A Mini Review: Mucormycosis in Coronavirus Disease-19, Host-Iron Assimilation, and Probiotics as Novel Therapy

Mucormycosis is an acute fungal infection with 90% of cases in the form of rhino-orbito-cerebellar. It is an aggressive and life-threatening fungal infection causing 50% mortality in people with coronavirus disease 2019 (COVID-19). In COVID-infected patients due to, diabetic ketoacidosis, epithelial damage, ciliary dysfunction, dysfunctional phagocytic mechanism, and immunosuppression, there is impaired chemotaxis and defective intracellular killing leads to fungal spores to invade, germinate and penetrate in surrounding tissues. The use of broad-spectrum antibiotics disrupts the normal microbiomes and increases the probability of growth of Rhizopus spp. Commercially available probiotics such as Lactobacillus, Bifidobacterium, Enterococcus, Streptococcus, and Saccharomyces when administered in adequate quantities form siderophores which induces iron stress in fungus and inhibits spore germination.

Effect of trimethoprim-sulfamethoxazole vs. norfloxacin on fecal E. coli resistance pattern and efficacy in patients receiving prophylaxis for spontaneous bacterial peritonitis

Background: Spontaneous Bacterial Peritonitis (SBP) is an infection of ascitic fluid. It is highly mortal and recurrent condition, so prophylaxis with Norfloxacin (NOR) or Trimethoprim-sulfamethoxazole (TMP-SMX) seems to play an important role in the prevention of further episodes of SBP. Aims of the study were to assess the effect of TMP-SMX/NOR on the sensitivity pattern of fecal E. coli after long term prophylaxis in Spontaneous Bacterial Peritonitis (SBP) and to compare the efficacy of TMP-SMX and NOR in prophylaxis of SBP.Methods: An interventional, prospective, open label, single center study conducted in Maulana Azad medical college, New Delhi, India. 52 patients of SBP or with high risk of SBP were screened and finally 39 patients were recruited. Stool sensitivity testing of fecal E. coli was done and they were divided into TMP-SMX group(n=18) and NOR group(n=21) according to sensitivity. After 45±3 days (7 weeks) their stool sample was re-examined for change sensitivity pattern of E. coli. Efficacy variables like any episode of SBP, fever (FEV) resolution of ascites (ASC), bacteremia (BACT), extraperitoneal infection (EPI), liver transplantation (LT) or death (D) were noted throughout the period of 24 weeks.Results: Resistance developed in 60% vs. 48% in TMP-SMX vs. NOR group(p=0.46) after 45 days of prophylaxis. By the end of 24 weeks, Incidence of SBP (29%vs. 25%, p>0.99), episodes of FEV(P=0.60), EPI(p>0.99), ASC(p>0.99) and death (14% vs. 16%, p>0.99) were almost similar in both the groups (TMP-SMX vs. NOR) respectively.Conclusions: Both TMP-SMX and NOR showed same degree of resistance and found equi-efficacious when administered as long-term prophylactic therapy in SBP. TMP-SMX can be a suitable as well as cost effective alternative to NOR for the prophylaxis of SBP.

Assessment of knowledge, attitude, and practice of self-medication among college students.

Background: Self-medication is widely practiced both in developed and developing countries. Self-medication has certain advantages as it is convenient, economical, and medical resources are not wasted for minor illnesses. However, there are disadvantages as the disease recognized may not be correct, there is delay in meeting a health care worker, the side-effects of the medication are not known, inappropriate usage of antibiotics leading to drug resistance, taking the same drug with different trade names, it can lead to drug interactions and can also lead to drug addiction. College students prefer self-medication for minor illness or to save time and money. There is no data on the prevalence and pattern of self-medication in college students in Delhi. The objective of this study was to assess knowledge, attitude, and practice of self-medication among medical and non-medical students. Methods: A cross-sectional study was carried out in 200 students of Delhi University using a pretested, structured questionnaire about demographics, knowledge, attitude, and practices of self-medication. Statistical analysis was done using SPSS version 16.0. Results: Self-medication is commonly practiced among both medical and non‑medical college students. From a total of 200 students, 93% of the students had used self-medication of which 7% used it always. Allopathy is the most preferred system of medication. Conclusions: The reasons for self-medication were similar among medical and non-medical students, but positive attitude and knowledge toward self-medication was more among the medical students.

Cost of medicines & their affordability in private pharmacies in Delhi (India).

Background & objectives: Medicines can account for up to 90 per cent of health care spending by poor people. High costs of medicines contribute to decreased access to healthcare. This study was conducted to assess the cost of medicines and their affordability in the private pharmacies in Delhi, India. Methods: A survey was conducted to assess the costs of prescribed medicines and treatment of community acquired pneumonia (CAP), with medicines purchased from 27 private pharmacies, in Delhi. Affordability of medicines was assessed by comparing the costs of treatment (medicines) to the monthly per capita expenditure (MPCE) on food, minimum monthly and daily wages for different classes of workers. Results: A large variability in the costs of prescriptions was observed (129.37+ 217.99) The cost of treatment of CAP varied from 34.50- 244.75 with azithromycin and 72.20- 277.30 with levofloxacin. The percentage of MPCE on food spent for a prescription was 17.64 per cent for urban and 23.4 per cent for rural population. The percentage of MPCE on food spent for treatment of CAP ranged from 10.11 to 13.42 per cent with azithromycin and 13.28 to 17.61 per cent with levofloxacin. The number of days a worker on minimum daily wages would have to work to enable him to purchase his prescription medicines ranged from 1-17 days, depending on the problem. The cost of treatment of CAP required 1-3 days of work by a daily wage earner, depending on the brand of medicine prescribed. Interpretation & conclusions: The findings of our study show that the costs of medicines are highly variable and not affordable for the economically poor in India. Modifications in National Pharmaceutical Policy need to be done urgently.

Fairness Creams in the Indian Market: Issues to be Resolved.

A number of skin fairness creams are available in the Indian market and are widely advertised. The objective of the study was to assess the composition, pharmacological basis of various constituents, cost and scientific evidence for claims made for the efficacy of three commonly used fairness creams. The total number of individual constituents was 54; of these, 14 were common in all three creams, while seven were common in two creams. A total of 22 pharmacological actions were attributed to the individual constituents. Only 15-23% of the constituents may directly have an effect on skin color. The monthly cost ranged from ` 20 to 82/-. Evidence regarding efficacy and safety of fairness creams was lacking. Regulatory requirement for fairness creams in India needs to be made stringent as regards evidence for its efficacy and safety before marketing and advertising.