Jigsaw Classroom: Perceptions of Students and Teachers.

Background: Various innovative teaching methods have been designed in an attempt to provide millennial students an interactive and stimulating learning environment. A jigsaw method is one such form of cooperative learning that enables students to develop critical-thinking and ability for effective communication and promotes positive student attitudes toward their own learning. The present study was thus undertaken to introduce a jigsaw-based cooperative learning method and to understand the perception of the students and faculty. Methodology: This was a cross-sectional study conducted among second year MBBS students. Students were randomly divided into 10 parent groups, with 10 students each. The topic was divided into 10 subtopics. Each student in the parent group was allotted a sub-topic. The students who were given the same sub-topic assembled to form an expert group. They interacted and discussed the subtopic. Students finally returned to their parent groups for peer teaching and presentation. A validated questionnaire was used to gather students and faculty feedback. Descriptive statistics were used to analyze responses to the Likert scale questions. Qualitative data was analyzed using thematic analysis. Results: The present study included 95 s year MBBS students. Majority (81%) students agreed that this teaching learning method enhanced their communication skills. Seventy-five percent of the students agreed that the activity helped in overcoming shyness and hesitation in the class. Overall the faculty also agreed that the jigsaw method was helpful for the students. Conclusions: Cooperative learning like jigsaw facilitates learning allowing student-student discussion, improving communication and teaching skills.

Short-Term Effect of Spiritual Music on Heart Rate Variability in Medical Students: A Single-Group Experimental Study.

BACKGROUND: There are ancient texts and modern studies alluding to the therapeutic benefits obtained from listening to music. Studies have shown that chanting "OM" has a relaxing effect by causing parasympathetic dominance, limbic deactivation, and decreasing the brain's dopamine levels. This research aims to study the effect of listening to OM chanting on the cardiovascular system and heart rate variability and its possible use as a stress buster among medical students. MATERIALS AND METHODS: Fifty medical undergraduates were selected for the study. After a 20-minute relaxation, a lead 2 electrocardiogram (EKG) was recorded for 10 minutes. Their blood pressure (BP) and heart rate were measured. The subjects were then made to listen to OM chanting for 20 minutes, immediately after which their BP and heart rate were measured. This was followed by another 10-minute lead 2 EKG. The EKGs recorded were then used to calculate the standard deviation in N-N interval (SDNN), total power, high-frequency power, and low-frequency power. RESULTS: The study reported a significant decrease in blood pressure and heart rate and a significant increase in SDNN and total power. There was also an insignificant increase in low frequency and an insignificant decrease in high frequency. CONCLUSION:  This study provides insight into the importance of spiritual music therapy in the maintenance of mental as well as cardiovascular health among medical students.

Applicability of Concept Maps to Assess Higher Order Thinking in the Context of Indian Medical Education: An Analytical Study in the Subject of Physiology.

Introduction: Concept mapping is a multidimensional tool that has been put to little use in India. We designed this study to check its applicability for assessing higher-order thinking in the subject of Physiology. Methods: This interventional analytical study was carried out among 65 students of Phase I of MBBS in the year 2021. The students were sensitized to the technique and were given a practice session. On a pre-informed date, an assessment of a topic taught to them was done using concept mapping and a multiple-choice question (MCQ) based test. Feedback on the technique was taken from the students. The statistical tests used were test of normality - Kolmogorov-Smirnov Test, significance of association - Wilcoxon Signed Rank test, correlation - Spearman's correlation, and agreement - Bland Altman Analysis. The discrimination index was calculated for both concept mapping and MCQ based tests, separately. Percentages were calculated for feedback questionnaire items. The data were analysed using Microsoft Excel (2019) and an online calculator. P-values <0.05 were considered statistically significant. Results: Students scored more in concept mapping. There was a significant difference in the scores of the students on the two tests (Wilcoxon Signed-Rank test, Z=-2.66, p=0.008) and a weakly positive non-significant correlation between them (Spearman's correlation coefficient, rs=0.07 p=0.60). Bland Altman's Analysis showed agreement in the scores of the students in the two tests. The mean score of the students in the two tests increased, so did the difference in the scores in the two tests. The discrimination index of concept mapping (0.28) was higher than that of the MCQ-based test (0.18). Most of the students agreed on the advantages of concept mapping in the feedback. Conclusion: The assessment result of concept mapping is better than that of MCQ-based test and it may be included as a teaching-learning and assessment strategy in the context of Indian medical education in the subject of Physiology.

