Evaluation of prescription practices in rheumatoid arthritis at the rheumatology clinic in a tertiary care teaching hospital in Uttarakhand: A cross-sectional study.

OBJECTIVE: This study was aimed to analyze the prescription pattern of disease modifying anti-rheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA) in a tertiary care teaching hospital in Uttarakhand, India. METHODOLOGY: This cross-sectional study was conducted in 150 RA patients who were given DMARD therapy. Patient's demographic details, drugs prescribed with their dosage and administration routes and the usage of complementary and alternative medicine (CAM) therapy were recorded to study the prescription pattern. RESULTS: Overall, 4 DMARDs were prescribed in all the studied patients: Methotrexate (n = 150), hydroxychloroquine (n = 35), leflunomide (n = 5), and adalimumab (n = 1). Single DMARD therapy with methotrexate was prescribed to 110 (73.3%) followed by double therapy with methotrexate + hydroxychloroquine in 35 (23.3%), triple therapy (methotrexate + hydroxychloroquine + leflunomide) in 4 (2.7%) and triple therapy with biological DMARD (methotrexate + hydroxychloroquine + leflunomide + adalimumab) in 1 (0.7%) patient. Adjuvant therapy drugs included: Prednisolone (n = 150), folic acid (n = 150), naproxen (n = 150), calcium (n = 150), vitamin D (n = 150) and indomethacin (n = 40). Of the total, 61.4% patients also took complimentary alternative medicine (CAM) therapy. CONCLUSION: Our study concludes that the most commonly prescribed DMARDs in our setting, to patients of RA, in descending order of frequency were methotrexate, followed by hydroxychloroquine, leflunomide and lastly adalimumab. A total of five adjuvant medications were commonly prescribed to all patients. There was a high prevalence of self-medicated CAM therapy in the majority of these patients.

Multimodal management of arteriovenous malformations of the basal ganglia and thalamus: factors affecting obliteration and outcome.

OBJECTIVE: Arteriovenous malformations (AVMs) of the basal ganglia and thalamus are particularly difficult lesions to treat, accounting for 3%-13% of all AVMs in surgical series and 23%-44% of malformations in radiosurgery series. The goal of this study was to report the results of multimodal management of basal ganglia and thalamic AVMs and investigate the factors that influence radiographic cure and good clinical outcomes. METHODS: This study was a retrospective analysis of a prospectively maintained database of all patients treated at the authors' institution. Clinical, radiological, follow-up, and outcome data were analyzed. Univariate and multivariate analyses were conducted to explore the influence of various factors on outcome. RESULTS: The results and data analysis pertaining to 123 patients treated over 32 years are presented. In this cohort, radiographic cure was achieved in 50.9% of the patients. Seventy-five percent of patients had good clinical outcomes (stable or improved performance scores), whereas 25% worsened after treatment. Inclusion of surgery and radiosurgery independently predicted obliteration, whereas nidus diameter and volume predicted clinical outcomes. Nidus volume/diameter and inclusion of surgery predicted the optimal outcome, i.e., good clinical outcomes with lesion obliteration. CONCLUSIONS: Good outcomes are possible with multimodal treatment in these complex patients. Increasing size and, by extension, higher Spetzler-Martin grade are associated with worse outcomes. Inclusion of multiple modalities of treatment as indicated could improve the chances of radiographic cure and good outcomes.

Pharmacokinetics of rifabutin during atazanavir/ritonavir co-administration in HIV-infected TB patients in India.

