Use of telerehabilitation platforms for delivering patient education among patients with asthma: a scoping review.

OBJECTIVE: Use of tele-technology for monitoring symptoms, functional parameters and quality of life of people with asthma is essential. Delivering this information among patients is mandated for a better outcome are made possible via patient education (PE). This review aims to summarise the types of telerehabilitation modalities dosage, outcome measures used to assess the effectiveness of PE among people with asthma. METHODS: We adopted a scoping review methodology. Thematic analysis was used to synthesize the data. The Preferred Reporting System for Meta-Analysis for Scoping Reviews was followed during the review process (PRISMA-ScR). RESULTS: PubMed, Embase, and Scopus were searched with thirty-four studies meeting inclusion criteria. Results were presented in three themes: telerehabilitation platforms used to deliver PE among patients with asthma; content, duration and frequency of the PE administered; patient-reported outcome measures used to evaluate the effectiveness of PE. CONCLUSION: This scoping study detailed the types of telerehabilitation modalities, dosage, and outcome measures used to assess the effectiveness of PE in people with asthma. This review will be especially beneficial to those considering where additional research or implementation of telerehabilitation for asthma patients is required. The studies emphasized the involvement of several healthcare experts, emphasizing the significance of a multidisciplinary approach to efficient PE delivery and possible improvements in asthma management through telerehabilitation. Although a range of telerehabilitation platforms were generally accepted, hybrid models that integrate online and in-person sessions could further enhance patient satisfaction and quality of life. Comprehensive economic analyses are also required, and solving technology issues is essential to maximizing the efficacy of these initiatives.

Effectiveness of physiotherapy in children with functional constipation.

PURPOSE: The objective was to compare the immediate effects of pharmacological versus physiotherapy intervention versus a combination of physiotherapy and pharmacological treatment, as well as the quality of life and the recurrence of symptoms in children with functional constipation after 3 months. METHODS: A total of 69 children with functional constipation between the ages of 5 and 14 years of either gender were assessed and randomly assigned to one of three groups: Group A, B, and C. Visual Analogue Scale, Bristol Stool Form Scale, frequency of defecation, PedsQL GI symptom scale, and PedsQL Generic Core Scale were used as outcome measures. Pharmacology was used to treat Group A, physiotherapy was used to treat Group B, and a combination of both was used to treat Group C. RESULTS: The study revealed statistically significant results on Visual Analogue Scale, Bristol Stool Form Scale, and frequency of defecation in all groups. However, no significant changes were observed on the PedsQL GI symptom scale and the Generic Core scale in Group A, whereas significant changes were observed in Groups B and C. CONCLUSION: In this study, we found that there were significant differences in the short- and long-term effects across all groups. More changes occurred in Group C than in Groups A and B.

Role of physical therapy intervention in acute disseminated encephalomyelitis.

We reported a case of a school-going child, diagnosed with acute disseminated encephalomyelitis (ADEM) who presented with symptoms such as high fever, acute hemiplegia and ataxia and was referred for physiotherapeutic intervention. This case report aims to document the assessment and management of ADEM from the intensive care unit to the home setting by physical therapy. Also, the child developed ventilator-associated pneumonia and a right lower motor neuron facial injury for which the child was referred to paediatric physical therapy. Since then, continuing for 8 months has helped the child to be independent in all aspects of mobility with no complaints. The child showed improvement in WeeFIM scores and Sunnybrook facial grading after 99 sessions of intensive physical therapy for approximately 83 hours along with the home programme. It has been proven an efficient treatment method along with other medical lines of treatment for neurological impairment associated with ADEM.

Can an inexpensive light-emitting diode loupe magnification device be as good as an expensive dermatoscope?