Adverse Drug Reactions in Corona Virus Disease Patients Admitted to Intensive Care Unit: An Observational Study.

BACKGROUND: Occurrence of adverse drug reactions (ADRs) in COVID-19 patients has not been extensively studied. AIM: The present study was conducted to analyze the pattern of suspected ADRs in the COVID-19 Intensive Care Unit (ICU). METHODS: In this cross-sectional study, all the individual case study reports of patients admitted to the COVID ICU (August-October 2020) were analyzed for type of ADRs, system involved, suspected drug, onset time, time to revert and management. RESULTS: Thirty six patients (out of 395 patients admitted) experienced 44 ADRs. Dermatological manifestations were the most frequent ADRs. Remdesivir was the most common drug associated with ADRs. The female gender, polypharmacy (>5 drugs) and presence of comorbidities were the independent risk factors for the occurrence of ADRs. CONCLUSION: Use of many of these drugs in COVID-19 is experimental and the literature does not guarantee their safety and efficacy. During these times of uncertainty, the results from the present study reinforce the importance of monitoring patients.

Development of a structured validated module to inculcate research skills in medical undergraduates.

Background Evidence-based research aids in decision-making in the health sector for developing health policies for prevention, diagnosis and treatment of diseases. Medical research is not taught in the undergraduate curriculum. Studies show that attributes of research knowledge, awareness and practical involvement in research are low among undergraduate students. We developed and validated a module and trained undergraduate students in research skills through an inter-ventional workshop using the structured module. Methods We did this participatory action research with a mixed-methods approach in the Department of Community Medicine at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab. A structured module was developed by the core committee and validated internally and externally. Pilot testing of the module was done by delivering it in the form of a workshop to 46 students. For statistical analysis, percentage agreements, validity indices, median (interquartile range), satisfaction percentages and Wilcoxon sign test were used. Results The structured and validated module was established to have high face validity (>90%) and content validity (CVI=0.975). The module was successfully pilot tested for delivery through both onsite and online modes. The satisfaction percentage with the workshop was 91% and 100% and overall rating of the module was 74% and 91% by interns and MBBS students, and 100% by faculty. The scores of knowledge and skills were found to be significantly higher on all variables post workshop with p<0.001. All students scored satisfactory grades for research skills. Conclusions Teaching research using a structured validated module improved the knowledge and skills related to research among students. Both students and faculty were satisfied with the use of the structured module.

Assessment of the psychological impact of COVID-19 pandemic on undergraduate medical students in India.

BACKGROUND: Medical students who are prone to psychological stress due to their overburdened curriculum, are at an increased risk of getting adversely affected by the pandemic. The present study was planned to assess the anxiety level among undergraduate medical students across the country using generalized anxiety disorder scale (GAD-7). MATERIALS AND METHODS: In this online survey, anonymous data was collected through Google forms from undergraduate students from all the phases of MBBS course across the country from August 15, 2020, to October 15, 2020. Section I collected various demographic information, section II included GAD-7 questionnaire for assessing anxiety and section III had open- ended questions about their impending fear, uncertainties, and apprehensions. The data was expressed in percentage and association among the variables was determined using Chi-square test. Thematic analysis of the open-ended responses was done. RESULTS: Among the sample of 1208 students, 81% were from urban areas. During the pandemic, 77% were residing with their parents and 71% parents having stable jobs. Eighty percent students had no relative diagnosed with COVID-19, whereas 52% students had family members with comorbidity. The GAP score showed mild, moderate, and severe anxiety in 27, 24, and 16% students, respectively. Anxiety was significantly associated with rural setting and with COVID-19 positive or comorbid family member (P < 0.05). Open ended responses revealed that majority of the students were finding it difficult to cope with the academic stress at home but still did not want to join back. CONCLUSION: With such a high incidence of anxiety among medical students, it is pertinent to safeguard the mental health and implement efficient approaches to upkeep the scholastic, physical, emotional, and professional well-being of medical students during such vulnerable times.

Implementation of Self-Directed Learning in Physiology for Phase 1 Undergraduate Medical Students.

