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Abstract Older adults are vulnerable to unsafe medication practices. This cross-sectional study estimated the prevalence and factors of polypharmacy and self-medication among 600 older adults from six Indian cities. The updated Screening Tool of Older Persons’ Prescriptions and Screening Tool to Alert to Right Treatment criteria (version 3) were used. Knowledge, attitudes, and reported practices regarding self-medication were assessed. Descriptive statistics, binary logistic regression, and multivariable analysis were used. The prevalence of polypharmacy was 33.7% (95% CI 29.9–37.6%), with significant associations to multiple comorbidities [adjusted odds ratio (aOR) 2.5 (95% CI 1.1–4.1)], recent transition of care [aOR 3.3 (95% CI 1.4–5.7)], and recent hospitalization [aOR 4.6 (95% CI 2–7.7)]. The proportions of prescriptions with potentially inappropriate medications and potential prescribing omissions were 28.8% (95% CI 25.2–32.6%) and 20.3% (95% CI 17.2–23.8%), respectively. The prevalence of self-medication was 19.7% (95% CI 16.6–23.1%), associated with factors, such as staying alone [aOR 4.5 (95% CI 2.4–6.6)], multiple comorbidities [aOR 3 (95% CI 1.4–6.7)], and recent hospitalization [aOR 4.8 (95% CI 1.5–8)]. Among those who self-medicated, 65.3% lacked knowledge of self-medication, 50% did not comprehend the risks, and 40.7% reported unsafe self-medication practices. The findings emphasize interventions’ necessity for promoting safe medication use in older adults.

Background: No clinical trials have compared the efficacy and safety of beta-lactam antibiotics and fluoroquinolones in acute uncomplicated bacterial tonsillitis. This study aimed to compare the efficacy and safety of co-amoxiclav (amoxicillin/clavulanic acid), cefpodoxime proxetil, and levofloxacin monotherapy in patients with acute uncomplicated bacterial tonsillitis. Methods: This was a prospective, open-label, parallel-group study where 90 patients with acute uncomplicated bacterial tonsillitis were equally divided into three groups to receive either tablet co-amoxiclav 625 mg thrice daily, tablet cefpodoxime proxetil 200 mg twice daily, or tablet levofloxacin 500 mg once daily for five days. The efficacy was assessed by subjective clinical improvement and objective bacteriological cure at the end of treatment. Safety was assessed by monitoring adverse events during the study period. Results: Co-amoxiclav, cefpodoxime proxetil, and levofloxacin showed comparable clinical responses on days three and seven; however, on day five, levofloxacin showed a significantly reduced cure rate, but a higher improvement rate, than co-amoxiclav and cefpodoxime proxetil. Bacteriologically, the responses were similar in all three groups at week 1. All drugs were well tolerated with a few self-limiting adverse effects. Conclusions: Co-amoxiclav, cefpodoxime proxetil, and levofloxacin showed a comparable clinical and bacteriological cure in acute uncomplicated bacterial tonsillitis and showed a good safety profile.

Abstract Background Pharmacogenomic (PGx) factors significantly influence how patients respond to antipsychotic medications This systematic review was performed to synthesize the clinical utility of PGx-assisted treatment versus standard of care in schizophrenia. Methods PubMed, Embase, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) from inception till June 2024 that had compared the clinical utility of PGx-assisted intervention as compared to the standard of care in schizophrenia. The primary outcome was safety, and the secondary outcomes were efficacy and medication adherence. Pooled standardized mean differences (SMD) along with a 95% confidence interval (CI) were calculated (random-effects model) wherever feasible. Results A total of 18,821 studies were screened, and five were included for review. All the RCTs had a high risk of bias. Four studies included the commonly used antipsychotics. Three studies reported negative outcomes (safety, efficacy, and medication adherence) and two reported positive outcomes (safety) using different scales. In the meta-analysis, there were significant differences in the total Udvalg for Kliniske Undersogelser Side-Effect Rating scale score [SMD 0.95 (95% CI: 0.76–1.13), p

