Rheumatoid arthritis: new developments in biologic therapy.

With the development of biologic agents our therapeutic approach to rheumatoid arthritis (RA) and inflammatory diseases in general, has dramatically changed within the last few years. Biologic technically means a substance as the product of biologic system and functionally as an agent that targets specific biologic molecule. Recently a number of endogenous antigens have been identified and these are known to activate CD4+ T cells leading to production of cytokines [interleukin (IL)-1, IL-6] and tumour necrosis factor (TNF)-alpha and immunoglobulins like rheumatoid factor and expression of osteoprotegerin ligands that stimulate osteogenesis leading to joint distruction. Rheumatologists and other practitioners are facing a remarkable wave of new therapies for RA like infliximab, adalimumab, atlizumab, etanercept, anakinra, prosorbacolumn, anti-IL-6 agents, IL-10 and inferferon-r. To date combination therapy of methotrexate plus a single biologic has been widely studied with synergistic effect. Etanercept and infliximab are two biologics available in India.

Comparative Effect of Timolol, Levobunolol and Betaxolol on IOP in Patients of Chronic Simple Glaucoma

In this prospective randomized parallel study we compared the effects of topical timolol maleate, levobunolol hydrochloride and betaxolol hydrochloride on intraocular pressure (IOP) in the patients of primary open angle glaucoma after 16 weeks of instillation as 1 drop 12 hourly in 0.5% concentration. 23 eyes of 16, 19 eyes of 12 and 20 eyes of 12 patients were included in timolol, levobunolol and betaxolol groups respectively. Timolol, levobunolol and betaxolol lowered IOP by 13.05 ± 1.53, 14.05 ±1.47 and 7.58 ± 0.90mmof Hg respectively after 6weeks and by16.12±1.67,16.28 ±1.85 and 8.535 ± 0.983 mm of Hg respectively after 16 weeks (P<0.001). Both levobunolol and timolol produced greater reduction in IOP than betaxolol (P<0.001). The results of our study indicated that betaxolol is less efficacious in lowering IOP in Indian patients and could only be preferred over timolol in glaucoma patients with associated chronic obstructed pulmonary disease (COPD) or bronchial asthma. However, Levobunolol could be a better alternative to timolol , as being a longer acting agent with IOP control for 24 hrs after single instillation and can be used as once a day instillation with better safety profile.

Antibacterial resistance: current problems and possible solutions.

Antimicrobial resistance is a natural biological phenomenon of response of microbes to the selective pressure of an antimicrobial drug. Resistance may be inherent, which explains the phenomenon of opportunistic infection or acquired. Concern about the resistance increased in the late 1990's and since then, many governmental and agency reports have been published regarding the agricultural use of antibacterials, advising less use of antibacterials, appropriate choice of antibacterials and regimens, prevention of cross-infection and development of new antibacterials. The emergence of multidrug resistant strains of Gram-negative bacteria (Pseudomonas, Klebsiella, Enterobacter, Acinetobacter, Salmonella species) and Gram-positive organisms (Staphylococcus, Enterococcus, Streptococcus species) is the more worrisome in the present therapeutic scenario. Multidrug - resistant tuberculosis is another serious public health problems. Resistance to some agents can be overcome by modifying the dosage regimens (e.g., using high-dose therapy) or inhibiting the resistance mechanism (e.g., beta-lactamase inhibitors), whereas other mechanisms of resistance can only be overcome by using an agent from a different class. It is urgently required to ban the sale of antibiotics without prescription, to use antibiotics more judiciously in hospitals by intensive teaching of the principles of the use of antibiotics and to establish better control measures for nosocomial infections. Thus, it is highly recommended that practicing physicians should become aware of the magnitude of existing problem of antibacterial resistance and help in fighting this deadly threat by rational prescribing.

Effects of Fexofenadine, Cetirizine and Diphenhydramine on Psychomotor Performance in Adult Healthy Volunteer

The present study was conducted to assess and compare the cognitive and psychomotor effects of fexofenadine, a newer second generation antihistamine with cetirizine, diphenhydramine and placebo in 10 healthy adult volunteers in a double blind, randomized cross over study. Following single dose of each drug, the volunteers were subjected to perform a series of tests of cognitive and psychomotor performance at 1, 3 and 6 hours post dose. The test battery consisted of both subjective and objective tests which were further grouped into instrumental and non-instrumental. Instrumental tests included – Simple reaction time (SRT), Multiple Choice ReactionTime Task (MCRT) and Critical Flicker Fusion frequency threshold (CFFT). The tests used in the non instrumental group were- Stanford Sleepiness Scale (SSS), Digit Cancellation Task (DCT), Digit Symbol Substitution Task (DSST) and mental arithmetic tests. Fexofenadine at doses of 120 mg was not significantly different from placebo in any of the tests used. However, as expected for a verum, all the measures were significantly disrupted by diphenhydramine 25 mg upto 6 hours post dose. Cetirizine 10 mg has produced significant subjective somnolence at 3 & 6 hours post dose but without any impairment of objective tests. These results allow the conclusion that fexofenadine at its recommended therapeutic dose of 120 mg is free from impairment effects on aspects of psychomotor function and hence can be used safely. Cetirizine is mildly sedating though it did not impair any of the objective psychometric tests.