BACKGROUND: Dermoscopy is an invaluable technique used in both primary and secondary care to provide clinical information for diagnosis of skin disorders. Access to dermatoscopes is limited because of their high cost that limits clinicians at early levels of training, as well as those in low-resource settings, from developing the essential skills of dermoscopy. Previous solutions that have been proposed to address this issue have failed to demonstrate sufficient evidence for their use as an alternative compared with the gold standard of a dermatoscope, making it difficult to justify adoption of such solutions. AIM: To assess the noninferiority of an inexpensive light-emitting diode (LED) loupe magnification device compared with a nonpolarized dermatoscope. METHOD: This study looked at 100 paired photographs of lesions taken with both devices and asked 26 clinicians to categorize the lesions. RESULTS: Considering the consistency of the responses, this study confirmed noninferiority of the inexpensive LED loupe magnification device. Our results showed that the LED loupe magnification device is noninferior within a 25% margin and performs 82% as well as a nonpolarized dermatoscope. CONCLUSION: Our findings encourage the implementation of use of the cheaper LED loupe magnification device both in the early stages of medical training and in settings where expensive dermatoscopes are not available.

Evaluation of a computer game-assisted rehabilitation program for manual dexterity of children with cerebral palsy: Feasibility randomized control trial.

BACKGROUND: There is a need for innovation to improve the engagement and compliance of rehabilitation programs for children with upper extremity (UE) motor impairments due to cerebral palsy (CP); a computer games-based rehabilitation platform (GRP) was developed to address this need. The GRP provides engaging task-specific exercises targeting manual dexterity (object handling and manipulation). OBJECTIVE: To evaluate the therapeutic value and treatment effect size of an exercise program using the GRP in children with CP. METHODS: A total of 63 children with CP, aged 4 to 10 years, were recruited. The Peabody Developmental Motor Scale-2 (PDMS-2) Grasp and Visual-Motor Integration (VMI) subscores and Computer game-based Upper Extremity (CUE) assessment of manual dexterity were used to assess participants before and after a 16-week intervention program, delivered three times per week. The experimental group (XG) received a computer games-based exercise program targeting object manipulation tasks. The active control arm (CG) consisted of task-specific training similar to the tasks used in constrained induced movement therapy. RESULTS: There were only a few dropouts during the 16-week program, and compliance was high. Both groups showed significant improvements with medium to large effect sizes. Improvements in the PDMS-2 Grasp and VMI subscores observed in the XG were significantly greater than that in the CG. There were significant improvements (p < .01) in PDMS-2 grasp and VMI subscores for XG with moderate to large effect sizes (0.5-0.8). For CG, the Grasp and VMI subscores did improve but these changes were not statistically significant. There was a significant improvement observed in the majority of CUE object manipulation test scores for XG (p < .01) with moderate to large effect sizes (0.50-1.2) Although CG did show improvements in all CUE object manipulation test scores, the changes did not reach statistical significance (p < .01). CONCLUSION: This study demonstrates the utility of the GRP to practice a broad range of object manipulation tasks in children with CP. The present findings are positive and support further research and development. The long-term effects of the GRP program in children with CP will need to be confirmed in a future randomized controlled trial. In addition to measures of structure and function, future trials should also include outcome measures such as health-related quality of life and level of participation to validate the findings.

Effectiveness of structured physiotherapy in constipation in children with neurodevelopmental disorders-a randomized trial.

INTRODUCTION: Constipation is one of the major issues faced by children with neuro-developmental disorder (NDD). The aims of the study were to: 1) examine the effectiveness of a structured physiotherapy program on constipation in children with NDD; and 2) compare if conventional physiotherapy along with structured physiotherapy intervention has any combined effect on constipation in children with NDD. METHOD: Thirty-five children with neurodevelopmental disorder were assessed and randomly allotted into two groups. Twenty-two completed the intervention for 2 weeks and were statistically analyzed at baseline and post 4 weeks at a single tertiary center. The outcome measures used were Pediatric quality of life inventory (PedsQL), Peds QL Gastrointestinal symptoms scale, Bristol stool form scale, and defecation frequency. Group A received the conventional treatment, whereas group B received structured physiotherapy along with the conventional treatment. RESULTS: Group A had no significant outcomes, whereas in group B there were statistically significant differences for all outcome measures. Comparatively, a statistically significant change was noted for PedsQL GI symptoms scale (p = .045) and its constipation sub-scale (p = .002) in group B along with change in the Bristol stool form. CONCLUSION: Combined effect of structured along with conventional physiotherapy was better in terms of form of stool, constipation, and its associated quality of life factors as compared to conventional physiotherapy alone.

Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial.

The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children's experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant's experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.

