Association of health literacy and cognition levels with severity of adverse drug reactions in cancer patients: a South Asian experience.

Background The occurrence of adverse drug reactions with chemotherapy among cancer patients is a well-documented phenomenon. However, the understanding of contributoring factors and their influence on the severity of adverse drug reactions is incomplete without the psychosocial factors affecting them. Objective The present study was done to understand if factors like Health literacy and cognition levels have an association with the severity of adverse drug reactions of cancer chemotherapy. Setting This study was done in the Department of Medical Oncology in a tertiary care hospital in India. Method Two hundred and twenty-four patients meeting the study inclusion and exclusion criteria took part in the study. Details of adverse drug reactions were collected as per the central drugs standard control organization format and severity of adverse drug reactions assessed with National Cancer Institute common terminology criteria of adverse events, version 5.0. Health Literacy and Cognition Levels of patients were assessed using standardized questionnaires, i.e., Short test of functional health literacy in adults and short portable mental status questionnaire, respectively. Data were anonymized and analyzed using Statistical Package for Social Sciences version 16.0 software. Pearson's Chi square test (p value ≤ 0.05 was considered statistically significant) was used to study the associations. Main outcome measure The associations of Health Literacy and Cognition Levels with the severity of adverse drug reactions. Result We found that both Health Literacy and Cognition Levels had a statistically significant association with Grade 3 and above adverse drug reactions in cancer patients receiving chemotherapy. Conclusion An initial assessment of Health Literacy and Cognition Levels in cancer patients by cancer care providers can help identify patients at high risk of developing severe adverse drug reactions. Interventional measures for improving Health Literacy by healthcare providers can help reduce the overall burden of disease on the patient due to adverse drug reactions.

Effect of Gmelina arborea on learning and memory in amnesia-induced and non-amnesia groups of albino Wistar rats.

Background The brain is the centre of the nervous system in all vertebrates. The central cholinergic pathways play a prominent role in learning and memory processes. Dementia is a mental disorder characterized by the loss of intellectual ability, which invariably involves the impairment of memory. The crude extracts of the Gmelina arborea plant are reported to possess wound-healing, anti-diarrheal, anti-oxidant, anti-diabetic, and anti-ulcer property. The present study was designed to evaluate the effects of G. arborea on learning and memory in albino Wistar rats. Methods A total of 36 healthy rats were selected for the study, which were divided in to six groups. Standard screening tests such as the elevated plus maze (EPM), Morris water maze (MWM), and step-down passive avoidance (SDA) tests were used for testing the learning and memory processes. Results Gmelina arborea at higher doses (1000 mg/kg) showed statistically significant activity in EPM, MWM, and SDA tests for assessing the learning and memory paradigms when compared to the control group in amnesia-induced and non-amnesia groups of rats. Conclusions This is the first ever study to report the effects of G. arborea on learning and memory in both amnesia-induced and non-amnesia groups of rats. Our results show that G. arborea potentiates the processes of learning and memory. The observed pharmacological activities should be further evaluated by detailed experimental studies and revalidated by clinical trials.

Opportunistic infection at the start of antiretroviral therapy and baseline CD4+ count less than 50 cells/mm3 are associated with poor immunological recovery.

Introduction There is a dearth of studies assessing the efficacy and immunological improvement in patients started on antiretroviral therapy (ART) in India. This study was undertaken to assess the 2-year treatment outcomes in HIV-positive patients initiated on ART in a tertiary-care hospital. Methods After approval from the Institutional Ethics Committee, adult HIV-positive patients from a tertiary-care hospital, initiated on ART between January 2013 and February 2015, were included in the study. Data on clinical and immunological parameters were obtained from medical case records over a period of 2 years after initiation of therapy. Intention-to-treat analysis was done using a descriptive approach, using SPSS version 15 (SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). A logistic regression analysis was done to assess the predictors for poor outcomes. A p-value <0.05 was considered statistically significant. Results ART was initiated in 299 adult patients. At 1 and 2 years, the median (interquartile range) change in CD4+ cell count was 65 (39, 98) cells/mm3 and 160 (95, 245) cells/mm3. The change observed after 2 years of treatment initiation was statistically significant compared with that after 1 year. Three deaths occurred during the study period and 28 were lost to follow-up. Male sex, presence of at least one opportunistic infection at the start of therapy, and baseline CD4+ count <50 cells/mm3 were associated with poor immunological recovery. Conclusions With long-term treatment and regular follow-up, sustained clinical and immunological outcomes can be obtained in resource-limited settings.

Evaluation of Acute and Chronic Effects of D-Galactose on Memory and Learning in Wistar Rats.

OBJECTIVE: D-galactose has been commonly used in rodent models to induce accelerated effects of aging, including those on learning, memory, and muscular tone and coordination. This is normally seen on chronic administration of D-galactose. However, there is minimal suggestive evidence on the short-term effects of the same. The aim of the study was to study the acute and chronic effects of D-galactose on learning and memory in Wistar rats. METHODS: Twenty four male Wistar rats were randomly assigned to the control, standard (rivastigmine), oral D-galactose (200 mg/kg/day) and subcutaneous D-galactose (200 mg/kg/day) for a total duration of 8 weeks. Effects on learning and memory were assessed at 2 weeks, 4 weeks and 8 weeks by Morris water maze model and passive avoidance testing. RESULTS: Both oral and subcutaneous D-galactose showed positive effects on learning and memory on acute dosing, whereas this beneficial effect was lost during chronic dosing. CONCLUSION: Short-term administration of D-galactose showed positive effects, while long-term administration nullified these effects.

A Retrospective Study to Assess the Effect of Proton Pump Inhibitors on Renal Profile in a South Indian Hospital.

INTRODUCTION: Proton Pump Inhibitors (PPIs) are arguably among the most commonly prescribed drugs in clinical practice, either as part of treatment or prophylaxis. Many clinicians prescribe these drugs as part of any prescription, without a proper rationale. Recent studies done outside India have shown that these drugs are not entirely safe, and they can result in the development of acute renal injury. AIM: To assess the effect of PPIs on blood urea and serum creatinine, when administered for at least seven consecutive days. MATERIALS AND METHODS: The study was conducted in a retrospective manner, using data from the medical records department. Values of blood urea and serum creatinine were taken twice, first before start of therapy and then after at least one week of therapy. RESULTS: A total of 175 subjects were selected for the study. When their case files were analysed, acute kidney injury was identified in 19 (10.86%) of them. Pantoprazole was the most common drug involved (84.21%). Renal injury was more common in the age group of over 50 years of age. CONCLUSION: PPIs are not entirely free of adverse effects, as assumed by several practitioners. A vigilant eye has to be maintained on the patient's renal profile so as to avoid any untoward decline in renal function, as evidenced in the current study.