Clinical pharmacology and pharmacogenomics for implementation of personalized medicine.

With the aim of integrating clinical pharmacology with pharmacogenomics and providing a platform to gather clinicians, academicians, diagnostic laboratory personnel and scientists from related domains, the International Conference on Clinical Pharmacology and Pharmacogenomics 2023 (ICCPP 2023) was jointly organized by the Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, India and the CANSEARCH research platform in Pediatric Oncology and Hematology, University of Geneva, Geneva, Switzerland. The conference was held on 31 August and 1 September 2023, as a continued Indo-Swiss scientific exchange event series. In this report we describe the proceedings of this conference for the benefit of peers who could not attend the conference but are interested in knowing about the scientific program in detail.

A Review of the Safety of Interleukin-17A Inhibitor Secukinumab.

Secukinumab is an anti-interleukin (IL)-17A IgG1-κ monoclonal antibody approved for psoriasis, psoriatic arthritis, and ankylosing spondylitis. Its efficacy is well documented, but the complete safety profile of secukinumab, especially on long-term use, needs to be studied. IL-17 inhibitors increase the risk of infections, especially respiratory tract infections and candidiasis, and inflammatory bowel disease; the causal relationships are well described. However, evidence regarding the other adverse events is scarce, and causal associations between the adverse events and the biologic remain unresolved. This review aims to present a narrative perspective on the safety of secukinumab and identify some key areas where the safety of secukinumab may potentially be useful in understanding the scope of secukinumab therapy and making informed clinical decisions.

Diurnal Variation in Visual Simple Reaction Time between and within Genders in Young Adults: An Exploratory, Comparative, Pilot Study.

Simple reaction time (SRT) is the minimum time required to respond to a stimulus; it is a measure of processing speed. Our study aimed to determine the variation in visual SRT with time among individuals of the same gender and between genders. We carried out a prospective, parallel group, pilot study involving ten male and ten female medical students aged 18-25 years. After obtaining written informed consent, the participants were familiarized with the procedures, and each completed a single practice session of a computerized visual SRT which was administered using Psychology Experiment Building Language Version 2.0 software. On a predetermined day, the participants completed the exercise at 10 a.m., 1 p.m., and 5 p.m. The results showed no statistically significant difference in SRT based on time of day between genders (χ 2(2) = 4.300, p=0.116) as well as within gender (males (χ 2(2) = 0.600, p=0.741); females (χ 2(2) = 5.000, p=0.082). Our study showed that visual SRT does not change significantly at different times of the day and within and between genders. Intraindividual variations in visual SRT can mask the presence of a small but significant difference; hence, further studies are warranted.

The Proportion of Type 2 Diabetic Patients Achieving Treatment Goals and the Survey of Patients' Attitude Towards Insulin In tiation ini Patient s with Inadequate Glycaemic Control with Oral Anti-diabetic Drugs.

BACKGROUND: Type 2 diabetic patients often require insulin therapy for better glycaemic control. However, many of these patients do not receive insulin or do not receive it in a timely manner. OBJECTIVE: The study was planned to assess the proportion of type 2 diabetic patients attaining treatment goals as per the ADA 2018 guidelines. In addition, patient's perception of insulin therapy was assessed and compared between insulin naïve and insulin-initiated type 2 diabetic patients. METHODS: The study was conducted in type 2 diabetic patients. Data on their demographics, medical history, duration of diabetes, history of diabetes related complications, the current anti-diabetic medication received, and the most recent glycaemic parameters were all noted. Patient's perception of insulin initiation was recorded through a structured interview. RESULTS: A total of 129 patients were included in the study. Around 76.7% patients achieved HbA1c target (<7%). The duration of the disease is much higher in patients who did not meet the HBA1c target. A good number of patients felt that insulin injection would be physically painful (56.5%). The majority of the patients also felt that insulin would make their life less flexible (64.8%). Many patients have the opinion that insulin is required for life long (73.2%). More number of patients on insulin agreed with the statement 'Leads to good short-term outcomes as well as long-term benefits' compared to insulin naïve patients. CONCLUSION: The results highlight that the proportion of patients achieving the recommended glycaemic target is not satisfactory. Many patients who are inadequately controlled with oral anti-diabetic drugs were reluctant to initiate insulin.

Effects of Yoga Versus Sham Yoga on Oxidative Stress, Glycemic Status, and Anthropometry in Type 2 Diabetes Mellitus: A Single-Blinded Randomized Pilot Study.

