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   2012| October-December  | Volume 3 | Issue 4  
    Online since November 24, 2012

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Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis
Jaykaran Charan, Jagdish P Goyal, Deepak Saxena, Preeti Yadav
October-December 2012, 3(4):300-303
DOI:10.4103/0976-500X.103685  PMID:23326099
Objectives : To explore the effect of vitamin D supplementation in prevention of respiratory tract infections on the basis of published clinical trials. Materials and Methods : Clinical trials were searched from various electronic databases. Five clinical trials were suitable for inclusion. Outcome was events of respiratory tract infections in vitamin D group and placebo group. Data was reported as odds ratio with 95% confidence interval. Both random and fixed model was used for analysis. Analysis was done with the help of Comprehensive meta-analysis software 2. Results : Events of respiratory tract infections were significantly lower in vitamin D group as compared to control group [Odds ratio = 0.582 (0.417 - 0.812) P = 0.001] according to random model. Results were similar in fixed model. On separate analysis of clinical trials dealing with groups of children and adults, beneficial effect of vitamin D was observed in both, according to fixed model [Odds ratio = 0.579 (0.416 - 0.805), P = 0.001 and Odd ratio = 0.653 (0.472 - 0.9040, P = 0.010 respectively]. On using random model beneficial effect persisted in children's group but became nonsignificant in adults group [Odds ratio = 0.579 (0.416 - 0.805), P = 0.001 and Odd ratio = 0.544 (0.278 - 1.063) P = 0.075 respectively]. Conclusion : Vitamin D supplementation decreases the events related to respiratory tract infections. There is need of more well conducted clinical trials to reach to a certain conclusion.
  11,182 3,763 112
Ethics of expert opinion and the observations of the department-related parliamentary standing committee on the CDSCO
Amar Jesani
October-December 2012, 3(4):297-299
DOI:10.4103/0976-500X.103684  PMID:23326098
  2,434 5,860 2
Acetic acid induced painful endogenous infliction in writhing test on mice
Shivaji P Gawade
October-December 2012, 3(4):348-348
DOI:10.4103/0976-500X.103699  PMID:23326113
  6,661 1,282 43
Comparison of the effectiveness and safety of cefpodoxime and ciprofloxacin in acute exacerbation of chronic suppurative otitis media: A randomized, open-labeled, phase IV clinical trial
Arijit Ghosh, Utpal Jana, Ajoy Khaowas, Saumik Das, Ananya Mandal, Nina Das
October-December 2012, 3(4):320-324
DOI:10.4103/0976-500X.103689  PMID:23326103
Objective : To compare the effectiveness and safety of cefpodoxime and ciprofloxacin for the treatment of mild to moderate cases of acute exacerbation of chronic suppurative otitis media (AECSOM). Materials and Methods : Adult patients diagnosed with AECSOM were screened and patients fulfilling the inclusion criteria were randomized to receive either cefpodoxime 200 mg twice daily or ciprofloxacin 500 mg twice daily orally for 7 days. The primary outcome of this randomized, open-labeled, phase IV clinical trial (Registration Number - CTRI/2011/10/002079) was clinical success rate at day 14 visit and the secondary outcome was incidence of adverse events (AEs). Forty-six patients were enrolled: 23 in the cefpodoxime group and 23 in the ciprofloxacin group. Results : The clinical success rates were 95.6% in the cefpodoxime group versus 90.9% in the ciprofloxacin group. These rates are comparable, but no statistically significant difference was observed between the groups. Few mild and self-limiting AEs were observed and the tolerability of both the drugs was also good. Conclusion : The results of this randomized, open-labeled phase IV clinical trial showed that a 7-day course of cefpodoxime is therapeutically comparable to ciprofloxacin in terms of both clinical effectiveness and safety for the treatment of patients with AECSOM.