ObjectiveInformal healthcare providers (IHCPs) play a big role in health systems in low-and middle-income countries (LMICs) and are often the first point of contact for healthcare in rural and underserved areas where formal healthcare infrastructure is insufficient or absent. This study was performed to systematically review the literature on interventions targeting IHCPs in improving the delivery of healthcare services in LMICs.MethodsPubMed, Embase, and Cochrane CENTRAL databases were searched for studies that assessed any type of intervention among IHCPs to improve the delivery of healthcare services in any LMIC. Outcomes included changes in knowledge, attitude, and reported practice of appropriate case diagnosis and management; improved referral services; effective contraceptive use; and medication appropriateness (PROSPERO ID: CRD42024521739).ResultsA total of 7,255 studies were screened and 38 were included. Most of the studies were conducted in Africa and Asia. The IHCPs who were trained included medicine sellers, community health workers/traditional healers, and traditional birth attendants. The main intervention used was educational programs in the form of training. The other interventions were health services, policy and guidelines, and community-based interventions. Most of the interventions were multi-faceted. The disease/service areas targeted were mainly maternal and child health, sexually transmitted diseases, common infectious diseases, medicine use/dispensing practices, and contraception. The outcomes that showed improvements were knowledge, attitude, and reported practice; diagnosis and case management; improved referral services; contraceptive uses; and medication appropriateness. Around one-fourth of the studies reported negative results. The certainty of evidence generated (GRADE criteria) was very low.ConclusionSome multifaceted interventions coupled with training showed improvements in the delivery of healthcare services by IHCPs. However, the improvements were inconsistent. Hence, it is unclear to identify any context-specific optimum intervention to improve the delivery of healthcare services by IHCPs.

Aim: This analysis was conducted to review the number, and describe the characteristics of first-in-human (FIH) Phase 1 clinical trials registered in India from 2008 to 2022. Materials and Methods: The data were extracted from the Clinical Trials Registry – India database for all FIH Phase 1 clinical trials registered between 2008 and 2022. Early-phase trials that were not FIH trials (e.g., pharmacokinetic studies and drug–drug interaction studies) were excluded from the study. Results: A total of 1891 trials were retrieved and 220 were included in the analysis. Most of the investigational products were drugs (55%) followed by vaccines (38.2%). The most common therapeutic class of drugs was cancer chemotherapy (19.8%), followed by antimicrobial chemotherapy and endocrinology (18.2% each). The most common vaccine was the influenza vaccine (21.4%), followed by the measles–mumps–rubella vaccine (15.5%). The pharmaceutical industry was the predominant sponsor for most (91%) of the Phase 1 trials. Of the top five sites where most of the Phase 1 trials were conducted, three were private nonacademic centers (cumulatively 31%) and two were tertiary care medical colleges (cumulatively 9%). Conclusion: Phase 1 clinical trials seem to be conducted in India predominantly with industry sponsorship. There is a need to have an alternate ecosystem to take forward molecules that do not receive adequate attention from the industry and molecules that are of national health priority other than areas such as chemotherapy, antimicrobials, and endocrinology. The Indian Council of Medical Research is setting up Phase 1 clinical trial capacity for molecules that predominantly may arise from nonindustry channels.