Background: One of the primary roles played by Indian medical graduates is that of a lifelong learner. To this end, students must acquire the habit of self-directed learning (SDL). Lack of SDL skills among undergraduate medical students is a concern; hence, this study was designed to introduce SDL in physiology to phase 1 undergraduate medical students and assess its effectiveness through student and faculty perceptions. Methods: The project commenced after obtaining clearance from the institutional ethics committee. The faculty members and students were sensitized on SDL. A feedback questionnaire was framed and the topics for SDL were selected. SDL was implemented for six topics. The effectiveness of the sessions was evaluated by administering the feedback questionnaire to the students and recording perceptions of the students and faculty on SDL. The data were subjected to quantitative and qualitative analysis. Results: A total of 96 phase 1 students participated in the study. A majority of the students felt that after SDL sessions, they were more prepared and aware of their learning strengths and had started taking ownership of their learning. However, some students felt that the activity was not useful in improving their analytical skills. Both the students and the faculty were fairly satisfied with this teaching learning innovation. Conclusions: SDL was successfully implemented for phase 1 medical students. Both the students and faculty were satisfied with the SDL strategy. SDL has been shown to make students independent learners who are aware of their learning goals and capable of evaluating their learning.

Chimeric antigen receptor T cell: A cancer immunotherapy.

During present decade, targeted drug therapy has been the epitome for treatment of cancer. Drugs like Imatinib, a tyrosine kinase receptor inhibitor and Trastuzumab, an human epidermal growth factor receptor-2/neu inhibitor, has been developed and accepted widely for management of chronic myeloid leukaemia and breast cancer respectively. Recent development among the various immunotherapies is adoptive cell transfer (ACT). Research on development of various types of ACT immunotherapy is going on, but so far, Chimeric antigen receptors T cell therapy (CAR-T) has achieved the maximum advancement in terms of clinical development. CARs are the modified receptors that integrates specificity and responsiveness onto immune cells to enhance the recognition of cancer cells. For the CAR-T, the T cells are sequestered from a blood of a participant via apheresis. DNA of particular antigen is injected into harvested T cells to generate CARs on cell surface. Following surface manifestation of receptors, multiplication is carried out in enriched media followed by infusion into patient. After infusion, CAR-T cells targeted and exterminate the cancer cells. Initially, only two drugs targeting CD19 as genetically modified autologous immunotherapy has been approved in CAR-T therapy i.e., Tisagenlecleucel and Axicabtagene Ciloleucel, which are discussed in detail in current review. Recently two more drugs got approval i.e., brexucabtagene ciloleucel and lisocabtagene maraleucel, both are directed against CD19, similar to tisagenlecleucel. CAR-T cell therapy is approved for management of Acute Lymphoblastic Leukaemia, Chronic Lymphocytic Leukaemia and lymphoma. CAR-T cell persistence responsible for effectiveness and safety concerns are barriers for their wide application among patients. Growth factor receptors and cluster of differentiation are new drugs targets that are being explored as effective immunotherapy against cancers.

Variations in Pulmonary Fissure: A Source of Collateral Ventilation and Its Clinical Significance.

INTRODUCTION: Oblique and horizontal fissures divide the lungs into lobes. Assessing the incompleteness or absence of fissures is important when planning any surgical procedure in this region. This study aimed to investigate the incidence of variations in the fissures and their implication in clinical practice. METHODS: The sample consists of 70 formalin-fixed lungs (32 right and 38 left lungs). These lungs were assessed for complete, incomplete, and absent fissures and any variations in the fissures on the sternocostal and mediastinal surfaces. RESULTS: Oblique fissure was incomplete on the sternocostal surface in 18.75% and 21% and on the mediastinal surface in 25% and 21% on the right and left lungs, respectively. Additionally, it was absent in 10.5% of the left lung samples. The horizontal fissure was incomplete in 12.5% on both surfaces and was absent in 25% on the right lung samples, of which 50% had no oblique fissure. No accessory fissure was seen in any of the lungs. CONCLUSION: Incomplete and absent fissures can be observed in the right as well as the left lung, suggesting the source of collateral ventilation. This study imparts important information to pulmonologists doing bronchoscopic lung volume reduction therapy or bronchopulmonary segment resection and also to radiologists and anatomists.

