Uma Tekur

Plasma cortisol levels in acute asthma

Objective : The study was undertaken with the aim to determine correlation between the initial plasma cortisol level and severity of asthma attack and the response to standard treatment for acute exacerbation of bronchial asthma in pediatric age group.Methods : The study was performed in 33 asthmatic patients between 5 2–12 years of age, presenting to pediatric emergency with acute exacerbation of bronchial asthma. None of the patients included in the present study was on steroids. Venous blood sample for determination of plasma cortisol level was taken and patients were nebulized with salbutamol every 20minutes, upto 1 hour. The patients who failed to respond even after three nebulizations were labeled as nonresponders and repeat venous blood sample for plasma cortisol estimation was taken before giving injection hydrocortisone. In responders sample was taken 1hour after last nebulization.Results : The mean plasma cortisol value at the time of admission in responders (12.42 ± 1.9 ng/dl) was not found to be significantly different from that in nonresponders (13.1 ± 2.74 ng/dl). Children with severe attack of asthma had significantly higher plasma cortisol levels both at the time of admission (p=0.03) and at the end of study (p=0.001), as compared to patients with moderate attack. The mean percentage change in plasma cortisol levels in nonresponders was an increase of 80.65 ± 60.64%, whereas, in responders it decreased by 16.49 ± 21.7% and this difference was statistically significant (p s<0.05).Conclusion : The hypothalamo pituitary adrenal axis functions normally in asthmatic patients, producing a rise in cortisol levels corresponding to degree of stress; and from initial cortisol level alone, it cannot be predicted, whether a patient will respond to β-2 agonist (salbutamol) nebulization alone or will require exogenous corticosteroids.

Drug Utilisation Patterns in the Third World

SummaryDrugs are not available to the majority of the population in developing countries. Aggravating factors include weak healthcare structure, inadequate financial resources, nonavailability of pharmaceuticals, lack of drug legislation and policy. ineffective drug utilisation and the prevalence of self-medication. Although most of the population lives in rural areas, available funds are mostly utilised for urban areas.The use of drugs by injection is common in developing countries. In addition, many patients self—medicate because most drugs are available without a prescription from a doctor. There is therefore a great need for prescriber education in rational drug use, and for public education in the use of commonly used drugs. National health and drug policies should be formulated which incorporate the essential drug concept, and drug legislation needs to be revamped and implemented effectively. These measures may be helpful in providing better healthcare to the majority of the population in developing countries.

Endoscopic, Radiological, and Symptom Correlation of Olfactory Dysfunction in Pre- and Postsurgical Patients of Chronic Rhinosinusitis

The aim of the present study was to correlate olfactory dysfunction determined with psychophysical testing with nasal endoscopy, computed tomography (CT) scan, and patients self-assessed olfactory deficit in patients of chronic rhinosinusitis (CRS) before and after sinus surgery. It was a prospective cohort study comprising of a total of 40 consecutive patients of CRS. All of them were given Connecticut Chemosensory Clinical Research Center Test for olfactory evaluation, nasal endoscopy, CT scan, and a graded questionnaire for perceived olfactory ability preoperatively on the same day after failing maximal medical management for 3 weeks. All investigations except CT scan were repeated 3 months postsinus surgery. For metrics, Visual Analog Scale (VAS) score, Lund Kennedy nasal endoscopy score, and Lund MacKay CT score were used. Spearmans correlation coefficients were determined between olfactory scores and endoscopic, CT, and VAS scores. Significant positive correlation was found between subjective VAS scores and composite odor scores both preoperatively (r = 0.89, P < 0.001) and 3 months postoperatively (r = 0.54, P < 0.001). Significant negative correlation was established between olfactory scores and CT (r = -0.71, P < 0.001). With nasal endoscopy also, the correlation results of odor scores were significant (r = -0.39, P = 0.01 in preoperative period and r = -0.47, P = 0.002 in postoperative period). Hence, it could be concluded that severity of olfactory disturbance determined by olfactory tests correlates well with nasal endoscopic findings, presence of CT opacification, and the patients self-perceived olfactory insufficiency in CRS both before and after sinus surgery and can guide us well to determining the olfactory burden.

