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  • ISSN: 2333-7079
    Volume 9, Issue 1
    Research Article
    Julekha Khatun*, Arif Hosen MM, Ashim Kumar Ghosh, Rawshan Ara Khatun, and Shish Mohammad Sarkar
    Background: Neoadjuvant chemotherapy is an innovative approach that has got significant attention for treating breast cancer. Optimal management of locally advanced breast cancer (LSBC), generally includes a combination of neoadjuvant chemotherapy followed by surgery, local radiotherapy and adjuvant chemotherapy with or without hormone therapy.
    Methodology: Our study was carried out on histopathologically confirmed 60 locally advanced breast cancer patient [tumor > 5cm in diameter (T3), with mobile or fixed nodes (N1-2), OR associated with involvement of skin or chest wall (T4), OR with fixed axillary nodes or ipsilateral Supraclavicular nodes] were enlisted and were divided into two study groups. Arm-A consisting of 30 patients were treated with Adriamycin 60 mg/m2 and Cyclophosphamide 600 mg/m2 (AC), & Arm-B consisting of 30 patients were treated with Adriamycin 50 mg/m2 and Docetaxel 75 mg/m2 (AD), 4 cycle 3 weeks interval.
    Results: The study was designed to compare the response of neoadjuvant chemotherapy with Adriamycin and Cyclophosphamide versus Adriamycin and Docetaxel in locally advanced breast cancer. As the result of the study, baseline characteristics were almost similar between the two arms. In Arm-A clinical complete response (CR), was achieved in 05 patients (16.7%), and clinical partial response (PR), was 18 patients (60%). In Arm-B clinical complete response (CR), was achieved in 08 patients (26.7%), and clinical partial response (PR), was 19 patients (63.3%). Overall clinical response (complete & partial), in Arm-A & Arm-B was 76.7% versus 90%. After 4 cycle chemotherapy, 23 patients in Arm-A and 27 patients in Arm-B underwent a modified radical mastectomy. Among them, pathological complete response (CR), was found in 02 patients (8.7%), in Arm-A and 04 patients (14.9%), in Arm-B. Hematological toxicities especially grade-3 anemia & neutropenia were more in Arm-B than Arm-A, but no patient develop grade-3 thrombocytopenia. Among non-hematologic toxicities, grade-3 nausea vomiting was more in Arm-A but alopecia and neuropathy were more in Arm-B. All these toxicities were managed by symptomatic management.
    Conclusion: The overall clinical and pathological response was found greater in Arm-B but not statistically significant. Both hematologic and non-hematological toxicities were a little bit more in Arm-B specifically grade-3 neutropenia, except the incidence of nausea and vomiting was more in Arm-A but those were acceptable and manageable.
    Enes Seyda Sahiner* and Ali Akcay
    Objective: The aim of this study was to examine the relationship between obestatin and malnutrition in patients with chronic renal failure (CRF).
    Method: The study included 43 hemodialysis patients with chronic renal failure aged >18 years and 43 healthy matched controls.
    Results: CRF patients and healthy controls were not significantly different in terms of obestatin levels. For all subjects, obestatin was positively correlated with body fat, waist circumference, Mini Nutritional Assessment score, body mass index, triglycerides, and low-density lipoprotein levels. Regression analysis showed that body fat was a determinant of obestatin.
    Conclusion: In reference to our results, we conclude that obestatin is a marker associated with obesity and was not significantly different between patients with CRF and healthy controls.
    Review Article
    Roy G Beran*
    Introduction: Carbamazepine (Tegretol®) (CBZ), has been available for half a century suggesting all that needs to be said has been said but it has truly withstood the test of time.
    History revisited: CBZ was discovered during the research and development of imipramine, a tricyclic antidepressant and retains psychotropic benefits which are propitious in the treatment of epilepsy. CBZ has both standard antiseizure medication (ASM), adverse events (AEs), as well as idiosyncratic AEs that must be appreciated when using CBZ. Genotyping allows definition of those for whom CBZ is contra indicated. It can also exacerbate certain seizure types, such as generalised epilepsies, such as juvenile myoclonic epilepsy.
    Risk/Benefit Ratio: Blood level monitoring of CBZ levels allows tailoring of treatment to the patient’s needs and identifies both ASM causing toxicity or non-compliance/non-adherence, possibly before breakthrough seizures occur. Medication interactions, consequent to liver enzyme induction, need to be acknowledged and monitored.
    Conclusion: It follows that with adequate preparation and understanding, CBZ remains a favoured ASM in the treatment of focal epilepsy. As with any medication it is imperative to understand the ‘pros and cons’ but, with due diligence, CBZ deserves to remain at the top of the list for quite some time to come.
    Gary F. Merrill*
    We live in an increasingly dangerous and uncertain world. Part of the danger and uncertainty stems from the costs and high rates of turnover of new drugs created by ‘profit margins’ within big pharmaceuticals and the biotechnology sectors (e.g. coronavirus vaccinations). The elderly and poor are frequently in the dark about the efficacy, legitimacy and safety of the drugs they are prescribed (personal communication). Some think they have to choose between buying groceries, paying property taxes, or losing health because they can’t afford their prescription medications. This is a shameful and unfortunate price to pay in exchange for the greed and indifference of profiteers.
