Drug-drug Interaction between Psychotropic Medications and Medications Used in COVID-19: Comparison of Online Databases

Objective@#COVID-19 has gravely affected patients with psychiatric conditions. Potential interactions may occur between psychotropic medications and medications used in treatment of COVID-19. This study aimed to compare the online databases in terms of the quality of drug-drug interaction related information available on them. @*Methods@#216 drug interactions which included fifty-four psychotropic medication interactions with four COVID-19 drugs across six databases were analyzed by four authors independently. The overall grading of the databases was done on Likert scale independently by the authors using the parameters of ease of understanding for consumers and professionals, level of completeness, discussion on level of evidence and the number of available drugs, congruity with other databases and the mean score was tabulated. @*Results@#Drugbank and Lexicomp had maximum discrepancy. The safety profile of Hydroxychloroquine was the best (eighteen moderate/severe psychotropic medication reactions) while Ritonavir has worst profile with thirty-nine medications. Drugbank had the highest SCOPE score (1.00) for completeness and covid19druginteractions.com had least (0.81). Overall, Liverpool© Drug Interaction Group and Lexicomp scored the highest (23/30 each) and were the best interaction checker software closely followed by Drugs.com (22/30). Medscape and WebMD were the poorest interaction checker databases. @*Conclusion@#There is significant variability in the available online databases. Liverpool © Drug Interaction Group and Lexicomp were the most reliable sources for healthcare workers whereas for patients, Drugs.com was the easiest to understand (as it segregates the needs of general consumers and professionals distinctly to explain the interaction).

comparative study to assess preoperative anxiety in obstetric patients undergoing elective or emergency cesarean section

Background: A common response to stress is anxiety which is present in patients undergoing surgery. As compared to general surgical population, a higher level of preoperative anxiety has been reported in obstetric patients. The present study was conducted to assess and compare preoperative anxiety in obstetric patients undergoing elective or emergency cesarean section

Methodology: A total of 200 obstetric patients, having physical status II according to the American Society of Anesthesiologists, undergoing elective [n=100] or emergency [Grade 2] [n=100] cesarean section were included in the study. State version of state trait anxiety inventory scale [S-STAI] and Visual analogue scale for anxiety [VAS-A] were used as study tools

Results: A high level of anxiety in patients undergoing emergency cesarean section as compared to elective patients [S- STAI [67.29 +/- 8.51 vs 48.35 +/- 10.29] and VAS -A [73-61 +/- 5.31 vs 52.43 +/- 4.16]] was observed in present study, the difference found to be statistically highly significant [p < 0.001]. Overall 110 [55%] patients had anxiety. Out of these 40 patients [40%] belonged to elective group and 70 patients [70%] were of emergency group. Anxious patients had higher education level. The difference in hemodynamic parameters was highly statistically significant between the two groups

Conclusion: Every patient requiring surgery whether elective or emergency should be assessed for the presence of anxiety in their routine preoperative anesthesia assessment and the patients found to have a high level of anxiety should be scheduled for an additional counselling session

Hemophilia A: an anesthetic challenge

Hemophilia A is a congenital bleeding disorder with low factor VIII levels in the blood. We report the anesthetic management of a hemophilic patient presenting with trauma in the left forearm. Patient received Factor VIII perioperatively with no excessive blood loss intraoperatively. We stress that adequate preoperative preparation and a planned anesthesia leads to a successful management of hemophilic patients

Recombinant activated factor VII: a savior in management of postpartum hemorrhage

Bleeding, a major cause of morbidity and mortality, is one of the most difficult challenges for obstetricians and anesthesiologists. The management of major obstetric hemorrhage is challenging resulting in surgical and medical interventions, sometimes requiring hysterectomy. Use of Recombinant activated factor VII r[FVIIa] is a recent advancement in the control of PPH. In situations of intractable PPH, where primary measures to control hemorrhage fail, administration of rFVIIa should be considered before decision to perform a hysterectomy is undertaken. We hereby present a case report of a 21 year female presenting with post caesarean PPH refractory to standard therapy, managed successfully by r[FVIIa]