Hydroxychloroquine: Adverse Drug Reaction Profile of an Old Drug in a New Situation.

BACKGROUND: Hydroxychloroquine (HCQ) has been extensively used during the COVID-19 pandemic both as a therapeutic and prophylactic drug. HCQ is generally well tolerated; however, adverse drug reactions (ADRs) in COVID-19 need further exploration. In this study, we have determined the type and pattern of ADRs of HCQ as a prophylactic and therapeutic drug in COVID-19. METHODS: All spontaneous suspected ADR reports due to HCQ in COVID-19 patients submitted to the ADR monitoring of a tertiary care hospital were included. Additionally, a survey was designed for active surveillance of ADRs among healthcare professionals (HCPs) who were on prophylaxis with HCQ. The ADRs were analyzed to determine severity, causality, and preventability using the Hartwig Scale, World Health Organisation-Uppasala Monitoring Centre (WHO-UMC) scale, and modified Schumock and Thornton criterion respectively. RESULTS: Sixty-four ADR reports were received from COVID-19 patients. A total of 78 ADRs were reported by 49 HCPs who were on HCQ prophylaxis. The majority of the patients had ADRs related to skin and soft tissues (37.5%), whereas the HCPs on prophylaxis mostly had gastrointestinal complaints (42.3%). ADRs observed in HCPs on prophylaxis were mild, not requiring any intervention. However, 50% of ADRs in patients were of "moderate" category. CONCLUSION: Undiscerning and unsupervised use of HCQ can expose the general population as well as patients to serious adverse drug effects. Utmost care is necessary before using HCQ prophylactically or for treatment in COVID-19.

Effect of Resonance Breathing on Heart Rate Variability and Cognitive Functions in Young Adults: A Randomised Controlled Study.

INTRODUCTION: Heart rate variability (HRV) is an important physiological biomarker of wellbeing, mood, and adaptation, and hence improvements in HRV signify improved health, mood, and adaptation to stress. Resonance breathing has consistently been shown to increase HRV, mood, and adaptability. The study investigated the effects of four-week training of resonance breathing in young adults on HRV, stress, and cognition functions. METHODS: The randomized controlled study was conducted on young men (18-30 years) after obtaining Institutional Ethics Committee approval and written informed consent from the participants. Participants were randomly divided into two groups: the control group and the resonance breathing (RB) group. Baseline parameters, along with heart rate variability, trail tests for cognition, and perceived stress level, were assessed in both groups. After undergoing four weeks of training, the intervention group practiced deep breathing at the resonance frequency for 20 minutes per day for four weeks, whereas the control group did not. All parameters were recorded again after four weeks of resonance breathing. RESULTS: No difference was observed in the HRV parameters in the control group at baseline and four weeks after the baseline recording (p>0.05). In the intervention group, there was a significant improvement in the HRV parameters, the standard deviation of the normal-to-normal interval (SDNN), the proportion derived by dividing NN50 by the total number of NN intervals (pNN50), and total power, after practicing four weeks of resonance breathing (p<0.05). A significant difference in these parameters was also observed in the control and intervention groups after four weeks (p<0.05). There was a significant improvement in the Trails A and B test performance in the intervention group after practicing for four weeks of RB. Similarly, the perceived stress score decreased significantly in the RB group in comparison to its baseline value as well as the control group value.  Conclusion: Increased parasympathetic and decreased sympathetic activity were observed after practicing 20 minutes of resonance frequency breathing every day for four weeks. It also improved cognition and reduced perceived stress levels among young adults. It is recommended that young adults should practice deep breathing at the resonance frequency for a few minutes every day. This would allay anxiety and stress, improve their cognitive performance, and also reduce their cardiovascular morbidity.

Cardiac Autonomic Modulation and Anti-Thyroid Peroxidase (TPO) Antibodies in Subclinical Hypothyroidism: Does a Correlation Exist?

