Background: Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) is an important health concern worldwide, and AIDS-related morbidity and mortality have seen a sharp decline due to the introduction of highly active antiretroviral therapy (HAART). To address the problems of high cost, poor compliance, lack of awareness, social stigma, and occurrence of adverse effects in India, National AIDS Control Organization (NACO) has organized a simplified drug regimen with regular monitoring, counseling, and follow-up by specially trained personnel with necessary laboratory facilities and infrastructure. Objectives: The present study was taken up to assess the efficacy of the NACO-recommended HAART regimen in subjects with HIV in the south Indian population. Materials and Methods: HAART, consisting of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor, was instituted in 158 properly selected subjects. The initial therapy in most of the subjects was zidovudine (AZT)+lamivudine (3TC)+nevirapine (NVP). AZT was substituted by stavudine (d4T) in patients with Hb %o8 g, whereas NVP was substituted by efavirenz (EFV) in the event of non-availability, adverse effects, or possible interactions. All subjects received cotrimoxazole prophylaxis. Patients were monitored at regular intervals for 24 weeks. Efficacy was assessed by response based on CD4 count; total lymphocyte count; and improvement assessed in terms of general health, weight gain, functional status, and improvement in WHO clinical staging. Results: There was good clinical improvement with increase in CD4 count in the majority of the subjects. Antiretrovirals were well tolerated, with only mild, tolerable, and controllable adverse events, and death occurred only in 5.71% the subjects. Conclusion: The NACO-sponsored HAART regimen was found to be effective and well tolerated in the majority of the subjects, with minimum and tolerable adverse effects.
Background: Alcohol abuse is a chronic behavioral problem that can further develop as a progressive disease. Disulfiram is the most extensively used deterrent drug for clinical management of alcoholism. A supervised disulfiram-ethanol reaction (DER) test is carried out in patients who are willing for it, and who are skeptical of the effect of disulfiram in causing a DER. Objective: The aim of this work was to study the possible cardiovascular changes and complications during disulfiramethanol reaction in persons fulfilling the inclusion and exclusion criteria. Materials and Methods: After written informed consent was obtained, 60 subjects underwent alcohol detoxification and received disulfiram 250 mg BD orally for 5 days. On 5th day, alcohol challenge was carried out with constant monitoring of all the vital parameters. Cardiovascular changes were monitored and recorded during the DER. Results: Disulfiram was generally well tolerated and DER started to occur within 10-15 minutes and lasted for 90-240 minutes. Cardiovascular changes observed were blood pressure changes [hypotension (n=16, 26.67%) and hypertension (n=3, 5%)] and ECG changes [sinus tachycardia (n=22, 36.67%), transient ischemic changes (n=13, 21.67%), occasional atrial ectopics (n=1, 1.67%) and junctional rhythm (n=1, 1.67%)]. Only 23 subjects (38.33%) did not show any significant ECG changes. All subjects recovered with no residual ECG changes except those who developed hypotension (n=16) who required intervention with IV fluids. Conclusion: Cardiovascular complications can occur even in properly selected subjects having no baseline cardiovascular impairment, which could be serious and potentially life threatening. Based on the results of the present study, disulfiram-ethanol challenge test appears to be a relatively safe procedure if carried out under standardized conditions and using a safe maintenance dose of disulfiram.
Background: Teratogenicity is a major cause of abortion, still birth and can result in longterm disability with a significant impact on individuals, families, societies and healthcare systems. Drugs being one of the causes of teratogenicity, creating awareness among medical students, the future prescribing physicians, the rate of teratogenicity can be decreased. The objective was to compare the attitude and knowledge about teratogenicity among the medical undergraduates before and after an educational session on teratogenicity.Methods: A pre-validated semi structured questionnaire on attitude and knowledge about teratogenicity was distributed to 2nd year medical students (147) before and after teratogenicity educational session. Results obtained were compared within the group. Paired t test was used for within the group comparison. P-Value <0.05 was considered to be statistically significant.Results: Improvement in knowledge showed statistically significant improvement following teratogenicity educational session (P-Value=0.0003). Improvement was there in post session attitude scores as well, however, it was not significant (P-Value=0.64).Conclusions: Early reinforcement about teratogenicity in medical students enables them to decide appropriate drug therapy while prescribing for females of reproductive age group.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity syndrome most commonly caused by anti-epileptics like carbamazepine, phenytoin. It usually manifests as maculopapular rash, fever, eosinophilia, generalized lymphadenopathy, hepatitis, atypical lymphocytosis, and leucocytosis with the involvement of other organs. Valproate, a broad-spectrum antiepileptic, also used in bipolar disorders and migraine prophylaxis, is generally well tolerated. To date, very few cases of valproate monotherapy induced DRESS syndrome have been reported worldwide and here we are reporting one such rare case in a 72 years old Indian woman with a history of generalised tonic convulsions. The patient was classified as a ‘probable’ case of DRESS syndrome using the WHO-UMC criteria and Naranjo scale. Discontinuation of the offending medication and treatment with intravenous (IV) fluids, antihistamines, and steroids helped in recovery of the patient. Healthcare practitioners must be aware of valproate monotherapy induced DRESS syndrome and take effective measures to avoid severe side effects.
Introduction: Hyperpigmentary disorders, a common skin disorder affecting individuals with darker skin especially Asians, Blacks, Hispanics and American Indians, has a great impact on patient’s Quality of Life (QOL) with physical distress and psychological impact, and studies have shown that there is an improvement in QOL after treatment. The topical medications include sunscreens, demelanising agents, immunomodulators like tacrolimus, retinoids and Glucocorticoids (GCs). Systemic therapy includes GCs and antioxidants. Physical therapy includes chemical peels, microderma abrasion, Laser and light therapies and mesotherapy. Aim: To determine the pattern of drug use in hyperpigmentary disorders, to assess the tolerability of therapy and to analyse the effect of hyperpigmentary disorders of skin to the prescribed medications on the QOL before and after treatment. Materials and Methods: This was a prospective, observational study conducted on 102 newly diagnosed and untreated participants with hyperpigmentary disorders, who attended Dermatology Outpatient Department of a tertiary care hospital, Bangalore, India. The pattern of drug therapy, route of administration and Adverse Events (AEs) to the therapy was documented and analysed using descriptive statistics. The QOL using Dermatology Life Quality Index (DLQI) was assessed before and after treatment using Analysis of Variance (ANOVA). The patients were monitored every 30 days for three months to study the appropriateness, changing trends in prescription pattern, tolerability and QOL. Results: A total of 102 participants were enrolled for the study. The mean age was 33.71±10.68 years in males and 34.07±10.27 years in females. The different classes of drugs used were demelanising agents, sunscreens, antifibrinolytics, calcineurin inhibitors, keratolytics, glucocorticoids. The number ranged from 2-4 drugs per participant with a mean of 3.01±1.01. A significant improvement in the QOL was observed after treatment (p-value <0.01). Most of the AEs were self limiting except a few (acneiform eruption, rosacea) which were topical GCs induced. Conclusion: The individualised prescription pattern by treating physician was in concurrence with the standard line of therapy as they fulfilled the desired objectives. Hydroquinone (HQ), tranexamic acid and triple formula were the mainstay of treatment. The QOL improved after treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
334 Leonard St
Brooklyn, NY 11211
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.