IntroductionIndia launched the COVID-19 vaccination drive on 16th January 2021 by vaccinating the adult population above 18 years of age. This was followed by the introduction of an additional precaution dose. As on 18th October 2022, 1,02,66,96,808 (1.02 Billion) first dose and 94, 95, 39,516 (949 Million) second doses of COVID-19 vaccine were administered. However, when compared to the uptake of the primary doses, the precaution dose uptake lagged behind with only 21,75, 12,721 (217 million) doses administered. Even though, the uptake of the primary doses remained optimal, irrespective of different interventions by the Government of India, the uptake of the precaution dose remained poor. In this context, the Ministry of Health & Family Welfare wanted to understand the facilitators and Barriers for precaution dose uptake among adults so that future immunization campaigns could address these issues.MethodsAn exploratory qualitative study was conducted to assess the facilitators and barriers for COVID-19 precaution dose uptake at community level across 6 different states in India. From each of the states, two districts with the highest and lowest rates of COVID-19 vaccine precaution dose uptake were selected. In each of these districts, 2 block Primary Healthcare Centres (PHCs), one with high and one with low uptake were identified. Within these block PHCs, a PHC field area with high and low precaution dose uptakes was identified. From the identified sites a minimum of four IDIs, four FGDs were conducted among the community members. KIIs of the State Immunization Officers, District Immunisation Officers, PHC Medical Officers, healthcare workers like Accredited Social Health Activist/Auxiliary Nurse Midwife were also conducted. The data was audio recorded and it was transcribed, translated and analysed using framework approach.ResultsIt was observed that rise in COVID-19 cases prompted the community to take the precaution dose, this along with the cost of hospitalization and the number of productive days being lost as a result of being infected resulted in vaccine uptake. The fear of non-availability of COVID-19 vaccines latter on also prompted people for vaccine uptake. While the barriers were, poor accessibility to vaccination centers, long hours of travel, poor road connectivity and lack of transportation facilities. However, the most prominent barriers observed across all study sites was that a sense of pandemic fatigue and complacency had developed both among the providers as well as the beneficiaries. Other barriers include differences in vaccination schedules and longer duration between the primary doses of some vaccines. Media was identified to be both a barrier and facilitator for Covid-19 Precaution dose uptake. Even though media played an important role in disseminating information in the beginning of the campaign, it was soon followed by the circulation of both misinformation and disinformation.DiscussionThe study identified that dissemination of accurate information and community involvement at each stage of planning and implementation are crucial for the success of any campaign. Efforts should be constantly made to address and re-invent strategies that will be most suitable for the needs of the community. Therefore, in order to ensure successful vaccination campaigns, it is crucial that along with political will it is also important to have a decentralized approach with inter-sectoral coordination with different stakeholders such as healthcare workers, community members and the different departments such as the local self-governments, education department, law & order department etc. These lessons learnt from COVID-19 vaccination campaigns must not be forgotten and must be applied in future vaccination campaigns and while framing public health policies.

ObjectivesThe response to antipsychotic therapy is highly variable. Pharmacogenomic (PGx) factors play a major role in deciding the effectiveness and safety of antipsychotic drugs. A hybrid type 2 effectiveness-implementation research will be conducted to evaluate the clinical utility (safety and efficacy), cost-effectiveness, and facilitators and barriers in implementing PGx-assisted management compared to standard of care in patients with schizophrenia attending a tertiary care hospital in eastern India.MethodsIn part 1, a randomized controlled trial will be conducted. Adult patients with schizophrenia will be randomized (2: 1) to receive PGx-assisted treatment (drug and regimen selection depending on the results of single-nucleotide polymorphisms in genes DRD2, HTR1A, HTR2C, ABCB1, CYP2D6, CYP3A5, and CYP1A2) or the standard of care. Serum drug levels will be measured. The patients will be followed up for 12 weeks. The primary endpoint is the difference in the Udvalg for Kliniske Undersøgelser Side-Effect Rating Scale score between the two arms. In part 2, the cost-effectiveness of PGx-assisted treatment will be evaluated. In part 3, the facilitators and barriers to implementing PGx-assisted treatment for schizophrenia will be explored using a qualitative design.Expected outcomeThe study findings will help in understanding whether PGx-assisted management has a clinical utility, whether it is cost-effective, and what are the facilitators and barriers to implementing it in the management of schizophrenia.Trial registrationThe study has been registered with the Clinical Trials Registry-India (CTRI/2023/08/056210).

