Pattern of cutaneous adverse drug reactions in an adverse drug monitoring center at a tertiary care hospital in Kerala

Background: Pre-marketing clinical trials can filter only about 50% of the drug reaction. Hence, to prevent the morbidity and mortality due to severe cutaneous reactions early detection, evaluation and monitoring of adverse drug reaction (ADR) especially cutaneous ADR (CADR) are mandatory. Hence, it is imperative that we update our knowledge of the precise nature of ADR which will prevent the reactions as well as to find the offending drug. Aim and Objectives: The aim of the study was to evaluate the pattern of CADR, the suspected drugs and to perform the causality assessment using WHO casualty assessment scale. Materials and Methods: A retrospective descriptive study was done using the data reported to ADR monitoring center in the Department of Pharmacology by the health-care professionals. Suspected CADR was diagnosed by the consultants concerned. The CADRs collected were categorized according to their morphology into maculopapupar rash (MPR), fixed drug eruptions (FDE), urticaria, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The causality assessment was done using WHO Causality assessment scale. Results: The mean age was 47.20 + 22.31. The most common CADR reported was Urticaria 65.5% followed MPR 23%, FDE 8.8%, and Steven Johnsons Syndrome 2.2%. Anti-microbial drugs were the most frequent cause of the adverse reactions with Amoxicillin clavulinic acid combination being the most frequent suspected drug producing CADR (13.3%). The WHO causality assessment for majority of CADR was Possible (73.5%). Conclusion: Clinical Patterns of CADRs in this set up have some minor variations when compared to studies done across India. Amoxicillin clavulinic acid is the most common suspected drug in this study which was not frequently reported in other ADR monitoring centers.

Added Effect of Pratimarsha Nasya with Ksheerabala Taila (14 Aavartita) over Selected Yoga Techniques in Insomnia

Insomnia is a prevalent psycho physiological sleeping disorder, included in the International Classification of Sleep Disorders-2 (ICSD-2). By definition insomnia is a difficulty in initiating or maintaining sleep, or both or the perception of a poor quality sleep. Insomnia leads to various social, interpersonal and occupational impairments. Clinical studies have proven that Yoga is effective in insomnia. Present study was to find out the added effect of Pratimarsha nasya with Ksheerabala taila (14 Aavartita) over selected Yoga techniques in relieving insomnia. As per Acharya Susrutha in Chikitsa Sthana, doing Pratimarsha nasya daily during evening hours (Sayamkala) renders Sukhanidraprabhodanam. A pre-post interventional study was performed in 40 participants both male and female, satisfying the inclusion and exclusion criteria. Out of 40 participants, 20 each were randomly allocated to Group I and Group II. In Group I, Pratimarsha nasya using Ksheerabala taila (14 Aavartita) was administered 1ml in each nostril at evening time along with the practice of selected yoga techniques during morning hours. In Group II, only selected Yoga techniques were advised. The study period was for 30 days. The pre & post changes in mean score value was assessed using Pittsburgh Sleep Quality Index (PSQI) score. The data was analyzed using unpaired t test, and was statistically significant with a p value ?0.01. Thus the added effect of Pratimarsha nasya with Ksheerabala taila (14 Aavrtita) over selected Yoga techniques in insomnia is more effective than selected Yoga techniques alone.

Comparative Analytical Study of Madana Shalatu (Unripen Fruit of Randia Dumetorum Lam) and Phalapippali (Processed Fruits of Randia Dumetorum Lam) - A Study of Abhava Pratinidhi Dravya

