Publications by authors named "Pramod Sharma"

142 Publications

Clinicoepidemiological Profile and Genetic Characterization of Circulating Rotavirus Strain among Children < 5 Years Hospitalized for Acute Gastroenteritis in Western Rajasthan, India.

Indian J Pediatr 2021 Mar 8;88(Suppl 1):97-104. Epub 2021 Feb 8.

The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India.

Objective: To determine the clinical and epidemiological profile and circulating strains of rotavirus among children less than 5 y of age hospitalized for diarrhea in a tertiary care center of western Rajasthan.

Method: Children < 5 y of age admitted for acute gastroenteritis were recruited in this hospital-based surveillance study. Detailed clinical history and sociodemographic information was collected for all enrolled children. Severity of the gastroenteritis was assessed using the 20-point Vesikari Clinical Severity Scoring System. Rotavirus positivity was tested in the stool samples collected from children by commercially available techniques and further molecular characterization done as per defined protocol.

Results: Out of 1055 enrolled children, overall positivity rate of typable rotavirus was 18.95% (169/892). Among children who were less than 24 mo of age, positivity due to rotavirus diarrhea was maximum (24.4%). Distinct seasonality was observed as maximum cases of rotavirus diarrhea were detected in the months of December to February. Commonest G type was G3 (54%) followed by G1 (19%) while predominant P type was P[8] (77%) followed by P[4] (11%). G3P[8] (51.83%) was the commonest genotype observed in the study region.

Conclusion: The current study found positivity of rotavirus to be 18.95% among children aged 0-59 mo admitted due to acute gastroenteritis is a tertiary care setting in northern part of India. Emergence of newer predominant strains emphasizes the need of continued surveillance to determine the changing trends.
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http://dx.doi.org/10.1007/s12098-020-03628-xDOI Listing
March 2021

A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in Children < 2 Years in Rajasthan, India.

Indian J Pediatr 2021 Mar 6;88(Suppl 1):131-137. Epub 2021 Jan 6.

Christian Medical College, Vellore, Tamil Nadu, India.

Objective: To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan.

Method: This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed.

Results: During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases.

Conclusion: Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.
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http://dx.doi.org/10.1007/s12098-020-03601-8DOI Listing
March 2021

Risk Recognition and Multidisciplinary Approach for Non-Cardiac Surgeries in Paediatric Cardiac Patients: A Retrospective Observational Study.

Cureus 2020 Dec 11;12(12):e12030. Epub 2020 Dec 11.

Anesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, IND.

Background Congenital heart disease (CHD), a structural and functional heart disease, is the commonest birth defect with an incidence of one in 125 live births worldwide with ventricular septal defect (VSD), atrial septal defect (ASD) and tetralogy of Fallot (TOF) constituting the majority. Surgery for associated extra-cardiac anomalies (airway, skeletal, genitourinary, and gastrointestinal) may be required in 30% of these patients. Delivery of uneventful anaesthesia in these children requires an understanding of not only paediatric anaesthesia but also of the pathophysiology of the cardiac lesion and its associated risks. Aims The purpose of this retrospective review was to highlight the approach to the anaesthetic management and outcomes of patients with significant cardiac lesions presenting for non-cardiac surgeries. Material and methods A retrospective chart review of all children with congenital heart disease (CHD) (repaired or unrepaired) who were posted for a non-cardiac surgery in this tertiary care Paediatric super-specialty hospital from January 1, 2018 to December 31, 2019 was carried out. Data on demographics, peri-operative management, and clinical course was retrieved. Inclusion criteria were paediatric patients (0-18 years) of either gender with a diagnosis of a CHD (repaired or unrepaired) undergoing any non-cardiac surgeries (NCS) under anaesthesia/Monitored Anaesthesia Care (MAC). Exclusion criteria were procedures only under local anaesthesia (LA) or a minor procedure done solely under sedation not involving an anaesthesiologist. Results During the study period, we found five eligible cases who underwent a total of six procedures. Five procedures were elective and one was an emergency. Preoperative optimization was conducted by a multidisciplinary team including paediatric surgeons, anaesthesiologists, physicians, and cardio-thoracic surgeons. Anaesthesia was conducted by at least a consultant paediatric anaesthesiologist. Overall all patients tolerated anaesthesia well without any adverse events or complications. All six anaesthetic encounters were safe and uneventful.
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http://dx.doi.org/10.7759/cureus.12030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755101PMC
December 2020

The Burden of Rotavirus Gastroenteritis in Children: A Hospital-Based Prospective Study in Western Rajasthan.

Cureus 2020 Oct 18;12(10):e11020. Epub 2020 Oct 18.

Psychiatry, Griffin Memorial Hospital, Norman, USA.

Objective  Rotaviruses are the prime cause of gastroenteritis amongst infants and young children worldwide. In India, the mortality and economic impact caused by rotavirus are high. The objective of this is to understand the burden of rotavirus in acute watery diarrhea and its circulating genotypes in hospitalized children less than five years of age for acute gastroenteritis in western Rajasthan. Methodology This is a hospital-based prospective study conducted in the pediatrics department of Dr. Sampurnanand (S.N.) Medical College of Jodhpur in India for one year during 2018. The study included 399 children less than five years old, presenting with acute gastroenteritis who needed to be admitted for at least six hours. We enrolled subjects after obtaining informed consent from the guardian. Stool samples of 5 gm or ml were collected in a sterile container and stored at minus 20 degrees centigrade while transporting to Christian Medical College (CMC) virology lab in Vellore, India. The stool samples were subjected to Enzyme-Linked Immunosorbent Assay (ELISA) testing, followed by genotype determination. We investigated data through statistical analysis from all collected data. Results A total of 399 patients fulfilled the enrollment criteria; out of them, 92 (23.05%) were positive for rotavirus, and maximum cases were seen in the age group of six months to two years (78.26%). Rotavirus positivity was more in males (64.13%) than females (35.86%). The rotavirus infection was seen throughout the year, with a peak in cases from November to February (73.91%). G3P8 (55.43%) was the most common strain causing rotavirus diarrhea, followed by G1P8 (9.72%) and G3+G12P8 (8.69%). Based on the Vesikari clinical severity score, 70.65% of patients had severe diarrhea. Conclusion This prospective study highlights the healthcare and economic burden of rotavirus, especially in children of less than five years. The incidence of rotavirus is observed in winter months, and its prevalence in all cases of acute diarrhea in our study is 23.05%. G3P8 was the most common genotype causing rotavirus diarrhea in our region in both non-vaccinated and vaccinated children, followed by G1P8 and G3+G12P8, respectively.
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http://dx.doi.org/10.7759/cureus.11020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671170PMC
October 2020

Intussusception after Rotavirus Vaccine Introduction in India.

