analyses were performed between the parameters and acute respiratory distress syndrome (ARDS) stages. Logistic regression and ROC curve analysis were performed to assess the various parameters for distinguishing COVID-19 patients requiring ICU admission. Mean hospital stay, NLR, CEA, IL-6, CRP, Ferritin (P< 0.0001) and PCT (P =0.01) were significantly higher in ICU patients when compared to general ward patients. NLR, median serum CEA, IL-6, and CRP levels were significantly higher in non-survivor compared to the survivors (P< 0.0001, 0.0341 and 0.0092). CEA correlated well with disease severity based upon ARDS classification and was a better marker to differentiate patient according to ARDS stages (ARDS 0 vs 2 P= 0.0006; 0 vs 3 P< 0.0001; ARDS 1 vs 2 P= 0.0183; 1 vs 3 P=0.0006). The area under the Receiver operating characteristic (ROC) curve for CEA was 0.7467 (95% CI- 0.64885- 0.84459) which revealed the potential of CEA as a biomarker to distinguish COVID-19 patients requiring ICU admission. CEA can be used to predict the severity of COVID-19 associated ARDS as well as patients requiring ICU admission. Along with routine inflammatory biomarkers (NLR, CRP, IL-6, PCT, and ferritin), CEA should be used for early identification of critical COVID-19 positive patients and for assessing prognosis.
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During COVID-19 pandemic, one of the most common arrythmia reported with this illness is sinus bradycardia. Treatment for COVID-19 and associated cardiac dysfunction is still evolving. Temporary pacemaker insertion is difficult due to pandemic and risk of spread of infection to the additional staff involved. Orciprenaline stimulates the sino-atrial and atrioventricular nodes and accelerates atrioventricular conduction. Theophylline improves sinus node function in subjects with sinus bradycardia and enhances atrioventricular nodal conduction We report a case series of 10 patients admitted in dedicated COVID-19 ICUs and developed sinus node dysfunction. All of these patients were started on etophylline and theophylline prolonged release tablet (150mg) once a day. On subsequent follow up after 72 hours, all patients reported heart rate well within normal range. COVID-19 virus directly involves the myocardium by entering the cardiac myocytes resulting in inflammation and injury. As the sinus bradycardia due to COVID-19 is usually transient and respond well this drug, short course of this drug could be added to treat this arrythmia in future.
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Background: Drug promotional literature (DPL) is used by the pharmaceutical companies for promotion of their drug. It is the commonest source for providing information about the drug to the physician. According to WHO promotional literature should be reliable, truthful, informative, balanced and up to date.Methods: Study was conducted in Department of Pharmacology, Muzaffarnagar Medical College. 200 drug promotional literatures like advertisements published in medical journal, package insert of medicinal products and brochures were collected and analysed according to WHO criteria.Results: Total 200 promotional literatures were analysed. 100 promotional literatures were from the medical journal, 50 were package inserts of medicinal products and 50 were medicinal brochures. On assessing DPL using WHO criteria, all DPL mentioned brand names and dosage form (100%). Most of them published the generic name (98.5%), therapeutic uses (78%), side- effects (75%), dosage regimen (70%), contraindication (62.5%), warnings (55%), drug interaction (54%), precaution (50%), reference to scientific literature (45%), name of manufacture and distributor (99%), address of manufacturer and distributor (50%). Out of 200 DPL only 151 DPL contain references to scientific literature, 88 DPL references were retrievable and 63 were non retrievable.Conclusions: Our study shows although pharmaceutical companies are trying to adhere to the WHO criteria it is not fulfilled. As DPL are an important source of seeking information by the medical practitioner who rely on them to impart treatment to the patient, strict steps to regulate fulfilment of the WHO criteria should be taken by the government and authorities.
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Background: Pain and pyrexia are the warning signals, primarily protective in nature, that cause discomfort and suffering and may even be unbearable and incapacitating. The modern drugs (like opioids, NSAIDs, corticosteroids) currently used for the management of pain, fever and inflammatory conditions, present with many known adverse effects. Tinospora cordifolia known as Giloe, widely used in folk medicine due to its property to cure a number of diseases. Hence the present study was undertaken to explore the analgesic activity of water-soluble extract of stem of T. cordifolia in albino rats in experimentally induced pain.Methods: Present study was done in the department of pharmacology, albino rats were used to study the analgesic activity of T. cordifolia aqueous extract at the dose of 1.25g/kg,2.5g/kg and 5g/kg p.o. Various methods like Eddy’s hot plate, tail flick test and acetic acid induced writhing were used for the anti- nociceptive study.Results: In Eddy’s hot plate and tail flick test an increase in reaction time was observed with peak effect at 90min. Results were similar to the standard drug Tramadol in acetic acid induced writhing increase in time of onset, decrease in number and duration of writhing was observed.Conclusions: Aqueous extract of T. cordifolia was effective in all the three models of pain suggesting its possible action by central and peripheral mechanisms. Activity of T. cordifolia can be attributed to various phytoconstituents viz. protoberberine alkaloids, terpenoids, glycosides and polysaccharides. It can be developed as potent analgesic agent in future.
