Objectives of this review is to evaluate the role of cytochrome P450 gene polymorphisms in COVID-19 infected patients with pre-existing OA on corticosteroids. The purpose of this review is to analyze whether polymorphisms of Cytochrome p450 isoforms (CYP2C9 and CYP3A4) affect the dosage of steroids in OA patients in COVID-19 infected patients. This review may provide more therapeutic options; suggest a few guidelines which may be useful in managing COVID-19 patients with pre-existing osteoarthritis. The important role of corticosteroids in treating patients infected with COVID-19 with preexisting osteoarthritis, its influence on incidence of mortality or morbidity may be highlighted. The influence of CYP enzymes and their polymorphisms suggest safety of treatments as well as the possible need for the dosage adjustment or their discontinuation.
Introduction: Inspite of HAART, it has been found that viral replication persists even when viral load is undetectable. Adherence has been reported to be positively associated with CD4 count in various settings. Objectives of our study were comparison of basal CD4 count of HIV patients on various ART regimens with that at six months and one year as well as finding correlation between percentage adherence to ART and CD4 counts at six months and one year. We also aimed to compare percentage adherence and CD4 counts of patients on various ART regimens. Methodology: A retrospective observational study was conducted on 63 HIV patients, receiving four antiretroviral regimens (AZT/3TC/NVP, AZT/3TC/EFV, d4T/3TC/NVP and d4T / 3TC / EFV). Patient demography, drug regimen, baseline CD4 counts, serial CD4 counts (every six months), and adherence to ART (monthly) were recorded. Comparison of basal CD4 counts with that at six months and one year was done. Comparison of CD4 count and adherence were done between the groups. Results: An extremely significant elevation was seen in CD4 counts at six months and at one year (p < 0.0001). Linear regression showed a significant positive correlation (p = 0.037) between adherence and CD4 counts at one year. There was no significant difference in percentage adherence and CD4 counts between four groups. Conclusion: We conclude that optimal CD4 levels were obtained in patients on all four different regimens. However percentage adherence was suboptimal in all groups which caution to take appropriate measures to achieve optimal drug adherence.
Introduction Student assessment by multiple-choice questions (MCQs) is an integral part of student evaluation in medicine. The medical teacher should be trained to construct an item with proper stem and valid options. Periodic item analyses will make the process of assessment more meaningful. Hence, we conducted the study to analyze MCQs (item analysis) tested on a batch of MBBS students in pharmacology in their three internal assessment examinations. Methods The study was conducted in the Department of Pharmacology of a medical college in Mangaluru on 150 students. The MCQs of the three internal assessment examinations (20 each) respectively were analyzed. We analyzed each question for difficulty index (DI), discrimination index (DsI), and distracter efficacy or functionality and expressed the percentage results. Results The DI was in an acceptable range of 60, 75, and 90%, respectively, in the three internal assessments. The percentage of “too difficult” questions was 10, 20, and 10% and the average DsI was 0.32 ± 0.04, 0.28 ± 0.02, and 0.26 ± 0.02, respectively. In the second and third internal assessments, 95% of questions had functional distracters, while in the first internal assessment, only 60% of questions had functional distracters. Conclusion We conclude from our study that even though the items (MCQs) framed for the internal assessments were in the acceptable range of quality in terms of the parameters assessed, we must improve MCQ’s construction in selecting distracters in some topics.
Objective: The aim of the study was to study the cost of illness of uncomplicated and complicated type 2 diabetes mellitus.Methods: The non-interventional retrospective study was carried out in K.S. Hegde Medical Academy. Annual laboratory costs, pharmacy cost, consultation charges, hospital bed charges, and surgical/intervention costs of 340 diabetic patients were obtained from the medical record section of the hospital. Patients were divided into six groups, uncomplicated, diabetic retinopathy (DR), nephropathy, neuropathy, diabetic foot (DF), and those with ischemic heart disease (IHD) and different costs were compared. Correlation of costs with duration of the study and glycemic control were studied.Results: Uncomplicated patients had significantly lower costs (p<0.0001) compared to other groups. Patients with IHD had highest expenses (p<0.0001), followed by diabetic nephropathy (DN) and DF (p<0.0001). Cost incurred in diabetic neuropathy (DNeu) was almost the double compared to uncomplicated group, but annual medical cost (AMC) was minimum among other diabetic complications. DR had higher expenses compared to DNeu. The similar pattern of distribution was observed in other individual costs. A positive correlation was observed between the costs incurred and duration of diabetes, a negative correlation between the glycemic status and cost incurred. Cost incurred was double when compared to that of previous decade.Conclusion: The total AMC is significantly higher in complicated diabetic patients as compared to those without complications. Diabetic patients with IHD had the highest expenses, followed by DN, DF, DR, and DNeu which was least expensive.
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