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico-mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies (21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Introduction: Interleukin-10 (IL-10) is a major anti-inflammatory cytokine, which plays an important role in regulating inflammatory responses of the immune system. Changes in IL-10 level and its function can cause an imbalance in immune response, which can be associated with various disease conditions. Aim: To study the influence of vitamin D status and IL-10 gene promoter polymorphism (rs1800871) on circulating IL-10 cytokine levels in apparently healthy South Indian population. Materials and Methods: A cross-sectional study was conducted at the Department of Clinical Pharmacology, JIPMER, Puducherry, India from January 2016 to December 2017. Apparently healthy South Indian volunteers (N=101) of either sex, age more than 18 years, were recruited for the study, after obtaining written informed consent. Serum 25-hydroxy vitamin D and plasma IL-10 levels were measured by using Chemiluminescence and Enzyme Linked Immunosorbent Assay (ELISA), respectively. IL-10 rs1800871 genotyping was performed by Real Time-polymerase Chain Reaction (RT-PCR). Values were expressed as median, Inter quartile Range (IQR) and proportions were described as number with percentage. Results: The median serum vitamin D and plasma IL-10 levels observed among the study population were 18.21 ng/ mL IQR, 11.3-23.08 ng/mL) and 9.04pg/mL (IQR, 7.75, 11.34 pg/mL) respectively. The genotype and allele frequencies of rs1800871 were consistent with that of the African, South Asian population of 1000 genome project. Plasma IL-10 levels were not significantly different across genotypes (p-value=0.091), even though the median level among homozygous mutant (TT) volunteers was observed to be less (8.35 pg/mL vs 9.69 pg/mL, 9.83 pg/mL). The correlation between vitamin D and IL-10 levels was observed to be insignificant (p-value=0.143). Conclusion: The present study has reported the rs1800871 genotype frequency, circulating serum vitamin D levels and plasma IL-10 levels in the apparently healthy South Indian population. IL-10 cytokine levels were not significant across the different genotype and vitamin D status groups. No significant correlation was observed between the IL-10 and vitamin D levels among the sample studied.

Objective: This review was performed to compare the efficacy and safety among hospitalized patients with COVID-19 who received baricitinib and those who received tocilizumab independently with placebo or the standard of care (SOC).Methods: Relevant databases were searched for randomized controlled trials which evaluated the effect of baricitinib or tocilizumab as compared to placebo or the SOC in hospitalized patients with COVID-19. The primary endpoint was the comparison of the 28-day mortality. Risk ratios (RR) and mean differences were compared and pooled for dichotomous and continuous variables, respectively. A two-staged exploratory network meta-analysis using a multivariate meta-analysis was also performed. All analyses were performed in Stata version 16.0. The GRADE approach was used to assess the quality of the generated evidence (PROSPERO ID: CRD42022323363).Results: Treatment with baricitinib [RR, 0.69 (95% CI, 0.50–0.94), p = 0.02, i2 = 64.86%] but not with tocilizumab [RR, 0.87 (95% CI, 0.71–1.07), p = 0.19, i2 = 24.41%] led to a significant improvement in the 28-day mortality as compared to that with the SOC. Treatment with baricitinib or tocilizumab, both independently led to a significant reduction in the duration of hospitalization [baricitinib: mean difference, −1.13 days (95% CI, −1.51 to −0.76), p < 0.001, i2 = 0.00%; tocilizumab: mean difference, −2.80 days (95% CI, −4.17 to −1.43), p < 0.001, i2 = 55.47%] and a significant improvement in the proportion of patients recovering clinically by day 28 [baricitinib: RR, 1.24 (95% CI, 1.03–1.48), p = 0.02, i2 = 27.20%; tocilizumab: RR, 1.41 (95% CI, 1.12–1.78), p < 0.001, i2 = 34.59%] as compared to those with the SOC. From the safety point of view, both these drugs showed similar results. There were fewer patients who experienced any serious adverse event following treatment with barictinib and tocilizumab as compared to those following treatment with the SOC [baricitinib: RR, 0.76 (95% CI, 0.62–0.92), p = 0.01, i2 = 12.63%; tocilizumab: RR, 0.85 (95% CI, 0.72–1.01), p = 0.07, i2 = 0.00%].Conclusion: As baricitinib and tocilizumab are recommended interchangeably by various guidelines for the management of COVID-19, considering the better 28-day mortality data and other comparable efficacy and safety outcomes, baricitinib may be favored over tocilizumab considering its ease of administration, shorter half-life, and lower cost of treatment.

