Nirmala Infobliss

STEM CELL THERAPY

2022-02-03T20:31:00.001+05:30

Today, living in 21^st century, we still do not have proper treatments for diseases like Diabetes, Parkinson’s disease, Alzheimer’s disease etc. Some light of hope for these incurable disease is the Stem Cell Therapy. Research on how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms is advancing. This area of science investigates the possibility of cell-based therapies to treat disease which is often referred to as Regenerative or Reparative Medicine.

First successful human transplant of insulin-making cells from cadavers was done in 1999. Followed by first cloned human embryos created by Advanced Cell Technology in 2001 and Harvard Researchers grow stem cells from embryos in 2004.

Stem cell has the ability to continuously divide and differentiate into various other kinds of cells or tissues. The stem cells have general properties:

· They are capable of dividing and renewing themselves for long periods.

· They are unspecialized.

· They can give rise to specialized cell types.

Stem cells are of various types- Totipotent, Pluripotent, Multipotent, Oligopotent, Unipotent.

Stem cell therapy is introduction of new adult stem cells into damaged tissue in order to treat disease or injury. The ability of stem cells to self-renew and give rise to different cells, that can potentially replace diseased and damaged areas in the body, with minimal risk of rejection and side effects. Any disease in which there is tissue generation can be a potential candidate for stem cell therapies.

Stem cell transplant is proceduralized by the following steps:

o Evaluation and pre transplant testing

o Identification of the appropriate type of transplantation

o Obtaining stem cells from the patient or a donor

o Conditioning treatment

o Infusion of healthy stem cells into the patient

o Engraftment and recovery

o Post-transplant care

o Coordination of continuing care

The applications of stem cell therapy includes, Tissue repair which involves the regeneration of spinal cord, heart tissue or any other major tissues in the body; For Heart disease , in which adult bone marrow stem cells injected into the heart are believed to improve cardiac function in victims of heart failure or heart attack; For Leukemia and Cancer, in which when Leukemia patients treated with stem cells emerge free of disease and also reduce emergence of pancreatic cancers in some patients; Adult stem cells may be helpful in starting repair of eroded cartilage for Rheumatoid Arthritis patients; It can also be given for type 1 diabetic patients in which embryonic stem cells might be trained to become pancreatic islets cells that are needed to secrete insulin. Nowadays, the therapy is indicated for various other medical conditions. It is a new form of emergence to the treatment era.

In conclusion, stem cell therapy has become a very promising and advancing scientific research topic in recent years. The development of treatment methods has evoked great expectations. The genesis of stem cells is followed by laboratory steps of controlled stem cell culturing and derivation. Quality control and teratoma formation assays are important procedures in assessing the properties of the stem cells tested. Derivation methods and the utilization of culturing media are crucial to set proper environmental conditions for controlled differentiation. The stem cell therapy must overcome the challenges to be accepted worldwide. A wide variety of possibilities makes this cutting-edge therapy a turning point in modern medicine, providing hope for untreatable diseases.

Shefin Siby - Third Pharm -D

COVID-19 VACCINE IN ORGAN TRANSPLANT RECIPIENTS

2021-09-20T21:12:00.003+05:30

COVID-19: Issues related to solid organ transplantation

Solid organ transplant recipients is at an increased risk for COVID-19 because they are immunosuppressed and have frequent contact with the health care system.

Risk of transmission

I. Potential for donor-derived infection

· To date, one episode of donor-derived infection involving a lung transplant recipient has been reported.

· Blood-borne transmission has not been reported.

II. Post transplantation risk

· Chronic immuno-suppression may lower the infectious dose needed to cause COVID- 19 and impair adequate immune control once infection is established.

Pre transplantation screening

· All organ donors and potential recipients

should be screened for COVID-19 prior to organ procurement via RT-PCR.

· Donors with known or suspected active COVID-19 based on symptoms or chest imaging should generally be declined or deferred.

· Donors with known or suspected COVID-19 within the past 21 days should generally be declined or deferred.

Studies have shown that many organ recipients don’t produce corona virus-fighting antibodies even after two doses of the highly effective messenger RNA (mRNA) vaccines— an indication their bodies are unable to mount a strong defense against SARS-CoV-2.Severe cases of corona virus disease 2019 (Covid-19) have also been reported in transplant recipients who had received two doses of vaccine. People who receive solid organ transplants (such as hearts, lungs and kidneys) often must take drugs to suppress their immune systems and prevent rejection.

Such regimens may interfere with a transplant recipient’s ability to make antibodies to foreign substances, including the protective ones produced in response to vaccines. This may mean that despite vaccination, transplant recipient may still get COVID-19 and it might progress to severe disease.

