Efficacy and safety of Risankizumab in moderate to severe psoriasis: A systematic review and meta-analysis.

Monoclonal antibodies are explored for their therapeutic potential in Psoriasis. To evaluate Risankizumab in the moderate to severe psoriasis with regard to efficacy, tolerability, and safety PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and clinicaltrials.gov, databases were searched for relevant RCTs. The reference lists of relevant publications were also scanned manually to identify any further studies not indexed in the searched databases. Only RCT aiming to evaluate the role of Risankizumab in the treatment of moderate to severe psoriasis were considered eligible for this systematic review. Intervention group was patients taking Risankizumab and placebo or other monoclonal antibody was considered as control group. Cochrane review manager 5 (RevMan) version 5.3 was used for data synthesis and meta-analysis. Quality assessment of included randomized controlled trials was done with Cochrane Collaboration risk of bias assessment tool, version 2.0 (ROB-2). Overall Grading of evidence for study objectives was performed with GRADE Pro GDT software. A total of seven studies were included in analysis with total of 1533 and 710 patients in Risankizumab and standard care groups, respectively. Statistically significant increase in percentage of individual achieving PASI90 (OR = 11.01 (95% CI = 8.67-13.99), DLQI-01 (OR = 6.95 (95% CI = 5.53-8.75), sPGA-01 (OR = 14.22 (95% CI = 11.10-18.22); sPGA-0 (OR = 6.39 (95% CI = 4.79-8.54) in risankizumab group as compared with control, with high quality of evidence. Increased risk of infections with risankizumab as compared with placebo (OR = 1.44 [95% CI = 1.13-1.83], high quality evidence), while no difference in SAE among two groups. Analysis of all outcome data from RCTs. In the light of evidence from systematic review on effectiveness of Risankizumab, we propose treatment with risankizumab for psoriasis patients not responding to available treatment.

Impact of regulatory spin of pioglitazone on prescription of antidiabetic drugs among physicians in India: A multicentre questionnaire-based observational study.

Background & objectives: Pioglitazone was suspended for manufacture and sale by the Indian drug regulator in June 2013 due to its association with urinary bladder carcinoma, which was revoked within a short period (July 2013). The present questionnaire-based nationwide study was conducted to assess its impact on prescribing behaviour of physicians in India. Methods: Between December 2013 and March 2014, a validated questionnaire was administered to physicians practicing diabetes across 25 centres in India. Seven hundred and forty questionnaires fulfilling the minimum quality criteria were included in the final analysis. Results: Four hundred and sixteen (56.2%) physicians prescribed pioglitazone. Of these, 281 used it in less than the recommended dose of 15 mg/day. Most physicians (94.3%) were aware of recent regulatory events. However, only 333 (44.8%) changed their prescribing pattern. Seventeen of the 416 (4.1%) physicians who prescribed pioglitazone admitted having come across at least one type 2 diabetes mellitus patient (T2DM) who had urinary bladder carcinoma, and of these 13 said that it was in patients who took pioglitazone for a duration of more than two years. Only 7.8 per cent of physicians (n=58) categorically advocated banning pioglitazone, and the rest opined for its continuation or generating more evidence before decision could be taken regarding its use in T2DM. Interpretation & conclusions: Majority of the physicians though were aware of the regulatory changes with regard to pioglitazone, but their prescribing patterns were not changed for this drug. However, it was being used at lower than the recommended dose. There is a need for generating more evidence through improved pharmacovigilance activities and large-scale population-based prospective studies regarding the safety issues of pioglitazone, so as to make effectual risk-benefit analysis for its continual use in T2DM.

Nutritional Status in Leprosy Patients: A Systematic Review and Meta-analysis.