We assessed the association between polypharmacy and cardiovascular autonomic function among community-dwelling elderly patients having chronic diseases. Three hundred and twenty-one patients from an urban municipality area of Kolkata, India were studied in August 2022. The anticholinergic burden and cardiac autonomic function (Valsalva ratio, orthostatic hypotension, change in diastolic blood pressure after an isometric exercise, and heart rate variability during expiration and inspiration) were evaluated. Binary logistic regression analysis was performed to find out the association of polypharmacy and total anticholinergic burden with cardiac autonomic neuropathy. A total of 305 patients (age, 68.9 ± 3.4; 65.9% male) were included. Of these patients, 81 (26.6%) were on polypharmacy. Out of these 81 patients, 42 patients were on ninety-eight potential inappropriate medications. The anticholinergic burden and the proportion of patients with cardiac autonomic neuropathy were significantly higher among patients who were on polypharmacy than those who were not (8.1 ± 2.3 vs. 2.3 ± 0.9; p = 0.03 and 56.8% vs. 44.6%; p = 0.01). The presence of polypharmacy and a total anticholinergic burden of > 3 was significantly associated with cardiac autonomic neuropathy (aOR, 2.66; 95% CI, 0.91–3.98 and aOR, 2.51; 95% CI, 0.99–3.52, respectively). Thus, polypharmacy was significantly associated with cardiac autonomic neuropathy among community-dwelling elderly patients.

The Indian Council of Medical Research (ICMR) recently published the third revised guidelines “National Ethical Guidelines for Biomedical and Health-Related Research Involving Human Participants” in 2017. The changes to the guidelines were needed to acculturate the rapid advances in the research environment and advances in science and technology. The revised guidelines propose substantial changes/ modifications compared to the previous version. These include the introduction of broad consent, ethical issues related to deception, review of multi-centric research by a single ethics committee and ethical issues involved in implementation research and other issues related to public health research. The revised guidelines also incorporate modifications and minor changes to the previous version. Although most of the changes in the revised guidelines are in parallel to most of the international guidelines, we have also highlighted the minor differences compared to other international guidelines.

Objectives: The study was designed to evaluate the single-nucleotide polymorphisms (SNPs) of genes involved in Vitamin D actions (rs2228570) and metabolic pathways (rs2248137 and rs10766197) and their associations with serum 25-hydroxy Vitamin D (25(OH)D) level and asthma control in South Indian patients with bronchial asthma. Materials and Methods: One hundred and two patients of South Indian origin with bronchial asthma either naive to inhaled corticosteroids (ICSs) or not receiving ICS for ≥1 month were included and were treated with ICS (beclomethasone 200 μg twice daily) for 8 weeks. One hundred and one unrelated healthy South Indians were used as controls. Pulmonary function test and fractional exhaled nitric oxide were used to assess asthma control. Serum 25(OH)D levels (chemiluminescence immunoassay) and SNPs in Vitamin D pathway (real-time polymerase chain reaction) were assessed. The associations of SNPs and serum 25(OH)D with asthma control was determined using linear regression. All analyses were performed using SPSS (version 19) and “SNPStats.” P < 0.05 was considered as statistically significant. Results: Vitamin D receptor (VDR) polymorphism (rs2228570) was found to be protective against asthma (P = 0.022), while there were no significant associations between the other two SNPs and asthma. Similarly, poor correlation and insignificant associations between the SNPs and serum 25(OH)D levels were observed in both cases and controls. There were also insignificant associations between the SNPs and asthma control. Conclusion: VDR polymorphism (rs2228570) was found to be protective against asthma in South Indians, while other genes involved in the metabolic pathway of Vitamin D did not show associations with asthma.

