Patients’ sensory perception and satisfaction with use of metered dose inhalers and dry powder inhalers in moderate persistent asthma

Background: Inhalers containing corticosteroid and a long acting ?2 agonist (LABA) are widely used in asthma treatment. This study assessed the patient sensory perception and satisfaction of budesonide/formoterol fixed dose combination by pressurized metered dose inhalers (pMDI) with spacer and dry powder inhalers (DPI) in patients of moderate persistent asthma.Methods: This was a 6 week prospective, randomized, open label, comparative, parallel group clinical study. All patients had a forced expiratory volume in 1 second (FEV1) of 60-80% predicted normal. The patients were assessed for sensory perception and satisfaction in group I (pMDIs with spacers) and group II (DPIs) using patient evaluation questionnaire (PEQ) and patient satisfaction and preference questionnaire (PASAPQ) at the end of 6th week.Results: In PEQ, statistical analysis of the mean attribute ratings showed that both the devices were easy to use by patients. More medication was felt reaching throat using DPIs. Patients on DPI liked the taste and felt it to be less strong than patients on pMDIs. The overall liking was statistically comparable in two groups. In PASAPQ, the patients on DPI group were very satisfied with the treatment than pMDI (p<0.05).Conclusion: Overall liking of both DPIs and pMDIs was comparable and patients on DPI were satisfied more with the treatment device. Patient sensory perception and satisfaction may be taken into account in selecting device to improve compliance to treatment.

Clomiphene citrate: the changing landscape

Ovulatory dysfunction is one of the leading causes of female infertility. Clomiphene citrate has emerged as a boon in the induction of ovulation in the human female. Clomiphene results in many adverse effects some of which are documented, and some reported spontaneously. Clomiphene citrate is a non-racemic mixture of two isomers, zuclomiphene and enclomiphene, having individual and opposite biological actions. It is accepted that cis isomer (zuclomiphene) is estrogenic and trans isomer (enclomiphene) is anti-estrogenic. Zuclomiphene does not have any ovulation-induction propertybut gets accumulated for a longer time in the human body and it has more agonistic activity than enclomiphene. Thus, Zuclomiphene may be responsible for the adverse effects by clomiphene citrate. Enclomiphene is being explored for its potential use in male as well as female infertility. Trails are underway to explore its effectiveness and safety in various disorders. This article highlights the pharmacology of Clomiphene with respect to its isomers and the potential uses of enclomiphene based on evidences available.

Microscopical evaluation of leaf of Maytenus emarginata.

Microscopical investigation was carried out on leaves of Maytenus emarginata (Willd.) Ding Hou belongs to family celastraceae, is an evergreen tree that tolerates various types of stresses of the desert, locally known as “Kankero” in Hindi, “Thorny staff tree” in English. Literature survey revealed that not much work has been done on this plant, especially on leaves. So we have taken its detailed microscopical studies to prove its appropriate identification. Microscopical study provide information that the lamina is dorsiventaral and 380µm thick. The Lamina is amphistomatic, the stomata being distributed both on the adaxial and abaxial sides. Calcium oxalate crystals of druses are fairly abundant in the mesophyll tissue. The stomata are cyclocytic type. The venation is densely reticulate. The terminations are either simple or more commonly forked into deuse clusters. Powder Microscopy show that the sclereids are fiber like in shape and size. The sclereids are 500 µm long and 30 µm thick. Long or short, cylindrical mesophyll cells are common with powder. They have dense tannin contents. The cells have thin wall and the cells are up to 200 µm long and 60 µm wide. Calciumoxlate druses are quite abundant in the power. They are spherical bodies with spiny surface. The druses are 30 µm in diameters. The above studies provide useful information in regard to its correct identity, evaluation and help to differentiate from the closely related other species of Maytenus Emarginata (Willd.)Ding Hou

An evaluation of adverse drug reactions monitoring at a pharmacovigilance unit under pharmacovigilance program of India in a tertiary care hospital of Haryana.