Studies have shown a beneficial role of yoga in tre a t i n g type 2 diabetes mellitus. The present study proceeds in the field by providing an active control. We aimed to evaluate the effect of 3 months of yoga on oxidative stress, glycemic status, and anthropometry in type 2 diabetes mellitus. Forty participants were randomized to receive either yoga (n = 20) or sham yoga (n = 20) as a control. Yoga included postures and breathing exercises, and nonaerobic stretching exercise comprised the control. Significant within-group differences in malondialdehyde, vitamin C, superoxide dismutase, fasting blood glucose, glycosylated hemoglobin, body mass index, waist circumference, and blood pressure were evident in both groups. Yoga participants had significantly greater improvement in reduced glutathione compared to controls. No significant differences between groups were observed in any other outcome variables. Yoga and sham yoga had identical effects on oxidative stress, glycemic status, and anthropometry in type 2 diabetes mellitus. Levels of reduced glutathione improved only in the yoga group. This research needs to be confirmed by larger and sufficiently powered studies.

Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital.

OBJECTIVES: To assess the polypharmacy and appropriateness of prescriptions in geriatric patients in a tertiary care hospital. METHODS: An observational study was done in geriatric patients (>60 years) of either gender. The data collected from patients included: Socio-demographic data such as age, gender, marital status, educational status, socioeconomic status, occupation, nutritional status, history of alcohol/smoking, exercise history, details of comorbid diseases, medication history, findings of clinical examination etc. In this study, polypharmacy was considered as having 5 or more medications per prescription. Medication appropriateness for each patient was analysed separately based on their medical history and clinical findings by applying medication appropriateness index, screening tool to alert to right treatment (START) and Beers criteria and STOPP criteria. RESULTS: A total of 426 patients, 216 (50.7%) were males and 210 (49.3%) were females. Polypharmacy was present in 282 prescriptions (66.2%). Highest prevalence of polypharmacy was seen in 70-79 years age group compared to the other two groups and it was statistically significant. Out of 426 patients, 36 patients were receiving drugs which were to be avoided as per Beers criteria. Among the total patients, 39 patients were overprescribed as per MAI, 56 patients were under prescribed as per START criteria and 85 out of 426 prescriptions were inappropriate in accordance with beers criteria, stop criteria, start criteria and MAI index. CONCLUSION: Around 66.19% patients were receiving polypharmacy. Significant number of patients were receiving drugs which are to be avoided as well as overprescribed and under prescribed. Inappropriate prescription was seen in a good number of patients.

Anxiolytic activity of aqueous extract of Camellia sinensis in rats.

OBJECTIVES: The present study was undertaken to evaluate anxiolytic effect of Camellia sinensis (CS) and possible mechanism on acute and chronic administration in rats. MATERIALS AND METHODS: Eight groups of rats with six in each group were used. Group I served as control. Group II received diazepam (1 mg/kg). Groups III, IV, and V received CS in doses of 3.3, 16.5, and 33 mg/kg, respectively. Three pharmacologically validated experimental models - elevated plus maze (EPM), light and dark box (LDB), and open field tests (OFT) - were employed. Each animal was tested initially in the EPM and then in the LDB, followed by the OFT in a single setting. In EMP, number of entries into, time spent in, and number of rears in each arm in a 5-min period were noted. In LDB, number of entries and time spent in bright arena, number of rears, and duration of immobility were noted. In OFT, number of peripheral and central squares crossed, time spent, and number of rears in central squares were observed for a 5-min period. One-way ANOVA followed by post hoc least significant difference test was performed. RESULTS: In EPM and LDB, CS at 3.3, 16.5, and 33 mg/kg (acute and chronic models) increased the number of entries and time spent and rearing in the open arms and bright arena, respectively, compared to control. In the OFT, CS at 16.5 and 33 mg/kg significantly increased the number of squares crossed, time spent, and the number of rears in the central squares compared to control. Anxiolytic effect was dose dependent in EPM and LDB and CS at 33 mg/kg showed better anxiolytic activity compared to diazepam (1 mg/kg) in all models. Flumazenil (0.5 mg/kg) and bicuculline (1 mg/kg) completely inhibited while picrotoxin (1 mg/kg) partially inhibited the anxiolytic effect of CS. Diazepam and CS at 33 mg/kg reduced the locomotor activity in rats. CONCLUSION: CS has dose-dependent anxiolytic activity which is comparable to diazepam. Anxiolytic action of CS is likely mediated through GABAA-benzodiazepine receptor - Cl - channel complex - since flumazenil and bicuculline inhibited the anxiolytic effect.