Aim: Although drug-drug interactions (DDIs) cause major adverse drug reactions (ADRs) in patients under polypharmacy, the risk of some specific DDIs may be overrated in literature and different software. This study was conducted to determine the frequency and type of potential and clinically significant DDIs among inpatients admitted in a tertiary care hospital in South India. Materials and Methods: This longitudinal study was conducted for 30 days. Preformatted forms were used to collect data on the second day of admission. “Medscape Drug Interaction Checker” was used to evaluate and grade the DDIs. All the potential serious DDIs were intimated to the treating physicians and their responses in the prescriptions were noted. The same patients were followed up to evaluate the occurrence of any clinically significant DDIs. Results: A total of 763 drugs with 125 discrete types were prescribed in 155 patients with an average of 4.9 drugs per patient. One hundred and eight minor, 169 significant, and 24 serious potential DDIs were identified. Patient's age did not correlate, but number of drugs prescribed strongly correlated (P < 0.001) with the incidence of different types of DDIs. The prescription was modified in only 6 (25%) cases where potential serious DDIs were reported. Interestingly, no ADRs or impaired efficacy was observed due to the potential serious DDIs. Conclusion: There was a disparity between the potential and clinically relevant DDIs. Hence, clinical prudency is required before changing prescription due to potential DDIs reported by different software.

Objectives. To evaluate the effects of atomoxetine on complex attention and other neurocognitive domains in idiopathic Parkinson’s disease (PD). Methods. Interventional trials reporting changes in complex attention and other neurocognitive functions (Diagnostic and Statistical Manual of Mental Disorders-5) following administration of atomoxetine for at least 8 weeks in adults with idiopathic PD were included. Effect sizes (Cohen’s d), the standardized mean difference in the scores of each cognitive domain, were compared using a random-effects model (MetaXL version 5.3). Results. Three studies were included in the final analysis. For a change in complex attention in PD with mild cognitive impairment (MCI), the estimated effect size was small and nonsignificant (0.16 (95% CI: −0.09, 0.42), n = 42). For changes in executive function, perceptual-motor function, language, social cognition, and learning and memory, the estimated effect sizes were small and medium, but nonsignificant. A deteriorative trend in executive function was observed after atomoxetine treatment in PD with MCI. For a change in global cognitive function in PD without MCI, the estimated effect size was large and significant. Conclusion. In idiopathic PD with MCI, atomoxetine does not improve complex attention. Also, a deteriorative trend in the executive function was noted.

Uncertified rural practitioners (URPs) without formal medical qualification occupy an indispensable yet dangerous position in the rural health care system in India. The low cost, close proximity, and higher health hazards in rural areas along with the inability of established health-care setups to fulfill existing demands have favored the flourishing trade of URPs. Irrational and dangerous drug prescriptions, unauthorized interventions, improper waste disposal, and several cases of malpractice by URPs are serious threats to the exposed population. However, because of the practical compulsion and real-world necessity of their existence, URPs should be scientifically trained and sensitized to regulate, qualify, and integrate them as a part of the existing health care system in India.