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Background Despite several decades of use of calcium channel blockers, the side effect of edema persists as a class effect, and its mechanism is unresolved. Amlodipine has effects on hemorheology (HR), and its hemodilutory property may partly contribute to its antihypertensive action. This aspect is not well studied, and the literature is sparse in this regard. Objective This experiment was planned to determine effect of a single-dose administration of amlodipine on HR parameters in normal human volunteers. Methods and results Amlodipine (5 mg) or S (-) amlodipine (2.5 mg) was administered to 27 normal human volunteers. Whole-blood viscosity (WBV) at different shear rates, plasma viscosity (PV), red cell rigidity (RCR), red cell aggregation (RCA), hematocrit (Hct), plasma hemoglobin, along with plasma drug concentration were determined at time intervals, t = 0, 4, 8, 12, and 24 h. Statistically significant reductions were observed at tmax = 4 h in WBV at shear rates of 0.512 s–1 (p < 0.005), WBV at shear rates of 5.26 s–1 (p < 0.01), PV (p < 0.05), and Hct (p < 0.01). At t = 8 h, as drug concentration reduced, some of the changes persisted and later slowly decreased with the decreasing drug concentration till t = 24 h. Red blood cell–related parameters such as RCA and RCR remained unaltered. WBV values at all shear rates, when corrected for Hct = 0.45, did not show deviation from their original values at any time. Conclusions Amlodipine causes a reduction in Hct and blood viscosity, along with hemodilution. These effects persist as long as the drug remains in plasma. Edema resulting from chronic dosing may be explained by the aforementioned effects. It is possible that antihypertensive action of the drug may be due to a combination of vasodilatation and an improvement in the HR properties.
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Background: This study has been performed to compare the pulmonary functions of healthy adolescents studying in schools situated in highly polluted areas with those studying in schools of low polluted areas of south western Punjab.Methods: This study was conducted in various schools located at Faridkot and Bathinda city. These places had been identified by the Punjab Pollution Control Board (PPCB) as having low and high air pollution levels respectively. Study Population divided into two groups that is Group A: 300 children from schools situated in Bathinda city. Group B:' 301 children from schools situated in Faridkot city. Spiro Excel spirometer was used, and following parameters were obtained: FVC, FEV?, FEV?% (relation of FEV? to FVC), PEFR, FEF25-75%. Results: FVC was low in males and females in the high polluted group as compared in the low polluted group (p = 0.042; significant; males) (p = 0.039; significant; females). FEV? was low in males and females in high polluted group as compared in low polluted group (p = 0.003; significant; males) (p = 0.026; significant; females). In this study only, males showed a significant fall in mean percentage of FEF25-75%. PEFR was low in males in high polluted group as compared to that in low polluted group (p = 0.007; significant) while in females it was insignificant.Conclusions: It is concluded that in South Western Punjab, air pollution has detrimental effect on pulmonary functions (FVC, FEV?, FEV?%, FEF25-75% and PEFR) in healthy adolescents.
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The present investigation was undertaken to explore the ulcer healing properties of three dosage schedules of different strengths of topically administered amiloride solution in thermally produced skin ulcers on the side of the midline on the back of the rabbits. Four circular thermal burns about 4.0 cm in diameter (two on either side of the midline) were made 4.0 cm apart on the pre shaved back of each anaesthetized (with thiopentone sod., 45 mg/kg, ip) rabbit with a heated template, applied for 30 sec. Three days later under anaesthesia, the burns were excised removing epidermis, dermis and subcutaneous tissue. The animals were randomly divided into various groups. Ulcers on one side of the midline were treated with normal saline and served as control, whereas those on the other side were treated with amiloride solutions. Each ulcer was observed for its size, slough formation and any sign of irritation on alternate days until healing was complete. Healing of ulcers were significantly delay in comparison to control group with all the strength of amiloride (0.02%, 0.5% and 1%) in all the dosage schedule (o.d., b.i.d. and q.i.d.) in terms of days required for complete healing (except with b.i.d. dosage schedule of 0.5% &q.i.d. dosage schedule of 1% amiloride solution), ulcer size and area under the size time curve (except with b.i.d. &q.i.d. dosage schedule of 1% amiloride solution). Thus, it is concluded that unlike mechanical ulcers topical amiloride delays wound repair in deep burn lesions.