N Engl J Med 2020 11;383(20):1932-1940

From the Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences (S.N.R., N.P.N., V.T., S. Giri, I.P., S. Babji, S. Bidari, S. Senthamizh, G.K.), and the Department of Community Health (V.R.M.), Christian Medical College Vellore (T.J.K.J.), and Government Vellore Medical College (G.V.), Vellore, Kanchi Kamakoti Child Trust Hospital (B.S.), the National Institute of Epidemiology (G.K.C.P.), and the Institute of Child Health (P.D., M.J.), Chennai, Government Rajaji Hospital and Madurai Medical College, Madurai (K.M., H.B.), Coimbatore Medical College, Coimbatore (R.M., R. Gurusamy), the Indian Council of Medical Research, New Delhi (S. Giri, I.P., M.D.G.), Translational Health Science and Technology Institute, Faridabad (R.A., G.K.), Kurnool Medical College and Government General Hospital, Kurnool (S.M.), Government General Hospital and Rangaraya Medical College, Kakinada (K.B.G., B.R.), King George Hospital and Andhra Medical College, Visakhapatnam (P.P., R.P.G.), Sri Venkateshwara Medical College, Tirupati (M.B., V.M.), Sardar Valla Bhai Patel Post Graduate Institute of Paediatrics, Cuttack (S. Sathpathy, H.M.), the Institute of Medical Sciences and SUM Hospital, Bhubaneswar (M.D.), Kalinga Institute of Medical Sciences (N.K.M.) and Hi-Tech Hospital (R.K.R., P.M.), Bhubaneswar, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak (G.G.), Shaheed Hasan Khan Mewati Government Medical College, Mewat (S.C.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G.), Sawai Man Singh Medical College, Jaipur (R. Gupta), Rabindranath Tagore Medical College, Udaipur (S. Goyal), Dr. Sampurnanand Medical College, Jodhpur (P.S.), Malankara Orthodox Syrian Church Medical College Hospital, Kolencherry (M.A.M.), Jawaharlal Nehru Institute of Post-graduate Medical Education and Research, Puducherry (S.K., A.S.), Mahatma Gandhi Memorial Medical College, Indore (H.J.), the Government Medical College, Guwahati, Assam (J.K.G.), King George Medical College, Lucknow (A.W.), and the Institute of Medical Sciences, Banaras Hindu University, Varanasi (V.G.) - all in India; and the Centers for Disease Control and Prevention, Atlanta (J.E.T., U.D.P.).

Background: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries.

Methods: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location.

Results: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis.

Conclusions: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).
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http://dx.doi.org/10.1056/NEJMoa2002276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492078PMC
November 2020

Role of signaling pathway in biological cause of Rheumatoid arthritis.

Curr Drug Res Rev 2020 Nov 9. Epub 2020 Nov 9.

Department of Pharmacy, School of Medical and Allied Science, Galgotias University, Plot N. 2, Sector 17- A, Yamuna Expressway, Gautam Buddha Nagar, Greater Noida, Uttar Pradesh 201306,. India.

Rheumatoid Arthritis is a chronic progressive inflammatory auto-immune disease in which the immune system of the body attacks its cartilage and joints lining. It not only affects synovial joints but also many other sites including heart, blood vessels, and skins. It is more common in females than in males. The exact cause of rheumatoid arthritis is not well established but the hypothesis reported in the literature is that in the development stage of the disease, both genetics and environmental factors can play an inciting role. Along with these factors alteration in the normal physiology of enzymatic action, acts as a trigger to develop this condition. Numerous signaling pathways involved in the pathogenesis of Rheumatoid Arthritis involves activation of mitogen-activated protein kinase, kinases Janus family, P-38 Mitogen-Activated Protein Kinase, Nuclear Factor-kappa B. Interleukin-1 to play a proinflammatory cytokine that plays an important role in inflammation in RA. These are also associated with an increase in neutrophil, macrophage and lymphocytic chemotaxis, mast cell degranulation, activation, maturation and survival of T-cells and B-cells activated. These signaling pathways also show that p38α downregulation in myeloid cells exacerbates the severity of symptoms of arthritis. Thus, present review carters about the detail of different signaling pathways and their role in rheumatoid arthritis.
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http://dx.doi.org/10.2174/2589977512999201109215004DOI Listing
November 2020

Sexual function outcomes and risk factors of erectile dysfunction after surgical repair of penile fracture.

Turk J Urol 2021 Mar 9;47(2):106-112. Epub 2020 Oct 9.

Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India.

Objective: To determine the erectile dysfunction (ED), overall sexual function, and risk factors for developing ED after surgical repair of penile fracture.

Material And Methods: This was an ambispective observational study conducted from September 2014 to August 2019, which included 68 patients with a clinical diagnosis of penile fracture. The clinical presentation, etiology, and surgical details were recorded. Patients were contacted via telephone and called for follow-up. Their sexual function was objectively recorded using the sexual health inventory for men questionnaire, erection hardness grading scale, and the brief male sexual function inventory (BMSFI). Patients were categorized in 2 groups on the basis of ED. These 2 groups were compared on the basis of preoperative and intraoperative factors to determine the predictors of postoperative ED.

Results: The mean age at presentation was 33.64±9.46 (range, 19-54) years. The most common mode of injury was injury during the sexual intercourse (78%). All the patients underwent surgical exploration through subcoronal degloving incision. On follow-up, 7 patients (11.3%) developed ED (mild ED, 5 patients; mild-to-moderate ED, 2 patients). Per BMSFI, 58 (93.5%) patients had no bothersome issues with their sexual life, and they were mostly satisfied. The significant risk factors for ED were age >50 years and bilateral corporal involvement.

Conclusion: Penile fracture is a true urological emergency, and prompt diagnosis by clinical acumen and emergent surgical exploration provide good functional results with low morbidity. The main predictors of postsurgical ED are increasing age (>50 years) and bilateral corporal involvement.
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http://dx.doi.org/10.5152/tud.2020.20311DOI Listing
March 2021

Community-acquired infection caused by small-colony variant of .

