Evaluation of the antiplatelet effect of generic ticagrelor 90 mg (ticaspan®) alone and in combination with aspirin 75 mg as compared to ticagrelor (innovator): An in vitro study.

Objective: To evaluate an in vitro antiplatelet effect of generic ticagrelor 90 mg (ticaspan) alone and in combination with aspirin 75 mg as compared to the innovator formulation of ticagrelor alone and in combination with aspirin among healthy Indian volunteers. Methods: 18 volunteers were enrolled and platelet viability was tested using lactate dehydrogenase (LDH) assay in six of 18 volunteers. In 12 volunteers, maximum platelet aggregation (MPA) and percentage inhibition of platelet aggregation (PI) were assessed using a platelet aggregometer in six study groups. Results: There was no significant increase in LDH levels when platelets were incubated with an innovator or generic drug alone and in combination with aspirin as compared to the dimethyl sulfoxide [DMSO] group. All five study groups showed a significant reduction in the MPA values compared to the DMSO group (P < 0.01). The extent of decrease in MPA observed with the generic drug was not significantly different from the innovator drug (P = 0.325). Similarly, the MPA observed with the two combination groups did not differ from each other (P = 1.000), but it was significantly different from the MPA observed with aspirin (P = 0.039, each). The PI of platelet aggregation was significantly more in four study groups [generic drug alone; innovator alone; generic drug + aspirin; and innovator drug + aspirin] (P < 0.01) as compared to the aspirin group. Conclusion: The generic ticagrelor and its combination with aspirin demonstrated an antiplatelet effect equivalent to the innovator drug and its combination with aspirin.

Evaluation of antiglaucoma drug treatment awareness and patient-reported medication adherence: Determinants of glaucoma management.

Introduction: Primary open angle glaucoma (POAG) treatment is characterized by long-duration therapy, prescription variability, and non-adherence. Patient awareness toward drug treatment is crucial to ensure adherence. The present study was planned to evaluate drug treatment awareness, patient-perceived drug adherence, and prescription patterns in POAG patients. Methodology: This was a cross-sectional, single-center, questionnaire-based study conducted in the ophthalmology out patient department of a tertiary care hospital from April 2020 to November 2021. Patients of either gender, aged 40-70 years, with a confirmed diagnosis of POAG, who had records of POAG medications for at least last 3 months and who provided written informed consent, were included. Prescription details were recorded, and subsequently, patients were administered a pre-validated drug treatment awareness (14 items) questionnaire, a self-reported medication adherence (9-item) questionnaire, and then they performed eye drop instillation in a simulated setting. Results: The total number of patients enrolled was 180, which yielded 200 prescriptions. The mean drug treatment awareness score was 8.18 ± 3.30, and 135 (75%) patients scored more than 50% (≥7/14). Similarly, 159 patients (83.33%) had scored >50% (i.e. >5/9), with a mean score of 6.30 ± 1.70 in the medication treatment adherence questionnaire. The mean eye drop instillation performance score was 7.18 ± 1.20. The 200 POAG prescriptions containing 306 drugs were analyzed, with beta blockers (184/200, 92%) and timolol (168/200, 84% encounters) being the highest prescribed classes/drugs. Conclusion: POAG patients did have adequate treatment awareness with good self-reported medication adherence and performance of eye drop instillation technique. Around 25% patients lacked awareness; hence, reinforcement education programs on medication regimens need to be implemented.

Clinical profile of chikungunya fever in patients in a tertiary care centre in Maharashtra, India.