SETTING: Rifabutin (RBT) is reported to be as effective as and to have less inducing effect on cytochrome P450 enzymes than rifampicin against tuberculosis (TB). The optimal dose of RBT during ritonavir (RTV) co-administration remains a matter of debate. OBJECTIVE: To study the pharmacokinetics of 150 mg RBT thrice weekly during concomitant atazanavir/RTV administration in human immunodeficiency virus (HIV) infected TB patients. METHODS: This observational study was conducted in 16 adult HIV-infected TB patients being treated for TB with an RBT-containing regimen and an antiretroviral therapy regimen with RTV; the dose of RBT was 150 mg thrice weekly. Serial blood draws were performed at pre-dosing and at 1, 2, 4, 6, 8, 12 and 24 h after the drug was administered. Plasma RBT was estimated using high-performance liquid chromatography. RESULTS AND CONCLUSIONS: Peak RBT concentration was below the lower therapeutic limit (<0.3 µg/ml) in seven patients, while 10 patients had trough concentrations below the minimal inhibitory concentration against Mycobacterium tuberculosis (0.06 µg/ml), suggesting that the RBT dosage may be inadequate. Prospective studies in different settings are required to arrive at the proper therapeutic dose for RBT to be used during co-administration with RTV.

Involvement of health professionals in tobacco control in the South-East Asia Region.

Tobacco use is widely entrenched in the South-East Asia (SEA) Region leading to high morbidity and mortality in this region. Several studies revealed that tobacco use is widespread among youth and school children. Exposure to second-hand smoke was reported as around 50% or more in three countries - Myanmar (59.5%), Bangladesh (51.3%), and Indonesia (49.6%). Health profession students encompassing medical, dental, nursing and pharmacy disciplines, and even qualified health professionals are no exception from tobacco use. While they are regarded as role models in tobacco cessation programs, their tobacco addiction will carry a negative impact in this endeavour. A mere inquiry about the smoking status of patients and a brief advice by doctors or dentists increases quit rates and prompts those who have not thought about quitting to consider doing so. Evidence from some randomized trials suggests that advice from motivated physicians to their smoking patients could be effective in facilitating cessation of smoking. However, the low detection rate of smokers by many physicians and the small proportion of smokers who routinely receive advice from their physicians to quit have been identified as a matter of concern. This paper describes the role and issues of involvement of health professionals in tobacco control. Data from a variety of sources is used to assess the status. Although there are some differences, tobacco use is widespread among the students and health professional students. Exposure to second hand smoke is also a matter of concern. Tobacco-related problems and tobacco control cut across a vast range of health disciplines. Building alliances among the health professional associations in a vertical way will help synergize efforts, and obtain better outcomes from use of existing resources. Health professional associations in some countries in the SEA region have already taken the initiative to form coalitions at the national level to advance the tobacco control agenda. In Thailand, a Thai Health Professional Alliance against Tobacco, with 17 allies from medical, nursing, traditional medicine, and other health professional organizations, is working in a concerted manner toward promoting tobacco control. Indian Dental Association intervention is another good example.

Herbo-mineral supplementation in men with idiopathic oligoasthenoteratospermia : A double blind randomized placebo-controlled trial.

INTRODUCTION: There is insufficient scientific data on the medical management options for idiopathic oligoasthenoteratospermia (iOATs). We conducted a double blind, randomized, placebo-controlled trial to assess the efficacy and safety of the herbo-mineral supplement, Addyzoa(®), in infertile men with iOATs. We also evaluated its effect on semen reactive oxygen species (ROS) levels, total antioxidant capacity (TAC) and DNA fragmentation index. MATERIALS AND METHODS: Fifty infertile men with iOATS were recruited into an institutional ethics committee approved protocol from April to August 2009. Randomization was done using numbered, identical containers. Baseline semen samples were evaluated for routine parameters, ROS level, DNA fragmentation index and TAC. Drug/placebo was administered at a dose of two capsules twice a day for 3 months. All parameters were reassessed at 3 months and clinical side-effects were recorded. The study was registered with the Clinical Trials Registry of India and is available at www.ctri.in as study protocol number CTRI/2009/091/000551. RESULTS: Forty-four subjects completed the study, 21 in the drug arm and 23 in the placebo arm. There was no difference in baseline parameters between the two groups. Men in the drug group had significant improvement in mean total motility from 23.2 ± 17.3% to 33.4 ± 23.2% (P-value: 0.008) and mean progressive (Type A+B) motility from 15.7 ± 12.6% to 22.6 ± 18.0% (P-value: 0.024). ROS, TAC and DFI did not change significantly in either group and did not show any correlation with other semen parameters. CONCLUSIONS: Treatment with Addyzoa resulted in a significant improvement in total and progressive motility in the semen of men with iOATs after 3 months of therapy. There was no change in the sperm concentration, ROS, DFI or TAC levels.