ABSTRACT
The present investigation was undertaken to explore the ulcer healing properties of three dosage schedules of different strengths of topically administered amiloride solution in thermally produced skin ulcers on the side of the midline on the back of the rabbits. Four circular thermal burns about 4.0 cm in diameter (two on either side of the midline) were made 4.0 cm apart on the pre shaved back of each anaesthetized (with thiopentone sod., 45 mg/kg, ip) rabbit with a heated template, applied for 30 sec. Three days later under anaesthesia, the burns were excised removing epidermis, dermis and subcutaneous tissue. The animals were randomly divided into various groups. Ulcers on one side of the midline were treated with normal saline and served as control, whereas those on the other side were treated with amiloride solutions. Each ulcer was observed for its size, slough formation and any sign of irritation on alternate days until healing was complete. Healing of ulcers were significantly delay in comparison to control group with all the strength of amiloride (0.02%, 0.5% and 1%) in all the dosage schedule (o.d., b.i.d. and q.i.d.) in terms of days required for complete healing (except with b.i.d. dosage schedule of 0.5% &q.i.d. dosage schedule of 1% amiloride solution), ulcer size and area under the size time curve (except with b.i.d. &q.i.d. dosage schedule of 1% amiloride solution). Thus, it is concluded that unlike mechanical ulcers topical amiloride delays wound repair in deep burn lesions.
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The present study was planned to investigate the effects of Anuloma-viloma and specific yogic asanas in Premenstrual syndrome (PMS). The study group comprised of 60 females suffering from PMS between the age group of 18- 40 years, having 28-34 days regular menstrual cycle, further subdivided into 3 groups having equal number (n=20) of subjects-group A (no intervention), group B (Anuloma-viloma) and group C (yogic asanas). Age-matched 30 healthy female subjects were taken as control. In all the subjects, a baseline recording of the systolic (SBP) and diastolic blood pressure (DBP) from the right arm was taken using an automated sphygmomanometer. The heart rate (HR/min), electromyogram (EMG; mV), galvanic skin response (GSR;kΩ), respiratory rate (RR/min), peripheral temperature (T;°F), were recorded simultaneously, on an automated biofeedback apparatus Relax 701. The subjects of group A and group B performed yogic exercises, regularly for 7 days prior to the expected date of menstruation for 3 consecutive menstrual cycles. The parameters were recorded again at the end of 7 days in each menstrual cycle. We observed that, in the group A and group B, HR, SBP, DBP, EMG, GSR and RR showed a very significant reduction (P<0.001) and T rose more significantly (P<0.001) after the 3rd menstrual cycle, when compared with their basal levels. On computing the percentage difference between the baseline and post values in all the three groups and than comparing this percentage difference, we found a y significant difference (P<0.05) between the groups. In the present study, the relaxation response in the females suffering from PMS showed a reduction in an abnormally high basal sympathetic activity and a heightened relaxation response in both the study groups (group B and Group C) in comparison with group A.
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Eclipta alba (L.) Hassk is small branched annual herbaceous plant with a long history of traditional medicines uses in many countries especially in tropical and subtropical regions. The herb has been known for its curative properties and has been utilized as antimytotoxic, analgesic, antibacterial, antihepatotoxic, antihaemorrhagic, antihyperglycemic, antioxidant, immunomodulatory properties and it is considered as a good rejuvenator too. A wide range of chemical compounds including coumestans, alkaloids, thiopenes, flavonoids, polyacetylenes, triterpenes and their glycosides have been isolated from this species. Extracts and metabolites from this plant have been known to possess pharmacological properties. The present study confirmed the antibacterial potential of aerial parts extracts of Eclipta alba in solvents like acetone, ethanol, methanol, aqueous and hexane against selected gram positive and gram negative bacterial species. The antibacterial studies were done by agar well diffusion methods. The MIC and MBC methods were also used. Hexane extract of showed Eclipta alba high antibacterial activity against S.aureus, B.cereus, E.coli, S.typhi, K.pneumoniae,S.pyogenes and P.aeruginosa. whereas acetone, ethanol, methanol and aqueous extracts showed intermediate activity against S.aureus, B.cereus, E.coli, S.typhi, K.pneumoniae, P.aeruginosa, P.mirabilis and S.pyogenes. The inhibitory activities of all the extracts reported were compared with standard antibiotics (Ciprofloxacin 25 μg/ml). An MIC of 90.0μg/ml shown by E.coli and S.aureus was considered to be the best (below 100μg/ml), an MIC of 125.0μg/ml shown by E.coli, K.pneumoni, P.mirabilis and S.typhi was considered to be better (100-500μg/ml) as such by the action of acetone, ethanol, methanol and hexane extracts on test bacterial spp respectively MIC between (500-1000μg/ml) was considered to be good. The aqueous extracts of Eclipta alba showed good activity against S.pyogenes, B.cereus, E.coli and P.aeruginosa. If the dilution was above 1000μg/ml the extract were considered inactive against S.aureus, K.pneumoniae, P.mirabilis and S.typhi. MBC results were similar to MIC results but in the case of MBC the confirmation was made by absence of growth in culture plates after 24 hrs of incubation at 37ºC. A potent antibacterial and hepatoprotective drug could probably be formulated from the plant extract of Eclipta alba to combat the effects of bacterial and hepatotoxic infections.