Three studies found that the antibody response to a two-dose mRNA vaccine is substantially lower in solid organ transplant recipients when compared with the general population. In a study involving 658 transplant recipients, just 54% of patients given two doses of an mRNA vaccine developed antibodies to protect them against the pandemic corona virus.

Dorry Segev, a transplant surgeon with Johns Hopkins University and colleagues obtained SARS-CoV-2 infection and testing data on more than 18,000 fully vaccinated recipients of large organs like kidneys or lungs at 17 transplant centers across the United States. They found that 151 of these patients caught the virus. Of those that became infected, more than half were hospitalized with COVID-19 symptoms and nearly one in 10 died. The rate of infection in the study was low, just 0.83%. But it’s still 82 times higher than in the general vaccinated public and the rate of serious illness was 485 times higher.

ANOTHER CASE STUDY

The new study evaluated immunogenic response following the second dose of either of the two messenger RNA (mRNA) vaccines (made by Moderna and Pfizer-BioNTech) for 658 transplant recipients, none of whom had a prior diagnosis of COVID-19. The participants completed their two-dose regimen between Dec. 16, 2020, and March 13, 2021.

The researchers found that only 98 of the 658 study participants (15%) had detectable antibodies to SARS-CoV-2 at 21 days after the first vaccine dose. At 29 days following the second dose, the number of participants with detectable antibodies rose to 357 out of 658 (54%). Among the participants, the most likely to develop an antibody response were younger, did not take immunosuppressive regimens including anti-metabolite drugs.

Given these observations, transplant recipients should not assume that two vaccine doses guarantee sufficient immunity against SARS-CoV-2 any more than it did after just one dose. A potential solution is a third shot of vaccine. Segev, and other researchers are studying whether a booster dose could give transplant recipients better COVID-19 protection. These reports prompted the French National Authority for Health to recommend the use of a third dose in immunosuppressed patients.

Antibody Response After a Third Dose of the mRNA Vaccine in Kidney Transplant Recipients

The antibody response of kidney transplant recipients who did not respond to 2 doses and received a third dose (100 μg) of the mRNA-1273 vaccine (Moderna) was measured in this study. The median age of all the participants was 57.6 years.One month after the second dose, 159 kidney transplant recipients had IgG levels less than 50 AU/mL.

The third dose was injected of 51 days after the second dose. The antibody response was measured 28 days after the third vaccine injection, and 78 patients (49%) had antibody levels greater than 50 AU/mL.

Patients who had a weak response after the second dose were more likely to develop an antibody response after the third dose compared with those without an antibody response. None of the patients developed COVID-19 after their third dose. No severe adverse events were observed after the third dose. Limitations of this study include that detailed B- and T-cell studies were not performed.

Another case series reported by Dorry Segev, MD, PhD, of Johns Hopkins University cited that the third dose was likewise safe and got all of the initially low-positive patients to high antibody titers and a third of the initially-negative patients to at least low-positive titers. A major aspect that is missing from the current evidence is risk to the transplanted organ in the context of the immune activation from the third dose. The measures to be taken incase of persistently low or negative antibody levels even after a third vaccine dose isn't clear as of now.

Third doses aren’t yet an officially recommended course of action for immune-compromised people in most countries, but as more data come out, policies are shifting. The French government endorsed third doses for transplant patients in April. The United Kingdom’s National Health Service also plans to begin to offer a third vaccine dose to immuno- compromised individuals beginning at the end of September, this year.

Conclusion

A three-dose COVID-19 vaccine regimen may provide protection for some immune- compromised patients who have not had adequate immunological response after two doses. The risks of a three-dose regimen – including organ rejection and autoimmune disease exacerbation – have not been adequately studied. Organ transplant recipients should continue to adhere to protective measures (such as masking and social distancing) despite vaccination.

Gautham Gopakumar - II Pharm D

BACTERIA TO GRAPPLE CANCER: BACTERIUM MEDIATED CANCER THERAPY (BMCT)

2021-07-15T20:00:00.001+05:30

Cancer is characterized by uncontrolled and invasive growth of cells. These cells may spread to other parts of body and this is called metastasis. Cancer may be benign or malignant. The International Agency for Research on Cancer (IARC) estimates that 1 in every 5 people develop cancer during their lifetime. These new estimates suggest that more than 50 million people are living within 5 years of a past cancer diagnosis.

Conventional anticancer therapies consisting of surgical resection, radiotherapy, chemotherapy, are effective in management of many patients, but for about half of cancer sufferers these are ineffective. Resistance to conventional anticancer therapies has prompted the need for novel strategies.

