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In this retrospective observational study, we have performed a comparative analysis of the demographic, clinical and epidemiological characteristics of the HCWs affected with SARS-CoV-2 infection during first two waves in India. The overall prevalence of SARS-CoV-2 infection among HCWs was found to be 15.24% (14.20-16.33) and 23.38% (22.14-25.65) during first and second waves respectively. The second wave showed an adjusted odds ratio of 0.04(0.02-0.07) and 2.09(1.49-2.93) for hospitalization and being symptomatic, respectively. We detected significantly higher level of C-reactive protein (CRP) among admitted HCWs during the second wave (5.10 -14.60 mg/dl) as compared to the first wave (2.00 - 2.80 mg/dl). Our study found the relative risk of SARS-CoV-2 reinfection among HCWs during the second wave to be 0.68 [0.57-0.82

Background: The medical and social impact of being overweight, as well as the difficulty in making long-term changes in diet, physical activity, and pitfalls associated with allopathic management, lure obese individuals to over-the-counter weight-loss herbal products (WHPs). However, the safety of herbals is questionable, as reports from all over the world suggest adulteration with synthetic weight loss agents. Objective: The present study was carried out to develop a rapid and sensitive method to screen potential weight loss adulterants in WHPs. Methodology: We procured 33 licensed brands of WHPs that are available in Puducherry (India) and through web stores. Drug-free spiked herbal matrices were used for internal proficiency testing. Spiked herbal matrices and samples were extracted and centrifuged. The supernatant was collected and subjected to liquid chromatography–tandem mass spectrometry analyses. Isocratic elution was carried out by the mobile phase of methanol: 0.1% v/v formic acid (70%:30% v/v) through a C18 column. Analytes were monitored in electrospray ionization positive and negative modes, and an multiple reaction monitoring (MRM) scan was used. Results: Run time was 12 min. Intra- and inter-day precision was < 15% and recoveries were in the range of 99% to 115%. Limit of quantification (LOQ) of the analytes were in the range of 0.1 to 0.3 ng/ml. Conclusion: We developed a sensitive and rapid validated method for the detection of potential adulterants in WHPs. None of the WHPs analyzed were found to contain adulterants. The proposed method will be useful for routine monitoring. WHPs analyzed in this study were not adulterated indicating that WHPs from licensed sources are reliable.

BACKGROUND: Drug–drug interactions are a major source of adverse drug events (ADEs). Polypharmacy, age and the number of comorbid conditions are important predictors of adverse drug interactions. ADEs account for up to 5% of hospital admissions per year and an increase in the length of hospital stay. OBJECTIVE: To find the prevalence and predictors of potential drug–drug interactions (pDDIs) in patients admitted to the wards of an internal medicine department of a tertiary care hospital. METHOD: Patients admitted to internal medicine wards with prescriptions having more than one drug were selected. Demographic details including age, gender, number of comorbid conditions, number of drugs prescribed and the disease for which the patient was admitted were recorded in a case record form. Interactions were checked using Micromedex DrugReax software. RESULTS: A total of 939 patients were recruited for this study based on inclusion criteria. 433 prescriptions (46%) had one or more pDDIs, with a range of 1–13 drug interactions per prescription. A total of 1395 drug interactions were found, with 866 moderate drug interactions (62%), 435 major interactions (31.1%) and 89 minor interactions (6.3%). During the study period only three contraindicated drug combinations (0.2%) were recorded. A significant association (p6 drugs are at major risk for occurrence of pDDIs. Moderate severity interactions were the highest number followed by major severity interactions.