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Background: Abuse of topical corticosteroids (TC), especially over the face, is prevalent worldwide, including in India. Data about the magnitude of this problem in our country is lacking. Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face in the dermatology outpatient department (OPD) attendees in order to raise awareness about this problem and to analyze its causes. Methods: This was a prospective multicenter questionnaire-based clinical study conducted at 12 dermatology centers nationwide. Patients with relevant facial dermatoses reporting to the investigator were asked about their current use of over-the-counter topical formulations and a structured questionnaire applied in case the same was confirmed to be TC. Results: A total of 2926 patients with facial dermatoses were screened, of which 433 (14.8%) were using TC. TC was used as a fairness/general purpose cream or aftershave in 126 (29%) and in 104 (24%) for acne. Steroid combinations were used by 258 (59.6%). Potent and super-potent TC were significantly (P = 0.05) more frequently used by the rural/suburban population. The younger age groups used more potent formulations. A non-physician recommendation for TC use was obtainable in 257 (59.3%) patients. Of these, 232 (90.3%) were for potent/super-potent steroids. Among 176 physician prescriptions, 78 (44.3%) were from non-dermatologists. All non-physician prescriptions and 146 (83%) physician prescriptions for TC were inappropriately refilled. Adverse effects were seen in 392 (90.5%) TC users. Acne/exacerbation of acne was the most common adverse effect. Conclusions: TC misuse in patients with facial dermatoses is quite common, and most of this use is unwarranted. Use as a fairness cream is the most common indication in this cohort. Limitations: This was an OPD-based study and, therefore, it may or may not accurately reflect the community data.
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A multicentric quasi-experimental study was conducted in Delhi, from March 2007 to September 2007, on i) the factors which stimulate the donors to donate blood, ii) major barriers and myths associated with blood donation and iii) clinicians perception of the rational use of blood. The study design included a face-to-face survey, with a pre-tested questionnaire paper in two leading blood banks of Delhi and by relevant interviewers from the community and medical fraternity. The sample size was 240-blood donors from two different blood banks and the control group included 100 potential donors from community and 50 clinicians from various hospitals. The data generated was analyzed using excel sheet and Epi-Info software. The study revealed the factors which influence the blood donation included replacement credit and family/peer pressure. Regarding myths and barriers, among potential donors, about a quarter of them felt that it is time consuming, and 20% felt it could lead to sexual impairment or is not rewarding. A total of 10% were not aware about the blood donation while 15% said that donation time was inconvenient. Of the 50 clinicians, a quarter of them were not aware of the rational use of blood.
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Media scanning & verification cell (MSVC) was established on 24th July 2008 under IDSP at National Centre for Disease Control (NCDC), Delhi for providing supplemental information on early detection of outbreaks in India so that a timely and an appropriate action can be taken. Since then the system is working efficiently and has detected many outbreaks before the conventional system in their incipient stages and helped in their containments at early stages. Media scanning & verification cell is an “Early Warning System” (EWS) that gathers preliminary reports of public health significance on a real time basis and immediately disseminate the information to the users electronically for verification. This unique system monitors Global and National Media sources such as National and Regional print media, news on internet, websites, news channels and news shared by partners like Global Public Health Intelligence Network (GPHIN), Canada, WHO and other International and national agencies. Media scanning & verification cell is managed by trained Epidemiologists and Public Health Consultants working in Central Surveillance Unit of IDSP. The major part of work is manual with two rounds of screening by experts that fulfills issues regarding quality assurance.
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Communicable disease control relies on effective response systems and effective response systems rely on effective disease surveillance. Surveillance is first step towards prevention. In addition to conventional routine indicator based surveillance system, countries must develop additional tools in terms of supplementary surveillance system for providing information on early detection nf outbreaks in India so that a timely and an appropriate action can be taken. Presently Integrated Disease Surveillance Project (IDSP) at National Centre for Disease Control, DeIhl, India is carrying out country wide surveillance. IDSP has developed four supplementary event reporting tools to strengthen and increase the sensitivity of its routine weekly indicator based surveillance system. These event based reporting tools are Early Warning Signallif Outbreak reporting, Media Surveillance, Toll free number (1075) and Community Based Surveillance. These supplementary tools have proven to be efficient and effective in timely detection nf many public health threats.