Safety and efficacy of nicotinamide in the management of hyperphosphatemia in patients on hemodialysis.

Hyperphosphatemia is an important modifiable risk factor for death and cardiovascular events in patients on hemodialysis (HD). As nicotinamide has been shown as an inhibitor of sodium-dependent phosphate co-transport in rat renal tubule and small intestine, we examined whether nicotinamide reduces hyperphosphatemia in patients undergoing HD. The study was conducted in 30 end-stage renal disease (ESRD) patients [20 (66.7%) males and 10 (33.3%) females; mean age 54 ± 14.9 years] undergoing twice/thrice weekly HD for more than 3 months. Patients on other phosphate binders were given a 2-week wash-out period. Nicotinamide 250 mg capsules were given twice daily for 25 patients with serum phosphorus greater than 5 mg/dL and thrice daily for 5 patients with serum phosphorus greater than 8 mg/dL immediately after food for 8 weeks. Serum phosphate and calcium levels were estimated every month prior to HD session, and complete blood count, blood sugar, renal profile, liver function tests were estimated at beginning and end of the study. Patients were regularly monitored for side effects. There were significant decreases in the serum phosphate (6.85 ± 1.35 mg/dL at the baseline to 5.74 ± 1.18 mg/dL at the 4(th) week and to 4.54 ± 0.86 mg/dL at the 8(th) week), the serum calcium-phosphorus product (57.8 ± 12.21 at the baseline to 48.3 ± 10.71 on 4(th) week and to 38.201 ± 8.21 at the 8(th) week), and alkaline phosphatase levels (130.23 ± 50.13 IU/L at the baseline to 116.40 ± 48.27 IU/L after 8 weeks) on treatment with nicotinamide (P < 0.001). Other parameters remained unchanged. Watery stools reported by seven patients resolved during the course of the therapy. Nicotinamide is safe, cheap and effective in controlling serum phosphorus, Ca × P product and alkaline phosphatase levels in patients on maintenance HD.

A study of drug-drug interactions in cancer patients of a south Indian tertiary care teaching hospital.

BACKGROUND: Drug interactions in oncology are of particular importance owing to the narrow therapeutic index and the inherent toxicity of anticancer agents. Interactions with other medications can cause small change in pharmacokinetics or pharmacodynamics of chemotherapeutic agents that could significantly alter their safety and efficacy. AIM: To identify and document the potential drug-drug interactions in prescriptions of patients receiving cancer chemotherapy. Settings and Design : A tertiary care teaching hospital based prospective study. MATERIALS AND METHODS: Patients admitted in the medical oncology wards with different types of malignancies and receiving cancer chemotherapy during the period of June 2009 to November 2009 were included in the study. A detailed data collection was done in a specially designed proforma with ethical approval and consent of patients and their prescriptions were subjected to drug-drug interaction screening using Drug Interaction Fact Software Version-4 and standard references. Incidence of drug-drug interactions, their types, correlation between age, cancer type, number of drugs prescribed and incidence of drug interactions were analyzed. STATISTICAL ANALYSIS: Logistic regression analysis and Odds ratio were performed to identify the incidence of drug-drug interactions and their correlation with the factors above mentioned. RESULTS: A total of 75 patients (32 males and 43 females; median age 56 years, age range 23-74) were enrolled in the study and their prescriptions were screened. 213 interactions were identified of which, 21 were major, 121 were moderate and 71 were minor. There were 13 (6.1%) clinically significant interactions between anticancer drugs and 14 (6.5%) drug-drug interactions between anticancer drugs and other drugs prescribed for co-morbidities. There was a positive correlation between number of drugs prescribed and drug interactions (P=0.011; OR 0.903). CONCLUSION: Though there was not any life threatening interactions, the potential interactions were brought to the oncologist purview for ensuring patients safety and to avoid undesirable effects.

Pharmacokinetic evaluation of Paclitaxel in South Indian cancer patients: a prospective study.

Paclitaxel is a promising drug in the treatment of different solid tumors. It exhibits nonlinear pharmacokinetics, particularly when administered as a constant rate infusion for shorter duration (e.g., 3 h). Because of the nonlinearity, relatively small changes in dose may lead to large changes in peak plasma concentration and total drug exposure. The study was conducted to evaluate the pharmacokinetics of different doses of paclitaxel administered intravenously as an infusion. A prospective study was conducted in 23 cancer patients aged between 28 and 74 years, treated with paclitaxel (130, 200, 230, and 260 mg/m(2)) over 3 h as constant rate infusion. Plasma samples were collected from all patients at 0, 1, and 3 h and for five patients at 5 and 13 h and paclitaxel concentrations were determined using high-performance liquid chromatography method. The overall mean clearance was found to be 47.5847 ± 142.028 l/h; the mean volume of distribution was 142.028 ± 73.438 l; mean elimination rate constant was 0.336 ± 0.002/h; mean half-life was 2.086 ± 0.009 h; mean area under the curve (AUC) was 5.5917 ± 2.707 mg/ml*h; and the mean of mean residence time was 2.980 ± 0.0131 h. Paclitaxel showed nonlinear kinetics and the pharmacokinetic parameters calculated were similar to those quoted in the literature. The peak plasma concentration at 130 mg dose level was 2 µ/ml, but an increase in dose was not associated with proportional increase in plasma concentration. No significant difference was found between pharmacokinetic parameters such as clearance, volume of distribution, and AUC at different dose levels.