Colonoscopic findings in Patients of Portal Hypertension Due to Different Etiologies and their Correlation.

INTRODUCTION: Recently, it is established that portal hypertension also produces vascular changes throughout the colon similar to lesion on Upper GI endoscopy. So we planned this study to see the spectrum and frequency of colonic lesions in patients with portal hypertension due to different etiologies, to assess whether the presence of portal hypertension related colonic lesions correlates with severity of liver disease as indicated by CTP and MELD scores and to study the relationship between upper GI lesions of portal hypertension and colonic lesions. MATERIAL AND METHODS: This study was done over a period of one year. In this study, 100 patients of portal hypertension due to different etiologies were taken if they met the inclusion criteria. RESULTS: The frequency of portal hypertension related colonic lesions including rectal varices, rectopathy and portal hypertensive colopathy increases with increase in the severity of liver disease as ascertained by Child-turcotte-Pugh score. Portal hypertension related colonic lesions and hemorrhoids are more frequent in cirrhotic patients with higher MELD score. Rectal varices are more frequent among who had esophageal varices on upper GI endoscopy. There is significant increase in bleeding PR as frequency of hemorrhoids increases, whereas there was not any significant relationship between bleeding PR and rectal varices suggesting that cause of lower GI bleeding in present were haemorrhoids most likly. CONCLUSION: Patients with portal hypertension due to any etiology have significantly higher frequency of colonic lesions as severity of liver disease increases indicated by worsening CTP and MELD scores. Inspite of large number of lower GI manifestations of Portal Hypertension seen in our patients none had significant life threatening lower GI bleeds. So it can be concluded that only upper GI manifestation of Portal Hypertension are clinically significant.

Computer Game-Based Telerehabilitation Platform Targeting Manual Dexterity: Exercise Is Fun. "You Are Kidding-Right?"

There is a need for innovation to improve the engagement and accessibility of rehabilitation programs for children and adults with upper extremity motor impairments due to neurodevelopmental disorders, acquired brain injuries, or spinal cord injuries. For this purpose, a computer game-based telerehabilitation platform (GTP) was developed to address this need. Through the application of a miniature inertial-based computer mouse and the wide variety of commercial computer games, the developed GTP can provide engaging task-specific exercises for the rehabilitation of manual dexterity (object handling and manipulation). A purpose-built repetitive task practice software (RTP) was also developed to gather event data and synchronize it with patient movements during gameplays. This provides automated monitoring and quantification of patients' motor skills, while they practice a range of game-based exercises with their hand and/or arm. The GTP would initially be used in a supervised clinical setting followed by a transition to function at home and be monitored by clinician specialists. Clinical support for home and rural communities, with protocols that can be easily updated, will help increase accessibility to targeted and personalized solutions for patients and achieve the desired training effect.

Reliability and validity of a computer game-based tool of upper extremity assessment for object manipulation tasks in children with cerebral palsy.

INTRODUCTION: A computer game-based upper extremity (CUE) assessment tool is developed to quantify manual dexterity of children with Cerebral Palsy (CP). The purpose of this study was to determine test-retest reliability of the CUE performance measures (success rate, movement onset time, movement error, and movement variation) and convergent validity with the Peabody Developmental Motor Scale version 2 (PDMS-2) and the Quality of Upper Extremity Skills Test (QUEST). METHODS: Thirty-five children with CP aged four to ten years were tested on two occasions two weeks apart. RESULTS: CUE performance measures of five chosen object manipulation tasks exhibited high to moderate intra-class correlation coefficient (ICC) values. There was no significant difference in the CUE performance measures between test periods. With few exceptions, there was no significant correlation between the CUE performance measures and the PDMS-2 or the QUEST test scores. CONCLUSIONS: The high to moderate ICC values and lack of systematic errors indicate that the CUE assessment tool has the ability to repeatedly record reliable performance measures of different object manipulation tasks. The lack of a correlation between the CUE and the PDMS-2 or QUEST scores indicates that performance measures of these assessment tools represent distinct attributes of manual dexterity.

Parents' Perspectives on a Computer Game-Assisted Rehabilitation Program for Manual Dexterity in Children With Cerebral Palsy: Qualitative Analysis of Expectations, Child Engagement, and Benefits.

