Oseltamivir (Tamiflu), a neuraminidase inhibitor, was approved for seasonal flu by US Food and Drug Administration in 1999. A number of randomized controlled trials, systematic reviews, and meta-analysis emphasized a favorable efficacy and safety profile. Majority of them were funded by Roche, which also first marketed and promoted this drug. In 2005 and 2009, the looming fear of pandemic flu led to recommendation by prominent regulatory bodies such as World Health Organization (WHO), Centers for Disease Control and Prevention, European Medicines Agency and others for its use in treatment and prophylaxis of influenza, and it's stockpiling as a measure to tide over the crisis. Serious Adverse Events, especially neuropsychiatric events associated with Tamiflu started getting reported leading to a cascade of questions on clinical utility of this drug. A recent Cochrane review and related articles have questioned the risk-benefit ratio of the drug, besides raising doubts about the regulatory decision of approving it. The recommendations for stockpiling the said drug as given by various international organizations viz WHO have also been put to scrutiny. Although many reviewers have labeled the Tamiflu saga as a “costly mistake,” the episode leaves us with some important lessons. This article takes a comprehensive relook on the subject, and we proceed to suggest some ways and means to avoid a similar situation in the future.

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Background Metastatic burden and aggressive behavior determine severity stratification and guide treatment decisions in prostate cancer (PCa). Monoamine oxidase A (MAOA) may promote tumor burden and drug/castration resistance in PCa. A positive association will pave the way for MAOA inhibitors such as moclobemide for PCa therapy. Objective To analyze MAOA in peripheral blood mononuclear cells qualitatively and p38, c-Jun N-terminal kinases, nuclear factor kappa B, and their phosphorylated forms, vascular endothelial growth factor (angiogenesis), transforming growth factor beta, interleukin 6, and tumor necrosis factor-α (cytokines), Bcl-2 associated X, B-cell lymphoma 2, and P53 (apoptosis), prostate-specific membrane antigen, and epithelial cell adhesion molecules (surface markers) in plasma of patients with PCa. Methods This was a 1-year pilot study in which patients with PCa were recruited and stratified into 2 groups and subgroups: treatment-naive with (M1) (n = 23) or without (M0) (n = 23) bone metastasis; hormone-sensitive prostate cancer (n = 26) or hormone/castration-resistant prostate cancer (n = 26). MAOA was detected using ELISA and other proteins were detected using immunoblotting technique. Results MAOA was detected in 8.6% of M0 compared with 30.4% of M1 patients, and in 7.7% of hormone-sensitive compared with 27% of hormone/castration resistant PCa patients, associating it with bone metastasis and castration resistance. Multivariable regression analysis showed a correlation of MAOA with serum prostate-specific antigen, a marker for progression in PCa (Pearson correlation coefficient r = 0.30; P < 0.01). In patients with positive MAOA, there was overexpression of p38, phosphorylated-p38, c-Jun N-terminal kinases, phosphorylated c-Jun N-terminal kinases, nuclear factor kappa B, phosphorylated nuclear factor kappa B, transforming growth factor beta, vascular endothelial growth factor, interleukin 6, tumor necrosis factor α, Bcl-2 associated X, B-cell lymphoma 2, prostate-specific membrane antigen, and epithelial cell adhesion molecule in M1 compared with M0 group patients, associating these proteins with tumor burden. Overexpression of Bcl-2 associated X, tumor protein 53, c-Jun N-terminal kinases, nuclear factor kappa B, transforming growth factor beta, vascular endothelial growth factor, and prostate-specific membrane antigen and underexpression of B-cell lymphoma 2 and phosphorylated nuclear factor kappa B were observed in hormone-sensitive prostate cancer compared with hormone/castration-resistant prostate cancer, associating these proteins with castration resistance. Conclusions Association of key molecules of oncogenesis and metastasis with MAOA suggests that MAOA inhibitors such as moclobemide might be effective in the management of PCa.

Background: RIF is a frustrating condition, both for the clinician and the patient. Clinical trials have shown that PRP might improve live birth and clinical pregnancy rate in women with RIF undergoing IVF. Materials, setting, and methods: An electronic database search of PubMed, EMBASE, SCOPUS, and Cochrane Central was performed for articles published in the English language by two independent reviewers using predefined eligibility criteria Women of reproductive age group diagnosed with RIF and are planned for IVF cycle with fresh or frozen embryos were included. Included studies were clinical trials comparing PRPa against routine care or used as a standalone therapy in patients with RIF. Bias was assessed using the Cochrane Collaboration Network Risk of Bias Tool version 2. Quality of evidence was determined and a summary of findings table was prepared for individual outcomes using GRADEpro software. Main results and the role of chance: We identified 1146 records, of which, we screened 531 records and ten studies were included for final review. For live birth rate, we have little confidence that administration of PRP had any significant effect on live birth rate (RR 3.01, 95% CI 1.13 to 7.99, I2 = 80%, very low quality of evidence). Similarly, the quality of evidence was low for clinical pregnancy rate, we are uncertain that the administration of PRP had any significant effect on clinical pregnancy rate (RR 2.09, 95% CI 1.71 to 2.55, I2 = 25%). The protocol was registered on PROSPERO (registration number CRD42021292209).

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Capturing real-world prescription data is important for evaluating clinical practice in prostate cancer. The aim of this study was to evaluate prescribing practices in prostate cancer. This was a cross-sectional study in which four groups were identified based on tumour aggressiveness (bone metastasis absent and bone metastasis presnt) and castration response (castration-sensitive prostate cancer and castration-resistant prostate cancer). Drug utilisation methodology and core indicators of World Health Organization were used. A total of 150 patients were stratified into the four groups. The most common regime was complete androgen blockade in both bone metastasis groups and castration-sensitive prostate cancer. Palliative radiotherapy was part of the management in the bone metastasis (present) group. In castration-resistant prostate cancer, abiraterone, fosfestrol, docetaxel, and enzalutamide were prescribed. Approximately 78% of prescriptions contained medicines from the National List of Essential Medicines, India, 2015. Polypharmacy was not a common practice, antibiotics and antidepressant medicines were rarely prescribed. The prescribing trend for prostate cancer conformed to National Comprehensive Cancer Network guidelines.

Background: Monitoring of anti-tubercular therapy (ATT) response necessary for successful completion of ATT regimen. Presently available monitoring tools are invasive and have limitations. This study undertaken to see whether non-invasive tools like body mass index (BMI), hand grip strength (HGS) and quality of life (QOL) can serve as a reliable tool for monitoring ATT response.Methods: The 50 patients of tuberculosis were monitored for BMI, HGS and QOL via WHOQOL-BREF questionnaire and analyzed at baseline, 2 months and 6 months of starting ATT.Results: BMI HGS increased significantly at 2 months and 6 months compared to baseline with ATT. Physical and social domain of WHOQOL-BREF increased at 2 and 6 months with ATT, other domains shown no significant changes.Conclusions: Monitoring of BMI, handgrip strength and QOL can be a cost-effective tool for monitoring ATT response, both in pulmonary and extra pulmonary tuberculosis.