Hydroxychloroquine pre-exposure prophylaxis provides no protection against COVID-19 among health care workers: a cross-sectional study in a tertiary care hospital in North India.

OBJECTIVES: The use of Hydroxychloroquine (HCQ) prophylaxis has been recommended by the National task force constituted by the Indian Council of Medical Research (ICMR) for the prevention of corona virus disease 2019 (COVID-19) among healthcare workers (HCWs). However, this recommendation was based essentially on the preclinical data and limited clinical experience. The aim of this study was to evaluate the efficacy and safety of HCQ as a pre-exposure prophylaxis for COVID-19 infection among Indian HCWs. METHODS: A cross-sectional study was conducted among HCWs of a tertiary care hospital in north India. The HCQ prophylaxis was initiated among 996 HCWs and they were followed up to 8 weeks for conversion to COVID-19 positive status and any adverse drug reaction (ADR). RESULTS: About 10.3% of the study participants were tested positive for COVID-19 which was comparable to the positivity rate among HCWs not taking HCQ prophylaxis (9.7%). CONCLUSIONS: HCQ was well tolerated at a weekly dose of 400 mg for 8 weeks but provided no additional benefit in prevention of COVID-19 among HCWs.

Role of Cytochrome Modulators in Altering the Occurrence of Cataract in Rats.

BACKGROUND: Cataract is one of the primary causes of blindness all over the world. It indicates the onset of secondary complications of diabetes. The only treatment available is surgery as there are no satisfactory drugs which can prevent or retard the initiation and maturation of cataract. It was hypothesized that cytochrome P 450 (CYP) inducers or inhibitors can modify the cataract occurrence by accelerating or delaying the occurrence of cataract respectively. OBJECTIVE: To study the effect of two commonly used drugs, phenytoin (CYP inducer) and ciprofloxacin (CYP inhibitor) on the initiation and maturation of cataract with the galactose- induced cataract model. MATERIALS AND METHODS: The experiment was conducted in 24 new born male Wistar rats. Cataract formation was induced with a 50% galactose diet. The rats were randomized into four groups of 6 rats each: Group 1 rats received a normal diet; Group 2, 3 and 4 rats received 50% galactose diet day 23 onwards. In addition, Group 3 rats were pre-treated with ciprofloxacin (20mg/kg) and Group 4 rats were pre-treated with phenytoin (50mg/kg) day 18 onwards once a day orally. The appearance of cataract was checked daily with an ophthalmoscope. The maturation pattern was examined using Fundus Fluorsen Angiographer (FFA). The cataract was graded according to Sippel's classification. The experimental and control groups were compared by chi square test and the results were considered significant at p< 0.05. RESULTS: The initiation of cataract was significantly delayed with ciprofloxacin as compared to galactose; however, there was no difference in the maturation pattern of cataract in both the groups. In spite of being a CYP inducer, the initiation of cataract was not accelerated in phenytoin group. Rather, it was significantly delayed and the cataract did not progress to stage 5 even on 30(th) day of galactose administration. CONCLUSION: CYP450 modulators have a significant effect on the initiation of cataract without significantly altering the maturation pattern. It is not reasonable to extrapolate the results of one enzyme inhibitor or inducer to other CYP modulators. Hence, further studies are needed to identify the pharmacological profile of various CYP modulators on the occurrence of cataractogenesis.

Stroke outcome after domiciliary use of opioids in the peri-stroke period.

BACKGROUND: Stroke affects large number of people worldwide resulting in disability. The people in the northern region of India follow some domiciliary practices, which include administration of opioids at the onset of stroke to retard its progression. AIM: To study the effect of opioids on the outcome and severity of stroke when used as domiciliary treatment in peri-stroke period. MATERIALS AND METHODS: A prospective, observational study on stroke patients was carried out in Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India from March 2012 to March 2013. Data were collected in a semi-structured proforma. The variables which were studied included socio-demographic characteristics such as age, gender, religion, socio-economic status, and place of inhabitation. The time of opioid administration, approximate amount administered, frequency of administration, duration of hospital stay, risk factors and co-morbid conditions were also studied. The stroke severity was analyzed by comparing National Institutes of Health Stroke Scale (NIHSS) score and outcome by comparing Modified Rankin Scale (MRS) score in both the groups at the time of admission and at the time of discharge. RESULTS: Out of n = 100 recruited patients, n = 44 (Group A) reported opioid intake in the peri-stroke period and n = 56 (Group B) did not. Proportions of patients from rural areas were 61.4% in Group A and 37.5% in Group B. Mean age in groups A and B was 63 ± 9.15 and 59.8 ± 13.87 years, respectively; in these groups male proportions were 70.5% and 60.7%, respectively. At admission, mean NIHSS scores in Groups A and B were 10.0 ± 4.48 and 10.8 ± 4.51, respectively; on discharge, these scores were 6.3 ± 3.83 and 7.7 ± 3.79, respectively. At admission, mean MRS scores in Groups A and B were 3.7 ± 1.14 and 3.8 ± 1.32, respectively; upon discharge, these scores were 2.8 ± 1.18, 3.1 ± 1.23 respectively. CONCLUSION: In this cohort, we found that the domiciliary practice of opioids administration in the peri-stroke period is more common among the elderly and in the rural areas. There was no statistically significant difference in the mean NIHSS and MRS scores at admission as well as discharge implying that the opioid administration did not improve outcome or decrease the severity of the stroke. Our findings are robust enough to propose a larger sample size and follow-up in future studies to definitively ascertain the effect of opioids as pretreatment in stroke patients.