BACKGROUND: Children with motor impairments affecting the upper extremity benefit from task-specific therapy, such as constraint-induced movement therapy. However, there is a need to improve engagement and compliance with task-specific exercise programs that target manual dexterity for children with cerebral palsy (CP). A computer game-based rehabilitation (GRP) platform was developed that combines fine manipulation and gross movement exercises with engaging game activities appropriate for young children with CP. OBJECTIVE: The objectives of this qualitative analysis were to compare parents' perspectives and opinions about expectations, challenges, and benefits between 2 interventions. METHODS: A mixed methods, randomized controlled trial (RCT) was conducted to examine the feasibility and estimate the effect size of 2 exercise programs for rehabilitation of manual dexterity of children with CP using either GRP or conventional therapy. Parents of 26 of the children who completed the GRP program (n=33) and parents of 15 of the children who completed the conventional therapy program (n=27) participated in the interviews. A general conductive approach was used to analyze the data recorded during the parents' interviews. RESULTS: Five themes captured the range of the parent's experiences, viewpoints, and ideas: (1) parents' expectations, (2) child's engagement with therapy, (3) positive effects of the interventions, (4) challenges, and (5) improving the protocol. CONCLUSIONS: Parents from both groups recognized that their expectations related to improving children's object handling and manipulation skills including participation in activities of daily life were addressed during the 16-week therapy program. Parents perceived a change in the children's level of independence in their daily tasks at home, school, and leisure activities. TRIAL REGISTRATION: ClinicalTrials.gov NCT02728375; https://clinicaltrials.gov/ct2/show/NCT02728375.

Bilateral Masseter and Internal Pterygoid Muscle Hypertrophy: A Diagnostic Challenge.

OBJECTIVE: To describe an unusual case of bilateral masseter and pterygoid muscle hypertrophy. CLINICAL PRESENTATION AND INTERVENTION: A 23-year-old male patient presented with a bilateral, painless swelling of 1 year duration at the parotid areas without improvement after using antibiotics/systemic corticosteroids/non steroidal anti-inflammatory agents. His medical history was not significant. The initial differential diagnosis included salivary gland/jaw bone/masseter pathology, but the MRI revealed only an increase in the size of the masseter and pterygoid muscles. The patient was informed of the benign nature of the swelling and was advised to discontinue the use of non steroidal anti-inflammatory agents. CONCLUSION: The bilateral hypertrophy of masseter muscles should be considered in differential diagnosis in cases of unilateral or bilateral swelling of the parotid or lateral mandible area.

Response of stigma receptivity in CMS and male fertile line of Indian mustard (B. juncea) under variable thermal conditions.

Field experiments were conducted for 2 years to examine the response of stigma in two different pollination systems, viz., CMS line (MJA5) and open-pollinated variety (Pusa Bold) of Indian mustard (Brassica juncea), to varying weather conditions created by different sowing dates. The CMS line MJA5 (female) with its male line in 8:2 (A:R) row ratio, and Pusa Bold in an isolated field were sown on 21st of October, 30th of October, and 18th of November in 2 consecutive years in North Indian condition. Temporal differences in sowing provided differed weather conditions during flowering, which resulted in variations in the duration to attain the peak flowering stage. Stigma was receptive for longer duration (8 days from the day of anthesis) in CMS line which needs an external pollen source for fertilization to happen, whereas it was only 4 days in open-pollinated variety, assessed in terms of siliqua set and number of seeds/siliqua. Substantial effect of sowing date on stigma receptivity was observed; it was longer in plants sown during October in comparison to those of November in both years. The energy requirement parameters, viz., growing degree days and photo-thermal unit, confirmed that plants sown later failed to accumulate sufficient energy for satisfactory phenological growth and for good seed development.

The Effectiveness of a Computer Game-Based Rehabilitation Platform for Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial.