BACKGROUND & OBJECTIVE: In India a chikungunya fever outbreak started in December 2005 when the country experienced more than 13 lakhs of chikungunya infected cases. We undertook this study to study detailed clinical profile of chikungunya fever in both indoor and outdoor patients in a tertiary care hospital in Nagpur, Maharashtra in 2006. METHODS: Suspected cases of chikungunya fever (n=405) during the period of July to September 2006, having clinical triad of fever, arthralgia and/or rashes were included in the study. Clinical profile was studied in all the cases. Of the 405 samples collected, 166 were tested for serum CHIK IgM antibodies. RESULTS: Of the 166 samples tested for CHIKV IgM antibodies, 87 (52.4%) were positive (confirmed cases). Male: female ratio was 2.3:1. Fever and arthralgia were present in all cases. Rash was present in 27 (31%) confirmed and 38 (12%) suspected cases. Lymphadenopathy was present in 12 (13.8 %) confirmed and 4 of suspected cases. Chronic polyarthritis was seen in 22 (25.3%) confirmed and 75 (23.6%) suspected cases. Neurological manifestations were observed in 08 (9%) confirmed and 10 (3.14%) suspected cases. Mortality was 7 (2.2%) in 318 suspected cases and 3 (3.4%) in 87 confirmed cases. INTERPRETATION & CONCLUSION: Our findings showed that about half of the serum samples for CHIKV IgM antibody tested positive from cases suspected to have chikungunya fever. Fever, joint pain and headache were major symptoms. Certain rare manifestations like lymphodenopathy, oral ulcers and encephalitis were also seen. Mortality in confirmed cases was about 3.4 per cent.

Study of metallo-beta-lactamase production in clinical isolates of Pseudomonas aeruginosa.

A study of metallo-beta-lactamase (MBL) production was done in clinical isolates of Pseudomonas aeruginosa. Isolates resistant to ceftazidime and imipenem were screened for MBL production by double disc synergy test (DDST) and minimum inhibitory concentration reduction test. There was complete correlation between two methods for imipenem. For ceftazidime, there was correlation between the two methods in all except four strains. In the screening test for MBL, ceftazidime-EDTA combination was better than imipenem-EDTA combination. 8.05% strains were MBL producers. Presence of MBL producer P. aeruginosa is a cause of concern. Simple DDST can be helpful for monitoring of these emerging resistant determinants.

Emergence and re-emergence of Vibrio cholerae 0139: an epidemiological study during 1993-2002 at Nagpur, Central India.

The pattern of Vibrio cholerae 01 and 0139 isolates at Indira Gandhi Medical College and Mayo General Hospital, Nagpur from 1993 to 2002 is presented. Emergence of the novel serotype 0139 in 1993 was followed by periods of quiescence and re-emergence. For the first time after 1993, the 0139 isolates out numbered 01 isolates in 2001. The peculiar epidemiological pattern is compared with other reports.

Concurrent infection with S.typhi and V. cholerae--a case report".

An eight year old male child presented with symptoms of diarrhoea, vomiting & fever with signs of moderate dehydration. He was treated with tetracyline and fluid replacement therapy. Inspite of treatment and control of diarrhoea and vomiting patient developed gastrointestinal bleeding and tenesmus with continued fever. Deterioration in patient's condition to suspicion of another infection. High level of suspicion and appropriate microbial investigations revealed dual infection with S. typhi and V. cholerae.

An unusually high occurrence of Salmonella enterica serotype paratyphi A in patients with enteric fever.

BACKGROUND & OBJECTIVES: Salmonella enterica serotype Paratyphi A has been reported less frequently as a causative agent of enteric fever. Reports on the antimicrobial susceptibility of this pathogen are few and varied. An unusually high occurrence of S. Paratyphi A was noted in a tertiary care hospital at Nagpur, Maharashtra during April 2001-September 2002. An effort was made to study the antimicrobial susceptibility pattern and phage types of the isolates. METHODS: Blood cultures of patients suspected to have enteric fever admitted to the Indira Gandhi Medical College and Hospital, Nagpur were processed by conventional methods. Antimicrobial susceptibility was tested by Kirby-Bauer disc diffusion method and the minimum inhibitory concentration (MIC) to chloramphenicol was determined. RESULTS: Eighteen (46.15%) of 39 Salmonella isolates were S. Paratyphi A and all were sensitive to ciprofloxacin and cephotaxime. Twelve (66.67%) strains were sensitive to ampicillin and 13 (72.22 %) to chloramphenicol. Two strains (11.11%) were resistant to three drugs (ampicillin, chloramphenicol and cotrimoxazole) simultaneously. The prevalent phage type in the local population was phage type I. INTERPRETATION & CONCLUSION: The high occurrence of S. Paratyphi A found in the present study indicated the emergence of this rare pathogen of enteric fever in the local population. Though some degree of resistance was encountered with ampicillin and chloramphenicol, all the isolates were sensitive to ciprofloxacin, currently a drug of choice for enteric fever. Multidrug resistance was rare.

