Diagnosis, monitoring, and management of adverse events from immune checkpoint inhibitor therapy.

Immune checkpoint inhibitor therapy (icit) is now a standard of care for a variety of cancers in both the metastatic and adjuvant settings. As a result, an understanding of the timing, epidemiology, monitoring, diagnosis, and management of immune-related adverse events (iraes) associated with icit is imperative. This article reviews specific iraes by organ system, consolidating recommendations from multiple guidelines and incorporating data from case reports to highlight additional evolving therapeutic options for patients. Managing iraes requires early recognition, early intervention, and education of the patients and the multidisciplinary health care team alike. Given the durable responses observed with icit, and the irreversible nature of some of the iraes, further research into management of the sequelae of icit is required.

Effect of standard treatment guidelines with or without prescription audit on prescribing for acute respiratory tract infection (ARI) and diarrhoea in some thana health complexes (THCs) of Bangladesh.

Inappropriate prescribing for ARI and diarrhoea is a serious health problem in many developing countries including Bangladesh. A baseline retrospective prescribing survey for ARI and diarrhoea have been conducted in randomly selected 60 thana health complexes (THCs) of Dhaka division of Bangladesh. In the 38 of 60 THCs, the prescribers did not comply with the standard treatment guidelines (STG) for ARI. They are marked as 'unsatisfactory performers'. In these THCs unnecessary antibiotics were prescribed in more than 50% of the encounters. The study further revealed that in 26 THCs, comprising 41.6% of the 38 THCs, the situation was even worse regarding the indiscriminate use of antibiotics. In these THCs antibiotics were prescribed in > or =72% of the encounters. For diarrhoea, only in 8.3% of the THCs antibiotics were prescribed in > or =50% of the encounters. Encouragingly, most of the prescribers prescribed ORS. So the diarrhoea cases were dropped from the intervention. The 24 out of 26 worse performing THCs for ARI management, were grouped into three groups: Group-I (implementing STG+ Audit), Group-II (STG) and Group-III (no intervention, control). The prescribers of the THCs belonging to Group-I and Group-II received STG+Audit and STG only respectively as intervention(s). On the contrary, the prescribers of the THCs of Group-III (control) did not receive any intervention. It was observed that after the implementation of interventions the use of the unnecessary antibiotics to treat ARI was significantly reduced (p<0.01) compared to pre-intervention period in Group-I (STG+Audit). In this group highly significant (p<0.000) reduction in antibiotics use was achieved in 6 out of 8 THCs. The average reduction in antibiotic use in terms of encounters was 23.7 and 15.2% in the Group-I and Group-II respectively owing to the intervention(s). Significant reduction in antibiotic use in terms of THCs was 3 (out of 8 THCs) and 2 (out of 8 THCs) belonging to the Group-II and Group-III respectively. When compensated for the change in the control group, the reduction of antibiotic use in terms of encounters was 15.2 and 6.9% in the THCs of the Group-I and Group-II respectively due to introduction of the interventions. The study concludes that STG supported by prescription audit are highly effective interventions to change the prescribing behaviour of the prescribers for ARI in the THCs.

Antidiarrhoeal activity of the bark extract of Careya arborea Roxb.

The methanol extract of the Careya arborea Roxb. bark significantly reduced castor oil-induced diarrhoea in mice. This effect supports the local traditional use of the plant against diarrhoea.

A preliminary study on the analgesic activity of Grangea maderaspatana.

The methanol extract of the whole plant of Grangea maderaspatana showed a dose-dependent analgesic activity. At doses of 1 and 3 g/kg, the extract significantly (P<0.001) inhibited acetic acid-induced writhing in mice by 50 and 80%, respectively.

Prescribing pattern in acute diarrhoea in three districts in Bangladesh.

PIP: Since the irrational administration of drugs in diarrhea cases is a serious problem, a prescribing survey was made among 10 government health facilities (GHF) and private dispensaries (PD) in the Dhaka, Tangail, and Serajgong districts of Bangladesh. Using standard indicators on prescribing, patient care, and drug supply developed by the International Network for the Rational Use of Drugs, 12 prescriptions written for children under 5 years old with acute diarrhea were studied from each center (total = 120). It was found that the average number of drugs administered per encounter was 1.82 and 2.30 in the GHFs and PDs, respectively. Almost every prescription (0.79 and 0.96 in the GHFs and PDs, respectively) had an antimicrobial component, with metronidazole used in most cases despite the fact that it is not indicated in acute diarrhea and treatment guidelines advise against its use in children under age 5 years in Bangladesh. Oral rehydration salt solution was used in each facility in about 80% of cases (vs. 11% of cases in the community). Because of the inclusion of the antimicrobial, standard treatment guidelines were followed in only 17 and 23% of cases in the GHFs and PDs, respectively. Patient care indicators revealed that 1.8% of patients were examined in the GHFs vs. 65% in the PDs. 50% of patients in both facilities could report the correct dosing schedule for the drugs they were given. The GHFs do not label prescriptions, but all the drugs administered by the PDs remain in manufacturer-labeled containers. The existence of an essential drugs list and the distribution of standard treatment guidelines have not ensured good prescribing habits among health professionals for this common disease. Additional efforts are required to improve this situation.^ieng