Showing papers by "Siddhartha Dutta published in 2020"

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future.

Abstract: Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Favipiravir use in COVID-19: Analysis of suspected adverse drug events reported in the WHO database

Abstract: Background COVID-19 caused by SARS-CoV-2 virus emerged as an unprecedented challenge to discover effective drugs for its prevention and cure. Hyperinflammation-induced lung damage is one of the poor prognostic indicators causing a higher rate of morbidity and mortality of COVID-19 patients. Favipiravir, an antiviral drug, is being used for COVID-19 treatment, and we currently have limited information regarding its efficacy and safety. Thus, the present study was undertaken to evaluate the adverse drug events (ADEs) reported in the WHO pharmacovigilance database. Methods This study analyzed all suspected ADEs related to favipiravir reported from 2015. The reports were analyzed based on age, gender, and seriousness of ADEs at the System Organ Classification (SOC) level and the individual Preferred Term (PT) level. Results This study is based on 194 ADEs reported from 93 patients. Most frequent ADEs suspected to be caused by the favipiravir included increased hepatic enzymes, nausea and vomiting, tachycardia, and diarrhea. Severe and fatal ADEs occurred more frequently in men and those over the age of 64 years. Blood and lymphatic disorders, cardiac disorders, hepatobiliary disorders, injury poisoning, and procedural complications were more common manifestations of severe ADEs. Conclusion This study revealed that favipiravir appears to be a relatively safe drug. An undiscovered anti-inflammatory activity of favipiravir may explain the improvement in critically ill patients and reduce inflammatory markers. Currently, the data is based on very few patients. A more detailed assessment of the uncommon ADEs needs to be analyzed when more information will be available.

Household Transmission of COVID-19: A Cross-Sectional Study

Abstract: Introduction: The COVID-19 pandemic has brought the entire world to a standstill The disease is rapidly transmitting in the community Imposed lockdowns due to the COVID-19 pandemic have effectively delayed the transmission in the community but the transmissibility in households needs to be explored The aim of this study was to estimate the household transmission of COVID-19 and assess the factors affecting transmission Patients and Methods: A cross-sectional study where the data were collected from a single isolation center, was conducted Patients were contacted by phone Information regarding number of COVID-19-positive cases in the family, their demographic details, along with number of rooms in their household was collected Results: A total of 369 families of COVID-19-positive patients were contacted Nineteen families with a single member were excluded Out of 350 families with a total 2126 members, 480 (22 5%) were COVID-19 positive Mean age was 30 12 years (+/-14 39) and majority of them were males (68 9%) Majority of the cases (67 3%) were in the age group (19-49 years) Mean rooms per person were 0 51+/- 0 20 (0 14 to 1 50) Mild negative correlation was seen between number of positive COVID-19 cases and rooms per person (r= -0 138, p=0 008) while moderate negative correlation with number of family members and proportion of family members being COVID-19 positive (r= -0 542, p<=0 0001) Conclusion: One in four family members got infected with COVID-19, they were majority males and in the working age group Negative correlation of positive cases with number of family members and mild negative correlation between rooms per person and proportion of family member affected indicates some other factors may be responsible for household transmission than these factors

Opinion of patients seeking primary care regarding prescription of generic drugs: A cross-sectional study

Abstract: Background: Generic drugs are low-cost alternatives to branded drugs. The government of India is encouraging physicians to prescribe the generics to decrease out-of-pocket expenditure of health care. Looking at India's low-prescription on generic drugs, it is crucial to analyze the factors responsible for it. A patient's unawareness may be an important factor; hence, it should be evaluated systematically. Objectives: This study was designed with the aim of assessing knowledge and perception of generics among patients visiting the outpatient department of primary care physicians at the Patan city of Gujarat. Material and Methods: A trained research associate visited the OPDs of various general practitioners to collect the data. A prevalidated questionnaire was administered to these patients. The data was analyzed with the help of statistical software. Descriptive statistics were used to analyze the data. Results: Among 345 patients, only 33.6% reportedly heard about generics. Of these only a few patients ( 60%) believed that generics are safe. Those who were not willing to take generics reported efficacy as the major concern. Out of various factors that may affect knowledge of generic drugs, young age (OR = 5.3) and education (Primary (OR = 8.01), Secondary (OR = 6.19), and Higher secondary (OR = 3.07) were statistically significant. Conclusion: Awareness about the generic drugs was low among the patients visiting the primary care physician. The young age and primary and secondary education levels were significantly associated with the awareness regarding generics.