BACKGROUND: Leprosy, a chronic mycobacterial disease, is frequently accompanied by malnutrition. However, it is important to regularly assess the nutritional state of leprosy patients in a resource-poor nation like India, where undernutrition is widespread. OBJECTIVES: This study aimed to compare the nutritional status of leprosy patients to that of normal individuals using the body mass index. METHODS: The electronic databases PubMed, Google Scholar, and Embase were used to conduct an open literature search. From 1st January 2000 to 31st January 2023, all articles were screened using the following MeSH terms: (nutrition OR body mass index OR body weight) AND (leprosy OR lepra) to find possibly relevant articles. RESULTS: This meta-analysis includes five research studies with a total of 1173 individuals (363 patients in the leprosy group and 810 patients in the non-leprosy group). The weighted mean difference (WMD) for BMI studies was -17.88 (95% CI -27.65 to -8.12), showing that there was a significant difference in BMI < 18.5 between leprosy patients and non-leprosy patients. There was a significant difference in DDS score and HFIAS score between patients with leprosy and non-leprosy. In a total of 342 leprosy patients, 206 developed deformities. CONCLUSION: This research increases our understanding of nutrition and leprosy. The results found that people with leprosy are nutritionally at a distinct disadvantage when compared to non-leprosy patients. It emphasises the several ways in which diet may generate circumstances that increase the risk of leprosy.

Antimicrobial Stewardship Program: Time to be Focused in Speciality Settings of Leprosy Institute and Related Health Care Setup.

Leprosy, often known as Hansen's disease is a contagious chronic infectious disease caused by Mycobacterium leprae (M. leprae). Our methodology is easily repeatable in tertiary care settings with diagnostic accuracy resources and staff capable of building a stewardship team. Comprehensive antimicrobial policies and programmes are required to properly alleviate the initial issue.

Ralstonia mannitolilytica Infections: A Systematic Review of Case Reports Unveiling Clinical Patterns and Therapeutic Insights.

BACKGROUND: Ralstonia mannitolilytica is an emerging opportunistic pathogen that has been increasingly reported in clinical settings. Despite its low pathogenicity in immunocompetent individuals, it poses a significant threat to immunocompromised patients, particularly those with underlying medical conditions or invasive medical interventions. OBJECTIVES: This study aimed to evaluate the clinical impact and management strategies based on the analysis of individual case reports on Ralstonia mannitolilytica . METHODS: A comprehensive search of PubMed was conducted from inception until July 31, 2023, using the terms "Ralstonia mannitolilytica" and/or "Pseudomonas thomasii". Inclusion criteria for our systematic review included human-centered case reports of Ralstonia mannitolilytica infections, excluding case series and review articles. Data extraction followed PRISMA guidelines, including study details and patient characteristics. Case reports were systematically assessed using the JBI critical appraisal checklist, evaluating patient demographics, clinical history, diagnostic methods, interventions, post-intervention outcomes, adverse events, and lessons learned to minimize bias risk. RESULTS: A total of 17 case reports of Ralstonia mannitolilytica infections were included in our systematic review. Studies published from 2001 to 2023 revealed diverse global contributions, with 29.41% from China. Infection origins varied, with catheter-related cases being predominant. Mortality was reported in two studies. Antibiotic sensitivity analysis showed sensitivity to third-generation cephalosporins, notably Ceftazidime. Quality appraisal revealed that all studies had a low risk of bias, ensuring the overall robustness of the case reports. CONCLUSION: This study emphasizes the importance of understanding Ralstonia mannitolilytica infections, given their varied clinical presentations and antibiotic responses. The study also underscores the necessity for precise identification, customized treatments, and ongoing research to manage these infections effectively.

Kisspeptin and its Current Clinical Status- A Systematic Review.