Medicines management in healthcare delivery: WHO/SEARO workbook tool and report template for undertaking a situational analysis of medicines management in health care delivery in low and middle-income countries, March 2016. Available online at: http://www.searo.who.int/entity/medicines/country_situational_analysis/en/ . PDF file of the data collection instrument used to collect data in the country situational analyses and that was analysed in this manuscript. (PDF 1236 kb)

Objective: To compare the differences in the efficacy and safety of the commonly prescribed AEDs in the management of epilepsy in children when using divided doses of adult solid oral formulations (DDSF) with the liquid oral formulations (LFs). Materials and Methods: Patients who had one or more seizures per month and prescribed with DDSF were recruited. Initially the patients were continued on DDSF for 4 months following which they were switched over to LF for the subsequent 4 months. Seizure frequencies and adverse drug effects (ADRs) were recorded every month for 8 months and plasma AED levels were estimated at the end of 4th and 8th months. Results: A total of 200 patients completed the study protocol. The median seizure frequencies per month with DDSF and LF were: partial seizures (20.5, 9.0; P < 0.001), generalized tonic-clonic seizures (6.5, 2.0; P < 0.001), myoclonic seizures (58.5, 29.0; P < 0.001). Mean plasma drug levels ± SD (μg/ml) with DDSF and LF were: sodium valproate (48.2 ± 13.7, 69.1 ± 16.3; P < 0.001), phenytoin sodium (5.0 ± 2.4, 12.8 ± 3.8; P < 0.001), carbamazepine (4.5 ± 2.0, 11.5 ± 4.8; P < 0.001) and phenobarbitone (14.1 ± 5.2, 25.4 ± 12.3, P < 0.001). The incidence of treatment emergent ADRs was poor scholastic performance (25.5%), behavioral problems and dizziness/sedation (21.0%), somnolence/sleep disorders (19.5%). Conclusion: Patients treated with LF had better seizure control and optimal therapeutic drug levels and less adverse effects when compared to DDSF.

Tablet splitting is the process of dividing a tablet into portions to obtain a prescribed dose of medication. Very few studies have investigated whether split parts of a tablet deliver the expected amount of drug to patients.Our objectives were to evaluate the split parts of adult-dose tablet formulations for percentage of weight deviation, weight uniformity, weight loss, drug content, and the content uniformity of four antiepileptic drugs (AEDs) prescribed to pediatric patients. We also measured AED plasma concentrations in the children.We chose to study first-line AEDs (phenytoin sodium [PHE], sodium valproate [SVA], carbamazepine, and phenobarbitone) as they are routinely prescribed in India. We asked caregivers to perform the same splitting process they follow in their homes on three whole tablets during their routine visit to the outpatient department. After caregivers split the tablets, we studied the weight and content of the split parts. We also used high-performance liquid chromatography to study plasma drug concentrations in children who had received split AEDs for at least 4 months.A total of 168 caregivers participated in the study, and we analyzed 1098 split tablet parts. In total, 539 (49.0 %) split parts were above the specified limit of the 2010 Indian Pharmacopeia (IP) acceptable percentage weight deviation (PHE 169 [48.8 %], SVA 187 [51.9 %], carbamazepine 56 [41.1 %], phenobarbitone 127 [49.6 %]); 456 (41.5 %) split parts were outside the proxy IP specification for drug content (PHE 135 [39.0 %], SVA 140 [38.8 %], carbamazepine 51 [37.5 %], phenobarbitone 130 [50.7 %]), and 253 split parts were outside the acceptable content uniformity range of85 % and115 % (PHE 85 [24.5 %], SVA 98 [27.2 %], carbamazepine 14 [10.2 %], phenobarbitone 56 [21.8 %]). In total, 130 (72.2 %) patients had plasma drug concentrations outside the therapeutic range (PHE 36 [72.0 %], SVA 39 [78.0 %], carbamazepine 34 [68.0 %], phenobarbitone 21 [70.0 %]).Splitting adult-dosage formulations of AEDs results in patients not receiving the optimal dose. Plasma drug concentrations are also not optimal. Pediatric dosage formulations should be preferred to splitting adult-dosage formulations in pediatric epilepsy.