Dermatological manifestations of COVID-19: A review based on existing reports

Abstract: Presently, the whole world is in distress due to the novel Coronavirus, which has put it on a standstill. It started with few unknown cases of pneumonia associated with unusual etiology were initially reported in Wuhan district of China in December 2019.1 Later, the pathogen was isolated from lower respiratory tract samples of infected patients, found to be a novel Coronavirus (nCoV), and was named severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2).2 Earlier, the nCoVwas found to be quickly spreading inside Hubei Province, and later it got spread to other countries of the world.3 It was declared as an emergency by the World Health Organization(WHO), and later by the midst of February 2020, the SARS-CoV-2 had already spread across the world.2,3 WHO named it Coronavirus Disease 2019 (COVID-19), and further, on March 11, 2020, it was declared as a pandemic.2,3,4 As of May 10, 2020, a total of 3,862,676 cases and 265,961 deaths have been confirmed by the WHO.5 Europe, USA, Eastern Mediterranean are worst hit apart from the reach in Western Pacific, South-East Asia, and the African region.5 The clinical signs and symptoms of COVID-19 are highly variable and include common symptoms like fever, dry cough, and fatigue.6 The less common symptoms are myalgia, rhinorrhea, headache, conjunctivitis, sore throat, diarrhea, anosmia or ageusia, skin rash or discoloration of fingers or toes.6 There is also instability in the vital parameters like temperature, pulse oximetry saturation, and changes in chest radiological findings in X-ray and Chest CT scan.7 In COVID-19, the patients most report with respiratory symptoms, which can range from mild flu to severe respiratory distress.7 The SARS-CoV-2 virus enters the cells through the angiotensin-converting enzyme 2 (ACE2) receptor, found on the surface of cells, and lungs are the primary site of infection.8, 9 Of the above varied symptoms mentioned, all symptoms are not essentially present in every successive patient, and besides, as this infective disease is primarily respiratory in nature, for this reason, the cutaneous manifestations have not been widely reported.7 This article is a review of all the possible dermatological manifestations reported by various . ABSTRACT

Anticoagulants in covid-19 therapy: An evidence-based review

Abstract: The novel coronavirus disease 2019 (COVID-19) which is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has affected humans globally and has led to significant morbidity and mortality The virus is believed to be transferred from bats and most commonly affects the respiratory system, lungs as the primary site of infection The patients can have a varied presentation from being asymptomatic to develop acute lung injury worsening to respiratory failure and even multiorgan failure leading to death The novel nature of the virus is the reason for the absence of prior immunity and has ended up in a huge surge of cases globally The clinical presentation of COVID-19 has been evolving as the number of cases increasing and hence the plan of treatment also keeps on modifying The classical symptoms include fever, dry cough, tiredness, and sometimes can also have nasal congestion, headache, conjunctivitis, sore throat, diarrhoea rash on the skin, anosmia, hyposmia, ageusia, and dysgeusia COVID-19 has also been seen to be associated with coagulopathy because of a prothrombotic state in the venous and arterial circulations which can be due to SARS-CoV-2 induced inflammation, dysregulation of the coagulation cascade, platelet activation and endothelial dysfunction The presentation can mimic the patients with disseminated intravascular coagulopathy and the initial stage mostly presents with an elevation of D-dimer and fibrin degradation products Primary screening of the coagulation profile is suggested along with the estimation of D-dimer and fibrinogen levels to assist in early recognition of the high-risk patients and also predict prognosis Early diagnosis and intervention with anti-coagulants can improve prognosis and associated complications This article reviews the epidemiology, pathogenesis, presentation, and management of the abnormal coagulation findings related to COVID-19