Vamana is the Agrya karma for Kaphaja vikaras. Madanaphala - Randia dumetorum Lam is the drug of choice for Vamana karma because of its property – Anapayitwat (without untoward effect). Specific collection method, season and processing is required to get Phalapippali to possess above quality. Madana shalatu– Unripen fruits of Madanaphala is an Abhavapratinidhi dravya mentioned in Sushrutha Samhita and Ashtanga Hrudaya which does not require this processing- Samskara. So, in the present study comparative qualitative and quantitative physicochemical and phytochemical analysis of the Madana Shalatu, Pakwa Madanaphala Ripen fruit of Madanaphala and Madanaphala Pippali– Processed fruits of Madanaphala has been carried out. Aim: 1. Pharmacognostic, Physicochemical and Phytochemical analysis of Madana Shalatu, Pakwa Madanaphala, Madanaphala Pippali. 2. Comparative qualitative and quantitative phytochemical analysis of Madana Shalatu, Pakwa Madanaphala, Madanaphala Pippali. Method: 1. Pharmacognostic study – Macroscopic study and Microscopic study. 2. Preliminary physico chemical analysis. 3. Qualitative phyto chemical evaluation of aqueous and alcoholic extracts of the test drugs. 4. Quantitative analysis– UV Spectrophotometry. Result: Microscopic study, qualitative phyto chemical evaluation of all test drugs did not showed much differences. In total saponin estimation by UV Spectrophotometry of methanol and Water extract of ripen processed fruits of Randia, Ripen fruits of Randia and Unripen fruits of Randia is found to contain 73.71, 83.23, 71.35 and 72.62, 92.44, 75.25µg DE/mL of Saponin content respectively. Conclusion: Quantity of Saponin which is the main active principle in Randia Dumetorum responsible for Vamana Karma was similar in the Madana Shalatu and in Phala Pippali, whereas it was highest in Pakwa Madanaphala, thus it may be used like Phala Pippali without any laborious process of Samskara. Further Toxicity studies and clinical trials are required to prove its safety and efficacy in humans.

Chromatographic study of sitagliptin and ertugliflozin under quality-by-design paradigm

Abstract The present study entails the systematic development and validation of a stability-indicating RP-HPLC method for the analysis of sitagliptin and ertugliflozin in a fixed-dose combination. Analytical quality by design (AQbD) concepts were used to define critical method variables, employing Pareto risk assessment and a Placket-Burman screening design, preceded by a Box-Behnken design with response surface analysis to optimise critical method parameters such as % acetonitrile (X1), buffer pH (X2) and column oven temperature (X3). Multiple response optimisation (Derringer's desirability) of variables was accomplished by studying critical analytical attributes, such as resolution, retention time and theoretical plates. The title analytes were separated effectively on a PRONTOSIL C18 column at 37 °C using a mobile phase of acetonitrile:acetate buffer, pH 4.4 (36:64 percent v/v), pumped at a flow rate of 1 mL/min, and UV detection at 225 nm. Linearity was observed over a concentration range of 25-150 µg/mL and 3.75-22.5 µg/mL at retention times of 2.82 and 3.92 min for sitagliptin and ertugliflozin, respectively. The method obeyed all validation parameters of the ICH Q2(R1) guidelines. The proposed robust method allows the study of the selected drugs in pharmaceutical dosage forms as well as in drug stability studies under various stress conditions.

Importance and Utility of Trisutra in Teaching, Research and Clinical Practice

The aim of Ayurveda is to maintain the health of individuals. It is accomplished through the two objectives; curing disease in the diseased and preventing disease in the healthy. For this purpose Ayurveda, the science of life is presented in the form of Trisutra (three aphorisms). They are Hetu (etiological factors), Linga (symptomatology) and Oushadha (therapeutics). The causative factors for the derangement of health and its reversal are coming under the purview of Hetu. Generally, excess, deficient and wrong union of sense objects, action and time result in diseases and health is the outcome of their proper union. Linga represents the clinical features of health and disease. Oushadha include drugs, therapies, wholesome diet and lifestyle which are intended to cure the disease and promote health. The entire Ayurveda is coded in these three aphorisms, hence it is known as Trisutra Ayurveda. The term Triskanda (three pronged) is synonymously used with Trisutra. The present knowledge of Ayurveda was evolved by the decipherment and elaboration of Trisutra through continuous research processes. Ayurveda compendia were designed in the order of Trisutra, Hetu, Linga and then Oushadha for the effective teaching and learning. Trisutra forms the ground for research in Ayurveda. Fundamental and applied researches in Ayurveda are primarily based on these three principles. Thorough understanding of Trisutra is essential for the accurate diagnosis of diseases and planning of effective management for them

A Review on Ayurvedic Perspective of PCOS

Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. It is characterized clinically as a combination of ovulatory dysfunction, hyper androgenic state and abnormal ovarian morphology. Women with PCOS are at increased risk of presenting with menstrual irregularities, hirsutism, obesity, insulin resistance, impaired glucose tolerance, Type 2 Diabetes mellitus, dyslipidemia and cardiovascular problems. PCOS being a syndrome cannot be correlated with any particular disease in Ayurveda. Hence for the better comprehension of this disease in terms with Ayurveda, the diseases mentioned in Ayurveda classics manifesting with signs and symptoms of PCOS have been studied in detail in relation with Nidana, Dosha, Srotas involved and their management. Diseases like Vandhya, Arajaska, Nashtarthava, Arthavakshaya and Pushpagni jathaharini shows resemblance in signs and symptoms and to some extend these can be related with PCOS