BACKGROUND: It is difficult to engage young children with cerebral palsy (CP) in repetitive, tedious therapy. As such, there is a need for innovative approaches and tools to motivate these children. We developed the low-cost, computer game-based rehabilitation platform CGR that combines fine manipulation and gross movement exercises with attention and planning game activities appropriate for young children with CP. OBJECTIVE: The objective of this study is to provide evidence of the therapeutic value of CGR to improve upper extremity (UE) motor function for children with CP. METHODS: This randomized controlled, single-blind, clinical trial with an active control arm will be conducted at 4 sites. Children diagnosed with CP between the ages of 4 and 10 years old with moderate UE impairments and fine motor control abnormalities will be recruited. RESULTS: We will test the difference between experimental and control groups using the Quality of Upper Extremity Skills Test (QUEST) and Peabody Developmental Motor Scales, Second Edition (PDMS-2) outcome measures. The parents of the children and the therapist experiences with the interventions and tools will be explored using semi-structured interviews using the qualitative description approach. CONCLUSIONS: This research protocol, if effective, will provide evidence for the therapeutic value and feasibility of CGR in the pediatric rehabilitation of UE function. TRIAL REGISTRATION: Clinicaltrials.gov NCT02728375; http:https://clinicaltrials.gov/ct2/show/NCT02728375 (Archived by WebCite at http://www.webcitation.org/6qDjvszvh).

Serum metabolic and minerals profile in norgestomet primed postpartum anestrous surti buffaloes.

AIM: The study was undertaken to find out the serum metabolic and minerals profile in postpartum anestrous surti buffaloes treated with norgestomet ear implants alone and in combination with pregnant mare serum gonadotropin (PMSG). MATERIALS AND METHODS: The study was conducted on 18 postpartum anestrous Surti buffaloes divided into three groups of six animals each at random to conduct the experiment. The buffaloes in Group-I and Group-II were implanted with Crestar ear implant for 9 days together with 2 ml injection of Crestar solution given i/m on the day of the implant insertion. In Group-II, additionally 500 IU PMSG was given i/m on the day of implant removal, whereas the buffaloes in Group-III served as anestrous control group and received 5 ml Normal Saline i/m on day 0 and 9 as a placebo treatment. RESULTS: The overall serum total protein values did not differ significantly (p > 0.05) between time (days) intervals in any of the groups. The mean serum total cholesterol levels at 10(th) day and on the day of estrus were found significantly lower (p < 0.05) in the control group as compared to treatment Groups I and II. However, there was no significant difference (p > 0.05) at 10(th) day and on the day of estrus between treatment groups (T1 and T2). The overall mean serum cobalt, zinc, iron, and manganese values did not differ significantly (p > 0.05) between different time intervals among any of the groups, except copper which was significantly lower (p < 0.05) at 10(th) day in control group as compared to treatment groups. CONCLUSION: Microelements cannot be synthesized in the body. Hence, it is concluded that the mineral mixture should be supplied daily in the animals ration to suffice the requirement of the trace elements. The mean serum metabolic and micro-minerals profiles in treatment and control groups revealed that overall mean serum total protein, cholesterol, copper, and zinc levels were apparently higher in treatment groups whereas, mean serum cobalt, iron, and manganese concentration had no consistent trend between treatment and control groups of Surti buffaloes.

Sesame (Sesamum indicum L.).

Sesame (Sesamum indicum L.) is an important oilseed crop grown in India, China, Korea, Russia, Turkey, Mexico, South America, and several countries of Africa. Sesame seeds are rich in oil, proteins, unsaturated fatty acids, vitamins, minerals, and folic acid. Nearly 70% of the world's sesame is processed into oil and meal, while the remainder is channeled to food and confectionery industries. Production of sesame is limited by several fungal diseases, water logging, salinity, and shattering of seed capsules during harvest. Introgression of useful genes from wild species into cultigens by conventional breeding has not been successful due to postfertilization barriers. The only alternative for the improvement of S. indicum is to transfer genes from other sources through genetic transformation techniques. Here, we describe a simple, fast, and reproducible method for the Agrobacterium-mediated genetic transformation of S. indicum which may be employed for the transfer of desirable traits into this economically important oilseed crop.

Coenzyme Q10 production in plants: current status and future prospects.