Indian J Med Microbiol 2020 Apr-Jun;38(2):216-218

Department of Clinical Microbiology, Super Specialty Paediatric Hospital, Postgraduate Teaching Institute, Noida, Uttar Pradesh, India.

Staphylococcus aureus and other Gram negative bacteria produce small colony variants (SCV) which usually emerge after exposure to antimicrobials. They cause repeated infections, treatment failures and often pass unnoticed during cultures due to unusual appearance and incomplete incubation. This infectious disease grand round highlights a similar clinical case with atypical history and appearance of a SCV of S. aureus and why prolonged incubation is necessary for aspirates from patients with recurrent infections like abscesses.
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http://dx.doi.org/10.4103/ijmm.IJMM_20_250DOI Listing
September 2020

Novel corona virus disease (COVID-19) and ophthalmic manifestations: Clinical evidences.

Dermatol Ther 2020 11 26;33(6):e13814. Epub 2020 Jun 26.

Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India.

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http://dx.doi.org/10.1111/dth.13814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300514PMC
November 2020

Cytokines, Angiogenesis, and Extracellular Matrix Degradation are Augmented by Oxidative Stress in Endometriosis.

Ann Lab Med 2020 09;40(5):390-397

Department of Biotechnology, National Institute of Technology, Yupia, Papum Pare, Arunachal Pradesh, India.

Background: The effect of the interplay among inflammation, angiogenesis, extracellular matrix (ECM) degradation, and oxidative stress (OS) on the pathogenesis of endometriosis remains unclear. Previously, we demonstrated the role of OS in endometriosis. Here, we performed a comprehensive investigation of several molecules involved in inflammation, angiogenesis, and ECM degradation in women with endometriosis to study their interplay with OS.

Methods: Blood samples were collected from women with endometriosis (N=80), as well as from women with tubal factor infertility as controls (N=80). Interleukin (IL)-1β, tumor necrosis factor-alpha, interferon-gamma, transforming growth factor-beta, IL-4, -10, -2, -6, -8, vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, -9, tissue inhibitor of metalloproteinases (TIMP)-1, -2, and cyclooxygenase (COX)-2 levels in serum samples were measured using an ELISA. Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) in peripheral blood mononuclear cells was measured using flow cytometry.

Results: Cytokines, VEGF, MMPs, and COX-2 were significantly higher and TIMPs were significantly lower in patients with endometriosis. Multivariate statistical analysis indicated that IL-10 was the most significant variable capable of discriminating endometriosis samples from controls.

Conclusions: Deregulation of NF-κB activation by OS affects the expression of various cytokines in endometriosis. Elevated cytokine levels further up-regulate IL-10, which subsequently activates the MMPs, leading to excessive ECM degradation and angiogenesis. Moreover, IL-10 emerged as the most important molecule involved in the pathogenesis of endometriosis. Measurement of these molecules may help in better management of the patients with endometriosis.
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http://dx.doi.org/10.3343/alm.2020.40.5.390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169633PMC
September 2020

Short-term Alteration of Renal Function and Electrolytes after Percutaneous Nephrolithotomy.

Urol J 2019 12 24;16(6):530-535. Epub 2019 Dec 24.

Department of Urology, Calcutta National Medical College and Hospital, Kolkata, India.

Purpose: To analyse the changes in renal function and serum electrolytes in the early post-operative period ofpercutaneous nephrolithotomy (PCNL).

Materials And Methods: A total of 110 patients with normal renal function, who underwent PCNL in our institutewere evaluated prospectively. Haemoglobin percentage, packed cell volume, blood urea nitrogen, serum creatinineand serum electrolytes, namely sodium, potassium, chloride and ionized calcium were measured on the day beforesurgery and after 72 hours of the procedure. Renal function was assessed by Cockcroft-Gault formula and estimatedglomerular filtration rate was calculated by modification of diet in renal disease formula.

Results: Serum creatinine increased significantly from a mean value of 0.89 ± 0.199 mg/dL to 0.96 ± 0.252 mg/dL(P = 0.0002) and both creatinine clearance and estimated glomerular filtration rate experienced a significant fall -from a median value (interquartile ranges) of 82.99 (72.37 to 96.88) mL/min to 75.38 (63.89 to 94.05) mL/min incase of creatinine clearance (P = 0.0004) and from a mean value of 95.18 ± 19.87 mL/min/1.73 m2 to 89.30 ± 23.14mL/min/1.73 m2 in case of estimated glomerular filtration rate (P = 0.003). Furthermore, there were significantdrops in both haemoglobin percentage and packed cell volume. There were no significant alterations in serum electrolytes- sodium and potassium (mmol/L) [Median (IQR)] changed from a pre-operative figure of 137.5 (134.0 to140.0) and 3.85 (3.60 to 4.10) to a post-operative value of 138 (135.0 to 140.0) and 3.85 (3.50 to 4.10) respectively.

Conclusion: Even though there is no significant variation in serum electrolytes, PCNL causes significant reductionin renal function in the early post-operative period.
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http://dx.doi.org/10.22037/uj.v0i0.4558DOI Listing
December 2019

A journey of celecoxib from pain to cancer.

Prostaglandins Other Lipid Mediat 2020 04 11;147:106379. Epub 2019 Nov 11.

Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Gautam Budh Nagar, Uttar Pradesh 201310, India.

The most enthralling and versatile class of drugs called the Non-steroidal anti-inflammatory (NSAIDs) showed its therapeutic utility in inflammation, beginning from the era of classic drug 'Aspirin'. NSAIDs and their well-established action based on inhibiting the COX-1 and COX-2 enzyme leads to blockage of prostaglandin pathway. They further categorized into first generation (non-selective inhibitor) and second generation (selective COX-2 inhibitors). Selective COX-2 inhibitors has advantage over non-selective in terms of their improved safety profile of gastro-intestinal tract. Rejuvenating and recent avenues for COXIBS (selective COX-2 inhibitors) explains its integrated role in identification of biochemical pain signaling as well as its pivotal key role in cancer chemotherapy. A key role player in this class is the Celecoxib (only FDA approved COXIB) a member of Biopharmaceutical classification system (BCS) II. Low solubility and bioavailability issues related with celecoxib lead to the development and advancement in the discovery and research of some possible formulation administered either orally, topically or via transdermal route. This review article intent to draw the bead on Celecoxib and it clearly explain extensive knowledge of its disposition profile, its dynamic role in cancer at cellular level and cardiovascular risk assessment. Some of the possible formulations approaches with celecoxib and its improvement aspects are also briefly discussed.
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http://dx.doi.org/10.1016/j.prostaglandins.2019.106379DOI Listing
April 2020

An open-label, randomized, 10 weeks prospective study on the efficacy of vitamin D (daily low dose and weekly high dose) in vitamin D deficient patients.