Soft tissue aneurysmal bone cyst of left hemithorax: An extremely rare case

Aneurysmal bone cyst (ABC) is a benign expansile cystic lesion that can affect any bone of the skeleton, especially the femur, tibia, and humerus. Lesions with histologic features of an ABC can be originated within soft tissue in exceedingly rare cases. Extra-skeletal ABC may mimic a variety of benign and malignant lesions and can be confused with other common or rare giant cell-rich tumors of soft tissue. Clinical, radiological and histologic correlation are crucial in reaching the correct diagnosis. Here we report a case of an extra-skeletal ABC arising in left hemithorax in a 13-year-old girl and discuss the common differential diagnosis of this rare entity.

Absence of Musculocutaneous Nerve: A Rare Anatomical Variation

Neural variation of the brachium constitutes a significant anatomical and clinical entity. The absence of Musculocutaneous Nerve is occasional in humans and accordingly there may be unforeseen clinical implication regarding the atypical innervations of musculature otherwise supplied by the Musculocutaneous Nerve. The present study is an absence of Musculocutaneous nerve observed during our routine educational dissection, where the lateral cord of brachial plexus took over the area of supply of Musculocutaneous Nerve by giving both the muscular and sensory branches. Knowledge of these variations is important in surgeries and during the administration of regional anaesthesia near shoulder joint and upper arm.

Analysis of H3K4me3-ChIP-Seq and RNA-Seq data to understand the putative role of miRNAs and their target genes in breast cancer cell lines

Breast cancer is one of the leading causes of cancer in women all over the world and accounts for ~25% of newly observed cancers in women. Epigenetic modifications influence differential expression of genes through non-coding RNA and play a crucial role in cancer regulation. In the present study, epigenetic regulation of gene expression by in-silico analysis of histone modifications using chromatin immunoprecipitation sequencing (ChIP-Seq) has been carried out. Histone modification data of H3K4me3 from one normal-like and four breast cancer cell lines were used to predict miRNA expression at the promoter level. Predicted miRNA promoters (based on ChIP-Seq) were used as a probe to identify gene targets. Five triple-negative breast cancer (TNBC)-specific miRNAs (miR153-1, miR4767, miR4487, miR6720, and miR-LET7I) were identified and corresponding 13 gene targets were predicted. Eight miRNA promoter peaks were predicted to be differentially expressed in at least three breast cancer cell lines (miR4512, miR6791, miR330, miR3180-3, miR6080, miR5787, miR6733, and miR3613). A total of 44 gene targets were identified based on the 3′-untranslated regions of downregulated mRNA genes that contain putative binding targets to these eight miRNAs. These include 17 and 15 genes in luminal-A type and TNBC respectively, that have been reported to be associated with breast cancer regulation. Of the remaining 12 genes, seven (A4GALT, C2ORF74, HRCT1, ZC4H2, ZNF512, ZNF655, and ZNF608) show similar relative expression profiles in large patient samples and other breast cancer cell lines thereby giving insight into predicted role of H3K4me3 mediated gene regulation via the miRNA-mRNA axis.

Analysis of H3K4me3-ChIP-Seq and RNA-Seq data to understand the putative role of miRNAs and their target genes in breast cancer cell lines

Breast cancer is one of the leading causes of cancer in women all over the world and accounts for ~25% of newly observed cancers in women. Epigenetic modifications influence differential expression of genes through non-coding RNA and play a crucial role in cancer regulation. In the present study, epigenetic regulation of gene expression by in-silico analysis of histone modifications using chromatin immunoprecipitation sequencing (ChIP-Seq) has been carried out. Histone modification data of H3K4me3 from one normal-like and four breast cancer cell lines were used to predict miRNA expression at the promoter level. Predicted miRNA promoters (based on ChIP-Seq) were used as a probe to identify gene targets. Five triple-negative breast cancer (TNBC)-specific miRNAs (miR153-1, miR4767, miR4487, miR6720, and miR-LET7I) were identified and corresponding 13 gene targets were predicted. Eight miRNA promoter peaks were predicted to be differentially expressed in at least three breast cancer cell lines (miR4512, miR6791, miR330, miR3180-3, miR6080, miR5787, miR6733, and miR3613). A total of 44 gene targets were identified based on the 3′-untranslated regions of downregulated mRNA genes that contain putative binding targets to these eight miRNAs. These include 17 and 15 genes in luminal-A type and TNBC respectively, that have been reported to be associated with breast cancer regulation. Of the remaining 12 genes, seven (A4GALT, C2ORF74, HRCT1, ZC4H2, ZNF512, ZNF655, and ZNF608) show similar relative expression profiles in large patient samples and other breast cancer cell lines thereby giving insight into predicted role of H3K4me3 mediated gene regulation via the miRNA-mRNA axis.