BACKGROUND: Heart rate variability (HRV) reflects the balance between the sympathetic and parasympathetic divisions of the autonomic nervous system. Anti-thyroid antibodies like anti-TPO and anti-Thyroglobulin have long been associated with thyroid dysfunction and abnormal thyroid profile testing. Subclinical hypothyroidism (SCHypo) is characterized by elevated thyroid-stimulating hormone (TSH) with normal thyroid hormones. We hypothesize that autonomic function may be deranged in anti-TPO positive sub-clinical hypothyroid cases, even before the onset of overt hypothyroidism. OBJECTIVES: To investigate the association between anti-Thyroid Peroxidase antibodies (anti-TPOAb) positive SCHypo and sympathovagal imbalance (SVI), if any. METHODOLOGY: The study was conducted on the age and body mass index (BMI) matched subclinical hypothyroid patients (n=52) and healthy controls (n=20). The cardiac autonomic activity was assessed by short-term HRV in the time (SDNN, RMSSD, pNN50) and frequency domains (LFms2, HFms2, LFnu, HFnu, TP, and LF/HF ratio). Nonlinear geometric measures (SD1, SD2, SD1/SD2, TINN, HRV triangular index) were also evaluated. Biochemical evaluation of serum thyroid profile and anti-TPOAb was done in all the subjects. RESULTS: Decreased HRV was observed in the anti-TPOAb positive group when compared to the antibody-negative and control groups. Significant positive correlation of anti-TPOAb with TSH, LFnu, LF/HF and negative correlation with SDNN, RMSSD, pNN50, SD1, SD1/SD2, HFnu, and TP of HRV was observed. CONCLUSION: Anti-TPOAb positive SCHypo group exhibited modifications in HRV characterized by decreased parasympathetic modulation, as compared to controls. The findings were also suggestive of increased risk of autonomic dysfunction in TPOAb-positive patients, as compared to antibody negative. An increase in anti-TPO antibodies was significantly correlated with TSH and SVI in SCHypo patients.

Prevalence of self-reported anxiety and self-medication among upper and middle socioeconomic strata amidst COVID-19 pandemic.

BACKGROUND: Amidst corona virus disease-2019 (COVID-19) pandemic, disruption to the usual ways of life can lead to anxiety and feeling of being unsafe, which may be associated with self-medication. The study was planned to investigate the prevalence of anxiety and self-medication during COVID-19 pandemic. MATERIALS AND METHODS: In this cross-sectional study, data were collected through an anonymous online survey with questionnaire consisting of four sections: demographic data of the participants, validated COVID-19 Anxiety Inventory Items, Self-rating Anxiety Scale, and self-medication practices during COVID-19 pandemic. The data were organized and analyzed using Windows Microsoft excel and SPSS software (Version 21). Descriptive statistics were calculated for all patient characteristics and survey responses. Analytical analysis included relationship between various parameters using Chi-square test. RESULTS: A total of 1100 responses were received. Approximately half of the participants were worried about getting severely ill. Majority reported reduced social contact (71.3%, n = 784) and also communicated that the pandemic has influenced their use of safety measures (86.5%, n = 951). The prevalence of mild-to-moderate, moderate-to severe, and extremely severe anxiety cases were 23.1%, 4.7%, and 0.54%, respectively. One-fourth of the responders reported self-medication, out of which 60% were found to be anxious. Nonsteroidal anti-inflammatory drugs were most commonly used. CONCLUSIONS: Rising to the present challenge will require integration across different sectors with the immediate aim of getting people safely through the pandemic. As the world focuses on containing and delaying the spread of the COVID-19, with burdened health-care systems, we should not miss out on people with anxiety disorders and self-medication problem, which may worsen with the pandemic.

Pharmacological Strategies for COVID-19 - A Review of the Most Promising Repurposed Antiviral Drugs.

A novel coronavirus, SARS- CoV-2 (2019-nCoV), emerged in December 2019 as an immediate global challenge. Comprehensive efforts at the present time are focused simultaneously on containing the spread of this virus and extenuating the ill effects. There is an immediate need for drugs that can help before a vaccine can be developed. Researchers are endeavoring to find antiviral therapies specific to the virus. As the condition is an emerging, rapidly evolving situation and development of new drugs is a long process, and is unfeasible to face the immediate global challenge. Strategy to reposition the previously used drugs can prove to be effective to combat this difficult to treat pandemic. Several drugs such as Hydroxychloroquine, Umifenovir, Remdesivir, Lopinavir/ Ritonavir, interferon, Darunavir, Favipiravir, Nitazoxanide, etc. are currently undergoing clinical studies to test the safety and efficacy of the drug against this pandemic. The present review gives a snapshot look at the current clinical experience with repurposed antiviral drugs.

