Current status of calcitonin gene-related peptide-based therapies in migraine: a scoping review

A significant proportion of patients exhibit sub-optimal response to the standard treatment of acute migraine such as triptans and NSAIDs. Even the conventional preventive therapies (e.g. beta-blockers) indicated for patients with frequent migraine attacks have varying responses. Moreover, evidence from animal studies elucidated the role of calcitonin gene-related peptide (CGRP) in the pathophysiology of migraine. Currently two classes are drug, the small molecule CGRP receptor antagonist or the ‘gepants’ (Ubrogepant, Rimegepant, Atogepant, Zavegepant) and CGRP monoclonal antibodies (Erenumab, Galcanezumab, Fremanezumab, Eptinezumab) have been found efficacious and safe in various clinical trials for the treatment and prevention of migraine. While the small molecule CGRP receptor antagonists are given orally, the monoclonal antibodies are injectable drugs. Ubrogepant and Rimegepant are the second-generation gepants approved for treatment of migraine. Zavegepant is a third generation gepant which has proven efficacy for acute treatment of migraine in a phase III trial. Atogepant has been approved for prevention of migraine. Rimegepant has also proven to be efficacious for preventing migraine attacks but has not yet been approved for this indication. Erenumab is the only monoclonal antibody which neutralizes the CGRP receptor. The latter three monoclonal antibodies target the CGRP peptide. The monoclonal antibodies have been approved for the prevention of migraine as a subcutaneously or intravenous infusion (Eptinezumab) given once a month or quarterly. Both the classes of drugs were well-tolerated in the clinical trials. Nausea was the most common adverse effect with gepants while injection-site pain was commonly reported with the antibodies.

Efficacy of current treatments against hepatitis C virus

It is estimated that currently, in the world, approximately 3% of the population has chronic hepatitis, the hepatitis C virus is the etiological agent most related to the development of this pathology. The diversity of genotypes (7) and quasi-species of HCV, due to its high mutation rate, interferes with an effective humoral immunity. The aim of this work is precisely to evoke those usual drugs used in HCV therapy, as well as cutting-edge drugs. The goal of treatment is the eradication of HCV infection. One strategy offered by the WHO is to eradicate the virus in at-risk populations. Alternatives to the previously used treatment with interferon and ribavirin are shown in this paper; protease inhibitors and other targets have now been developed to make eradication of the virus more effective.

Seroprevalence of COVID-19 antibody among patients visiting a large clinic in Uttar Pradesh

Background: The study was conducted to determine the Coronavirus disease 2019 (COVID-19) antibody titre among patients who visited our clinic in Lucknow in order to find out the prevalence of sero positivity and to determine the association between COVID anti-body titre and positivity to different age groups, sex, and religions etc., if any.Methods: Secondary data analysis was conducted at Lucknow's Sitara polyclinic from patients’ data, who had attended the clinic between May 2021 and July 2021 and had universally undergone COVID antibody testing. COVID antibody (including IgG) levels in patients' blood were determined using Roche's commercial "Elecsys Anti-SARS-CoV2-cobas e411,601,602 system.by Roche which measure by Eclia (electro chemilusence immunoassay) quantitatively antibodies (including IgG). Patients with titres less than 1 u/ml were deemed seronegative for anti –SARS COVID-2, while those with titres greater than or equal to 1 u/ml were declared seropositive.Results: The overall rate of seropositivity was 84.8%. Around 84.5% males and 85.1% females were seropositive. Seropositivity was higher among 18 to 60 years of age. But there was no significant relation between mean age and seropositivity. Muslims had slightly higher seropositivity (86.0%) as compared to non-Muslims (84.5%). There was no significant difference between age and gender having positive COVID 19 antibody titres. Although the incidence of seropositivity was similar between Muslims and Non-Muslims, the antibody titres were significantly higher in Muslim patients.Conclusions: In this part of central eastern UP, incidence of seropositivity could already be as high as 85%, which is a pointer toward adequate herd immunity. COVID-19 does not differentiate on the basis of age, gender or religious affiliations. However, Muslims were found to have more antibody titres compared to non-Muslims, possibly related to life style, degree of exposure to COVID-19 virus and presence of inherent immunity.