J Family Med Prim Care 2019 Jun;8(6):1958-1963

Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Basni, Phase-1, Jodhpur, Rajasthan, India.

Background: Vitamin D is an important vitamin required to maintain normal skeletal as well as nonskeletal functions. The daily supplementation of vitamin D not only have poor adherence to the regimen but also of doubtful efficacy in deficient patients.

Objectives: The aim of this study was to compare the effect of oral high-dose vitamin D regimens (60,000 IU weekly) and daily low-dose vitamin D regimen of 1000 IU in mitigating symptoms and increase in serum levels of vitamin D in patients with hypovitaminosis D.

Materials And Methods: A total of 90 patients aged 18-60 years with vitamin D deficiency (serum levels < 30 ng/mL) were enrolled. A total of 38 subjects received 60,000 IU of vitamin D weekly with 500 mg/day calcium and 40 subjects received a dose of 1000 IU of vitamin D daily with 500 mg/day calcium for 10 weeks. Baseline and follow-up total serum vitamin D levels and improvement in symptoms were measured within and between groups.

Results: For high-dose vitamin D (60,000 IU weekly), the increase in mean serum vitamin D levels from baseline was 28.33 ng/mL over 10 weeks' treatment period; whereas for the low-dose group (1000 IU daily) the mean increment in serum vitamin D was 6.79 ng/mL for the same period. The mean difference in increase in serum vitamin D between two groups was highly significant ( < 0.001). In both the groups, decrease in myalgia as evaluated on visual analog scale was observed after 10 weeks.

Conclusions: High-dose vitamin D (60,000 IU weekly) regimen rapidly normalized 25(OH) D levels and ensure symptomatic relief earlier than daily dosing of 1000 IU vitamin D for same duration.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_272_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618212PMC
June 2019

Essential Yet Neglected Role of Primary Care Physicians in Palliation Team.

J Assoc Physicians India 2019 Mar;67(3):81-83

Associate Professor, Department of Pharmacology, AIIMS, Jodhpur, Rajasthan.

Quality home-based care for patients with the end-stage disease is increasingly being preferred. Responding to disease associated symptoms and complications may pose an array of challenges in evolving palliative care systems, as no formal institutional mechanism exists to respond to patient and caregiver's wishes. Family and primary care physicians can play an instrumental role in such scenarios by bridging the gaps between cancer specialists and patient and caregivers expectations.
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March 2019

Experimental modulation of mood by acoustic stimulation and its effect on exertional dyspnoea.

Thorax 2019 07 6;74(7):707-710. Epub 2019 Mar 6.

Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.

We examined the interactions between acoustically driven mood modulation and dyspnoea. Following familiarisation, 18 healthy participants attended three experimental sessions on separate days performing two 5 min treadmill tests with a 30 min interval per session while listening to either a positive, negative or neutral set of standardised International Affective Digitised Sounds (IADS). Participants rated intensity and affective domains of dyspnoea during the first exercise test and mood during the second. Mood valence was significantly higher when listening to positive (mean (95% CI): 6.5 (5.9-7.2)) compared with negative sounds (3.6 (2.9-4.4); p<0.001). Dyspnoea and were statistically significantly lower when listening to positive (2.4 (1.8-2.9) and 1.3 (0.7-1.9)) compared with negative IADS (3.2 (2.3-3.7), p=0.013 and 2.3 (1.3-3.3), p=0.009). These findings indicate that acoustically induced mood changes influence exertional dyspnoea.
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http://dx.doi.org/10.1136/thoraxjnl-2018-212683DOI Listing
July 2019

Correlation of Serum Vitamin D Levels in Lactating Mothers and Their Infants.

Indian J Endocrinol Metab 2018 Nov-Dec;22(6):801-805

Department of Paediatrics, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.

Background: Although Vitamin D deficiency is highly prevalent in Indians, data on Vitamin D eficiency in lactating mothers and exclusively breast fed infants is inadequate.

Objective: This study was done to evaluate the prevalence of Vitamin D deficiency in lactating mothers and their infants and to find out any correlation between them.

Materials And Methods: This hospital based, cross sectional study included 200 healthy infants between 1-30 days and their mothers. Serum sample was collected from both for Ca, inorganic phosphate (IP), alkaline phosphatase (ALP), and 25(OH)D.

Results: Mean serum 25(OH)D level of mothers was 11.33 ± 5.86 ng/ml with a range of 2-37 ng/ml. Hypovitaminosis D was defined as serum 25(OH)D level <10 ng/ml. Almost 94 (47%) of mothers were having hypovitaminosis D. Mean serum 25(OH)D level of infants was 11.92 ± 7.89 ng/dl with a range of 2.5-68 ng/dl. Ninety (45%) infants were having hypovitaminosis D. There was a moderate positive correlation between individual mothers' and infants' serum 25(OH)D values (Pearson coefficient = 0.516, < 0.001). Using logistic regression, it was found that infants born to mothers with hypovitaminosis D carry a 4.47 times more risk of developing hypovitaminosis D as compared to infants born to mothers with normal serum 25(OH)D (Odds ratio = 4.47, < 0.001).

Conclusion: This study shows a high prevalence of Vitamin D deficiency in lactating mothers and their breastfeeding infants with a positive correlation between them. These results provide a justification for adequate Vitamin D supplementation of all exclusively breastfeeding infants and highlight the urgent need to improve maternal Vitamin D status.
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http://dx.doi.org/10.4103/ijem.IJEM_186_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330878PMC
February 2019

A retrospective analysis of reporting of adverse drug reactions to oncology drugs: An experience from a national center of clinical excellence.