Methicillin resistance among isolates of Staphylococcus aureus: antibiotic sensitivity pattern & phage typing.

Out of 3988 clinical specimens from hospital admitted patients 230 strains of Staphylococcus aureus were isolated, 45 strains (19.56%) were Methicillin resistance Staphylococcus aureus (MRSA). All MRSA strains were beta lactamase producers. Multidrug resistance was observed among MRSA strains more commonly than in methicillin sensitive strains of Staphylococcus aureus (MSSA). Maximum strains were resistant to penicillin (100%), co-trimoxa zole (97%) & chloramphenicol (93.33%). As least resistant to gentamicin & ciprofloxacin shown by MRSA, these drugs can be used in few situations after susceptibility test. All strains of MRSA were sensitive to vancomicin (100%). Majority of strains (34 out of 45) showed MIC values of 4 ug/ml. Twenty eight out of 44 strains were non typable using routine phages. Study revealed that MRSA with associated multidrug resistance is common in this region. There is need to develop local set of MRSA phages for improvement of typability.

Bacteriological study of pyogenic meningitis with special reference to C-reactive protein.

Seventy five clinically, biochemically and microscopically diagnosed cases of pyogenic meningitis including 28 adults and 47 paediatric patients were studied. Gram positive isolates in adults and gram negative bacilli in paediatric age group were the predominant organisms. Estimation of C-reactive protein (CRP) in cerebrospinal fluid (CSF) and serum was done in all cases as an early marker for rapid diagnosis of pyogenic meningitis. Simultaneous estimation of CRP levels in serum and CSF was found to have a significant diagnostic utility as compared to culture.

Re-emergence of Vibrio cholerae O139 serogroup during 1998 in Nagpur (Maharashtra), India.

In Nagpur, Maharashtra in 1993, V. cholerae serogroup O139 emerged as a novel epidemic strain. The decline in the isolation rate of this serogroup in subsequent year was followed by its re-emergence during 1998 indicating that this serotype requires careful monitoring.

Study of proteases and other enzymes of Vibrio cholerae 01 E2 Tor and 0139 serotypes isolated in Yavatmal (Maharashtra).

V. cholerae 01 E1 Tor isolated during Cholera epidemic of 1994 and V cholerae 0139 serotype isolated during 1993 epidemic were subjected to the study of proteases and other enzymes. Out of 26 strains of V. cholerae 01 studied, gelatinase and caseinase activity was seen in 100 and 69.23 percent strains respectively. All strains showed catalase and oxidase activity. Of the other enzymes studied 19.23, 65.38 and 57.69 percent strains were positive for DNAse, lipase and phosphatase respectively. None of the strains showed lecithinase activity. Similar findings were observed in 22 strains of V. cholerae 0139 except all strains were positive for phosphatase activity. Role of enzymes in virulence is suggested.

Re-emergence of Vibrio cholerae serogroup O139 during June-August, 1997 in Yavatmal (Maharashtra).

A clone of V. cholerae serogroup O139 which emerged as a novel epidemic strain, was reported from this region in 1993 as from many other parts of India and adjoining countries. The decline in the isolation rate of this organism in subsequent years was followed by a sudden increase in 1997, this requires careful monitoring.

Changing pattern of Vibrio cholerae serotype EL TOR and 0139 in Yavatmal (Maharashtra, India) during 1992 to 1994.

During 1992, 1993 and 1994 a total of 65, 123 and 142 faecal samples respectively yielded 9, 54 and 87 strains of V. cholerae. Simultaneous occurrence of EL TOR vibrio and non 01 (i.e. 0139) was noted during 1993 and 1994 with variations in relative and absolute prevalence of each serotype. Seasonal incidence is fairly consistent in this region. Both V. cholerae serotypes 01 and 0139 showed resistance to one or more drugs.

Outbreak of food poisoning due to Salmonella paratyphi A var durazzo (2,12:a:-) in Yavatmal (Maharashtra) in May 1995.

Thirty three patients presented with acute diarrhoea and vomiting, 12-24 h after consuming vegetarian food. Twenty three patients developed high grade fever, with two patients developing complications. Salmonella paratyphi A var durazzo was isolated from 12 faecal samples. This serovar of Salmonella as a causative organism of food poisoning is unusual.