Panda C.,Scb Medical College And Hospital
Journal of Association of Physicians of India | Year: 2013
Objective: To investigate the efficacy and safety of Telbivudine + Tenofovir combination therapy in chronic hepatitis B patients, over a period of 52 weeks, in real life clinical settings. Methods: HBeAg-positive and HBeAg-negative adult CHB patients, with hepatitis B virus (HBV) DNA > 4 log10 copies/ml and ALT 1.2 times above upper limit of normal (> 30 IU/L) were started on a combination of Telbivudine 600 mg + Tenofovir 300 mg in a real life clinical setting. The reduction in serum HBV DNA levels from baseline was evaluated at Week 24 and 52. The HBV DNA was measured using the PCR test with a lower limit of detection of 100 IU/ml Results: 21 (2 female/19 male) patients, with mean (SD) age of 46.2 (13.2), were prescribed this regimen. 70% of them were HBeAg negative at baseline. Data of 11 out of 21 patients was available at week 52. The mean HBA-DNA reduction from baseline to week 24 (n=15) was 2.6 log10 copies/mL (p =.000) and 4.0 log10 copies/mL (p =.001) at week 52 (n = 11). By the end of study visit at week 52, 10 out of 11 patients had achieved the HBV-DNA levels of < 100 Iu/ml. The mean ALT levels came down by 101.4 IU/L (p =.005) at week 24 (n = 15) and by 104.6 IU/L at week 52 (n = 11). 7 patients achieved ALT normalisation (ALT < 40 IU/L) at week 24, with additional 4 achieving the goals at week 52. Combination therapy was well tolerated, with no safety related concerns. No cases of virological breakthrough or primary treatment failure were observed. Being a real life setting, there were certain limitations: Out of 10 patients whose data was not available at 52 weeks, 5 patients were lost to follow-up; another 2 coming from far off remote areas were unable to report for follow-up every 3 months. 1 patient who was on chemotherapy expired due to progression of the malignancy, another patient with decompensated liver disease expired due to disease progression. Yet another patient was a pregnant lady on therapy who stopped treatment post partum to breast feed the baby. Conclusion: Chronic hepatitis B patients treated with Telbivudine + Tenofovir combination exhibited significant virologic and biochemical responses, over the period of 1 year. However, the mean decline in HBV DNA over 1 year with combination therapy was not higher than that seen with monotherapy. © JAPI.
Biswal S.,Scb Medical College And Hospital
Journal of Pharmacology and Pharmacotherapeutics | Year: 2012
We present a case of complete heart block (CHB) in a 58-year-old female patient with acute myeloid leukemia (AML) with no past history of cardiac disease, who received caspofungin in the treatment of disseminated fungal infection. To our knowledge, this is the first case of CHB associated with caspofungins. Subsequent to induction chemotherapy the patient developed invasive pulmonary aspergillosis with sudden tachypnea, dyspnoea, fever, bilateral pulmonary infiltrates and acute respiratory insufficiency consequent to neutropenia with ANC<500. During the first dose of antifungal therapy with caspofungins, she developed complete atrioventricular block and cardiac arrest. Complete heart block is an unusual adverse effect of caspofungins which has not been reported previously. Caspofungins release histamine in peripheral blood cells, so possible histamine-mediated symptoms ranging from severe fatal anaphylaxis can occur. These data suggest that infusion-related reactions associated with caspofungin may be mediated by histamine release secondary to caspofungin therapy.
Das R.R.,All India Institute of Medical Sciences |
Naik S.S.,Scb Medical College And Hospital
Pediatric Allergy and Immunology | Year: 2015
Studies have found a link between neonatal hyperbilirubinemia (NNH) and/or neonatal phototherapy (NPT) and childhood allergic diseases. The present systematic review was conducted to provide updated evidence and to provide direction regarding future research. A systematic search of the published literature was carried out. Observational studies including children up to 12 yr of age were included. Data extraction was carried out using a standardized data extraction form that was designed and pilot tested a priori. The analysis was carried out with the statistical software RevMan (version 5.2) [Protocol is registered at PROSPERO: CRD42014009943]. Of 79 citations retrieved, a total of 7 good quality studies (n = 101,499) were included in the final analysis. There was a significant increase in the odds of asthma and allergic rhinitis (AR) after NNH [asthma, OR 4.26 (95% CI 4.04-4.5); AR, OR 5.37 (95% CI 4.16-6.92)] and after NPT [asthma, OR 3.81 (95% CI 3.53-4.11); AR, OR 3.04(95% CI 2.13-4.32)]. A similar increase in the trend was noted for late onset of asthma after NNH [OR 4.1 (95% CI 2.82-5.94)], and hospitalization due to asthma after NPT [OR 3.56 (95% CI 2.93-4.33)]. The GRADE evidence generated was of 'low quality'. The current evidence finds a significant increase in the odds of childhood allergic diseases after NNH and/or NPT. As observational studies were included, the evidence generated was of 'low quality'. Future studies should try to elucidate the pathophysiologic link between NNH and/or NPT and childhood allergic diseases. © 2015 John Wiley & Sons A/S.