Indian J Pharmacol 2018 Sep-Oct;50(5):273-278

Department of Radiotherapy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Introduction: Adverse drug reaction (ADR) is a public health problem which constitutes one of the leading causes of morbidity and mortality worldwide. In India, only a few studies reported cancer chemotherapy-induced ADRs. The objectives of the present study were to assess the organ system involved, frequency, severity, and preventability of the ADRs occurred.

Materials And Methods: Data on ADRs of retrospective cohorts were extracted from the filled ADR forms received from the department of radiation oncology. Descriptive statistic was used to summarize and analyze the available data, namely patient demography, causality, severity, and preventability of the event.

Results: A total of 191 chemotherapy-induced ADR reports were received from 164 patients during the period March 2015 to August 2017. Almost three-fourth of the ADRs occurred in patients who were receiving regimens involving multiple drugs. Taxanes, alkylating agents, and platinum compounds were the common drug groups involved. The skin ( = 90) was the most frequently involved organ with alopecia and hyperpigmentation as most common manifestations. The severity (Hartwig and Siegel) and preventability scales (Modified Schumock and Thornton) indicated that most reactions were mild (54.45%) in nature and the majority of them were preventable. More than two-third (69%) of the reactions were related "possible" to the suspected drug as determined by the World Health Organization causality assessment.

Conclusion: Chemotherapy-related ADRs among cancer patients are worrisome. It has a negative impact on patient quality of life and in addition increases cost of therapy. It is found that timely reporting of chemotherapy-related ADRs and having an effective ADR monitoring system in place ensure preventability of the ADRs in many cases. Oncologists, Radiotherapists and Onco-surgeons should be actively involved in ADR reporting (Onco-Pharmacovigilance) and exchange constructive information, update and educate each other about appropriate use of anticancer drugs. Onco-pharmacovigilance is the need of the hour and could be of immense value in reducing morbidity and mortality if practiced with utmost importance.
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http://dx.doi.org/10.4103/ijp.IJP_544_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302695PMC
April 2019

Incidence of Congenital Hypothyroidism in Western Rajasthan Using Cord Blood Thyroid-stimulating Hormone Levels as a Screening Tool: A Cross-sectional Hospital-based Study.

Indian J Endocrinol Metab 2018 May-Jun;22(3):417-420

Department of Pediatric Medicine, Pediatric Cardiac Division, Umaid Hospital for Mother and Child Dr. S. N. Medical College, Jodhpur, Rajasthan, India.

Background: Congenital hypothyroidism (CH) is considered the most common preventable cause of intellectual impairment, with a worldwide annual incidence of 1:4000 live births. In the absence of screening program actual incidence in India is not exactly known, but in previous studies it varies from 1:500 to 1:3400. We wished to find out the incidence of CH in Western Rajasthan using cord blood TSH as a screening tool and venous TSH within 14 days of life as a confirmatory test.

Methods: This cross sectional descriptive study was conducted over a period of six months in teaching hospitals attached to Medical College. Cord blood TSH value of 20 mIU/L or >20 mIU/L was taken as cut off for screening and all screen positive neonates were re-tested for serum TSH by taking venous samples within 14 days of life. Repeat TSH levels of 20mIU/L or more tested by Enzyme Linked Fluorescent Assay were considered confirmatory.

Results: Total 9558 cord blood samples were analyzed for TSH levels, out of which 533 came out to be screen positive (recall rate 5.57%). Out of these 58 could not be confirmed, so were excluded from the further analysis. Effective sample size and screen positive cases dropped to 9500 and 475 respectively, and out of these 13 were confirmed as CH (incidence - 1.37 per thousand live births).

Conclusions: Considering the previous studies, incidence of CH is much higher in Western Rajasthan than the anticipated. Overall in India CH seems to be more prevalent than the other parts of the world, necessitating the need of national screening program.
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http://dx.doi.org/10.4103/ijem.IJEM_354_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063176PMC
August 2018

Stability facilitation of nanoparticles prepared by ultrasound assisted solvent-antisolvent method: Effect of neem gum, acrylamide grafted neem gum and carboxymethylated neem gum over size, morphology and drug release.

Mater Sci Eng C Mater Biol Appl 2018 Oct 15;91:772-784. Epub 2018 Jun 15.

Siddarth Institute of Pharmacy, Dehradun, Uttarakhand, India.

In present research, etoricoxib nanoparticles were prepared using newly developed ultrasonication assisted solvent-antisolvent method. Neem gum (NGP) and their semisynthetic derivatives NGP-g-Am (acrylamide graft copolymer of neem gum) and CMNGP (carboxymethylated neem gum) were used to provide stability to drug nanoprecipitates. In this research response surface methodology based on 3 factorial design was utilized to evaluate the effect of two independent variables (concentration of drug and polymer) over size and entrapment efficiency of nanoparticles (dependent variables). When compared with pure drug nanocrystals, polymer stabilized molecular composite nanoparticles were of smaller size and spherical shape. CMNGP stabilized composite nanoparticles shown smaller size hence better performance in terms of solubility and dissolution rate as compared to NGP and NGP-g-Am. As shown by zeta seizer analysis for the same concentration of drug and stabilizer, size of nanoparticles were found in the range of NGP-g-Am > NGP > CMNGP and reverse case was observed for dissolution rate. Contact angle determination easily predict better hydrophilicity of CMNGP than NGP followed by NGP-g-Am. DSC thermogram predict the amorphous nature of CMNGP than NGP and NGP-g-Am. SEM revealed spherical shaped and non-aggregation of nanoparticles. Prepared nanosuspension show no aggregation and Ostwald repining after 45 days when ultrasonicated for 5 s. t of optimized formulations of NGP (N9), NGP-g-Am (A8) and CMNGP (C1) was found to be 249.46 min, 296.63 min and 223.39 min and followed 1° order, Higuchi and 1° order kinetics of drug, respectively. Similarity factor analysis predict that release pattern of drug from three different polymer stabilized nanoparticles are significantly differ to each other. Particle size of nanoparticles was studied in presence of solvent and findings showed no change in size after 45 days.
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http://dx.doi.org/10.1016/j.msec.2018.06.013DOI Listing
October 2018

Kheri (Acacia chundra, family: Mimosaceae) gum: Characterization using analytical, mathematical and pharmaceutical approaches.