BACKGROUND: Kisspeptin was initially known as metastin for its role in suppressing metastasis in melanoma and breast cancer. Later, based on its ability to stimulate GPR54, its importance in maintaining an intact hypothalamic-pituitary-ovarian axis was recognised, which is the basis for the widespread application of the drug in several conditions such as secondary amenorrhea, regulation of puberty onset, ovarian function, trophoblast invasion, fertility regulation, parturition, and lactation. This systematic study aims to evaluate the current status of kisspentin in clinical trials. METHODS: The keywords 'kisspeptin' or 'metastin' were used in the clinicaltrials.gov website and Clinical Trial Registry of India (CTRI) to find eligible clinical trials or records carried out without time constraints until February 26, 2023. RESULTS: A total of 33 records were identified through clinical trial databases. All records were screened, and four trials were rejected as they failed to meet the inclusion criteria. Finally, 29 (87.9%) reports of interventional clinical trials with kisspeptin were reviewed. CONCLUSION: Kisspeptin can be viewed as a multipurpose drug with considerably fewer side effects due to its effects simulating normal physiological processes in our body.

Dog Bite Injury: Rusk Became a Risk - A Case Report.

BACKGROUND: Dog bites are a worldwide problem that disproportionately affects children. It might be difficult to keep in mind that even a man's closest buddy can be dangerous to people. In light of the significant morbidity and mortality associated with dog bites, we report, herein, an intriguing case in which a two-year-old boy appeared with eyelid facial lacerations as a result of a dog bite. CASE PRESENTATION: A two-year-old boy presented with bleeding around the right and left eyes. Local examination of the eyes revealed laceration and disfiguration of the left orbit and abrasion around the right eye. Preoperatively, parenteral antibiotics were started and continued postoperatively. Dressing was done for the right eye. Lid reconstruction surgery for the left eye was scheduled and it was carried out under general anaesthesia. The child was monitored for a month and showed satisfactory wound healing with no visible scars or complications. DISCUSSION: The standard treatment for bites is direct suture, grafting, or local flaps, depending on the type of wound and the surgeon's preference, regardless of the time since the attack. Crush wounds are difficult to treat because the damage to the tissues is often so profound that amputation is unavoidable. CONCLUSION: The global injuries caused by dog bites are the consequence of uncommon illnesses and often manifest as peri-orbital and ocular lesions. Most rabies cases occur in underserved rural and urban areas, with a high frequency of stray dogs without immunisation.

Sulbactam-Durlobactam, A Novel Drug for the Treatment of Multidrug Resistant Acinetobacter baumannii Infections - A Systematic Review.

BACKGROUND: Sulbactam-durlobactam (SUL-DUR) has been tested in vitro for its ability to generate resistance in clinical isolates of Acinetobacter species. According to prior studies, combining durlobactam with sulbactam causes sulbactam-resistant isolates to become more active and revert to susceptibility. We aimed to conduct a systematic review of the in vitro activity of SUL-DUR on A. baumannii (Ab) isolates, including carbapenem-resistant A. baumannii (CRAb), to provide an overview for physicians dealing with Ab infections. METHODS: The following keywords were searched in the PubMed, Google Scholar, and EMBASE databases to look for eligible original works that have been published without restrictions till June 30, 2023: A. baumannii and sulbactam-durlobactam, SUL-DUR, durlobactam, and sulbactam-ETX2514. We also searched clinicaltrials.gov and the Clinical Trials Registry of India (CTRI) for clinical trials involving sulbactamdurlobactam and Acinetobacter. RESULTS: There were a total of 852 abstracts found. Among them, 633 articles with titles, abstracts, and keywords were reviewed, and 574 articles were removed after the initial screening. A total of 59 full-text eligible articles were evaluated, and 51 of them were eliminated because they did not satisfy the criteria set for inclusion. The full texts of the final 8 in vitro studies on A. baumanii and sulbactam/durlobactam were further evaluated. There were 5 trials on A. baumanii and sulbactam/durlobactam found on clinicaltrials.gov and the Clinical Trial Registry of India (CTRI). CONCLUSION: The findings from the studies show that SUL-DUR might be a successful therapeutic option for multidrug-resistant-Ab infections. Future clinical trials will be required to validate the possibility of using this combination to treat multidrug-resistant A. baumannii infections.