Introduction: This community-based cross-sectional epidemiological study was performed to assess the awareness and attitude of youths toward AIDS in a rural area of West Bengal in India. Methods: Study population included 190 individuals (15–24 years). Data were collected using a semistructured, pretested questionnaire and analyzed using SPSS version 17 by logistic regression model. Results: It was revealed that older youths and particularly men compared to women had more comprehensive knowledge of AIDS than adolescents. Education, media exposure, marriage, and possessing above poverty level (APL) status, all had stronger positive association with youths (more in men) having comprehensive knowledge of AIDS. Older, never married youths, and particularly men were more likely than adolescents to have accepting attitudes toward people living with HIV/AIDS. Education, media exposure, and not having below poverty level card, all had stronger positive association with youths having accepting attitudes toward women than toward men. Surprisingly among the male APL population, this association was negative. Conclusion: Educational and socioeconomic setbacks should be overcome in order to impose a better and justified attitude toward HIV/AIDS. Improved health conditions, proper counseling, and knowledge are essential to break the barriers of communication and ignorance toward HIV/AIDS in these parts of the developing countries.

Objective: Evaluation of antidiabetic potential of the hydroalcoholic extract of Withania coagulans Dunal dried fruit (WCDF) alone and in combination with glipizide, in streptozotocin-induced diabetes, and evaluation of possible antihyperlipidemic activity of the same extract in high-cholesterol diet-induced hyperlipidemia, in albino rats. Materials and Methods: Experimental diabetes was induced in 30 albino rats with intraperitoneal injection of streptozotocin (55 mg/kg). The rats were divided into five groups receiving the following treatments orally for 4 weeks: Vehicle, glipizide (2.5 mg/kg), WCDF extract (1000 mg/kg), WCDF extract (1000 mg/kg) plus glipizide (1 mg/kg) and WCDF extract (1000 mg/kg) plus0 glipizide (2.5 mg/kg). Fasting and postprandial blood glucose levels were measured every week for 4 weeks. Endocrine pancreas histopathology was done at the end. In a separate set of experiment, five groups of six albino rats each, received orally for 4 weeks, vehicle, cholesterol (25 mg/kg/day), cholesterol (25 mg/kg/day) plus atorvastatin (7.2 mg/kg/day), cholesterol (25 mg/kg/day) plus WCDF extract (1000 mg/kg/day) and no treatment, respectively. Estimation of serum lipid profile and liver histopathology was done at the end of 4 weeks. Statistical Analysis: Between-group and within-group comparisons were respectively done by analysis of variance (ANOVA) and repeated measures ANOVA, followed by post hoc Tukey′s test, with a significance level of P < 0.05. Results and Conclusions: The 4-week treatment with WCDF extract significantly reversed hyperglycemia in streptozotocin-induced diabetes that was comparable to glipizide. When combined with glipizide (2.5 mg/kg), WCDF extract produced a synergistic antihyperglycemic effect as well as improvement in pancreatic histopathology. Moreover, hydroalcoholic extract of WCDF was effective and comparable to atorvastatin in controlling the high-cholesterol diet-induced hyperlipidemia in rats.

This case report highlights atenolol induced episodes of chronic and acute hepatotoxicities in 2 elderly hypertensive patients. The 1st patient manifested liver dysfunction after 8 months of 50 mg daily atenolol therapy and in the 2nd patient liver dysfunction was revealed within 3 weeks of 100 mg daily atenolol intake. There was no evidence of any other possible hereditary, traumatic, surgical, metabolic, infective, organic, or pathologic causes giving rise to these conditions. Possibilities of drug interactions were carefully ruled out and these episodes of hepatotoxicities were ‘probably’ drug (atenolol) induced, as depicted by CIOMS/RUCAM scale. Withdrawal of the offending drug resulted in reversal of the diseased states. Routine liver function tests may be warranted in patients on atenolol therapy.