  6,232 772 5
Protein data bank
S Parasuraman
October-December 2012, 3(4):351-352
DOI:10.4103/0976-500X.103704  PMID:23326114
  5,119 945 24
Comparison of efficacy and safety of two parenteral iron preparations in pregnant women
Jatin V Dhanani, BP Ganguly, LN Chauhan
October-December 2012, 3(4):314-319
DOI:10.4103/0976-500X.103688  PMID:23326102
Objective: To compare the efficacy and safety with a fixed dose of two parenteral iron preparations, iron sucrose complex and iron sorbitol citric acid as per the current practice. Materials and Methods: A prospective randomized open label study was conducted. In this study, 60 pregnant women with hemoglobin less than 8.5 g/dl received a fixed dose of either IV iron sucrose or IM iron sorbitol citric acid therapy. The efficacy of the therapy was assessed by laboratory parameters such as hemoglobin, hematocrit, MCV, MCH, and serum ferritin level after 14 and 28 days. To assess the safety, adverse drug reactions with both the therapies were recorded. Results: Hemoglobin concentration increased significantly (P < 0.001) with respect to time in both the groups. The rise in the hemoglobin level in third and fourth weeks was significantly higher in iron sucrose (0.92 g/dl) than iron sorbitol citric acid therapy (0.56 g/dl). There was no significant change in the rise of the serum ferritin level after both the therapies. Adverse events were common with iron sorbitol citric acid therapy. However, no serious adverse drug reactions were observed. Conclusions: No significant difference in the efficacy of both of the therapy. However, adverse events and dropout rates were much more common in the group of pregnant women who received iron sorbitol citric acid.
  4,442 654 11
The incidence and clinical relevance of drug interactions in pediatrics
Hasime Qorraj-Bytyqi, Rexhep Hoxha, Shaip Krasniqi, Elton Bahtiri, Valon Kransiqi
October-December 2012, 3(4):304-307
DOI:10.4103/0976-500X.103686  PMID:23326100
Objective: To investigate the prevalence of the major drug interactions in children and verify the rate and profile of drug interactions in hospitalized pediatric patients. Materials and Methods: A retrospective study was designed and data collected from the files of hospitalized children in Pulmonology, Nephrology, and Gastroenterology wards of a Pediatric Clinic, from July 1999 to 2004. Results: From the analyzed material, we detected 34 cases of interactions, of which 1 was pharmacodynamics interaction, 13 were pharmacokinetic interactions, and 20 of unknown mechanisms. According to the rate of significance, 4 cases were categorized in the first significance rate of interaction, 18 cases in the second significance rate, 1 case of the third significance rate, 4 cases of the fourth significance rate, and 7 cases of the fifth significance rate. According to onset of cases, 33 cases were of delayed onset, and according to severity of interactions, in 7 cases we noticed major severity interaction, in 19 cases moderate severity and in 8 cases minor severity. Conclusions: The presence of drug interactions is a permanent risk in the pediatric clinic. Then, we can conclude that continued education, computer system for prescriptions, pharmacotherapy monitoring of patients, and the pharmacist participation in the multidisciplinary team are some manners of improving the treatment to hospitalized patients.
  3,151 1,289 3
Insulin glargine overdose
Fatma Sari Dogan, Ozge Ecmel Onur, Arzu Denizbasi Altinok, Ozlem Guneysel
October-December 2012, 3(4):333-335
DOI:10.4103/0976-500X.103694  PMID:23326108
Insulin glargine is a long acting novel recombinant human insulin analogue indicated to improve glycemic control, in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. The time course of action of insulins including insulin glargine may vary between individuals and/or within the same individual. Insulin glargine is given as a 24-h dosing regimen and has no documented half-life or peak effect. Hypoglycemia is the most common adverse effect of insulin, including insulin glargine. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. We present a case of a 76-year-old male insulin-dependent diabetic patient with refractory hypoglycemia secondary to an intentional overdose of insulin glargine. We would like to highlight the necessity of prolonging IV glucose infusion, for a much longer period than expected from pharmacokinetic properties of these insulin analogues after intentional massive overdose.