Polim Med 2017 Jul-Dec;47(2):65-76

Siddarth Institute of Pharmacy, Dehradun, Uttarkhand, India.

Background: Natural polymers have been used in medical, pharmaceutical, cosmetic and food industry. They should be characterized before their possible applications in different industries.

Objectives: The objective of this study was to characterize Kheri (Acacia chundra, family: Mimosaceae) gum using analytical, mathematical and pharmaceutical approaches.

Material And Methods: Crude Kheri gum (KG) was purified using distilled water as a solvent and ethanol as a precipitating agent. KG was characterized in terms of phytochemical screening, micromeritic properties, microbial load, ash value, rheological behavior, solid state 1H nuclear magnetic resonance (NMR), mass spectra and Fourier-transform infrared spectroscopy (FTIR) studies for their possible applications in food, cosmetics and pharmaceutical industry.

Results: Studies show that KG contains carbohydrates, while protein, fat, volatile oils, alkaloids and glycosides are absent. 1% aqueous solution of polysaccharide showed 25.58 × 103 kJ/kg activation energy and 1.39 Reynold's number. Viscosity average molecular weight of purified gum was found 1.73 × 105 D. Thermodynamic parameters, i.e., change in enthalpy ΔHv and change in enthalpy ΔHv, were found to be 12.26 × 103 kJ/mol and 24.47 kJ/mol, respectively. Mathematical approach also determined the rod shaped conformation of KG in aqueous solution. IR spectroscopic study shows the presence of free (COO-) and esterified (COO-R) carboxylic acid, ether (C-O stretching), galacturonic acid and mannose in polysaccharide 1H NMR study predicts presence of tetrahydropyran hydrogen in molecule. Furthermore, KG was also characterized as a suspending agent using paracetamol as a model drug. Flow rate, pH, particle size and settling behavior of suspensions were evaluated. Initial particle size of dispersed phase particles does not change significantly after 45 days.

Conclusions: From the findings of the research it can be concluded that KG can be used as an excipient in cosmaceuticals and pharmaceuticals and its characteristic rheological behavior may attract rheologists.
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http://dx.doi.org/10.17219/pim/76515DOI Listing
November 2018

TGN-1412 and BIA-2474 Trials with Tragic End: Lessons Learnt To Make Clinical Trials Safer.

Rev Recent Clin Trials 2018 ;13(4):252-256

Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India.

Background: Globally, there have been tremendous efforts by regulatory authorities to make clinical trials safer by making stringent clinical trial regulations. Despite this, we witnessed several tragic events. TGN1412 and BIA 10-2474 phase I trials are infamous trails in which healthy volunteers either succumbed to severe adverse effects or faced irreversible impairments of the test drug. Such afflictions in clinical trials are not only turbulent to the image of pharmaceutical industry but it also conveys dispiriting message for clinical trial participants.

Objective: To make clinical trials safer for participants, some regulatory changes are warranted.

Methods: Some stipulated measures to improve safety of clinical trial participants include inclusion of patients instead of healthy volunteers in phase I clinical trials, all compounds which are used for first time in humans should be considered as high risk compounds, amendments in first in human clinical trial design to N of 1 randomized control trial in place of 6+2 design with the sequential dosing of subjects both within and between cohorts and the individual patient pharmacokinetic and pharmacodynamic data should be used to calculate sequential dosing. Besides these, there should be appropriate process for systematic risk assessment involving the use of statistical techniques to select pertinent risk factors with high predictive values of studies or sites that may be procumbent to non-compliance.

Conclusion: Inclusion of above mentioned measures in clinical trials are bound to make them safer and may help in pacifying the insecurity that has emerged among humans to participate in clinical trials.
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http://dx.doi.org/10.2174/1574887113666180521093529DOI Listing
April 2019

Quality of Life (QoL) and the Factors Affecting it in Transfusion-dependent Thalassemic Children.

Indian J Pediatr 2018 Nov 12;85(11):978-983. Epub 2018 May 12.

Department of Obstetrics & Gynaecology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.

Objectives: To evaluate the Quality of life (QoL) and the factors affecting it in transfusion-dependent thalassemic children.

Methods: Current study was conducted at Department of Pediatrics, Dr. SNMC, Jodhpur. Ninety-three transfusion-dependent thalassemic children aged between 8 and 18 y were enrolled. Quality of life was assessed using Pediatric Quality of Life (PedsQL) measurement model in thalassemic children.

Results: Mean age of children was 11.8 ± 3.2 y. Lowest mean score was observed in School functioning (57.4) while in Physical functioning, Emotional functioning and Social functioning it was 73.9, 82.2 and 83.49 respectively. Mean PedsQL score was higher in 8-12 y age group as compared to 13-18 y (p = 0.024). PedsQL score was higher in children who required transfusion once in a month (p = 0.028) and children on combined chelation therapy as compared to children who were on injectable chelator (p = 0.039). Health Related QoL was not affected with gender, education status, family history of thalassemia, ferritin level, splenectomy or consanguinity.

Conclusions: Factors related with low QoL in current study were higher age, increased transfusion frequency and injectable mode of chelation. In order to improve the QoL in thalassemic children appropriate programmes and interventions should be started targeting above domains.
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http://dx.doi.org/10.1007/s12098-018-2697-xDOI Listing
November 2018

(TMT) clusters as dilute debris-free tin source for generation of multiply charged tin ions-of relevance in extreme ultraviolet (EUV) lithography, under intense laser irradiation.

Rapid Commun Mass Spectrom 2018 May 7. Epub 2018 May 7.

Chemistry Division, Bhabha Atomic Research Centre, Mumbai, 400 085, India.

Rationale: Multiply charged tin ions ([Sn] to [Sn] ) are considered as ideal-emitters at extreme ultraviolet (EUV) wavelength ~ 13.5 nm, pertinent to advanced micro-electronic device fabrication. Solid tin targets have been widely explored for the generation of these ions, but debris generation has restricted their utilization. Tin-containing molecular clusters have, however, the potential to act as dilute and debris-free sources for the generation of tin ions, as investigated in the present study.

Methods: Efficient coupling of laser energy with clusters has been utilized for the generation of multiply charged tin ions. The ions generated have been characterized using time-of-flight mass spectrometry. By varying experimental parameters, the yield of multiply charged tin ions has been manipulated, for tetramethyltin (TMT) clusters. In addition, the energetic electrons and photons liberated upon laser-cluster interaction have been probed utilizing an in-house developed retarding field analyser.