Treatment Modalities for Trigeminal Neuralgia and the Need for Vigilance in Monitoring Adverse Drug Events: A Case Report.

INTRODUCTION: Trigeminal neuralgia is a rare condition characterised by paroxysms of intense pain in the distribution of the trigeminal nerve. This condition significantly diminishes the patient's quality of life, and the side effects from chronic use of medications for symptomatic relief further exacerbate their distress. CASE DESCRIPTION: The case report discusses a patient diagnosed with Trigeminal Neuralgia who commenced carbamazepine treatment. The report tracks the disease's progression, medication adjustments, and the eventual emergence of vertigo due to long-term carbamazepine use. CONCLUSION: The article covers fundamental information about trigeminal neuralgia and its management and also offers a comprehensive review of the basics of vertigo. It delves into carbamazepine's mechanism of action and its associated side effects. The paper also looks at prospective therapy changes that could improve patients' quality of life.

Vigilance Needed in Treating a Child with Disseminated TB: A Case Report.

BACKGROUND: Tuberculosis is still one of the biggest causes of infection-related death around the world. Disseminated tuberculosis is a potentially fatal disease caused by the haematogenous spread of Mycobacterium tuberculosis. First-line anti-tuberculosis drugs in-clude isoniazid, rifampicin, pyrazinamide, and ethambutol. The first three drugs are known to cause hepatotoxicity. CASE PRESENTATION: We have, herein, reported a case of Drug-induced Liver Injury (DILI) due to anti-tuberculosis therapy in a one-year-old male child with disseminated tuberculosis. He was started on a fixed-dose combination of Anti-tuberculosis Therapy (ATT; isoniazid 50 mg, rifampicin 75 mg, and pyrazinamide 150 mg) and pyridoxine 10 mg orally. Initially, liver pa-rameters were normal, but later on with the course of the treatment, there was a rapid rise in liver enzymes, suggesting liver injury. DISCUSSION: The association between liver injury and anti-tuberculosis therapy has been con-firmed by applying various causality association scales. It is obvious that proper treatment of disseminated tuberculosis can avoid the development of drug-resistant strains that can be harm-ful, worsening the prognosis as there are fewer therapeutic alternatives available. At the same time, there is a need to monitor the patient with ATT-induced DILI. CONCLUSION: The diagnosis of tuberculosis in children is difficult because of the mild, nonspe-cific clinical presentation, which usually reflects the implicated underlying organ. In addition to prompt diagnosis and treatment of disseminated TB, careful monitoring is equally important.

Hand Foot Syndrome Induced by Lenvatinib - A Case Report.

INTRODUCTION: Hand-Foot Syndrome (HFS), also known as palmar-plantar erythrodysesthesia, is a common reaction to Tyrosine Kinase Inhibitors ( TKIs), which can often lead to discontinuation of the drug. Lenvatinib is a recently approved drug for the treatment of endometrial carcinoma, which has been proven to provide a better overall survival rate and longer duration of progression-free survival among patients with advanced endometrial cancer. Herein, we have reported a case of carcinoma endometrium with metastasis who had to discontinue the use of lenvatinib due to the adverse drug reaction. CASE REPORT: A 60-year-old female patient with carcinoma endometrium with metastasis, post radical hysterectomy with bilateral salpingo-oophorectomy with omentectomy, was started on tablet lenvatinib 8 mg once daily orally for 15 days. After 12 days of treatment, the patient noticed painful lesions with reddish-black discoloration over the left forearm and dorsal aspect of the left hand and fingers, and was diagnosed with lenvatinib-induced hand-foot syndrome. Lenvatinib was discontinued and tab. prednisolone 30mg was taken orally. The reaction subsided after five days. CONCLUSION: Hand-foot syndrome is one of the commonest ADRs due to the use of lenvatinib. Lenvatinib is an oral formulation that patients can take at their homes. Hence, educating patients regarding the HFS is important so that they report it to the treating physicians on time. It is also essential to educate patients regarding the precautions to be taken to avoid hand-foot syndrome. This will help the physicians with the early discontinuation and appropriate treatment with corticosteroids, which will help in improving the quality of life of the patients already suffering from cancer.

