Bilateral Acute Angle Closure Glaucoma in a 50 year old female after Oral Administration of Flavoxate

Case Report published in British Journal of Clinical Pharmacology

Zakir Shaik Mohammed, 1 Zaka-ur-Rab Simi, 1 Salman Mohd Tariq 2 & Khan Rahat Ali 2
1 Institute of Ophthalmology, Aligarh Muslim University, Aligarh 202002 and 2 Department of Pharmacology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
DIGITAL OBJECT IDENTIFIER (DOI)10.1111/j.1365-2125.2008.03254.x

PMID: 18754848

Published Online: 8 Jul 2008

Journal Medline

Summary
A 50 yrs old female presented with sudden painful diminution of vision of both eyes after ingesting a tablet of Flavoxate (200 mg). She was diagnosed as a case of Bilateral Acute Angle Closure Glaucoma (ACG). Intra Ocular Pressure was 69.3 mmHg in both eyes which normalized within ten hours after discontinuation of Flavoxate and administration antiglaucoma drugs. The effect was probably due to anticholinergic activity of Flavoxate leading to narrowing of the angle of the anterior chamber by pupillary dilatation. Naranjo ADR Probability Scale as well as WHO Causality Categories indicated a probable relationship between the adverse effect (Bilateral Acute ACG) and Flavoxate therapy. To the best of our knowledge, this is the first case report of Flavoxate induced Bilateral Acute ACG

For full text please contact me.

Drug Prescribing Pattern in Surgical Wards of a Teaching Hospital in North India

Drug Prescribing Pattern in Surgical Wards of a Teaching Hospital in North India

Author(s): Salman MT, Akram MF, Rahman S, Khan FA, Haseen MA, Khan SW
Indian Journal for the Practising Doctor. Vol. 5, No. 2 (2008-05 - 2008-06)

ISSN : 0973-516X
Dr MT Salman, Dr SZ Rahman and Dr FA Khan are from the Department of Pharmacology; and Dr MA Haseen and Dr SW Khan from the Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India – 202002.

Free full text

Abstract
Irrational use of medicines is widespread throughout the world. The main problems include the unnecessary prescription of drugs, particularly antimicrobials and injections. To investigate the situation in surgery wards, the present study was undertaken. Ninety six prescriptions were collected prospectively from post-operative patients admitted in surgery wards of the JN Medical College Hospital, AMU, Aligarh, and subjected for analysis according to the WHO/INRUD Indicators. VEN method was also applied to ascertain quality of drug procurement. It was revealed that the proportion of drugs from Essential Medicines List (EML) was 61.4%, while no drug was prescribed by generic name. Groups of drugs most commonly prescribed by general surgeons were antibiotics (93%), analgesics (60%), antacids (43%) and antiemetics (10%). The most extensively prescribed drugs from each of the above groups were injections Ceftriaxone and Amikacin, tablets Voveron, Pantoprazole and Metoclopromide, respectively. The average number of drugs prescribed per patient and cost per day per prescription was 4.8 and 246.1 INR, respectively. Average number of antibiotics prescribed per prescription was 2.2 and the average number of injections per prescriptions was 2.3. The results showed that the pattern of drug prescribing is not based on WHO criteria for rational use of drugs. The system is not at all evidence-based. It is thus necessary to make surgeons aware about good prescribing habit by following 5 steps of the WHO Program on Rational use of Drugs (RUD).

