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This scoping literature review will explore the efficacy and safety of ivermectin and doxycycline when used as monotherapy and as combination for treating confirmed cases of COVID-19.

With an improvement in the realisation of the importance of collecting patient-reported outcomes (PROs), sponsors of randomized controlled trials (RCTs) around the world have started incorporating questions related to Quality of Life (QoL) and other PRO measures routinely. Some regulators also have actively started looking for changes in QoL after an intervention, in addition to the routinely collected disease-related measures. We are interested to measure the extent to which QoL information is collected in RCTs from India, and for analysing the same, we have planned this systematic literature review.

Hydroxychloroquine (HCQ) has recently gained significant interest across the world for its possible role as an antiviral drug against the SARS-CoV2 in the fight against COVID-19. HCQ is a derivative of the antimalarial drug chloroquine, and is used for a wide variety of indications including rheumatoid arthritis, lupus erythematosus, and malaria, apart from being used off-label (either alone or in combination with various drugs) to treat various conditions such as dermatomyositis, porpyria cutanea tarda, Sjögren's syndrome, Q fever, and sarcoidosis. Given the varied nature of conditions being treated using HCQ, the question as to whether HCQ has a broad-spectrum antiviral property requires to be answered using a systematic literature review. This scoping review is being done to fulfil the knowledge gap in this area, and to evaluate the published literature describing the antiviral activity of hydroxychloroquine.

Poor medication adherence is associated with poor treatment outcomes. Attempts have been made to improve medication adherence through multiple means. The objectives of this scoping systematic literature review is to explore the existing literature for evidence on the impact of rewards, and gamification on improving medication adherence across multiple disease conditions.

Many studies that evaluate the patterns of chemotherapy and immunotherapy of breast cancer are available in literature, which source the information from randomized control trials (RCTs) and observational studies. However, the real-world evaluation of the treatment patterns in the form of registry analysis, and the treatment outcomes, needs to be summarized. In this review our aim is to evaluate the different types of treatment patters of breast cancer and their effects on patient outcomes in the analysis of breast cancer registries.

Background: We critically evaluated the risk of bias in published systematic reviews (SRs) and meta-analyses (MAs) pertaining to COVID-19 using ROBIS tool. Materials And Methods: MEDLINE and Cochrane Central Library were searched for SRs/MAs on 14th May 2020, including studies of all designs describing various facets of COVID-19 in humans; no restrictions were applied for interventions, comparators, and outcomes. Two reviewers independently assessed all the SRs/MAs with ROBIS. Results: Out of 204 identified records, 48 SRs/MAs were included. The most frequently reviewed topics were therapy outcomes, diagnosis, and comorbidities (15, 8, and 6 papers respectively). Only 29/48(60.41%) papers had made a mention of using PRISMA or other guidelines for drafting the SR/MA. Only 5/48(10.42%) of all included SRs/MAs had low overall risk of bias as per ROBIS tool; 41/48(85.42%) had high risk of bias, 2/48(4.17%) had unclear risk of bias. The highest proportion of bias was found in data synthesis and findings (30/48, 62.50% of studies had high risk of bias), followed by study identification and selection (29/48, 60.42%). The IRR for methodological quality assessment was substantial, with the Cohen’s kappa values being 0.64, 0.68, 0.62, and 0.75 for domains 1-4 of ROBIS tool, and 0.66 for overall risk of bias assessment. Conclusion: There are serious concerns about the methodology employed to generate the results of the SRs/ MAs pertaining to COVID-19, with ‘quantity’ seemingly being given more importance than ‘quality’ of the paper.

Insomnia is a common condition that affects one's ability to sleep comfortably and consequently to work effectively. Its etiology is multifactorial and involves plethora of risk factors. Consequences can vary from mild sleepiness to more sever psychiatric disturbances and ischemic stroke. Despite several diagnostic criteria it is poorly diagnosed and less often treated. Benzodiazepines formed the mainline therapy for many years till the advent of newer nonbenzodiazepine group of drugs including zolpidem. Zolpidem is an imidazo-pyridine compound that enhances the GABA(A) receptor function by interaction with Omega-1 receptor subtype. Its pharmacokinetic profile allows the patients to use it later in the night when having trouble falling asleep without any residual cognitive impairment the next morning. It has rapid onset of action, improves total sleep duration, and reduces night-time awakenings. Its adverse effect profile is satisfactory as it appears to have low addiction potential. This review will focus on the current role of zolpidem in the management of insomnia.