    Gian Maria Pacifici*
    Cefotaxime is active against Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Citrobacter, Enterobacter, Serratia, Neisseria gonorrhoea, Staphylococcus aureus and Streptococcus pneumoniae. Cefotaxime cured the meningitis caused by Haemophilus influenzae, penicillin-sensitive Streptococcus pneumoniae, and Neisseria meningitides. The drug is metabolized in-vivo to desacetylcefotaxime and desacetylcefotaxime is converted into 3-desacetylcefotaxime lactone. Cefotaxime is administered intravenously and the dose is 50 mg/kg given twice-daily, thrice-daily, and 4 times-daily in infants with a postnatal age of 1 week, 2 to 3 weeks and > 3 weeks, respectively, and it is 50 mg/kg thrice-daily in children. The elimination half-life of cefotaxime ranges from 3 to 5 hours in infants and it is about 0.8 hours in children. The total body clearance of cefotaxime ranges from 0.1 to 0.3 L/h/kg in infants, it is 0.11 and 0.74 L/h/kg in two children, and the renal clearance is lower than the total body clearance. The total body clearance of desacetylcefotaxime is about 0.36 L/h/kg. Cefotaxime distribution volume is lower than the water volume in both infants and children. This drug interacts with drugs; the interaction may cause inhibitory or synergistic effects and the treatment with cefotaxime has been extensively studied in infants and children. Cefotaxime penetrates into the cerebrospinal fluid and the cerebrospinal fluid to serum ratio ranges from 10 to 26% for cefotaxime and from 21 to 29% for desacetylcefotaxime. Cefotaxime is transferred across the human placenta and the umbilical cord to maternal blood ratio is 77% for cefotaxime and 99% for desacetylcefotaxime. Cefotaxime migrates into the breast-milk in significant amounts. The aim of this study is to review the dosing, efficacy and safety, metabolism, pharmacokinetics, drug-interactions, treatment, meningitis, penetration into the cerebrospinal of cefotaxime in infants and children, and the cefotaxime transfer across the human placenta and migration into the breast-milk.
    Original Article
    Mulugeta Russom*, Filipos Yohannes, Abel Tekle, Ruth Ghirmay
    Introduction: Ibuprofen was associated with hypoglycemia in a single published case report in a diabetic patient. Ibuprofen, however, has never been associated so far with hypoglycemia in previously healthy non-diabetic individuals and thus, it is not listed as adverse effect in its summary of product characteristics approved by major regulatory authorities.
    Objective: This study was conducted to assess the causal relationship between ibuprofen and hypoglycemia in diabetic and non-diabetic individuals.
    Materials and Methods: Analysis of the literature and the WHO global database of individual case safety reports, VigiBase, was made to explore evidence on the association of ibuprofen and hypoglycemia. The unpublished data and the currently availablepublished toxicological, biological, clinical and epidemiological evidence, if any, was systematically organized using Austin Bradford Hill criteria, causality assessment framework, to assess the causal link between ibuprofen and hypoglycemia.
    Results: In VigiBase, there were 125 cases of hypoglycemia associated with ibuprofen, reported from 19 countries. About 50% had history of diabetes. Ibuprofen was reported as sole suspect in 36.8% of the cases and the only drug administered in18.4%. Hypoglycemia resolved following discontinuation of ibuprofen in 21.6% and recurred in three patients with rechallenge. Outcome was fatal in 10.5%. Where ibuprofen was solely administered, median time-to-onset of hypoglycemia was one-day following administration of the drug. In an experimental study, a significant decrease in blood glucose level was observed at a higher dose of ibuprofen compared to a low-dose.
    Conclusion: Currently available totality of evidence reflects a possible causal association between ibuprofen and hypoglycemia that need to be substantiated with further studies.
    Review Article
    Amit Joshi1 and Vikas Kaushik*
    Computational techniques in drug discovery and vaccine prediction basically revolve around molecular docking to retrieve perfect interaction models for ligand and receptor. Binding energies can be obtained for perfectly interacting complexes. Many tools like DINC, PatchDock-Firedock, and AutoDock-Vina are deployed to conduct molecular docking in various pipelines. Discovering drug and vaccine becomes facile due to use of advanced docking techniques. Also allow researchers to screen out possible models of interaction on the basis of atomic contact energy, binding energy, and global energy. This review article provides insights to use efficient approach for docking related investigations.
    Gian Maria Pacifici*
    Captopril is a potent angiotensin-converting enzyme inhibitor with a Ki of 1.7 nM. Captopril may be administered orally or intravenously and the oral bioavailability is about 75%. Most of the drug is eliminated in urine, 40 to 50% as captopril, and the rest as captopril disulphide dimers and captopril-cysteine disulphide. Captopril may be used in the treatment of congestive cardiac failure, and in moderate to severe hypertension in infants and children. The oral test dose of captopril is 10, 10 to 50, or 100 µg/kg thrice-daily in preterm infants, term infants, and older infants, respectively, and in children the oral test dose is 100 to 300 µg/kg twice-daily or thrice-daily. Captopril has been found efficacy and safe in treating heart failure in infant and in reducing hypertension in infants and children. The effects of captopril are: reduction of blood pressure, decrease pulmonary-to-systemic blood flow ratio, decrease systemic vascular resistance, and reduce aldosterone and natriuretic peptide blood concentrations in infants and children. Captopril causes different adverse-effects. The elimination of captopril is about 3 hours in infants and children. Captopril interacts with allopurinol, carnosine, potassium-sparing diuretics, or verapamil. Captopril treats infantile haemangioma, is a systemic vasodilator and reduces the blood pressure in hypertensive infants and children, and captopril poorly migrates into the breast-milk. The aim of this study is to review the published data of captopril dosing, efficacy and safety, effects, adverse-effect, pharmacokinetics, interaction with drugs, and treatments in infants and children, and the migration of captopril into the breast-milk.
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