Non-ionic surfactant based vesicles (niosomes) in drug delivery

time, probably by stimulation of the hepatic microsomal enzyme system3. Similar properties were exhibited by its roots. However, the petroleum ether extract (PEE) of the roots enhanced pentobarbitone sleeping time, probably due to CNS depression4. The PEE of the seed of Pongomia pinnata was further tested for nootropic activity in an experimental model of Alzheimer’s disease (created by ibotenic acid induced lesioning of nuclear basalis magnocellularis). It reversed both, the cognitive deficits and the reduction in cholinergic markers after 2 weeks of treatment. Reversal of perturbed cholinergic function appears to be the possible mechanism5.

/pdf/pharmacology-of-medicinal-plants-and-natural-products-55vzicfceo.pdf

Pharmacology of medicinal plants and natural products

Objective:To determine the prevalence of hospital admissions associated with ADRs and examine differences in prevalence rates between population groups and methods of ADR detection.Data Sources:Studies were identified through electronic searches of Cumulative Index to Nursing and Allied Hearth Literature. EMBASE, and MEDLINE to August 2007. There were no language restrictions.Study Selection and Data Extraction:A systematic review was conducted of prospective observational studies that used the World Health Organization ADR definition. Subgroup analysis examined the influence of patient age groups and methods of ADR detection on reported ADR admission rates. All statistical analyses were performed using STATA v 9.0.Data Synthesis:Twenty-five studies were identified including 106, 586 patients who were hospitalized; 2143 of these patients had experienced ADRs. The prevalence rates of ADRs ranged from 0.16% to 15.7%, with an overall median of 5.3% (interquartile range [IQR] 2.7–9.0%). Median ADR prevalence ...

Hospital Admissions Associated with Adverse Drug Reactions: A Systematic Review of Prospective Observational Studies

RUCAM (Roussel Uclaf Causality Assessment Method) or its previous synonym CIOMS (Council for International Organizations of Medical Sciences) is a well established tool in common use to quantitatively assess causality in cases of suspected drug induced liver injury (DILI) and herb induced liver injury (HILI). Historical background and the original work confirm the use of RUCAM as single term for future cases, dismissing now the term CIOMS for reasons of simplicity and clarity. RUCAM represents a structured, standardized, validated, and hepatotoxicity specific diagnostic approach that attributes scores to individual key items, providing final quantitative gradings of causality for each suspect drug/herb in a case report. Experts from Europe and the United States had previously established in consensus meetings the first criteria of RUCAM to meet the requirements of clinicians and practitioners in care for their patients with suspected DILI and HILI. RUCAM was completed by additional criteria and validated, assisting to establish the timely diagnosis with a high degree of certainty. In many countries and for more than two decades, physicians, regulatory agencies, case report authors, and pharmaceutical companies successfully applied RUCAM for suspected DILI and HILI. Their practical experience, emerging new data on DILI and HILI characteristics, and few ambiguous questions in domains such alcohol use and exclusions of non-drug causes led to the present update of RUCAM. The aim was to reduce interobserver and intraobserver variability, to provide accurately defined, objective core elements, and to simplify the handling of the items. We now present the update of the well accepted original RUCAM scale and recommend its use for clinical, regulatory, publication, and expert purposes to validly establish causality in cases of suspected DILI and HILI, facilitating a straightforward application and an internationally harmonized approach of causality assessment as a common basic tool.

https://www.mdpi.com/1422-0067/17/1/14/pdf

RUCAM in drug and herb induced liver injury: The update

Non-ionic surfactant vesicles (niosomes): Physical and pharmaceutical chemistry

SUMMARY Purpose The study was aimed to assess the pattern of occurrence of adverse drug reactions (ADRs) in the local population,severity of reported ADRs and additional ﬁnancial resource utilisation associated with ADRs.Methods This was a prospective, spontaneous reporting study conducted over a period of 7 months by clinical pharma-cists. The WHO deﬁnition of an ADR was adopted. Each ADR was assessed for its causality by using the WHO ProbabilityScale. The severity of each reported ADR was assessed using the criterion developed by Hartwig et al. The average costincurred in treating the ADRs was calculated.Results A total of 270 suspected ADRs were reported and evaluated from 164 patients. A total of 3.7% of the hospitalisedpatients experienced an ADR, 0.7% of the admissions were due to ADRs and 1.8% had a fatal ADR. The gastrointestinalsystem (36.3%) was most commonly involved with an ADR. The drug class most commonly implicated with ADRs wascardiovascular (18.3%). Majority (47%) of the reactions were ‘moderate’ in severity. The total cost incurred in managing allthe reported ADRs was Rs 76564 (US$ 1595) with an average cost of Rs 690 (US$ 15) per ADR.Conclusion Detection and prevention of ADRs at the earliest is very important as they can cause not only morbidity andmortality but also involve high health care cost in their management. Well-trained pharmacists in the area of ADR detection,reporting and monitoring could prove as an asset in providing better patient care. Copyright #2003 John Wiley & Sons, Ltd.key words—adverse drug reactions; pharmacist; hospitalised patients; spontaneous reporting; severity; cost

Adverse drug reactions in a south Indian hospital--their severity and cost involved.