Diarrhea kills nearly 650 children below the age of 5 years each day in India. Oral rehydration solution (ORS) and oral zinc have been recommended for the treatment of acute diarrhea in children by the Indian Academy of Paediatrics (IAP) National task force for use of ORS and zinc in the year 2003[1] and later endorsed in 2006.[2] Zinc was included in the National Programme for the treatment of Diarrhea in 2007.[3] The Integrated Management of Neonatal and Childhood Illness (IMNCI) advocates the use of these two drugs in the treatment of acute diarrhea.[4] The evidence for the use of ORS and zinc as fi rst-line treatment in children in resource limited countries is overwhelming.[5,6] If given early on during an episode of diarrhea it would help save 50% of children who would otherwise die. The treatment is effective, safe, cheap, and easily tolerated by children.[6] More importantly, there are no other alternatives to this treatment. Recognizing the importance of this, the National Rural Health Mission (NRHM) has included ORS and zinc in the list of medicines to be available at the subcenters.[3]

Objective: To collect information on the availability of five essential children's medicines in the public health facilities of India. Materials and Methods: A snap shot survey of the availability of five essential medicines for children was conducted. Five medicines which are included in the National Rural Health Mission (NRHM) list for subcentres were selected, i.e., vitamin A liquid solution, syrup cotrimoxazole, oral rehydration salt (ORS), syrup paracetamol, and zinc sulphate (oral liquid or tablets). Information about this survey was posted in two e-groups for pharmacologists and pharmacists and volunteers were requested to collect data on the availability of these five medicines and fill up a data sheet which was emailed back to the organizers. Data was collected from February 14 to 21, 2010. Results: Data were collected from 129 public health facilities spanning 17 states, two union territories and NCT Delhi. The overall median availability was 80% (range: 0%-100%). Punjab, Tamilnadu, and Jharkhand showed 100% median availability (range: 40%-100%). Ninety percent of the facilities have ORS, paracetamol, and cotrimoxazole whereas zinc was available in only 36% of the public health facilities. Syrup cotrimoxazole and ORS have 100% availability in all states except in four and paracetamol has nearly 100% availability in all but six states. Conclusion: The availability of essential medicines for children in public health facilities is not satisfactory and needs to be improved.

the morning after exposure to noise was significantly increased. Conclusion—Workers exposed to loud background occupational noise react to the stress and show changes in nocturnal sleep architecture and heart rate which may be contributed to the exposure to noise. (J Occup Health 2003; 45: 146-152) Abstract: Effect of Acute Exposure to Loud Occupational Noise during Daytime on the Nocturnal Sleep Architecture, Heart Rate, and Cortisol Secretion in Healthy Volunteers: Batmanabane GITANJALI, et al. Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India— Objectives—Noise is one of the commonest physical stressors to which industrial workers are exposed. Many workers complain of symptoms associated with a non-specific generalized stress response, including disturbed sleep. However, industrial workers may be exposed to more than one source of stress and it is not possible to completely attribute the disturbed nocturnal sleep and changes in heart rate to the effects of loud noise alone. This study was done to find out whether acute exposure of healthy individuals to loud occupational noise during the daytime would cause changes in their nocturnal sleep architecture, heart rate during sleep and serum cortisol levels. Methods— Baseline polysomnography was done on ten subjects who were exposed for eight hours either to continuous occupational background noise levels of >75dB(A), or a quiet environment. Sleep polysomnography was done on the night prior to and after exposure. Blood was collected for serum cortisol estimation at night prior to sleep and in the morning after waking up. Statistical analysis was done by repeated measures ANOVA with Tukey's post test. Results—The sleep efficiency was less than 80% and the total time spent in Rapid Eye Movement (REM) sleep, Slow Wave Sleep (SWS) and the REM onset latency were significantly decreased on the night after exposure to noise. There was a significant increase in stage shifts. The percentage fall in heart rate during sleep was decreased compared to the baseline values. The serum cortisol levels in