Das R.R.,All India Institute of Medical Sciences |
Sankar J.,All India Institute of Medical Sciences |
Naik S.S.,Scb Medical College And Hospital
Archives of Disease in Childhood | Year: 2015
Objective: We evaluated the role of diosmectite as an add-on treatment to the 'recommended treatment' of acute diarrhoea in children. Methods: We searched all published literature through the major databases: Medline via Ovid, PubMed, CENTRAL, Embase and Google Scholar till May 2014. Randomised clinical trials comparing diosmectite versus placebo were included (PROSPERO registration: CRD42014013783). Main outcome measures: The primary outcome measures were duration of acute diarrhoea (h), and dayto-day cure rates (%). The secondary outcome measures were stool output (volume), stool output (frequency) and adverse events. Results: Of 384 citations retrieved, a total of 13 randomised clinical trials (2164 children, 1-60 months old) were included in the meta-analysis. A dose of 3-6 grams per day of diosmectite was given for a duration from 3 days until recovery. Compared with placebo, diosmectite significantly decreased the duration of acute diarrhoea (mean difference, -23.39; 95% CI -28.77 to -18.01), and increased the cure rate (%) at day 5 (OR, 4.44; 95% CI 1.66 to 11.84), without any increases in the risk of adverse events. Diosmectite was effective in all types of acute childhood diarrhoea except dysentery. Because, most of the trials were open-label, and there was a high possibility of publication bias, the GRADE evidence generated was of 'low quality'. Conclusions: Diosmectite may be a useful additive in the treatment of acute childhood diarrhoea. As the evidence generated was of 'low quality', future research is needed with higher quality designs before any firm recommendations can be made. Trial registration number: PROSPERO registration: CRD42014013783. © 2015, BMJ Publishing Group. All rights reserved.
Rout R.,Regional Medical Research Center |
Dhangadamajhi G.,Regional Medical Research Center |
Mohapatra B.N.,Scb Medical College And Hospital |
Kar S.K.,Regional Medical Research Center |
Ranjit M.,Regional Medical Research Center
Infection, Genetics and Evolution | Year: 2011
The complement receptor 1 (CR1/CD35) protein acts as the major rosetting receptor in Plasmodium falciparum infection and several genetic variants of CR1 gene have been shown to be associated with quantitative expression of erythrocyte CR1 (E-CR1) level. However, CR1 level and gene polymorphisms exhibit differences in clinical manifestation of malaria in regions of varying disease endemicity. The result of the present study which analyzed three SNPs (intron 27 HindIIIA>T, exon 22 3650 A>G, and exon 33 5507 C>G) of the CR1 gene in Orissa, a hyperendemic state in eastern-India showed that a significantly increased risk for cerebral malaria (CM) was associated with AA genotype of both intron 27 and exon 22 when compared with mild, severe malaria anemia (SMA) and CM. +. SMA group respectively. Further, the overall haplotype analysis for all the three loci showed predominantly two major haplotypes 'AAC' coding for higher expression of CR1 and 'TGG' haplotype coding for low expression of CR1 level with the former haplotype being significantly associated with CM (P value. <. 0.00619 after Bonferroni correction) compared to mild malaria. The 'TGG' haplotype was proportionately more in SMA cases compared to mild malaria though statistically not significant. These findings suggest that the mild malaria group had an intermediate level of E-CR1 and extremely low or high levels of CR1 can cause severity in malaria. Further large scale studies in different endemic regions are needed to explain the epidemiological differences between E-CR1 expression and clinical manifestation of malaria which may contribute to the understanding of malaria pathogenesis. © 2010 Elsevier B.V.