New Antimicrobial against Methicillin-resistant Staphylococcus aureus (MRSA)

ZEFTERA the only approved antibiotic in its class (cephalosporin) by Health Canada to demonstrate efficacy against Methicillin-resistant Staphylococcus aureus (
MRSA), a growing public health concern in both hospital and community settings.ZEFTERA is specially designed to tightly bind to and inhibit targets in both gram-positive (including MRSA) and gram-negative bacteria. The approval of ZEFTERA for the treatment of complicated skin and skin structure infections, including non-limb threatening diabetic foot infections without concomitant osteomyelitis, was based on results of two Phase III, double-blind, randomized, multi-centre, global trials involving 817 patients with cSSSI 2,3. The second Phase III trial included patients with non-limb threatening diabetic foot infections (mild, moderate or severe)3. Pathogens identified at baseline in this subpopulation included MSSA (38 per cent), MRSA (13 per cent), E. cloacae (9 per cent), and P. mirabilis (7 per cent). The results demonstrated the non-inferiority of ceftobiprole versus vancomycin plus ceftazidime in the treatment of diabetic foot infections. In both studies, ZEFTERA was well tolerated. The most common treatment-emergent adverse reactions were nausea (9 per cent) taste disturbance (6 per cent), diarrhea (5 per cent) and vomiting (5 per cent).

In vitro antimicrobial activity of Nigella sativa oil against multi-drug resistant bacteria.

Salman, Mohd Tariq; Khan, Rahat Ali and Shukla, Indu (2006) In vitro antimicrobial activity of Nigella sativa oil against multi-drug resistant bacteria. Unimed Kulliyat, II (1). pp. 8-13.

Abstract
Nigella sativa L. essential oil was studied for antibacterial activity against various clinical isolates of bacteria resistant to a number of antibiotics, in varying concentrations by Disc Agar diffusion technique using impregnated filter paper discs on inoculated Muellar Hinton agar plates. The oil showed pronounced dose dependent antibacterial activity which was more against Gram +ve than Gram –ve bacteria. Among Gram +ve bacteria tested, Bacillus subtilis, Staphylococcus aureus, Staphylococcus epidermidis, other coagulase –ve Staphylococci and Streptococcus pyogenes were sensitive to the oil and 2 (Enterococcus faecalis, Streptococcus agalactiae) were resistant. Among Gram –ve bacteria tested, only Pseudomonas aeruginosa was sensitive to oil and rest (Acinetobacter baumannii, Citrobacter freundii, Klebsiella pneumoniae, Proteus mirabilis, Proteus vulgaris and Vibrio cholerae) were insensitive. Out of 147 strains tested, most of which were resistant to a number of antibiotics, 97 were inhibited by the oil.

Free full text

Antimicrobial activity of Black Cumin seeds (Nigella sativa) against multidrug resistant strains of Coagulase negative Staphylococci.

Salman, Mohd Tariq; Khan, Rahat Ali and Shukla, Indu (2008) Antimicrobial activity of Black Cumin seeds (Nigella sativa) against multidrug resistant strains of Coagulase negative Staphylococci. Hippocratic Journal of Unani Medicine, 3 (1). pp. 107-115

.Nigella sativa (black cumin) seed oil and methanolic extract were tested in varying dilutions against strains of Staphylococcus epidermidis and other coagulase-negative staphylococci resistant to a number of clinically used antibiotics isolated from patients attending JN Medical College Hospital, Aligarh, using disc agar diffusion technique on inoculated Muellar Hinton agar plates under standard laboratory conditions. Both the oil and extract showed remarkable dose dependent antibacterial activity against the tested strains upto a dilution of 1:50 as evident from the zones of inhibition. No cross resistance was noticed with any of the tested antibiotics. To the best of our knowledge, the activity of N. sativa against multidrug resistant clinical strains of Coagulase negative staphylococci is being reported for the first time.
For Free Full Text

Antimicrobial activity of Nigella sativa Linn. seed oil against multi-drug resistant bacteria from clinical isolates

Salman, Mohd Tariq; Khan, Rahat Ali and Shukla, Indu (2008) Antimicrobial activity of Nigella sativa Linn. seed oil against multi-drug resistant bacteria from clinical isolates. Natural Product Radiance, 7 (1). pp. 10-14. ISSN 0972-592X, IPC code; Int. cl.⁸— A61K 36/00, A61P 31/04.