The success of the alternative therapies depends on their cancer selectivity and reduced tissue toxicity. Despite being an unconventional and contentious therapy, the last two decades have seen a significant renaissance of bacterium mediated cancer therapy.

Scientists are harnessing a harmless soil bug to kill tumours by using it as a drug delivery vehicle. A bacterium found in the soil and harmful in its natural state has been converted through genetic methods into precise tumour destroyer. Researchers from USA’s John Hopkins Cancer Centre excised the toxin producing gene from the bacterium and the spores of. modified bacterium were introduced directly into the tumours and there was significant reduction in the tumour size or eradication without damaging healthy tissues.

The therapy uses Clostridium sporogenes – a bacterium that is widespread in the soil. Spores of the bacterium are injected into patients and only grow in solid tumours, where a specific bacterial enzyme is produced. An anti-cancer drug is injected separately into the patient in an inactive ‘pro-drug’ form. When the pro-drug reaches the site of the tumour, the bacterial enzyme activates the drug, allowing it to destroy only the cells in its vicinity – the tumour cells.

Bacterial anticancer therapy is an important weapon in the arsenal of fight against cancer. Strength of bacterial therapy depend in its specific targeting to the cancer cells. Different mechanisms responsible for anticancer activity include secretion of cytotoxic agent, immune engagement by the bacteria and engineered bacterial vectors for the expression and release of tumoricidal proteins.

Researchers at the University of Nottingham and the University of Maastricht have introduced a gene for a much-improved version of the enzyme into the C. sporogenes DNA. The improved enzyme can now be produced in far greater quantities in the tumour than previous versions, and is more efficient at converting the pro-drug into its active form.

Professor Nigel Minton, states that “Clostridia are an ancient group of bacteria that evolved on the planet before it had an oxygen-rich atmosphere and so they thrive in low oxygen conditions. When Clostridia spores are injected into a cancer patient, they will only grow in oxygen-depleted environments, i.e. the centre of solid tumours. This is a totally natural phenomenon, which requires no fundamental alterations and is exquisitely specific. We can exploit this specificity to kill tumour cells but leave healthy tissue unscathed,” he said.

The research will ultimately lead to a simple and safe procedure for curing a wide range of solid tumours. A successful outcome could lead to its adoption as a frontline therapy for treating solid tumours. If the approach is successfully combined with more traditional approaches this could increase our chance of winning the battle against cancerous tumours.

Dona Basil, II^nd Pharm D

HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: A SCARCE FORM OF NEOPLASIA

2021-07-01T22:30:00.001+05:30

Hemophagocytic Lymphohistiocytosis (HLH) , also known as Hemophagocytic Syndrome, is an

Bone marrow smear of a patient with HLH

unconventional form of hematologic disorder seen more often in children than in adults. Unlike previously nowadays, HLH is prevalent among all age groups, including adults. This is a hyper inflammatory Syndrome which is caused by the uncontrolled proliferation of activated lymphocytes and macrophages, characterized by proliferation of morphologically benign lymphocytes and macrophages that secrete high amounts of inflammatory cytokines that makes it classified as one of the Cytokine Storm Syndrome. That is, it’s an anomalous feedback of the immune system. Based on their etiologies, HLH can be classified broadly into two types - Primary and Secondary. Primary type expressly inherited form which is the Familial Hemophagocytic Lymphohistiocytosis and Secondary type that can be caused due to viral infections (Epstein-Barr virus), autoimmune diseases, Malignancy, Macrophage Activation Syndrome (MAS) etc.

The clinical presentations of HLH maybe difficult to find out as they are lot of symptoms that can mimic other conditions which bring up a way for many other differential diagnoses. However, the initial Signs and symptoms of HLH may include: Rash, Anaemia, Low Platelets and White Blood Cells, Enlarged Liver, Spleen and Lymph Nodes, Diligent Fever, Seizures, Liver Failure, Hepatitis, Jaundice etc.

Familial HLH, which is the Primary HLH maybe acquired from parents to children, but the Acquired HLH can be caused by,

Viral infections, mainly Epstein-Barr virus
Autoimmune diseases
Bacterial or Fungal Infections
Cancers, such as T-cell lymphoma

There are chances of being conditioned with X-linked lymphoproliferative disease (XLP), if one has an acquired HLH spawned by a virus.