Anti-diabetic activity of flowers of Hibiscus rosasinensis.

The ethanol extract of flowers of Hibiscus rosasinensis at doses of 250 mg/kg and 500 mg/kg significantly reduced the blood glucose level in both acute (1, 3, 5 h) and sub acute (1, 3, 5, 7 days) treatments.

Mother and child service coverage: reproductive and child health programme in Alwar district, Rajasthan state.

Present study was conducted to assess the child immunization coverage and availability of safe motherhood intervention services for expecting mothers under RCH programme in Alwar district. WHO-30 cluster sampling method was used and 26 rural and 4 urban clusters were surveyed. Fully immunized children were more in urban areas (82.1%) as compared to rural (45.1%) areas. The immunization coverage was more or less similar in both sexes. BCG and Measles coverage was also higher i.e. 89.3% and 85.7% in urban areas than 69.61%, and 52.2% in rural respectively. High drop out rate was found for DPT (25.3%) and OPV (23.2%) in rural areas as compare to urban (7.70/ each). Failure of immunization in rural areas was mainly due to unawareness of need for immunization (35.4%), mother too busy in 16.8%, place and time not known in 9.7%, place for immunization too far 8.8% and 7.1% each for unaware of need to return for subsequent doses, fear of side reactions and vaccinator absent. TT immunization coverage was mainly through Government source and two third of the mothers were immunized in both urban and rural areas. 71.4% of urban and 36.1% of the rural mothers received ANC >=3. However the iron folic acid supplementation was similar in urban and rural areas. Place of delivery was mainly hospital in urban areas (71.4%) and were home (61.7%) in rural areas. Hospital staff (Govt. or pvt.) conducted 82.1% of the deliveries in urban areas as compared to 58.5% in rural. The ANM/ Health staff (56.4%) and family members (27.0%) were main source of information for mother for the need of mother and child immunization.

Antihyperglycemic activity of Caralluma attenuata.

Extracts of Caralluma attenuata are screened for their antihyperglycemic activity. Ethanol, chloroform and butanol extracts were tested on glucose loaded and alloxan-induced diabetic rats. In both tests, the butanol extract, at the oral dose of 250 mg/kg, has shown statistically significant and considerable antihyperglycemic activity.

Antinociceptive activity of Malvastrum coromandelinum.

The aerial parts of Malvastrum coromandelinum showed antinociceptive activity in the 0.6% acetic acid-induced writhing test in mice, the effects of acetone extract (200 mg/kg, p.o.) being comparable with acetylsalicylic acid (100 mg/kg, p.o.)

Antinociceptive and anti-inflammatory activity of Sida rhomboidea leaves.

Various organic extracts of Sida rhomboidea leaves were studied for antinociceptive and anti-inflammatory activity at a dose of 200 mg/kg. Ethyl acetate extract has shown significant (P < 0.01) antinociceptive activity. Percentage inhibition of edema by butanolic extract (33.05, P < 0.001) is comparable to that of phenylbutazone, 100 mg/kg inhibition (38.83%). Phytochemical screening of the extracts indicated the presence of alkaloids, steroids and/or triterpenoids and their glycosides, tannins, flavonoids and their glycosides, carbohydrates and absence of cardiac glycosides.

Anti-inflammatory activity of dodonaea viscose.

Dodonaea viscose, Linn is a widely grown plant of Nilgiris district of Tamil and is commonly used by the tribals of Nilgiris as a traditional medicine for done fracture and joint sprains. Since it is generally believed tat fractures are accompanied by either some degree of injury or inflammations, it was felt desirable to carry our anti inflammatory activity of Dodonaea viscose. Anti-inflammatory activity of the plant was carried out by carrageenin induced paw edema method in Wister albino rats.

A study of structure of phenomenology of consciousness in meditative and non-meditative states.