Awareness, Knowledge, and Attitude of Saudi Students towards Basic Life Support: A Cross-Sectional Study

ABSTRACT Objective: To evaluate the knowledge and attitude in relation to basic life support (BLS) and cardiopulmonary resuscitation (CPR) skills among the dental undergraduates and interns in Sakaka, Saudi Arabia. Material and Methods: This cross-sectional study was undertaken between October 2019 and December 2019 in Sakaka, Saudi Arabia. One hundred and eighty randomly selected dental students aged over 18 years participated in the study. Their knowledge and attitude towards BLS were gathered through a questionnaire. Results: A total of 158 (out of 180) UG students and interns participated in this study, making the responses of 87.8%. The mean age of the participants was 24.6 years. The samples comprised 86 (54.4%) males and 72 (45.6%) females. The assessments showed that overall the participants had average knowledge towards BLS and CPR, with males responding significantly better than the females (p˂0.05). Furthermore, as students climb the academic ladder, their knowledge regarding BLS and CPR tends to rise. Also, their attitude was positive, and they were willing to receive CPR training. Conclusion: Attitude toward acquiring knowledge about CPR was very positive. However, their knowledge about the topic was average. Students should understand the importance of such skills and efficiently involve in these life-saving procedures.

Is mean platelet volume the earliest diagnostic marker of neonatal sepsis: a prospective case control study

Background: Neonatal sepsis is the third leading cause of neonatal mortality after prematurity and intrapartum related complications worldwide. The literature regarding the use of Mean platelet volume as a diagnostic tool in neonatal sepsis is scanty.Methods: Prospective case control study in a district hospital. Neonates > 30 weeks gestation admitted to NICU during the study period were included. Neonates who did not have any risk factors for sepsis and did not have a positive blood culture or elevated CRP were categorized as group 1. Neonates who were admitted with risk factors of sepsis but did not have a positive CRP or blood culture positivity were categorized as group 2. Neonates who were admitted as probable sepsis and subsequently developed blood culture or CRP positivity were categorized as group 3.Septic workup was done for all the subjects at admission and at 72 hours after admission. Newborn with congenital anomalies and who were already on antibiotics prior to admission were excluded from the study. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 20.0.Results: Total 240 Neonates were included in the study. Elevation of MPV in neonates with sepsis was seen as early as the first sample whereas CRP elevation was seen only on Day 3. Cut off value for Mean Platelet Volume (MPV) was found to be 10.15fl with sensitivity of 84% and specificity of 74%.Conclusions: MPV can be used as a earliest diagnostic marker for prediction of neonatal sepsis and mortality. It can facilitate early initiation of treatment without any additional exposure.

Clinico-pathological analysis of lymphoproliferative disorders: a 3 year study

Background: The incidence of lymphoproliferative disorders has increased in many parts of the world. Newer subtypes have been identified by the new WHO classification. Accurate subtyping of lymphomas is crucial for prompt treatment. Objective of the study was to assess the clinicopathological pattern of lymphoproliferative diseases diagnosed in Rajagiri hospital over a period of 3 years.Methods: A retrospective study on all patients who were diagnosed with lymphoma in Rajagiri hospital during January 2016 to December 2018 was conducted and the data were reviewed and analyzed.Results: A total of 151 patients were included in the study. Majority of the subjects (63%) were males. The predominant age group affected was 61-80 years. Mean age group was 58.46 years (SD=19.05 years). Most common presenting symptom was painless lymphadenopathy. B symptoms were seen in 18% of subjects and was found to be more commonly associated with B cell Non-Hodgkin lymphoma. Most common lymph node involved was cervical lymph node, while the most common extra nodal site was bone marrow. Most common lymphoproliferative disorder was Diffuse large B cell Lymphoma. Lymph node involvement was found in 74% of patients, while hepatomegaly and splenomegaly were seen in 11% and 18.5% of patients. 20% of patients had secondary bone marrow involvement. 8 patients developed recurrent lesions involving other organs.Conclusions: Clinicopathologic patterns of lymphoproliferative disorders vary across various regions. A proper understanding of demographical distribution of lymphomas is very essential, as it can provide valuable clues for accurate diagnosis and treatment.