Diabetes mellitus patients’ fasting blood sugar levels and quality of life following brief pharmacist counseling with reminders and motivational messages

Background: For chronic disease patients, pharmacist counselling with motivating reminder messages has been developed throughout time to promote the success of patient treatment. Diabetes mellitus is a long-term condition. Blood sugar control and an improved quality of life are therapeutic goals in the treatment of diabetes mellitus. The objective of this study was to determine whether changes in fasting blood sugar and quality of life occurred in individuals with diabetes mellitus who received pharmacist counselling coupled by motivating reminder messages.Methods: This quasi-experimental study used a pre-test-post-test design with control and intervention groups. Data on patients with type 2 diabetes were obtained prospectively at Jetis 1 primary health care in Bantul, Yogyakarta, Indonesia. Seventy-two respondents who met the inclusion criteria were separated into two groups: the control group (36 participants) and the intervention group (36 participants). The patients’ quality of life was assessed using the 36-item Short Form (SF-36) questionnaire.Results: Following pharmacist counselling coupled by motivating reminder messages, patients’ mean fasting blood sugar reduced significantly (∆ 34.85±63.36), while their mean quality of life score increased considerably (∆ 13.73±9.22).Conclusions: Pharmacist counselling combined with motivating reminder messages can help patients with type 2 diabetes lower their fasting blood sugar and enhance their quality of life. The provision of pharmacist counselling followed by brief reminders and motivational messages may be considered to improve type 2 diabetes patient management.

Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

Comparing the effect of statins on hepatic fibrosis induced by carbon tetrachloride in Wistar rats

Background: The clinical studies have shown contrary results regarding hepatoprotective effect of statins. However, antifibrotic properties of statins in in vitro and in vivo experimental models have been demonstrated. The purpose of this study was to assess and compare the effect of statins on serum liver enzymes and their antifibrotic effects.Methods: Forty two rats were divided into 7 groups (I to VII) (n=6). Liver toxicity was induced by injecting carbon tetrachloride (1 ml/kg). Control groups received corn oil (0.1 ml/100 gm) and carboxy methyl cellulose (0.50%) respectively. Group III to VII received carbon tetrachloride (CCl4) for 6 weeks and then groups IV, V, VI and VII received simvastatin (10 mg/kg), atorvastatin (15 mg/kg), rosuvastatin (2 mg/kg) and silymarin (50 mg/kg) for another 8 weeks respectively. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels were estimated in all the groups at baseline, 6 weeks and 14 weeks. At 14 weeks, histopathology of liver was done in all groups.Results: At 14 weeks, all the test groups (IV, V and VI) showed a significant decrease in serum ALT, AST and ALP levels as compared to control (p<0.05) and group III (p<0.05). On intergroup comparison, liver enzymes in rats in group VI (rosuvastatin) and group V (atorvastatin) were decreased more in comparison to group IV (simvastatin) but the difference was not statistically significant except for AST levels where the difference was significant between the statins. There was decrease in hepatic fibrosis by statins with rosuvastatin being superior followed by atorvastatin and simvastatin.Conclusions: In the present study statins decreased the serum AST, ALT and ALP levels and histopathological changes were reversed by statins in CCl4 induced hepatotoxic models.

Cost variation analysis of commonly prescribed anti-diabetic drugs available in Indian market: a pharmaco-economic study

Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary lifestyle, the incidence of DM is increasing. The chronic nature of DM causes significant personal suffering and economic difficulty to families. The was aimed at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various pharmaceutical companies were obtained from current index of medical specialties (CIMS) website, Indian drug review (IDR) 2021 issue and National pharmaceutical pricing authority-pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, metformin 500 mg sustained release showed highest price variation (3668%). Minimum cost variation was found with glipizide 2.5 mg (65%). Amongst the fixed dose combinations, highest cost variation was seen with glimepiride 2 mg+metformin 1000 mg (2703%) while minimum cost variation was found with repaglinide 1 mg+voglibose 0.3 mg (29%).Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all.Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands Background: Diabetes mellitus (DM) is a chronic metabolic disorder requiring lifelong treatment. Due to rapid expansion of urbanization, unhealthy diet habits and sedentary life style, the incidence of DM is increasing .The chronic nature of DM causes significant personal suffering and economic difficulty to families. The present study aims at investigating the cost difference in various brands of the same oral anti-diabetic drug.Methods: The minimum and the maximum cost in rupees (INR) of a particular anti-diabetic drug manufactured by various brands were obtained from Current Index of Medical Specialties (CIMS) website, Indian Drug Review (IDR) 2021 issue and National Pharmaceutical Pricing Authority – Pharma sahi daam. The cost ratio and percentage cost variation were noted for each brand.Results: Amongst single drug therapy, Metformin 500mg Sustained Release showed highest price variation (3668%). Minimum cost variation was found with Glipizide 2.5mg (65%).Amongst the fixed dose combinations, highest cost variation was seen with Glimepiride 2mg + Metformin 1000mg (2703%) while minimum cost variation was found with Repaglinide 1mg + Voglibose 0.3mg (29%). Conclusions: A noticeable cost variation was found in different brands of the same anti-diabetic drug. Prescribing a more expensive brand when a cheaper one is available can burden the patient financially and thus reduce patient compliance. In addition, the Government should also include more anti-diabetic drugs under the price control policy to ensure that affordable and efficacious medicines are available to all. Keywords: Anti-diabetic agents, Cost variation, Pharmaco-economics, Adherence, Brands