A cross-sectional study was conducted to evaluate the quality of life (QOL) of hemodialysis patients. An attempt was made to compare the QOL of hemodialysis patients with the QOL of the general population, renal transplant patients, and patients with a chronic disease, in this case, asthma. The WHOQOL-BREF questionnaire was used to assess the quality of life. Hemodialysis patients who had completed three months of maintenance hemodialysis (n = 75) were enrolled into the study. The quality of life of hemodialysis patients was found to be significantly impaired (P < 0.05) in comparison to healthy individuals of the general population, particularly with respect to the physical, psychological, and social relationship domains. In comparison to the quality of life of renal transplant patients, the quality of life of hemodialysis patients was significantly (P < 0.05) lower in all the four WHOQOL-BREF domains. Only in the environmental dimension was the quality of life of hemodialysis patients found to be significantly lower than that of the asthma patients. Female hemodialysis patients showed significantly (P < 0.05) lower quality of life than did male patients in the psychological and environmental dimensions of WHOQOL-BREF. A positive association was seen between higher education and the psychological functioning and the environmental dimensions of WHOQOL-BREF. Thus, the quality of life of hemodialysis patients was found to be considerably impaired when compared to that of healthy individuals of the general population as well as of renal transplant patients.

An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire.

Nonionic surfactant vesicles (niosomes) are promising drug carriers for anticancer drugs. Niosome encapsulated vincristine sulfate prepared by transmembrane pH gradient drug uptake process (remote loading method) was evaluated for toxicity and antitumour activity after administration to tumour bearing mice. The toxicity of vincristine sulfate was reduced after niosome encapsulation and anticancer activity improved, which may be due to better delivery of vincristine at the tumour site.

Niosome Encapsulated of Vincristine Sulfate: Improved Anticancer Activity with Reduced Toxicity in Mice

Background: Geriatrics is an emerging clinical specialty in India. Information about the appropriateness of prescription medication use among the elderly in India is limited. Aims: To determine the prevalence and predictors of potentially inappropriate medication (PIM) use, and assess the relationship between PIM use and adverse drug reactions (ADRs) in the hospitalized elderly. Settings: Medicine wards at two teaching hospitals. Design: Prospective observational study. Materials and Methods: Patients aged > 60 years admitted to medicine wards between January 2008 and June 2009 were included and reviewed for PIM use according to the Beers Criteria 2003 (BC). Severity of PIM use was classified as per BC as 'high' or 'low'. ADRs observed in the study patients were also recorded. Statistical Analysis: Association between ADRs and PIM use was assessed using Chi Square test. Bivariate analysis and subsequently multivariate logistic regression was used to identify predictors of PIM use. Results: PIM use was observed in 191 of 814 enrolled patients. At least one PIM at admission and during hospital stay was received by 2.4% (20) and 22.1% (180) patients respectively. High-severity PIM use showed a higher prevalence compared to low severity [26.8% (218) vs. 5.5% (45)]. Amongst the patients who received polypharmacy ( > 5 concurrent medications), 1.4% (5/362) and 22.1% (163/736) patients received PIMs at admission and during hospital stay respectively. Use of aspirin/clopidogrel/diclofenac in the presence of blood clotting disorder or anticoagulant therapy (8.3%) was the most commonly encountered PIM use. Medications not listed in BC were associated with increased occurrence of ADRs compared to medications listed in BC (349 vs. 11) (χ2 =98.4, P<0.001). Increased number of concurrent medications' use (≥9) during the stay in medicine wards was identified as an influential predictor of PIM use [Odds ratio: 1.9, 95% Confidence Interval: 1.34-2.69, P<0.001) in the hospitalized elderly. Conclusion: PIM use was common (23.5%) among the elderly patients during their stay in medicine wards in two tertiary care hospitals. Measures targeted only at BC medications may do little to change the risk of ADRs in elderly.

Potentially inappropriate medication use in elderly patients: A study of prevalence and predictors in two teaching hospitals

Aim: To compare Beers' criteria (BC) and Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) for prevalence, specificity, sensitivity and predictors for potentially inappropriate medication (PIM) use.

Methods:  Patients aged ≥60 years from medicine wards of a tertiary care hospital were included. Comparisons between BC and STOPP were made using Pearson's χ2-test for categorical variables and Mann–Whitney U-test for continuous variables. Specificity and sensitivity were assessed by using 2 × 2 contingency table. Bivariate analysis and subsequent multivariate logistic regression was used to identify the predictors of PIM use.

Results:  In the 540 patients included, prevalence of PIM use as per BC and STOPP was 24.6% and 13.3%, respectively. Sensitivity and specificity of BC in detecting PIM was 0.65 and 0.53, respectively. Considering the diagnoses/conditions, sensitivity and specificity of BC was 0.12 and 0.48, respectively, whereas independent of diagnoses/conditions, corresponding values were 0.75 and 0.54. PIM as per BC and STOPP accounted for 11 and 6 adverse drug reactions (ADR), respectively. Medications not listed in BC or STOPP were more likely to be associated with ADR. Multiple diseases (≥4) and use of more drugs during hospital stay (10–14) predicted PIM use as per BC, whereas age (60–74 years) predicted PIM use as per STOPP.

Conclusion:  Overall, BC is useful in the detection of PIM use independent of diagnoses/conditions, whereas STOPP is useful in detection of PIM use considering the diagnoses/conditions. There is a need for consensus on using the tool for detection of PIM use in Indian elderly. Geriatr Gerontol Int 2012; 12: 506–514.

Potentially inappropriate medication use in Indian elderly: comparison of Beers' criteria and Screening Tool of Older Persons' potentially inappropriate Prescriptions.

Gurumurthy Parthasarathi

Papers

Adverse drug reactions in a south Indian hospital--their severity and cost involved.

An assessment of the quality of life in hemodialysis patients using the WHOQOL-BREF questionnaire.

Niosome Encapsulated of Vincristine Sulfate: Improved Anticancer Activity with Reduced Toxicity in Mice

Potentially inappropriate medication use in elderly patients: A study of prevalence and predictors in two teaching hospitals

Potentially inappropriate medication use in Indian elderly: comparison of Beers' criteria and Screening Tool of Older Persons' potentially inappropriate Prescriptions.