  3,790 577 6
Hepatoprotective activity of active fractions of Thespesia lampas Dalz and Gibs (Malvaceae)
S Stephen Ambrose, P Solairaj, A Subramoniam
October-December 2012, 3(4):326-328
DOI:10.4103/0976-500X.103691  PMID:23326105
  3,562 496 5
Intensive monitoring of adverse drug reactions in hospitalized patients of two medical units at a tertiary care teaching hospital
Maulik S Doshi, Prakruti P Patel, Samidh P Shah, Ram K Dikshit
October-December 2012, 3(4):308-313
DOI:10.4103/0976-500X.103687  PMID:23326101
Objective: To detect incidence of adverse drug reactions (ADRs) in hospitalized patients and to assess their causality, seriousness, preventability, and the possible economic impact. Materials and Methods: This was a prospective study carried out in two medical units at a tertiary care, teaching hospital, for about 18 months. All the admitted patients who developed an ADR after admission (group A) or who were admitted primarily for the treatment of an ADR (group B) were included. Descriptive statistics with 95% CI, χ2 , χ2 for the trend and kappa test were used. Results: Out of 6601 patients, 140 patients developed 154 ADRs with an incidence of 2.12%. Causality of the majority of the ADRs in group A was 'possible' while those in group B was 'probable'. Among 109 ADRs (34 serious) in group A, 38 were preventable. On the other hand, out of 45 serious ADRs in group B, 19 were preventable. The total cost of 154 ADRs in 140 patients was Rs. 1,49,803 with an average of Rs. 1070 per patient. The preventable cost for 57/154 ADR was Rs. 96,310. Conclusion: Around 2% of the hospital patients develop ADRs. A large number of these ADRs were preventable. A substantial saving can be made if adequate caution is exerted.
  3,200 708 6
Istaroxime: A rising star in acute heart failure
Suruchi Aditya, Aditya Rattan
October-December 2012, 3(4):353-355
DOI:10.4103/0976-500X.103705  PMID:23326115
Heart failure in India is a growing epidemic. Around 30 to 40% of patients die from heart failure within one year of receiving the diagnosis. Currently available inotropes have not only failed to show consistent results but are also associated with adverse outcomes. Istaroxime is a novel intravenous agent with luso-inotropic properties that acts by inhibition of Na + /K + adenosine triphosphatase and stimulation of sarco/ endoplasmic reticulum calcium ATPase isoform 2. In clinical studies, it significantly decreased left ventricular end diastolic pressure, pulmonary capillary wedge pressure, heart rate and increased systolic blood pressure and cardiac index with no change in neurohormones, renal function or troponin I. Istaroxime is a promising alternative for patients presenting with acute heart failure syndrome for whom the therapeutic options are currently limited.
  3,170 665 6
Ciprofloxacin-induced erythema multiforme
HS Shilpashree, Shriprasad Sarapur
October-December 2012, 3(4):339-341
DOI:10.4103/0976-500X.103696  PMID:23326110
Ciprofloxacin is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with ciprofloxacin are rare with an incidence of 0.6%. One of the side effects of ciprofloxacin is erythema multiforme (EM). EM is an acute, self -limiting mucocutaneous hypersensitivity syndrome. It exhibits a diverse etiology, often recurs, has unusual clinical features and is of uncertain etiopathogenesis. It usually exhibits a distinctive skin or mucosal lesions that are characterized by combination of bullae, papules, macules or ulcers. It is most probably an immunologically mediated process. With the use of ciprofloxacin becoming more and more widespread, fatal complications of ciprofloxacin should be borne in mind. In this article we present a case of ciprofloxacin induced erythema multiforme in 40 year old woman.