Neuroleptic malignant syndrome: case report

Neuroleptic malignant syndrome (NMS) is an infrequent, but potentially life-threatening neurologic emergency associated with the use of neuroleptic or antipsychotic drugs. A 43 years old male with a history of trigeminal neuralgia developed Neuroleptic malignant syndrome while receiving Carbamazepine and Amitryptylline. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. Complications of NMS include acute renal failure and acute respiratory failure. The possible etiologies, triggering factors and treatment are discussed with reference to existing literature.

Effect of amitriptyline and pregabalin on heart rate variability and electrolytes in neurotrophic pain in diabetic patients

Background: The data regarding effects of amitriptyline and pregabalin on heart rate variability in patients with neuropathic pain in diabetic patients are poorly understood in India. The present study was conducted to evaluate the effect of amitriptyline and pregabalin on heart rate variability in diabetic patients with neuropathic pain and their effect on serum electrolyte (sodium and potassium).Methods: The patients include 60 diabetic patients of either sex aged 18-65 years diagnosed with neuropathic pain and divided into two groups. The study was prospective open label and observational study. Group 1 was treated with amitriptyline 10 mg once a day while group 2 with pregabalin 75 mg once a day and HRV, serum sodium and serum potassium levels and pain score were recorded; and data of post-treatment at 2 and 4 weeks were compared with pretreatment values (control). All the statistical analysis was performed by using SPSS 20.0 software.Results: Both the drugs have increased HRV and reduced neuropathic pain intensity after 2 and 4 weeks treatment. The sodium and potassium level were not altered by these drugs. No correlation was observed between HRV and neuropathic pain.Conclusions: In conclusion, both the amitriptyline and pregabalin have significantly increased HRV and reduced the neuropathic pain intensity; but no correlation was observed between increased HRV and reduced neuropathic pain intensity.

Study of role of vitamin C in type 2 diabetes mellitus patients

Background: Diabetes mellitus (DM) is the most common non-communicable diseases in the present millennium which has become a global public health problem. The treatment of type 2 Diabetes mellitus (T2 DM) often is initiated with monotherapy of oral antidiabetic drugs (OADs), which often do not decrease the plasma sugar levels effectively and consistently that will reduce short term and long-term complications associated with T2 DM. Hence the current study is aimed to determine the effectiveness of vitamin C supplementation with standard OADs on glycemic control.Methods: This study consisted of 120 T2 DM patients with 80 males and 40 females with a mean age of 50.88 yrs were divided into four groups with equal number of males and females in each group depending upon the OADs they received in solo or with vitamin C for 12 weeks. After the written consent, a detail clinical history, clinical examination, biochemical investigations including fasting plasma sugar (FPS), post prandial plasma sugar (PPS), glycosylated hemoglobin (HBA1c), serum creatinine, serum electrolytes, chest X-ray PA view and standard ECG were done. Repeat FPS, PPS and HBA1c were done after 4, 8 and 12 weeks of study.Results: After 12 weeks of study FBS, PPS and HBA1c decreased significantly (p<0.01) in study groups (Metformin and teneligliptin with vitamin C) as compared to control groups (OADs without vitamin C). Vitamin C supplementation with OADs found to be effective, well tolerated and devoid of any side effects.Conclusions: OADs are effective and affordable hypoglycemic agents with vitamin C supplementation.