Etoricoxib Attenuates Effect of Antihypertensives in a Rodent Model of DOCA-Salt Induced Hypertension

While it is known that non-steroidal anti-inflammatory drugs including selective cyclooxygenase-2 (COX-2) inhibitors influence BP, the exact relationship and underlying mechanisms are still unclear. We investigated the effect of etoricoxib, a selective COX-2 inhibitor on the antihypertensive efficacy of atenolol; beta-blocker, ramipril; angiotensin converting enzyme inhibitor and telmisartan; angiotensin receptor blocker in deoxycorticosterone acetate (DOCA)-salt hypertensive rats, a mineralocorticoid volume expansion model. Etoricoxib attenuated the antihypertensive-induced reduction of systolic (atenolol; P < .001, ramipril; P = .011, telmisartan; P = .003) and mean arterial pressure (atenolol; P < .001, ramipril; P = .032, telmisartan; P = .023). These results demonstrate that COX-2 dependent mechanisms play a significant role in blood pressure regulation, and etoricoxib-induced COX-2 inhibition blunts the therapeutic effect of different classes of antihypertensives in this mineralocorticoid volume expansion model of hypertension.

Impact of Endoscopic Sinus Surgery on Olfaction and Use of Alternative Components in Odor Threshold Measurement

Background One of the major causes of olfactory disturbances is chronic rhinosinusitis (CRS), and the main surgical modality to treat CRS is functional endoscopic sinus surgery (FESS). It, therefore, is essential to assess the effect of this surgery on olfaction. Also, it is necessary to find new ways of measuring olfaction so as to reduce dependability on standard tests available. Objectives To study the prevalence of olfactory impairment in patients with CRS and to evaluate the impact of FESS on olfaction. The study also aims at investigating the use of other odorants in place of butanol-1 in the Connecticut Chemosensory Clinical Research Center test. Subjects and Methods Forty patients of CRS without nasal polyposis were included in the study to analyze the prevalence of olfactory dysfunction and examine the influence of FESS at 1 and 3 months after surgery. Computed tomography scores (Lund Mackay scores) were calculated preoperatively, whereas other tests, viz., visual analog scale scoring, nasal endoscopy (Lund Kennedy scoring), and composite olfactory testing with odor thresholds of butanol-1, peppermint, lemon, clove, and ethyl acetate were carried out before surgery and after surgery at 1 and 3 months. Results Of 40 patients, 70% had symptoms of hyposmia or of anosmia before surgery, which dropped to 22.5% at 1 month after surgery and to 10% at 3 months after surgery. Nasal endoscopy and visual analog scale scores improved significantly. Odor threshold and odor identification scores also improved compared with the preoperative levels. A significant positive correlation was found between the threshold scores of butanol-1 and other odorants, both before and after surgery. Conclusion Significant improvement was observed in olfaction after FESS, both in patient responses and in objective testing. The olfactory results with peppermint, lemon, clove, and ethyl acetate were close to those with butanol-1, and, hence, these other odorants can be used in place of butanol-1 in measuring the odor threshold.