A Systematic Review of the COVID Vaccine's Impact on the Nervous System.

AIMS & OBJECTIVES: The objective of this study was to conduct a systematic review of research pertaining to the COVID-19 vaccine and its association with neurological complications. METHOD: We performed a comprehensive search of the literature using Google Scholar, PubMed, and NCBI databases from December 2021 to December 2022. For Google Scholar, PubMed, and NCBI databases we used the following key search terms: "neurological adverse effects", "COVID-19 vaccination", "SARS-CoV-2", CNS complications, and CNS adverse effects. Two reviewer authors individually searched and assessed the titles and abstracts of all articles. The third reviewer resolved the disagreement between them. Data were documented regarding title, study location, type of study, type of COVID-19 vaccine, type of neurological complications/adverse effects, and sample size. RESULTS: From our findings, it is confirmed that these neurological complications like GuillainBarre syndrome (23.6%), Neuromyelitis Optica spectrum disorder (5.5%), Neuropathy (6.9%), Transverse Myelitis (8.3%) and Acute disseminated Encephalomyelitis (4.1%) are majorly affected in most of the people. The increase in risks associated with SARS-CoV-2 infection far outweighs any previously reported associations with vaccination. CONCLUSION: We found no safety signal was observed between COVID-19 vaccines and the immune-mediated neurological events. Before assuming a causal relationship, the side effects of the COVID-19 vaccine should first be carefully examined to rule out known associated factors. Symptom onset was within two weeks of vaccination in the majority of cases; as such, this seems to be a high-risk period warranting vigilance.

Microteaching: Overview and examination evaluation.

Nearly all teachers are forced into teaching and gain experience through time, but many do not feel adequately prepared for their fieldwork in their training program. Only solution which helps teachers and students is to connect theory to practice by microteaching. It is a strategy for acquiring teaching abilities on a smaller scale, in which teachers may practice previously learned skills as well as acquire new ones. The efficiency of microteaching may be predicted using feedback from participants. While preservice instructors benefit from microteaching and students themselves find it helpful, academics have not yet looked closely at the assignment itself to determine precisely what microteaching entails. As a result, this study aids in learning more about the interactional aspects of microteaching and the effect of it in both teachers and students.

Efficacy and safety of sufentanil sublingual tablet system in postoperative pain management: a systematic review and meta-analysis.

