Rajiv Gandhi Government General Hospital is a major state-owned hospital situated in Chennai, India. The hospital is funded and managed by the state government of Tamil Nadu. Founded in 1664 by the British East India Company, it is the first modern hospital in India In the 19th century, the Madras Medical College joined it. As of 2018, the hospital receives an average of 12,000 outpatients every day.
Introduction: Narrow therapeutic index (NTI) drugs have a small margin between effective and toxic doses, so minor changes in blood levels can cause therapeutic failure or toxicity, leading to significant drug-related problems. The study aims to assess drug-related problems (DRPs) linked to NTI drugs at Government General Hospital, Kadapa, by screening prescriptions, classifying DRPs using Pharmaceutical Care Network Europe (PCNE) v9.0, implementing interventions to reduce them, and calculating drug risk ratios to determine each drug’s contribution. Methods: A six-month prospective observational study (June–November 2023) included 110 inpatients prescribed at least one NTI drug. Data from standardized forms and hospital records were analyzed, with DRPs identified using PCNE v9.0, Micromedex, and WHO adverse drug reaction (ADR) scales. Results: Of 110 patients, 48 (43.6%) had DRPs, mainly males (60.4%) aged 31–60 years. Treatment effectiveness issues dominated (74.5%), with major interactions from digoxin, telmisartan, and heparin. Heparin showed the highest drug risk ratio (0.53), indicating significant safety concerns. Discussion: Findings highlight the high DRP risk from multiple NTI drug prescriptions, particularly heparin and digoxin. Results align with existing research and underscore the role of clinical pharmacy in DRP prevention. Drug risk ratio offers a quantitative tool for prioritizing monitoring. Conclusion: In our study, the most common DRPs observed were related to the drug use process. Heparin and digoxin were found to be high-risk drugs, according to study results. Hence, special observation and monitoring from physicians and other health professionals are needed for the prescriptions with NTI drugs.
The aortomitral intervalvular fibrosa (AMIVF) is a thin, avascular structure that lies between the anterior mitral leaflet and the non-coronary cusp of the aortic valve. It is particularly susceptible to infection and mechanical insult, making it a rare site for pseudoaneurysm formation. Among the various causes, tuberculosis is an exceedingly uncommon etiology, especially in immunocompromised patients. We report the case of a 27-year-old retroviral-positive male who presented with shortness of breath, palpitations, and hemoptysis. Initial echocardiography revealed a pseudoaneurysm at the aortomitral continuity with severe mitral and aortic regurgitation. Subsequent computed tomography (CT) aortogram confirmed the presence of a contrast-filled pseudoaneurysmal sac protruding into the left atrium. Cardiac magnetic resonance imaging (MRI) further delineated the anatomy, showing a cystic structure arising between the aortic and mitral valves, compressing the left atrium and confirming the diagnosis. The patient underwent surgical aneurysm resection and aortic valve replacement. Histopathology and cultures revealed Mycobacterium tuberculosis as the causative agent. Pseudoaneurysms of the AMIVF are rare but clinically significant. In immunocompromised individuals, tuberculosis should be considered a potential etiology. Multimodal imaging, including echocardiography, CT, and MRI, is crucial for timely and accurate diagnosis. Early surgical intervention is often required to prevent catastrophic complications such as rupture or fistula formation.
This study presents an in-depth evaluation of 307 HIV-infected individuals, integrating global and national HIV perspectives with localized clinical data. The Introduction outlines the virology, epidemiology, transmission routes, and socio-cultural challenges of HIV, particularly in the Indian context. The Results and Discussion further elaborate on the clinical and demographic findings. Among the 307 participants, females constituted 61%, and the 40–49-year age group was the most affected. Most individuals were from labor- intensive occupations, indicating economic hardships. A key finding was the high prevalence of mycosis (44%), with Tenia and Candidiasis being the most common fungal infections, slightly more prevalent in females. ASocial habit analysis showed low rates of smoking and alcohol, but allergies were more common, and comorbidities such as type-2 diabetes and hypertension were present but not widespread. These findings point to the necessity of strengthening follow-up care, improving access to Antifungal Therapies, and addressing underlying factors such as stigma, limited healthcare infrastructure, and poor nutrition that continue to challenge effective HIV management in real-world scenario.
Gemcitabine is a nucleoside analogue commonly used in advanced ovarian cancer therapy and, also in various cancers. While it is generally well tolerated, rare adverse effects such as peripheral edema and hypersensitivity may occur. We report a case of a 54-year-old woman who developed bilateral pitting edema with burning sensation during gemcitabine maintenance therapy. The edema resolved following drug withdrawal and oral dexamethasone. Other causes were ruled out, and a Naranjo score of 7 indicated a probable drug-related event. This case highlights the importance of recognizing gemcitabine-induced edema early to prevent misdiagnosis and ensure timely management without compromising cancer treatment.
Elobixibat is a locally acting ileal bile acid transporter (IBAT) inhibitor that relieves functional constipation in patients by accelerating colonic transit. In this study, we aimed at determining the efficacy and safety of elobixibat for short-term treatment (two weeks) of chronic constipation in Indian patients. The present study was a randomized, double-blind, parallel-group, placebo-controlled, phase III study to evaluate efficacy and safety of elobixibat. The study planned to enroll patients with chronic constipation of at least six months' duration, satisfying Rome IV criteria for functional constipation. Following a run-in of approximately 14 days to confirm eligibility and determine baseline frequency of spontaneous bowel movements (SBMs), eligible patients were randomized 1:1 either to elobixibat or to placebo groups. The change in weekly frequency of spontaneous bowel movements (SBMs) at the end of treatment (week two) over baseline was the primary efficacy endpoint in this trial. Primary efficacy analyses were based on the modified intention-to-treat (mITT) population. This trial is registered at CTRI (Clinical Trial Registry of India). Between April 2023 and December 2023, 150 patients were randomized into the two-week trial. In mITT population (n = 146 [elobixibat = 75 and placebo = 71]), the least square mean (LSM) difference between elobixibat (3.83) and placebo (2.68) was 1.15 (95
