Background. Aducanumab, a new monoclonal antibody that targets β-amyloid aggregates, has been granted conditional approval by the U.S. FDA for treatment of mild Alzheimer’s disease (AD). The approval of this drug without a confirmed significant clinical impact has resulted in several debates. Objective. In this narrative review, aducanumab approval-related controversy, the drug’s pharmacokinetics and pharmacodynamic characteristics, evidence from the efficacy and safety trials of aducanumab, implications of the drug approval, and the future directions in the management of patients with AD are summarized. Methods. Using relevant keywords, Google Scholar, Web of Science, and MEDLINE databases and manufacturer’s website were searched. Results. Infusion of aducanumab at a higher dose resulted in a modest slowing of cognitive decline among patients with mild cognitive impairment or early-onset AD dementia. The drug however can cause amyloid-related imaging abnormalities. Due to modest impact on cognition, the use of this drug by patients with AD will most likely be limited. The manufacturer is required to run an extended phase IIIb trial to verify the benefit of this drug. Access to therapy requires a careful selection of patients and periodic monitoring to ensure the optimal use of the drug. Conclusion. Despite the limitations, aducanumab is the first disease-modifying therapy approved for the treatment of AD. Aducanumab addresses a part of the pathogenesis of AD; therefore, drugs that can act on multiple targets are needed. In addition, the search for preventive strategies, validated plasma-based assays, and newer drugs for AD, which are effective, safe, convenient, and affordable, is vital.
Aims The objective of the study was to determine the mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with type 2 diabetes mellitus (type 2 DM) compared to subjects without type 2 DM and their correlation with fasting blood glucose, glycosylated hemoglobin (HbA1c), and duration of type 2 DM respectively. Materials and methods A prospective analytical case—control study was conducted involving 50 subjects with type 2 DM and 50 subjects without type 2 DM. The mean and standard deviation were estimated for both the groups separately and independent Student's “t”-test was used for evaluating the significant difference. The statistical evaluation was carried out at 95% confidence level. Results Mean MPV and PDW in case group was significantly higher compared to control group (p < 0.005). Fasting blood glucose, HbA1c, and duration of type 2 DM did not significantly alter MPV or PDW. Conclusion The study concludes that MPV and PDW are significantly increased in patients with type 2 DM compared to patients without type 2 DM. Platelet volume indices are an important, simple, and cost-effective tool that should be used and explored extensively, especially in countries, such as India, for predicting the possibility of impending acute vascular events in patients with type 2 DM. Clinical significance This analytical method helps us to use MPV and PDW as early markers of vascular thrombosis. How to cite this article Bhanukumar M, Ramaswamy PKH, Peddi NK, Menon VB. Mean Platelet Volume and Platelet Distribution Width as Markers of Vascular Thrombosis in Type 2 Diabetes Mellitus. J Postgrad Med Edu Res 2016;50(3):127-131.
Background: Phenytoin is a commonly used sedative antiepileptic medication in many countries. It is used against tonic-clonic and complex partial seizures. Phenytoin is reported to cause a range of deleterious and erratic side effects at therapeutic and toxic doses. Case report: An eighteen year old female presented with ataxia, nystagmus, gingival hypertrophy, nodular skin lesions and hirsutism while she was on treatment with oral phenytoin at 200 mg once daily since the past five years for seizures. Based on the presenting signs and symptoms, her condition was diagnosed as phenytoin induced toxicity. The symptoms improved significantly after the offending drug was withdrawn. Alternatively she was started on oral carbamazepine. Naranjo and WHO causality assessment was done, indicating a probable relationship between the patient's symptoms and her use of phenytoin. Conclusion: This case report and review highlights the adverse drug reactions of phenytoin and the need of regular monitoring in patients on long term therapy.
Background Inappropriate prescribing results in serious health outcomes in the elderly, increasing morbidity and mortality and wasting resources. In developing countries, physicians sometimes ignore parasitological diagnoses and presumptively treat fever as malaria, leading to overtreatment and drug resistance. Aim The aim of this study was to determine the incidence, pattern, predictors and cost implications of inappropriate prescribing of antimalarials among elderly in‐patients. Methods A prospective interventional study was performed over 18 months at the Department of Internal Medicine, in a tertiary care teaching hospital. Fever case management of all patients was studied to identify inappropriate antimalarial prescriptions without a confirmed diagnosis. Root cause analysis was performed to characterise inappropriate prescribing, along with economic implications. Results During the study period, 403 fever cases were reported, of which 36% (n = 145) received a malaria test. Although 94% (n = 137) tests returned negative results, 32% (n = 44) of these patients were prescribed antimalarial drugs without a confirmed diagnosis, primarily monotherapy with injectable artesunate (61%) for an average of 4 days, resulting in 41% overdoses and 38% underdoses. The estimated direct cost associated with inappropriate prescribing was US$1291.67. Female bedridden patients who presented with fever associated with chills and rigors and hospitalised for longer were more likely to be irrationally prescribed antimalarials. Except for total leucocyte counts, all the other laboratory examinations were within normal limits for the study cohort (p < 0.05). Conclusion Strict treatment guidelines for antibiotic use and a multidisciplinary team approach are required to prevent inappropriate prescribing and possible adverse effects without affecting health‐related quality of life.
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