In India we have a large drug consuming population. There is a plethora of counterfeit and substandard drugs [1], drugs belonging to alternative systems of medicine like ayurveda, unani, siddha, homeopathy and drugs which have been banned/withdrawn in other countries [2]. Because of these factors, it is all the more important that a system of adverse drug reaction (ADR) reporting is established. In addition, without a proper ADR database, it is difficult to withdraw harmful drugs from the market. The enormity of the problem of ADR reporting and poor post marketing surveillance by pharmaceutical companies in India is well documented [3]. India rates below 1% in terms of ADR reporting against the world rate of 5% [4]. This clearly shows that the concept is still in its infancy here. To overcome this, the Ministry of Health & Family Welfare has initiated the National Pharmacovigilance Programme (NPP) which is co-ordinated by the Central Drugs Standard Control Organisation (CDSCO) in New Delhi. Under this programme 24 peripheral, five regional and two zonal Pharmacovigilance Centres are asked to work cohesively to improve ADR reporting in India [5]. A major proportion of India's population prefers government hospitals when seeking health care facilities. This means that a good ADR database can be generated from these hospitals. The most difficult task initially is to foster a culture of reporting among clinicians especially junior doctors who have the most contact with patients. Reasons for the low level of ADR reporting include lack of awareness, training, and most importantly, time. An additional factor is that the government has not made it mandatory for health care providers to report ADRs unlike some countries such as Spain and Sweden. Hence, there is definitely a need for spontaneous ADR reporting from these physicians [6]. The only way to inculcate the habit of ADR reporting among doctors, besides education programmes is to provide them with an easy and quick method of reporting. We carried out an extensive education programme for all clinicians and interns on the importance of ADR reporting and provided them with a simple method, by which to report ADRs (Figure 1). Figure 1 Adverse Drug Reaction (ADR) notification drop box with ADR notification forms (right) and ADR alert cards (left) Safely locked ‘ADR notification drop boxes’[7] (with the key purpose printed on them) were installed systematically in all the wards and selected outpatient departments (OPDs) in the hospital. Together with the boxes ‘ADR notification forms’ were kept. The form was designed in such a way that the ‘notifier’ (doctor, intern, medical student or nurse) finds it very easy to report an ADR. The moment any health care provider suspects an ADR, a duly filled notification form should be dropped in the ‘ADR notification drop box’. We collected and analyzed the notified ADRs at regular intervals. The drug manufacturer's name was tracked down as per the brand details provided by the ‘notifier’. In the case of hospital supply, the same was tracked down with the assistance from hospital pharmacy. On getting the required details, a red coloured CDSCO reporting form, provided by the pharmacovigilance centre, was completed. ADR reporting increased from 14 to 32 reports in the course of a 3 month period after the education programme and the introduction of the ‘ADR notification drop boxes’. This method has gained popularity among the doctors (Table 1). Monthly reports collected from the whole hospital were then forwarded to the pharmacovigilance centre. Confidentiality was maintained at all levels. Table 1 Number of ADRs reported to the Peripheral Pharmacovigilance Centre (Goa), India, in the 3 months after installing the ‘ADR notification drop boxes’ in the hospital To ensure patient safety, each patient with an ADR was provided with an ‘ADR alert card’ at the time of discharge, which was kept by the patient and presented to other health care providers when needed in the future. To get sustained results from this strategy for reporting ADRs, there should be strong collaboration between the Department of Pharmacology and other clinical departments. ADR monitoring should be a compulsory part of training for postgraduate students in the Department of Pharmacology, as a part of their M.D. curriculum. Lectures should be taken at the undergraduate level on the importance of pharmacovigilance and ADR reporting. Students could be given an exercise such as to report three ADRs in their term which they can do during their ward postings. Interns can be taught about ADR reporting during their Internship Orientation Programme, so that they too can assist the resident doctors working in various clinical departments. The Department of Pharmacology should provide pharmacovigilance awareness programmes to all the nurses and other allied health staff working in the hospital. Assistance should be provided by the CDSCO to sponsor ADR boxes, notification forms and ADR alert cards under the National Pharmacovigilance Programme (NPP). This strategy if adopted by all the government hospitals as well as government medical colleges could be a useful stepping stone in generating a genuine ADR database for our population. All marketed drugs could be monitored simultaneously. Another way could be a computer based online reporting system which is utilized by many developed countries but may be a challenge for public hospitals in developing countries like India.