Abstract

An alarming increase in bacterial strains resistant to existing antimicrobial agents demands a renewed effort to seek agents effective against pathogenic bacteria resistant to current antimicrobials. Nigella sativa Linn. essential oil was studied for antibacterial activity against various clinical isolates of bacteria resistant to a number of antibiotics, in varying concentrations by Disc Agar diffusion technique using impregnated filter paper discs on inoculated Muellar Hinton agar plates. The oil showed pronounced dose dependent antibacterial activity which was more against Gram positive than Gram negative bacteria. Among Gram positive bacteria tested, Staphylococcus aureus, S. epidermidis, other coagulase –ve Staphylococci and Streptococcus pyogenes were sensitive to the oil and Enterococcus faecalis, Streptococcus agalactiae were resistant. Among Gram –ve bacteria tested, only Pseudomonas aeruginosa was sensitive to oil and rest (Acinetobacter baumannii, Citrobacter freundii, Klebsiella pneumoniae, Proteus mirabilis, P. vulgaris and Vibrio cholerae) were insensitive. Out of 144 strains tested, most of which were resistant to a number of antibiotics, 97 were inhibited by the oil of black cumin. To the best of our knowledge, the activity of essential oil against coagulase negative Staphylococci (except S. epidermidis) and S. pyogenes is being reported for the first time.

Free full text

Newer drugs in Treatment of Type 2 Diabetes

Incretins

Incretins are gastrointestinally secreted insulinotropic hormones that play an important role in glucose homeostasis as they are involved in augmentation of -cell secretion of insulin and in suppression of glucagon secretion by the cell. The incretin effect refers to the augmented release of insulin that is observed from oral ingestion of glucose when compared with intravenous glucose challenge, even though the glucose concentration achieved in plasma may be equivalent. There are two different gut hormones that are mainly responsible for the incretin effect, which may include glucose-dependent insulinotropic peptide and GLP-1. In contrast to glucose-dependent insulinotropic peptide, GLP-1 maintains a glucoregulatory function in individuals both with and without diabetes. For this reason, GLP-1 was identified as a potential therapeutic agent for diabetes treatment.

One of the major concerns for GLP-1 that limited clinical applicability is the rapid enzymatic degradation by DPP-4 and as such, requires continuous intravenous or subcutaneous infusion. To address the problem, two research approaches have been attempted. One is to modify the molecule to resist or delay degradation. Agents such as exenatide and liraglutide are GLP-1 receptor agonists that are resistant to DPP-4 inhibition. A second approach has been to inhibit endogenous DPP-4 activity, thus prolonging the circulating half-life of native GLP-1. Agents in the DPP-4 inhibitor class are represented by vildagliptin and sitagliptin

Treatment of Type 2 Diabetes

Type 2 diabetes, the most common form of diabetes, is characterized by abnormalities in hepatic glucose production, insulin resistance, and a progressive decline in -cell function over time. To treat effectively the individual with type 2 diabetes, the provider must have a thorough understanding of the underlying pathophysiology to provide treatment that precisely addresses the metabolic abnormalities. Currently, the provider who cares for subjects with type 2 diabetes can choose an antidiabetic agent from no less than eight pharmacologic classes. These classes include agents that increase insulin secretion, improve insulin action, and delay absorption of carbohydrates. The newer treatments available, specifically incretin therapy, address a previously unmet need in diabetes by modulating glucose supply. The currently available agents can be combined and combination therapy markedly improves glycemic control. This allows the provider to design regimens to specifically address underlying abnormalities.
Goals
A1c goal recommended by the American Diabetes Association (ADA) is a A1c value <7%. This is not a value considered in the normal range, as an A1c level of 4.0–6.0% is considered as the non-diabetic range. However, this level was selected on the basis of practicality and the projected reduction in complications over time. The ADA guidelines also suggest that for "the individual patient," the A1c should be "as close to normal (<6%) as possible without significant hypoglycemia". The most recent glycemic goal set by both the American Association of Clinical Endocrinologists and the European Union–International Diabetes Federation is an A1c level <6.5%.