Efficacy of Sodium Valproate and Haloperidol in the Management of Acute Mania: A Randomized Open-Label Comparative Study

This study was carried out to compare the efficacy of intravenous sodium valproate with intramuscular haloperidol in patients with acute mania. A total of 30 patients meeting DSM‐IV criteria for acute manic episodes were enrolled. They were randomly assigned to 2 groups of 15 patients each. Both groups were treated twice daily with haloperidol (10 mg, intramuscular) and sodium valproate (500 mg, intravenous). The patients were assessed on days 1, 5, 9, and 13. Improvement in symptoms was assessed by reduction in the Young Mania Rating Scale (YMRS). Outcome criterions for analysis were latency of response and remission; additional drugs were required for sedation. At the end of the 2‐week study period, overall response rate in both the groups was similar (P > .1). In comparison to haloperidol group, patients treated with sodium valproate showed faster response, and on day 5, significant reduction in YMRS score was observed in the group treated with sodium valproate (P < .05). Total amount of lorazepam was less in patients treated with sodium valproate. Extrapyramidal symptom episodes were observed in 60% of patients treated with haloperidol. Sodium valproate in the treatment of acute mania is as efficacious as haloperidol but provides a faster response. It is safer compared to haloperidol.

Evaluation of the analgesic and anti-inflammatory activity of fixed dose combination: non-steroidal anti-inflammatory drugs in experimental animals.

BACKGROUND In India, a number of fixed dose drug combinations of non-steroidal anti-inflammatory drugs (NSAIDs) are available, often as over-the-counter products. These combinations are being prescribed too. Evidence for efficacy of NSIAD fixed dose combination is lacking. OBJECTIVES The current study was undertaken to assess the analgesic and anti-inflammatory efficacy of these combinations over their individual components. MATERIALS AND METHODS The study used three NSAIDs viz; paracetamol, ibuprofen and diclofenac sodium, alone or in combination with paracetamol. Animals were divided into six groups with six animals in each group. Analgesic activity was tested by writhing test and paw edema model was used to assess the anti-inflammatory activity. The test drugs were administered orally 30 min prior to injecting 0.6% solution of glacial acetic acid intraperitoneally for writhing test. For paw edema test, after 30 min of drugs administration, animals were injected with 0.1 ml of 1% carrageenan in subplanter region for inducing inflammation. Paw volume was again measured at baseline and after 3 h of subplanter injection of 1% carrageenan. RESULTS The analgesic and the anti-inflammatory activity of paracetamol and ibuprofen combination were significantly greater than the individual agents when used alone. However, no significant difference in the analgesic or anti-inflammatory activity was found between diclofenac sodium and its combination with paracetamol. It was observed that diclofenac sodium was the most efficacious of the analgesics tested. Combining paracetamol with diclofenac did not show superior analgesic activity compared to diclofenac alone (P = 0.18). CONCLUSION Combining paracetamol with ibuprofen enhances analgesic/anti-inflammatory activity over their individual component but potentiation of analgesic activity of diclofenac was not seen when paracetamol was added to it.

Prescription pattern in patients with rheumatoid arthritis in a teaching tertiary care hospital

Objective: This study was conducted, with the aim to analyze the pattern of use of antirheumatic drugs in a Tertiary Care Hospital in Delhi, India. Methodology: The study was carried out in 150 patients who were on treatment with antirheumatic drugs at least for the past 6 months. Patient demographic details, duration of illness, comorbid conditions, drugs prescribed, adverse drug reactions (ADRs), and usage of complementary and alternative medicine (CAM) were used to analyze the pattern of drug use. Results: In our study, we observed that in patients with rheumatoid arthritis (RA), the most commonly prescribed disease-modifying antirheumatic drugs (DMARD) was methotrexate followed by hydroxychloroquine and sulfasalazine. DMARD combination with 3 drugs (59.3%) was the most common regimen followed by DMARD combination with 2 drugs (32.6%). Polypharmacy was seen in most of the prescriptions, but 76.3% of the drugs were from Essential Medicine List of Government of National Capital Territory, Delhi. About 40.7% of the prescriptions were prescribed by generic names. CAM was used by 13.3% of the study patients. Conclusion: The drug use pattern in RA was found to be DMARDs dependent. The concomitant use of three DMARDs was the preferred therapy. Biologics were not being used although indicated as per guidelines. ADRs associated with RA treatment were generally mild in severity and involved gastrointestinal tract.