Background: Adverse drug reactions (ADRs) are among top 10 causes of mortality in patients. Pharmacovigilance programme of India (PvPI) is a step towards participation in the WHO programme for International Drug Safety Monitoring. The present article is an evaluation of the incidence and the patterns of ADRs from the reports collected from various clinical departments of this hospital. Methods: A total of 859 suspected ADR reports submitted to the pharmacovigilance unit at Department of Pharmacology under PvPI were evaluated for 6 months with respect to demographics, causative drug, organ system involvement, severity and seriousness of ADRs. The causality assessment was carried out by using WHO assessment method and Naranjo’s scale. Results: Males experienced more (66.33%) ADRs. The highest percentage (45.83%) of ADRs was seen in the age group of 46-60 years (35.33%), followed by 16-30 years (25.5%). The most common drug group causing ADRs was antimicrobials (43.37%), followed by anticancer and immunosuppressive agents (29.02%). The gastrointestinal system (31.43%) was most prone system, followed by generalized body reactions (22.93%) and cutaneous reactions (17.11%). 662 (77%) ADRs were non-serious, 197 (22.9%) were serious. On severity scale, 682 (79.39%) were mild, 168 (19.65%) moderate and only 9 (1.05%) ADRs were severe out of which three were fatal. As per WHO assessment method 66.94% ADRs were probable and 33.06% possible. The probability was comparable with Naranjo’s scale. Conclusion: ADRs to drugs happen commonly, and their reporting is important for the early recognition and prevention of ADRs and will also help in generating signals. ADR monitoring not only acts as an alerting mechanism for physicians, but helps the regulatory authorities in making the policy decision.

Pharmacoepidemiological study of potential drug interactions in heart and neurological outpatients.

Background: Drug-drug interaction (DDI) is a potential cause of adverse drug reactions. This study estimates the rate and factors associated with potential DDI in cardiac and neurological prescriptions from the out-patient department of various hospitals. Methods: A cross-sectional study was conducted from February to April, 2014 in various outpatients department of different hospitals in Indore. Total 60 prescriptions of cardiac and 60 prescriptions of neuro patients were collected from different hospitals. All the prescriptions were analyzes by various pharmaceutical and medical books, drug interaction checker software, and journals, etc. Results: Prescriptions having moderate drug interactions are more than that of severe and minor interactions and severity of the interaction found moderate in both type of prescriptions. Among cardiac patients 75% are male and 25% are females including all age groups, and in neuro patients, 58.33% are male, and 41.66% are females including all age groups. Types of drug interaction found in prescriptions are as follow, severe interaction (13% in cardiac, 8% in neuro), and moderate interaction (45% in cardiac, 37% in neuro), minor interaction (17% in cardiac, 25% in neuro), interaction not found (25% in cardiac, 30% in neuro patients). Conclusion: The hazards of prescribing many drugs, including side-effects, DDI and difficulties of compliance have long been recognized as particular problems when prescribing. Proper emphasis should be given to drug information center and training of clinical pharmacy across the country, which can play an important role in minimizing DDIs.

A promising strain of Streptomyces sp. with agricultural traits for growth promotion and disease management.

A bacterial strain, Streptomyces sp. CIMAP- A1 was isolated from Geranium rhizosphere and identified by morphological, physiological, biochemical and molecular characters (16S rDNA gene sequence). Phylogenetically, it was found most closely related to S. vinacendrappus, strain NRRL-2363 with 99% sequence similarity. The strain had potential antagonistic activity (in vitro) against wide range of phytopathogenic fungi like Stemphylium sp., Botrytis cinerea, Sclerotinia sclerotiorum, Colletotrichum spp., Curvularia spp., Corynespora cassicola and Thielavia basicola. The extracellular secondary metabolites produced by the strain in the culture filtrates significantly inhibited the spore germination, growth of germ tube of the germinated spores and radial growth of Alternaria alternata, Colletotrichum acutatum, Curvularia andropogonis and Fusarium moniliforme. The extraction of culture filtrate with solvents and purification by following VLC and PTLC methods always yielded a 10th fraction antifungal compound showing activity against wide range of phytopathogenic fungi. The strain was able to produce siderophores and indole-3-acetic acid. The strain was found to enhance the growth and biomass production of Geranium. It increased 11.3% fresh shoot biomass of Geranium and 21.7% essential oil yield.

Genetic risk factors for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a complex condition, influenced by environmental and/or genetic risk factors. It is important to identify these factors, and develop new therapies for the management of COPD. This review identifies these factors and highlights the role they will play in future treatment options of COPD.