Antimicrobial resistance of bacterial agents of the upper respiratory tract in South Indian population.

The study was aimed at determining bacterial agents of the upper respiratory tract and the susceptibility patterns of isolates to antibiotics. The throat swab samples from 250 patients suspected of upper respiratory tract infection (URTI) were obtained from the General Medicine outpatient department of a Rural Health Centre of Rajah Muthiah Medical College and Hospital (RMMC and H), Annamalai University, Chidambaram, Tamilnadu, India and inoculated in the culture medium. The bacterial infection was confirmed only in 228 patients. The organisms isolated on medium were identified by their cultural, morphological and biochemical characteristics. Staphylocccus aureus was identified as the most prevalent bacterial isolate (45.61%) followed by ß hemolytic streptococci (22.51%). Thirty four strains (14.91%) were identified as Klebsiella penumoniae, 19 (8.33%) as Pseudomonas aeruginosa and the rest belonged to a hemolytic streptococci, Escherichia coli and Haemophitus influenzae. All Staphylococcus spp, were resistant to penicillin., ampicillin and co-trimoxazole. All the isolates were resistant to at least one antibiotic. The overall resistance rates were generally low for gentaruicin, cefixine and ceftazidime respectively.

Drug usage evaluation of dapsone.

Dapsone has been the principal drug in a multidrug regimen recommended by the World Health Organization for the treatment of leprosy. It is also widely used by dermatologists in varied skin conditions like dermatitis herpetiformis, bullous pemphigoid, Behcet's disease, lupus erythematous and a host of other skin diseases. Hence an attempt has been made to review the utilization and qualitative evaluation of dapsone over a period of 6 months in a tertiary care teaching hospital. The study consisted of 80 patients (54 leprosy and 26 non-leprosy patients), prescribed with dapsone 100 mg oral once daily. The prescribing patterns of dapsone in leprosy and other dermatological conditions (non-leprosy) were analyzed and the safety, efficacy and appropriateness of the doses prescribed were reviewed. The adverse drug reactions observed in the study population were type I Lepra reactions, gastrointestinal side effects (abdominal pain and anorexia), peripheral neuropathy, other nervous side effects (insomnia, headache and vertigo) and other adverse reactions (fever and tinnitus). Patient information leaflets were distributed to patients to educate on the appropriate use of dapsone.

Antioxidant activity of Arthritin--a polyherbal formulation.

In complete freund's adjuvant induced arthritis in male albino rats, a significant increase in serum lipid peroxidase besides increase in paw swelling and a significant decrease in superoxide dismutase, glutathione peroxidase and total reduced glutathione levels were observed. Arthritin produced a marked reversal of these enzyme levels, besides a significant reduction in paw swelling. The results suggest that, the polyherbal formulation 'Arthritin' exerts its effects by modulating lipid peroxidation and enhancing anti-oxidant and detoxifying enzyme systems.

Antimicrobial activity of Leucas aspera flowers.

The methanol extract of Leucas aspera flowers, its fractions, the alkaloidal residue and the expressed flower juice, tested for antimicrobial activity, showed good antibacterial activity for methanol extract and methanol fraction with maximum activity for the alkaloidal residue.

Anti-inflammatory and antinociceptive activities of Trewia polycarpa roots.

The alcoholic extract of Trewia polycarpa roots, when administered orally to rats at doses of 50-400 mg/kg, exhibited a dose-dependent anti-inflammatory activity in both acute and chronic models. It also showed a significant antinociceptive action mice in the dose range of 25-200 mg/kg. The extract did not reveal any toxicity in rats up to a dose of 3.2 g/kg (p.o.). It showed the presence of terpenoids, alkaloids, flavonoids, quinones and glycosides on phytochemical screening.

Antibacterial and antifungal activities of Trewia polycarpa roots.

The total alcoholic extract, its chloroform soluble and aqueous fractions of the roots of the plant Trewia polycarpa exhibited varying degrees of antibacterial and antifungal activities when tested with six bacterial and four fungal strains.

Free radical scavenging activity of the alcoholic extract of Trewia polycarpa roots in arthritic rats.

The alcoholic extract of Trewia polycarpa roots (TPE), which exhibited significant anti-inflammatory activity, was evaluated for the possible mode of action by studying its antioxidant potential in adjuvant-induced arthritic rats. The biological defence system constituting the superoxide dismutase, glutathione peroxidase, ascorbic acid showed a significant increase while the lipid peroxide content was found to decrease to a large extent on TPE treatment thereby indicating the extracts free radical scavenging property. Histopathological studies too supported anti-arthritic potential of the roots of Trewia polycarpa.

Adverse effects of disulfiram and patient compliance.

Use of Disulfiram under supervision in well-motivated alcoholics is effective in reducing relapse rates. Several adverse effects, some of them life-threatening, have been reported due to the drug. An awareness of the adverse effects is useful to keep a follow up and sustain patient compliance with the drug. This study of 158 out patients on daily oral disulfiram revealed that though many patients report unpleasant effects most of them could not be distinguished from symptoms of alcoholism present before taking disulfiram and hence cannot be considered as adverse effects of the drug. The actual adverse symptoms were also mild and could be easily managed and were infrequent and not the common cause for poor patient compliance. The study suggests that Disulfiram with its low toxicity can be offered to patients without too much reservation.