Coenzyme Q10 (CoQ10) or Ubiquinone10 (UQ10), an isoprenylated benzoquinone, is well-known for its role as an electron carrier in aerobic respiration. It is a sole representative of lipid soluble antioxidant that is synthesized in our body. In recent years, it has been found to be associated with a range of patho-physiological conditions and its oral administration has also reported to be of therapeutic value in a wide spectrum of chronic diseases. Additionally, as an antioxidant, it has been widely used as an ingredient in dietary supplements, neutraceuticals, and functional foods as well as in anti-aging creams. Since its limited dietary uptake and decrease in its endogenous synthesis in the body with age and under various diseases states warrants its adequate supply from an external source. To meet its growing demand for pharmaceutical, cosmetic and food industries, there is a great interest in the commercial production of CoQ10. Various synthetic and fermentation of microbial natural producers and their mutated strains have been developed for its commercial production. Although, microbial production is the major industrial source of CoQ10 but due to low yield and high production cost, other cost-effective and alternative sources need to be explored. Plants, being photosynthetic, producing high biomass and the engineering of pathways for producing CoQ10 directly in food crops will eliminate the additional step for purification and thus could be used as an ideal and cost-effective alternative to chemical synthesis and microbial production of CoQ10. A better understanding of CoQ10 biosynthetic enzymes and their regulation in model systems like E. coli and yeast has led to the use of metabolic engineering to enhance CoQ10 production not only in microbes but also in plants. The plant-based CoQ10 production has emerged as a cost-effective and environment-friendly approach capable of supplying CoQ10 in ample amounts. The current strategies, progress and constraints of CoQ10 production in plants are discussed in this review.

Systemic exposure of sirolimus after coronary stent implantation in patients with de novo coronary lesions: Supralimus-Core® pharmacokinetic study.

OBJECTIVES: This study was conducted to assess the systemic drug release and distribution of sirolimus-eluting coronary stents. METHODS: Twenty patients with coronary artery disease (CAD) were treated with 1, 2, or 3 a newly designed metallic stents. Blood samples were drawn at 14 time points to determine the pharmacokinetic of sirolimus. Whole blood concentrations of sirolimus were determined by using a sensitive validated high-performance liquid chromatography mass spectrometry/mass spectrometry method. RESULTS: Minimal measurable blood levels were detectable at 7 days. Across all dose levels, individual T(max) values ranged from 1.00 hour and 12.00 hours; individual C(max) ranged from 0.73 ng/mL and 4.13 ng/mL. CONCLUSION: This study confirms the limited exposure of the systemic circulation of the eluted drug with the use of the Supralimus-Core® Sirolimus-Eluting Coronary Stent System (Sahajanand Medical Technologies Pvt. Ltd., Surat, India). In this study, sirolimus concentration in systemic circulation is to be safe, well-tolerated and short-lived.

An insight into the interaction between clopidogrel and proton pump inhibitors.

Platelet activation and aggregation have been established as pivotal elements in the pathogenesis of atherosclerotic and ischemic diseases, including acute coronary syndromes. The difficulty of achieving optimal platelet inhibition remains a major constraint following dual-antiplatelet therapy, which can lead to a diminished response following initiation of clopidogrel therapy. Though the absolute mechanisms underlying clopidogrel resistance are controversial, a variety of responsible factors are recognized. Clopidogrel, being a prodrug, requires conversion to an active metabolite for its activity. This metabolism involves various cytochrome P450 (CYP) enzymes at different steps, and it is hypothesized that competitive inhibition of CYPs may contribute to clopidogrel resistance. Proton pump inhibitors (PPIs) are competitive inhibitors of CYPs that can attenuate the antiplatelet activity of clopidogrel, and this can lead to clopidogrel resistance. Available data from different clinical studies have postulated the possibility of a drug-drug interaction between clopidogrel and PPIs. PPIs differ somewhat in their pharmacokinetic properties like bioavaibility and affinity for CYP2C19. However it is not clear whether the proposed drug interaction of PPI with clopidogrel is same with all PPIs (i.e., a class effect) or it is limited to a subset of PPIs (i.e., a drug effect). This interaction needs further assessment with well designed prospective clinical trials, before any change in clinical practice should be considered. In this review, we attempt to evaluate the available evidence exploring drug interactions with PPIs as the underlying mechanism for the reduced antiplatelet effect of clopidogrel.