Role of alcohol based hand rubs (ABHR) in the COVID-19 era: A concise review

Abstract: In this current pandemic of COVID-19, entire world is facing a huge crisis in healthcare and economic fronts. Till date, there is no definitive drug or vaccine for the cure of this novel Coronavirus 2019. Numerous repurposed and newer drugs are being tried in the therapy of this disease yet none have reached to conclusion of effectiveness in this disease. Hence, preventive strategies like social distancing, hand washing, using hand sanitizers, masks and personal protective equipment tends to be the crucial component in prevention from getting infected from this highly infective virus. Alcohol based hand sanitizers and hand rubs with more than 70 % alcohol seems to be effective in disinfecting the hands and touched surfaces. The sanitizers seem to be the first line of defense in the prevention of COVID19 as well as other microbial infections. The article elaborates the importance of hand sanitizers in the present new world pandemic and reduction in disease burden.

A concise review of existing therapies and recent advances in the management of HIV infection

Abstract: Human immunodeficiency virus (HIV) is an RNA retrovirus capable of replicating its genome by the DNA dependent RNA polymerase (DdRp) The virus infects the lymphocytes with the help of viral glycoproteins like Gp 120 and Gp 41 The entry of virus leads to the release of viral RNA inside the host cell, which is further replicated, and assembly of virion particles leads to the release of viral particles that further infect the other host cells Established therapies include those that inhibit the entry of virus in the host cell, those inhibiting the integrase activity, those acting as protease inhibitors and also we have Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and Non-Nucleoside reverse transcriptase inhibitors (NNRTIs) with NRTIS being the competitive inhibitors of DdRp also show mitochondrial toxicity Protease inhibitors are known for their adverse effect profile and several drug interactions due to their enzyme inhibitory property The most effective approach in the management is the highly active antiretroviral therapy containing the combined use of drugs having varied mechanisms of action Still, long term use of these agents can end up in resistance against these agents Well documented adverse effect profile along with various drug interactions associated with anti-HIV drugs mandates the need for the development of newer drugs against HIV Newer molecules provide a better safety profile and better alternatives for drug-resistant cases Therefore, this review focuses on existing therapies along with various newer pipeline drugs with their mechanisms and advantages over the existing therapies

Terminated Interventional Trials in the Clinical Trial Registry of India Database: An Analysis to Evaluate the Reasons for Termination

Abstract: Background: Clinical Trial Registry - India (CTRI) is a valuable tool to access information regarding clinical trials conducted in India. To serve this purpose, the information provided on it must be complete and accurate. The present study was designed to assess the reasons for premature termination of clinical trials on the CTRI database and determine the average timings related to updating information on CTRI. Methods: The data were extracted from the website of Clinical Trial Registry - India; all the terminated trials from 20 July 2007 to 18 December 2019 were included. The reasons given for termination were categorized as scientific reasons, nonscientific reasons, and unspecified reasons. Results: Of 16,579 interventional clinical trials, 243 trials were terminated. Out of these 243 trials, reasons were given in 50 (20.58%). In reasoning with scientific data, the most common reason was safety issues (14%), and among nonscientific data, a significant delay in recruitment was a principal reason (16%). The median time from date of registration to date of modification was 1034 days (0–3912), and the median time from the date of last revision to the date of our analysis was 1329 days (2–3138). Conclusion: The reasons for termination are not mentioned adequately for the terminated clinical trials in the Clinical Trial Registry of India. Efforts need to be done to motivate investigators to report the reasons for termination. Proper planning of trial before initiation may prevent premature termination of clinical trials and ensure fair use of resources.