BACKGROUND: Sufentanil sublingual tablet system (SSTS) is a recently approved formulation for postoperative pain management that has become popular due to its pharmacokinetic properties such as good bioavailability, rapid attainment of equilibrium and elimination without any metabolites, along with its pharmacodynamic properties such as rapid onset and effective pain reduction. It is also relatively well tolerated by patients. OBJECTIVE: This is a quantitative analysis of the efficacy and safety of SSTS in patients with moderate to severe postoperative pain. DESIGN: This is a systematic review and meta-analysis. Databases such as Cochrane Library, MEDLINE and EMBASE were searched for eligible articles. SETTINGS: Randomised controlled trials published after 2000 in English language and which assessed at least one of the outcome measures of interest with pain intensity difference between 12 hours and a maximum of 96 hours. PARTICIPANTS: Adults with moderate to severe postoperative pain and taking SSTS for pain management. METHODS: Data were analysed using Review Manager (RevMan) V.5.3. Risk of bias (RoB) assessment was done using RoB-2 scale, and overall grading of evidence of each outcome was done using GRADEpro Guideline Development Tool. RESULTS: Analysis of SSTS versus control indicates a statistically significant reduction in summed pain intensity difference at 12 hours (mean difference (MD)=-12.33 (95% CI -15.5 to -9.17), p<0.00001), summed pain intensity difference at 48 hours (MD=-43.57 (95% CI -58.65 to -28.48), p<0.00001), time-weighted total pain relief over 12 hours (MD=-4.77 (95% CI -6.28 to -3.27), p<0.00001) and pain intensity difference (MD=-0.73 (95% CI -1.00 to -0.46), p<0.00001) with SSTS, alongside high quality of evidence. Success of treatment as assessed by Patient Global Assessment (OR=4.01 (95% CI 2.74 to 5.89), p<0.00001) and Healthcare Professional Global Assessment (OR=4.46 (95% CI 3.03 to 6.56), p<0.00001) scoring at 72 hours was observed in a significantly high number of individuals using SSTS, with high quality of evidence. There was no difference in adverse events except for dizziness (RR=1.90, 95% CI 1.02 to 3.52). There was a significantly higher number of total adverse events in orthopaedic surgery in the SSTS group than in the comparator. CONCLUSION: SSTS is effective in postoperative pain management in patients with moderate to severe pain. It also has good tolerability and high patient satisfaction. PROSPERO REGISTRATION NUMBER: CRD42018115458.

A Change in the Trend of Quality Reporting in Leprosy Trials: A Systematic Review.

BACKGROUND: Leprosy is a communicable disease caused by bacteria Mycobacterium leprae. Despite all attempts, it has not been eradicated in several underdeveloped nations since the start of the antibiotic age. It's a social issue as well as a stigmatised disease. Due to these restrictions, randomised controlled trials in leprosy confront numerous obstacles, which are reflected in the quality of study reporting. OBJECTIVES: The objective of this study is to use the Consolidated Standard for Reporting Trials (CONSORT) 2010 checklist to assess the quality of leprosy trial reporting. METHODS: We assess the quality of reporting of randomised control trials on leprosy conducted after 2010 in the PubMed database, using the CONSORT checklist 2010. Second, we compare the quality of RCT reporting before and after the release of the CONSORT guidelines in 2010. RESULTS: A total of 19 full-text eligible articles were examined and included in the final list of articles, which were then evaluated further. 4 out of 19 trials had a compliance percentage of more than 75%. 6 out of 19 trials had compliance percentage of 50% to 75%. 9 trials had a compliance percentage of below 50%. Highest compliance was 86.48% and the lowest compliance was 32.43%. When compared with trials before 2010, we could see an improvement in some criteria showing a statistically significant rise in comparison with trials conducted before 2010. CONCLUSION: Leprosy is still a concern in developing countries, which have failed to eradicate the disease despite their best efforts and resources. The compliance of leprosy related RCTs has improved since the introduction of the CONSORT guidelines, but the quality of reporting still remains on the lower side.

Analysis of Research Publications on Pharmacogenomics of Sulphonylurea - A Scientometric Study.

This study analysed pharmacogenomics studies on sulfonylurea research publications using the Pubmed and Scopus databases. In the end, 65 publications from the years 2015 to 2021 were noticed. The objective of this study was to analyse these studies using scientometric tools, such as frequency counts, percentages, relative growth rates, doubling times, and collectively. A maximum of 19 (29.23%) research publications were contributed during the 2020 research period. The relative growth rate tends to decrease from 2015 to 2020 and the doubling time tends to increase and decrease after 2020. Up to 2 (3.08%) research publications were contributed by Ewan R. Pearson and Chen each. The top authors have an average degree of collaboration of 0.90 and 41 (63.83%) of their research publications are articles. The United States is the major contributor with 19 (29.23%) pharmacogenomics research publications on sulfonylureas. Although the United States is the most prolific country in sulfonylurea pharmacogenomics research, there are few Indian institutions that are not listed among the most prolific institutions.