Results: Interaction of tetramethyltin clusters with 1064 nm picosecond laser pulses of intensity ~ 10 W/cm leads to the generation of multiply charged tin ions (up to [Sn] ) and carbon ions (up to [C] ). Efficient laser-cluster interaction is evident from the generation of multiply charged tin ions with ionization energy ~ 282 eV ([Sn] ). By varying the experimental conditions, the distribution of multiply charged tin ions can be influenced to obtain significant relative ion yield of multiply charged tin ions from [Sn] to [Sn] .

Conclusions: Tetramethyltin clusters have the potential to act as dilute and debris-free source for EUV lithographic applications, in contrast to bulk tin targets. The inherent properties of clusters, such as higher local density and the pulsed nature of the cluster source, are appropriate for EUV lithographic applications.
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http://dx.doi.org/10.1002/rcm.8152DOI Listing
May 2018

A Narrative Review of Potential Future Antidiabetic Drugs: Should We Expect More?

Indian J Clin Biochem 2018 Apr 8;33(2):121-131. Epub 2017 Jun 8.

2All India Institute of Medical Sciences (AIIMS)-Jodhpur, Basni Industrial Area Phase-2, Jodhpur, Rajasthan 342005 India.

Prevalence of diabetes mellitus, a chronic metabolic disease characterized by hyperglycemia, is growing worldwide. The majority of the cases belong to type 2 diabetes mellitus (T2DM). Globally, India ranks second in terms of diabetes prevalence among adults. Currently available classes of therapeutic agents are used alone or in combinations but seldom achieve treatment targets. Diverse pathophysiology and the need of therapeutic agents with more favourable pharmacokinetic-pharmacodynamics profile make newer drug discoveries in the field of T2DM essential. A large number of molecules, some with novel mechanisms, are in pipeline. The essence of this review is to track and discuss these potential agents, based on their developmental stages, especially those in phase 3 or phase 2. Unique molecules are being developed for existing drug classes like insulins, DPP-4 inhibitors, GLP-1 analogues; and under newer classes like dual/pan PPAR agonists, dual SGLT1/SGLT2 inhibitors, glimins, anti-inflammatory agents, glucokinase activators, G-protein coupled receptor agonists, hybrid peptide agonists, apical sodium-dependent bile acid transporter (ASBT) inhibitors, glucagon receptor antagonists etc. The heterogeneous clinical presentation and therapeutic outcomes in phenotypically similar patients is a clue to think beyond the standard treatment strategy.
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http://dx.doi.org/10.1007/s12291-017-0668-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891460PMC
April 2018

Relationship between T2* magnetic resonance imaging-derived liver and heart iron content and serum ferritin levels in transfusion-dependent thalassemic children.

Asian J Transfus Sci 2018 Jan-Jun;12(1):69-74

Department of Pediatrics, Dr S N Medical College, Jodhpur, Rajasthan, India.

Context: T2* magnetic resonance imaging (MRI) is being increasingly used for the assessment of organ iron content in thalassemics, but cost is a major prohibitive factor for repeated measurements. If serum ferritin correlates well with the T2* MRI liver and heart, it will be economical and more simple tool to assess organ iron deposition.

Aims: The aim of this study was to find out the relationship between serum ferritin level and T2* MRI-derived liver and heart iron content in transfusion-dependent thalassemic children.

Settings: Thalassemia day-care center of a teaching hospital.

Design: This was a cross-sectional study.

Subjects And Methods: Seventy-three transfusion-dependent beta thalassemic children belonging to 2-18 years of age were subjected to T2* MRI of heart and liver to assess their iron content. Values obtained here were related to serum ferritin.

Statistical Analysis Used: Keeping the correlation between serum ferritin and T2* MRI as primary outcome, spearman's correlation coefficient was calculated.

Results: We found poor (negative) correlation between serum ferritin level and T2* MRI liver ( = -0.448, = 0.000) but no correlation between serum ferritin and T2*MRI heart ( = -0.221, = 0.060).

Conclusions: Serum ferritin cannot reliably predict the liver and heart iron content in Indian children with β thalassemia.
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http://dx.doi.org/10.4103/ajts.AJTS_3_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850701PMC
March 2018

Pediatric pharmacovigilance in an institute of national importance: Journey has just begun.

Indian J Pharmacol 2017 Sep-Oct;49(5):390-395

Department of Radio-Diagnosis, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Objective: The objective of this study is to determine the nature and severity of adverse drug reactions (ADRs) in pediatric patients.

Materials And Methods: In this retrospective cohort study, we extracted the data from all the available pediatric ADR forms submitted to ADR monitoring center (AMC) from May 2014 to December 2016. The data including nature, frequency, causality (World Health Organization [WHO] causality scale), and the severity (Hartwig and Siegel scale for severity) of ADR were extracted. We also assessed the preventability of the event on modified Schumock and Thornton scale of ADR preventability.

Results: There were a total of 20 pediatric ADRs reported during this period. Nearly two-thirds of the ADRs occurred in patients who were receiving multiple drugs (polytherapy). Antimicrobial agents were the most commonly implicated drugs. The most common ADRs were skin rash (maculopapular, erythematous, and urticaria, itching, etc.). The severity and preventability scales indicated that most reactions (18/20) were moderate in nature and all were preventable. Four reactions were "certainly" and ten ADRs were "probably" related to the suspected drug as determined by the WHO causality assessment.

Conclusion: Frequency of ADR increased with number of medications patient was receiving. Health-care providers (HCPs) involved in the care of children must be aware of this fact and should use additional drugs when absolutely necessary. They should be involved in pharmacovigilance program by exchanging and updating each other through sharing constructive information, communication, and education concerning the appropriate use of drugs in children. Pediatric pharmacovigilance is the need of the hour and should be given utmost importance for monitoring the safety of drugs in children. Motivating HCPs for voluntary reporting of ADRs for preventing the morbidity and mortality in this vulnerable population could be of immense importance.
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http://dx.doi.org/10.4103/ijp.IJP_256_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830850PMC
September 2018

Ganglion impar block in patients with chronic coccydynia.

Indian J Radiol Imaging 2017 Jul-Sep;27(3):324-328

Department of Pharmacology, AIIMS, Jodhpur, Rajasthan, India.