Twelve senior Kundalini (Chakra) meditators were assessed during meditation session and non-meditation or control session using Phenomenology of Consciousness Inventory. The data has been analyzed using structural analysis to measure the altered state of consciousness and the identity state by comparing meditative state with non-meditative state. The structural analysis of pattern of consciousness during the meditative state revealed altered experience in perception (percentile rank PR = 90), meaning (PR = 82) and time sense (PR = 87), while positive affect dimension showed increased joy (PR = 73) and love (PR = 67). The imagery vividness (PR = 72), self-awareness (PR = 77), rationality (PR = 73) and arousal (PR = 69) were found to be structurally different from the ordinary state. With regards to identity state meditative experience was found to produce statistically significant changes in terms of intensity in meaning (P < 0.05), time sense (P < 0.05), joy (P < 0.05), love (P < 0.05) and state of awareness (P < 0.01). Our results indicate that long term practice of meditation appears to produce structural as well as intensity changes in phenomenological experiences of consciousness.

Alteration of pulse configuration affects the pain response during diode laser photocoagulation.

BACKGROUND AND OBJECTIVE: The shape of the treatment pulse of the diode laser (810 nm) can be easily altered electronically in contrast to ion laser photocoagulators. We investigated whether changes in laser pulse shape influenced the subjective pain responses in patients undergoing retinal photocoagulation when only topical anesthesia was used. STUDY DESIGN/MATERIALS AND METHODS: Twenty consecutive patients required peripheral retinal photocoagulation for proliferative diabetic retinopathy or extensive retinal breaks. Three diode pulse waveforms including a square wave, shaped-wave, and an envelope of micropulses were compared to one another. Power was adjusted so that each waveform delivered the same total energy. The patients subjectively ranked the intensity of any pain they experienced for each group of lesions. Responses were compared to one another using an analysis of variance. RESULTS: 40% of patients found the standard square wave pulse to be significantly more painful (P < 0.05) than the shaped pulse mode and 30% found the square wave significantly more painful (P < 0.05) than the micropulse mode. CONCLUSION: Modification of the laser pulse waveform may ameliorate pain induced by diode laser photocoagulation of the retinal periphery.

Neuroaxonal dystrophy at birth with hypertonicity and basal ganglia mineralization.

A full-term male infant exhibited rigidity of all extremities with hyperreflexia beginning soon after birth and lasting until his death at age 6 months. Head circumference remained at the 25th to 50th percentile. Distinct sleep-wake cycles and responsiveness to visual, auditory, and tactile stimuli developed. Metabolic studies, skin biopsy, electroencephalography, and electromyography produced normal results. Head computed tomographic and magnetic resonance imaging scans revealed mineralization of the basal ganglia and thalamus. Muscle and nerve biopsy results were consistent with axonal dystrophy. Autopsy showed widespread neuronal loss, with reactive gliosis, marked in the globus pallidus and brainstem reticulate core; spheroids in globus pallidus, nucleus cuneatus, and upper cervical cord; and mineralized neurons in the inner division of globus pallidus and thalamus. Neonatal hypertonia, rapid progression, and mineralization of the basal ganglia are unusual features of neuroaxonal dystrophy exhibited in this case.

Alterations of auditory middle latency evoked potentials during yogic consciously regulated breathing and attentive state of mind.

Middle latency auditory-evoked potentials (AEP-MLRs) of 10 healthy male subjects in the age range of 21-33 years, were assessed to determine whether yogic pranayamic practice would cause changes in them. The pranayama type assessed here is an exercise of consciously-controlled rhythmic breathing involving timed breath-holding in each cycle of breathing, while the subject holds utmost attention and experiences the touch of inhaled air in the nasal passage. The results revealed that the Na-wave amplitude increased and latency decreased during the period of pranayamic practice, whereas the Pa-wave was not significantly altered. The change is interpreted as an indication of a generalized alteration cause in information processing at the primary thalamo-cortical level during the concentrated mental exercise of inducing modifications in neural mechanisms regulating a different functional system (respiratory). Further researches are required to understand the operational significances of such changes.