Satisfaction and maternal postnatal adjustments following different modes of delivery

Background: Childbirth has a profound influence in a women’s life. One factor that has been more consistently identified as influencing the women’s physical and psychological symptoms following childbirth is the mode of birth.  This study aims at figuring out on women’s satisfaction with their mode of delivery and what difficulties they faced in the immediate postnatal period accordingly.Methods: All women who delivered between the period 1st July 2019 to 1st August 2019 were interviewed with a pretested semi structured questionnaire on postnatal day two. Patient was asked how much they were satisfied with their mode of delivery, immediate postnatal adjustments like ambulation, holding the baby first time, initiation of breastfeeding and pain score following different modes of delivery. The data was analysed to find out which mode of delivery made women more comfortable in the immediate postnatal period.Results: A total 97.1% women were satisfied with the support they got from health care professionals during labour. But when compared, spontaneous vaginal delivery group were satisfied with their mode of delivery (P-value-0.0005 highly significant) than the rest. Women who had vaginal delivery were ahead of caesarean group in terms of ambulation, holding the baby, initiation of breastfeeding and were well adjusted in their postnatal period.Conclusions: Authors conclude that women in our study were more satisfied with spontaneous vaginal delivery than caesarean section which was reflected in their immediate postnatal adjustments. As obstetricians’ authors need to understand the empowering effects of the psychological experience of vaginal delivery. The benefits of this process can be maximized through good communication skills and emotional support for women, enhancing their confidence to deliver normally so that caesarean section is done only when really indicated.

Clinico-Etiological Profile and Outcome of Neonatal Respiratory Distress in Tertiary Care Hospital, Guntur

Introduction: Respiratory distress (RD) is a common causeof admission in the neonatal unit. Early recognition of RDand initiation of appropriate treatment is important to ensureoptimal outcomes. RD is one of the most common causes ofmorbidity in newborn. Aim of the present research was tostudy clinical profile of neonatal respiratory distress (RD),to find out most common etiology of respiratory distress innewborn and to assess the immediate clinical outcome of RDin our neonatal intensive care unit (NICU).Material and Methods: A prospective study was conductedat Tertiary Care Hospital, Guntur from May 2019 to October2019 and study includes 200 cases. Term, pre-term and postterm babies both in-born and out-born cases were included inthe study.Results: The study showed among the 720 newborns admittedin NICU, 200 (28 %) cases were admitted with Respiratorydistress. Of them, 116 babies (58%) were delivered vaginallyand 84 (42%) by lower segment caesarean section. There were122 (61%) pre-term babies, 68 (34%) term and 10 (5%) postterm neonates who were admitted with respiratory distress. Themajority of cases were clinically presented with tachypnea,flaring of alae nasi, and chest indrawing. The respiratorydistress resolved on the 4th day in majority of cases.Conclusion: Respiratory Distress is one of the commonestcause of NICU admissions. Transient tachypnea of thenewborn is the most common cause of respiratory distress interm babies whereas Hyaline membrane disease is common inpreterm babies. The survival rate was 90% among RD casesadmitted to NICU.

Prenatal diagnosis of harlequin ichthyosis: a case report

Quality Of Life Among Stroke Patients Admitted In A Tertiary Care Hospital

Stroke is defined by its aupt onset of a neurologic deficit that is attributable to a focal vascular lesion1. Hypertension, tobacco use, alcohol intake, unhealthy diet, and physical inactivity are common risk factors for stroke2. Stroke patients may be left with disability which affects their quality of life. This study aims to profile the morbidity of stroke patients admitted in a tertiary hospital, the prevailing risk factors and their quality of life. METHODOLOGY: A hospital based cross sectional study was conducted among 40 stroke using Stroke Specific Quality Of Life Scale (SS–QOL).RESULT: Of the 40 patients, 20% are females and 80% are males. Family role is severely affected among male patients (mean 1.2) and social roles are the most affected among females (mean 1.3). In motor functions, Upper extremity functions is severely affected (mean 1.2).Under higher functions, language is severely affected (mean score 3.5). CONCLUSION: Males are more affected. Hypertension, personality, smoking and alcohol are the common risk factors. The quality of life is severely affected.