Introduction: Coccydynia refers to pain in the terminal segment of the spinecaused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively, however in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studies the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management.

Materials And Methods: The study was carried out at the pain clinic in the departments of Physical Medicine and Rehabilitation and Radiology in a tertiary centre in India. It was a prospective hospital-based study, in which 35 patients with coccydynia were considered for fluoroscopy-guided trans-sacro-coccygeal ganglion impar block. The outcome assessment was done using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) scores for a follow-up period of 6 months. Of the 35 patients, 4 were lost to follow-up. Analysis was done usingthe data from the remaining 31 patients.

Results: The mean age of the patients suffering from chronic coccydynia was 42.9 ± 8.39 years, and patients' age range was 28-57 years. The mean score of NRS and ODI before the procedure was 7.90 ± 0.16 and 48.97 ± 1.05, respectively. The interquartile range (IQR) of NRS score remained almost unchanged during pre and postprocedure, however, IQR of ODI varied during the pre and post procedural events. The NRS and ODI scores immediately after the procedure decreased drastically showing significant pain relief in patients, and the difference of scores till the end of study was statistically significant.

Conclusion: This study recommends the trans-sacro-coccygeal "needle inside needle" technique for local anesthetic block of the ganglion impar for pain relief in patients with coccydynia. This should be integrated with rehabilitative measures including ergonomical modification for prolonging pain free period.
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http://dx.doi.org/10.4103/ijri.IJRI_294_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644328PMC
November 2017

Gingival hyperplasia: Should drug interaction be blamed for?

Indian J Pharmacol 2017 May-Jun;49(3):257-259

Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Gingival overgrowth (GO) is one of the common findings in clinical practice. There could be several causes including drugs associated with the GO. Carbamazepine (CBZ) and amlodipine are the drugs which are infrequently documented as a cause in inducing the gingival hyperplasia. Certain drugs in the body fluid might limit the population of plaque bacteria and alter their metabolism that in turn induce the inflammatory mediators and also activate the genetic and biochemical factors responsible for gingival fibroblast growth. Drug-induced GO is a side effect with a multifactorial etiology that seems to orchestrate the interaction between drugs and fibroblasts in the gingiva. We describe a case of trigeminal neuralgia with hypertension treated with multiple drugs including amlodipine and CBZ. Although amlodipine is known to be infrequently associated with GO, an association of CBZ with GO is even rarer. Causality analysis on the World Health Organization Uppsala Monitoring Centre's scale indicates a probable association with offending drugs.
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http://dx.doi.org/10.4103/ijp.IJP_57_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637138PMC
June 2018

Indian College of Physicians Position Statement: Addictive Disorders Among Persons with Diabetes Mellitus.

J Assoc Physicians India 2017 Oct;65(12):11-12

JIPMER,Puducherry.

Objectives: Migraine, a common primary headache disorder which can be severely disabling, associated with poor health-related quality of life (HRQoL) amongst affected patients. The present study was performed to provide adequate clinical data on migraine and the management practices in India.

Material And Methods: A cross-sectional study was designed to assess disease burden, HRQoL, symptom profile, management trends and comorbidities associated with migraine patients across ten centres in India. This study assessed HRQoL using Migraine Specific Quality of life (MSQ) and Migraine Disability Assessment Scores (MIDAS) questionnaire. Categorical variables were summarized as frequency, and percentage and continuous variables as mean and standard deviation respectively.

Results: A total of 705 patients were enrolled with a mean age of 35.2 years. Hypertension (7.0%) was the highest co-morbid illness associated with migraine. A higher MSQ score was observed in females as compared to males (39.3±12.4 and 37.4±11.6) while MIDAS showed a comparable score (27.7±47.6 and 27.2±35.4). Majority of migraine patients were unemployed (61.6%) and in profession, females had poor HRQoL than males by MIDAS and MSQ. Majority of patients had pulsating, bilateral attacks for the duration of 4h to 72 h. Paracetamol (47.1%) and propranolol (50.9%) was most commonly prescribed drugs for acute attack and prophylaxis, respectively.

Conclusion: The quality of life was superior in males as compared to females amongst migraine patients in India. Hypertension was the commonest comorbidity associated with migraine.

Key Messages: Migraine is associated with substantial disability with higher prevalence in females and older people (age >40 years). NSAIDs and propanol was widely prescribed drug in acute attacks and prophylaxis of migraine respectively. Cardiovascular diseases, diabetes mellitus and anxiety were common comorbidities associated with migraine.
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October 2017

Tailoring Ion Charge State Distribution in Tetramethyltin Clusters under Influence of Moderate Intensity Picosecond Laser Pulse: Role of Laser Wavelength and Rate of Energy Deposition.

J Am Soc Mass Spectrom 2017 11 21;28(11):2361-2370. Epub 2017 Jul 21.

Chemistry Division, Bhabha Atomic Research Center, Mumbai, 400 085, India.

Systematic manipulation of ionic-outcome in laser-cluster interaction process has been realized for studies carried out on tetramethyltin (TMT) clusters under picosecond laser conditions, determined by choice of laser wavelength and intensity. As a function of laser intensity, TMT clusters exhibit gradual enhancement in overall ionization of its cluster constituents, up to a saturation level of ionization, which was distinct for different wavelengths (266, 355, and 532 nm). Simultaneously, systematic appearance of higher multiply charged atomic ions and shift in relative abundance of multiply charged atomic ions towards higher charge state was observed, using time-of-flight mass spectrometer. At saturation level, multiply charged atomic ions up to (C, Sn) at 266 nm, (C, Sn) at 355 nm, and (C, Sn) at 532 nm were detected. In addition, at 355 nm intra-cluster ion chemistry within the ionized cluster leads to generation of molecular hydrogen ion (H) and triatomic molecular hydrogen ion (H). Generation of multiply charged atomic ions is ascribed to efficient coupling of laser pulse with the cluster media, facilitated by inner-ionized electrons produced within the cluster, at the leading edge of laser pulse. Role of inner-ionized electrons is authenticated by measuring kinetic energy distribution of electrons liberated upon disintegration of excessively ionized cluster, under the influence of picosecond laser pulse. Graphical Abstract ᅟ.
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http://dx.doi.org/10.1007/s13361-017-1755-3DOI Listing
November 2017