Self-directed learning: assessment of students' abilities and their perspective.

The introduction of Competency-Based Medical Education Curriculum in India has endorsed many new concepts, like foundation course, self-directed learning (SDL), early clinical exposure, etc. Emphasis is being given to active teaching-learning approaches. One such approach is SDL. SDL is an active learning approach in which the students are responsible for their own learning outcome, with teacher acting as a facilitator of learning. A medical graduate, being a lifelong learner, should inculcate the habit of SDL. In the present study, the SDL abilities of first year Bachelor of Medicine, Bachelor of Surgery students were assessed using a questionnaire. Based on their experience, students were also asked about the prerequisites of SDL, how it can be promoted, and their expectations from the teachers. Students scored high in most of the SDL skills. However, they felt they need improvement in time management. Furthermore, the students are required to develop their interpersonal communication skills, and they also find it difficult to express messages effectively in oral presentations. Most of the students felt they need help in finding the correct learning resources. According to them, the students should be focused, motivated and stress-free, have time management skills, and be able to search learning resources for successful implementation of SDL. They felt that events that encourage active participation by students, if organized at regular intervals, could promote SDL. Some felt that evaluation of SDL would motivate them to take it seriously. According to the students, teacher should act as a facilitator, a mentor, as well as an evaluator.

Screening asymptomatic school children for early asthma by determining airway narrowing through peak expiratory flow rate measurement.

BACKGROUND: Peak expiratory flow rate (PEFR) is widely used as a predictor of treatment of asthma patients. Peak expiratory flow and forced expiratory volume in first second (FEV1) are the most useful parameters for the diagnosis of asthma. Spirometry is not often available in the primary care setting, and economic factors may limit its testing. Mild airway narrowing may be present in asymptomatic children, which can be identified by determining their PEFR. This will enable us to initiate early treatment. MATERIALS AND METHODS: We selected 200 asymptomatic children at the age of 10-15 years without a history of smoking, tuberculosis, or other respiratory illness. A family history about asthmatic symptoms was sought. PEFR values of all children were recorded, and 40 children showed PEFR values less than 80% of their predicted values. To confirm whether the low observed values were because of airway obstruction, their spirometry was performed. RESULTS: Nine out of 47 (19.14%) children from asthmatic families and 31 out of 153 (20.26%) from nonasthmatic families showed PEFR values <80% of the predicted value (P > 0.05). Considering a decrease in the FEV1/forced vital capacity (FVC) ratio to <80% for the diagnosis of obstructive disease, only two out of 35 children were found to have it. Correlation between PEFR and FEV1/FVC ratio was not significant (r = 0.314 and P = 0.065). CONCLUSIONS: Asymptomatic children with low PEFR values may not show abnormal lung functions on spirometry. However, these children, particularly those having the risk of family history of asthma, may be followed for the development of airway obstruction.

Sofosbuvir: Really Meets the Unmet Needs for Hepatitis C Treatment?

Chronic hepatitis C remains a major public health concern with a prevalence of more than 1% worldwide. Of late, with the discovery of newer drugs, chronic HCV treatment has touched new dimensions. The treatment has progressed from Interferons to Pegylated interferon (Peg IFN) based therapy, with or without ribavirin to treatment with orally active Direct Acting Antivirals (DAA) with Peg IFN and ribavirin and eventually to various combinations of DAA, without IFN. Introduction of newer DAAs has transfigured the treatment of chronic HCV. Chronic HCV patients with advanced liver disease, psychiatric condition, anemia or autoimmune diseases, not eligible for Peg IFN based therapy have a ray of hope now. Amongst all DAAs, nucleoside inhibitors have been the most promising agent. Thus the present review focuses on Sofosbuvir, one of the most effective nucleoside inhibitors; in terms of potency, resistance profile, activity against all genotypes of HCV and adverse effects. FDA approved Sofobuvir for clinical use in 2013. Chemically, it is 2'-deoxy-2'-α-fluoro-ß-Cmethyluridine- 5'-triphosphate; a phosphoramidate prodrug that is activated by enzyme present in human liver. It is a highly potent inhibitor of HCV NS5B polymerase. Efficacy of the Sofosbuvir has been established in various phase 2 and phase 3 clinical trials like PROTON, ELECTRON, FUSION, POSITRON etc. Sofosbuvir has a good safety profile with few mild to moderate adverse effects. Evidence reveals that sofosbuvir has substantial impact on the treatment of HCV.