  2,395 443 4
Anabolic androgenic steroids in delayed diagnosis of tuberculosis
Suneet K Upadhyaya, Archana Sharma, Deependra K Rai, Vijay Thawani
October-December 2012, 3(4):345-347
DOI:10.4103/0976-500X.103698  PMID:23326112
This is the first case report depicting masking of symptoms of intestinal tuberculosis by anabolic androgenic steroids (AAS) causing delay in diagnosis which lead to a major surgery. Negative tuberculosis skin test (TST) probably due to immunomodulating effects of AAS also contributed to the delay. Patient also had early dependence on AAS and rapid growth of scrotal sebaceous cysts, findings of which have not yet been reported.
  2,488 260 1
Toxic epidermal necrolysis due to lamotrigine in a pediatric patient
Manish J Barvaliya, Mahendra K Patel, Tejas K Patel, CB Tripathi
October-December 2012, 3(4):336-338
DOI:10.4103/0976-500X.103695  PMID:23326109
A 12-year-male child developed toxic epidermal necrolysis (TEN) probably due to lamotrigine. The patient was on antiepileptic therapy (sodium valproate and clonazepam) since 6-7 months, and lamotrigine was added in the regimen 1-2 months back. A serious cutaneous reaction is more likely to occur during the first 2 months of starting lamotrigine. The use of lamotrigine as an add-on to valproate may have precipitated the reaction. Other drugs were ruled out based on the incubation period of TEN. Drug interactions should be kept in mind with multiple antiepileptic therapies. The patient died because of the severity of reactions and delay in starting the treatment with steroids. One must be vigilant in early detection of the reaction.
  2,321 405 4
Complete heart block in a neutropenic patient with aspergillosis: An unusual adverse effect of caspofungins
Sasmita Biswal
October-December 2012, 3(4):342-344
DOI:10.4103/0976-500X.103697  PMID:23326111
We present a case of complete heart block (CHB) in a 58-year-old female patient with acute myeloid leukemia (AML) with no past history of cardiac disease, who received caspofungin in the treatment of disseminated fungal infection. To our knowledge, this is the first case of CHB associated with caspofungins. Subsequent to induction chemotherapy the patient developed invasive pulmonary aspergillosis with sudden tachypnea, dyspnoea, fever, bilateral pulmonary infiltrates and acute respiratory insufficiency consequent to neutropenia with ANC<500. During the first dose of antifungal therapy with caspofungins, she developed complete atrioventricular block and cardiac arrest. Complete heart block is an unusual adverse effect of caspofungins which has not been reported previously. Caspofungins release histamine in peripheral blood cells, so possible histamine-mediated symptoms ranging from severe fatal anaphylaxis can occur. These data suggest that infusion-related reactions associated with caspofungin may be mediated by histamine release secondary to caspofungin therapy.
  2,277 377 3
Platelet aggregation inducing activity of Ficus racemosa stem bark extracts
Faiyaz Ahmed, MS Kumar, Asna Urooj, K Kemparaju
October-December 2012, 3(4):329-330
DOI:10.4103/0976-500X.103692  PMID:23326106
  2,215 348 -
Effect of rifampicin and erythromycin on the initiation of galactose induced cataract in rats
Raj Rajeshwari R Patil, Pratibha S Worlikar, Amol B Chaudhari, Ozhukil K Radhakrishnan, Rajendra P Gupta, Saurabh Puri
October-December 2012, 3(4):330-332
DOI:10.4103/0976-500X.103693  PMID:23326107
  2,009 350 1
Reporting of adverse drug reactions in clinical trials published in Indian Medical/Dental journals
Purav Mody, Tamoghona Biswas, Jaykaran Charan, Deval Parikh
October-December 2012, 3(4):325-326
DOI:10.4103/0976-500X.103690  PMID:23326104
  1,983 299 -
Old wine, old bottle, new customer
G Sivagnanam.
October-December 2012, 3(4):349-350
  1,502 269 -
Encourage cough to breath easy
G Sivagnanam
October-December 2012, 3(4):349-349
  1,473 246 -
One more option to void
G Sivagnanam
October-December 2012, 3(4):350-350
  1,260 196 -