Background: Antituberculosis (ATT) drug-induced liver injury (DILI) is a common and serious adverse effect of tuberculosis (TB) treatment. This retrospective study was carried out to study the prevalence of DILI among patients who had received anti-TB medications and to study some of the known risk factors responsible for causing DILI. Materials and Methods: This longitudinal descriptive study was performed to evaluate cases of DILI with predefined criteria. Patients of all ages, diagnosed and treated for smear positive pulmonary TB from January 1, 2008 to December 31, 2012 and those who came for regular follow-up were included in the study. Multiple logistic regression analysis was performed to determine the association of different risk factors and DILI. The confounders considered were age, sex, weight, body mass index, doses of drugs (fixed or per kg), ATT regimens (daily or intermittent), and treatment categories. Results: Of the 253 patients analyzed, 24 (9.48%) developed DILI. Associations of different risk factors were insignificant; including chronic alcohol consumption, hepatitis B infection, hepatitis C infection, HIV infection, and existing chronic TB. Conclusion: DILI was not significantly associated with known risk factors in our settings.

Background: During delivery, drugs being prescribed cause concerns due to their harmful effects on lactation as well as potential adverse reactions on the mother. This retrospective study was performed to evaluate the drug prescribing pattern during normal delivery in a secondary care hospital in India. Materials and Methods: This cross-sectional retrospective study included 3 months of patient’s medical records. Results: A total of 2222 drugs, comprising 51 different types of drugs were prescribed to 313 mothers undergoing normal delivery. Most of these drugs are safe in lactation. Ten types of drugs would have been better avoided, but they possibly did not cause harm because of their limited short-term use only during the intranatal period. Conclusion: This study reflects a good, safe, and rational medication practice during normal delivery for various common ailments in a secondary care hospital and can be cited as an example for similar settings.

Abstract Introduction : Although Phonosurgery has been the mainstay of treatment for benign vocal fold lesions for decades, advanced diagnostic modalities improved techniques of voice therapy and vocal hygiene have helped managing them in a more precise and better way. Objective : To study the role of phonomicrosurgery in benign vocal fold lesions. Methods : This prospective study was under taken in a tertiary health care centre for a period of one-year (October 2012) to September 2013, thirty two patients had undergone phonosurgery for vocal fold polyps (n = 14), vocal fold cysts (n=8), vocal fold nodules(n=3), Sulcus vocalis (n=2), vocal fold papilloma (n=l), vocal fold angioma (n=l), keratotic patch (n=2) and vocal fold oedema (n=1). Their average age was 41 years of which 62% werewomenand 69% were smokers. Postoperative voice therapy was given to sixteen patients. Post-operative clinical evaluation was available for data analysis in 30 patients (92%). Voice quality was assessed using the voice handicap index-10 questionaire (VHI-10), direct laryngoscopy was performed pre & post-operatively and self-reported assessment. The median follow-up time was 4 months. Result : Thirty out of 32 patients showed objective improvement in fibreoptic laryngoscopy post treatment. Two patients were noncompliant to voice therapy and showed recurrence of their pathologies.Mean VHI 10 score showed significant improvement from 8 in the preoperative period to 3 in the postoperative period. Conclusion : Phonosurgery is a quick and effective treatment with uncommon and transient post-operative complications. Pre and postoperative voice therapy plays an integral role in combination with phono-micro surgery enhances the outcome in patients with benign vocal fold lesions. Objective assessment of the voice pre- and postoperatively should be used consistently to evaluate the additional impact of pre- and postoperative voice therapy.

With increasing incidence of Clostridium difficile (C. difficile) associated diarrhea and pseudomembranous colitis, several extra-intestinal manifestations of the organism have been unmasked which include-bacteremia, brain abscess, pericarditis etc. We report a rare and interesting case of C. difficile bacteremia and subsequent meningitis in a 10 year old child. The child was immune competent, which further raises the question about the virulent possibilities of the organism and its implications in the near future. The condition resulted from a prolonged treatment with intravenous (I.V.) cefotaxime for staphylococcal pyogenic arthritis. The child recovered from the septic arthritis but on the 7th day post-admission developed features of bacteremia. The child was later treated with intravenous metronidazole and vancomycin and he was discharged on the 21st day post-admission. No recurrence of symptoms was noted.