Generalized seizure following lignocaine administration: Case report and literature review.

Local anaesthetics (LAs) are considered the most effective drugs for prevention and management of pain associated with dental procedures. Lignocaine is the most preferred LA worldwide. Adverse drug reactions reported with lignocaine use are usually mild, however severe complications have been encountered. This article reports a case of lignocaine-induced seizure in a child. We also reviewed similar cases encountered over the last 10 years. The possible explanations could be placement of the needle in a small vein or hypersensitivity to lignocaine. We hereby reinforce the fact that seemingly safe LA's can cause life-threatening complications and rapid identification of clinical symptoms can drastically change the clinical course. Hence it is vital that primary care physicians and other healthcare professionals should to be aware, alert and be able to diagnose and manage these reactions immediately.

Role of Terminalia arjuna Wight and Arn. in the treatment of chronic coronary artery disease from pharmacovigilance point of view.

BACKGROUND AND OBJECTIVES: Terminalia arjuna Wight and Arn. (Arjuna) has been used in indigenous system for the treatment of cardiac ailments since 500 BC. However, there is a lack of vigilance studies during long-term therapy. The present clinical study was planned to examine the long-term safety of Arjuna as an adjunct drug in chronic coronary artery disease (CAD) patients. MATERIALS AND METHODS: During the study period, a total of 35 patients of chronic CAD were enrolled to receive Arjuna bark extract powder (500 mg three times daily) along with conventional drugs. The control group (35 patients) received conventional drugs alone. Hemogram, liver function tests and kidney function tests were done at baseline and then every 6 months until the end of the study. Electrocardiography was done every 6 months and echocardiography was done yearly for left ventricular ejection fraction and regional wall motion abnormalities. Any adverse drug reactions reported by the patients were also recorded. RESULTS: The mean age of patients in test and control groups was 60.88 ± 9.02 and 58.51 ± 12.64 years, respectively. There was a predominance of male patients in both the groups. The patients were observed for duration ranging from 9 months to 4 years and 9 months. Other than baring gastritis and constipation, no other noteworthy adverse effects were reported. No significant difference was found in laboratory value on baseline and end of therapy in both the groups. CONCLUSION: The results of the present study concluded that Arjuna is safe and effective in patients with chronic coronary artery disease.

Linear Analysis of Autonomic Activity and Its Correlation with Creatine Kinase-MB in Overt Thyroid Dysfunctions.

Autonomic activity may be deranged in thyroid dysfunctions and may lead to cardiovascular morbidity and mortality. Myopathy is a common manifestation in thyroid disorders and may be associated with raised serum creatine kinase (CK). We hypothesized that cardiovascular abnormality in thyroid dysfunction may manifest as raised CK-MB. This study was designed to investigate the correlation of CK and its isoform CK-MB with thyroid profile and linear parameters of heart rate variability (HRV). The study was conducted on 35 hypothyroid and hyperthyroid patients each, and 25 age-matched healthy controls. Autonomic activity was assessed by simple short term 5-min HRV. Biochemical evaluation of serum thyroid profile, CK-NAC and CK-MB were estimated in all the subjects. Our results demonstrated low HRV in hypo- as well as hyperthyroid patients. We observed significantly higher serum CK levels in hypothyroid patients when compared to hyperthyroids and controls. However, no significant differences were observed in CK-MB levels in the three groups. Significant positive correlation of CK with TSH and negative correlation with some HRV parameters (LF power, HF power, total power, SDNN, RMSSD) was observed in hypothyroid patients. Whereas correlation of CK-MB with thyroid profile as well as HRV parameters was non-significant in all the groups. Based on the CK and CK-MB findings and their correlation, we conclude that the cardiovascular changes seen in thyroid dysfunctions may primarily be due to autonomic imbalance without apparent cardiac muscle involvement. Whereas, raised CK levels indicate predominantly skeletal muscle involvement in hypothyroid patients.