The pathophysiology of the condition is due to an abnormally activated immune system can result in multiple organ damage and severe adverse events. NK cell cytotoxicity is centric in the development of HLH. Familial HLH presents with granule related cytotoxicity. An inability to properly recruit immune cells to the antigen site causes the cytokine storm. With an impending immune system, the release of excessive cytokines threatens the organs with a paramount cytokine infiltration. The clinical presentation of HLH can be attributed to such mechanisms operating behind it. Fever is primarily caused due to IL-6, TNF-alpha and IL-1. TNF-alpha also has other important role where in, it inhibits lipoprotein lipase and stimulates the synthesis of TG. TNF-alpha in conjunction with TNF-gamma promotes cytopenia with an attenuation in haematopoiesis. These pathways culminate in HLH. Ferritin and Plasminogen activator which is secreted by activated macrophages may lead to hyperfibrinolysis.

The diagnosis for HLH is instituted through blood tests which include blood cell counts, liver function, markers of immune system activation such as ferritin and soluble IL-2 receptor levels. A bone marrow aspirate and biopsy may be performed to look for microscopic evidence of hemophagocytosis. A lumbar puncture may be performed to collect cerebrospinal fluid and to make sure the HLH is not affecting the brain. X-rays, CT scans, ultrasounds or MRIs may be performed.

The therapy of the ailment maybe approached by:

· Chemotherapy (cancer drugs)

· Suppress the severe inflammation: Steroids- Dexamethasone; Cyclosporine A; Intrathecate Methotrexate, Hydrocortisone (patient with persistent active CNS disease)

· Kill the over stimulated Antigen Presenting Cells: Etoposide (VP-16)

· Treat the triggering agent: Antibiotic drugs, Antiviral drugs

· Supportive Therapy: Prophylactic Cortimoxazole, Oral anti-mycoctic, Gasoprotection.

HLH is an uncommon but likely underdiagnosed disease. The mortality is uniformly high, and a timely diagnosis is imperative. Infections are common triggers in both genetic and acquired HLH. If not treated properly both the type may or may not lead to terminal multiple organ failure.

The disease had shown gender equivalence and estimation of universal generality of one in a count of 50,000. The genetic form is most likely to be present in the paediatric population and with some exceptional in adult population.

Angelin Jaimon Augustine , II Pharm - D

NEW BIOGEN ALZHEIMERS DRUG -ADUCANUMAB: WHETHER CURATIVE FOR THE FORTHCOMING?

2021-06-15T22:30:00.007+05:30

ABOUT THE DRUG

Aduhelm - Forecasts a first line treatment approved for Alzheimer's disease. It is the first new targeted therapy that focus mainly on the fundamental pathogenesis of the disease. The Food and Drug Administration on Monday ratified Biogen’s new Alzheimer’s drug, a decision with many controversies

or patients, clinicians, and others. Aduhelm, whose scientific name is aducanumab, eradicates beta-amyloid clumps in the brain — a process that can slow their ability to destroy neurons. Not all experts were convinced that clearing the toxic proteins will slow cognitive decline. And if Biogen’s drug does make out reverberations, the benefit still tends to be marginal as the measured tests of cognition and function revealed that difference between Aduhelm and placebo was a fraction of a point on an 18-point scale. Biogen stated the annual cost for a maintenance dose of Aduhelm, based on an average patient’s weight, would be $56,000. That’s the real list price, not the total net price or the price paid by patients with insurance. Aduhelm is infused intravenously over about an hour once every four weeks, potentially in a doctor’s office, infusion centre, or hospital clinic. ADUHELM is expected to be degraded into several small peptides and amino acids via catabolic pathways in the same manner as endogenous IgG.

The logistics of receiving Aduhelm will also be a challenge. Patients will have to undergo expensive brain scans to determine eligibility for Aduhelm, and then the drug must be administered monthly via an intravenous infusion at a doctor’s office or similar health care facility.

AFTERMATH

The drug is not a perfect cure as it does not reverse the disease’s conditions. In clinical trials, conquest was measured not by cognitive improvement but by slowing in the rate of cognitive and functional decline. Alzheimer’s disease is a progressive neurodegenerative disorder, manifested by deposits of protein structures named amyloid plaques in the brain. Amyloid-beta is normally present in the brain as a single protein or monomer. However, it aggregates into clumps in patients with Alzheimer’s disease. Researchers jumped into a conclusion that these clumps are toxic to brain cells, that has eliminating action. Aduhelm is an antibody that preys the amyloid-beta. The antibody can preferentially bind to the aggregated amyloid-beta. The reason behind this phenomenon is that it targets an epitope that is not normally accessible in the amyloid-beta monomer. Through this interaction, Aduhelm could reduce the number of amyloid plaques dwelling in the brain, potentially slowing neurodegeneration and disease progressions

CONCOMITANT SIDE EFFECTS

Based on two clinical trials, about 40% of clinical trial patients who got the approved dose of Aduhelm happened to have excruciating brain swelling. Symptoms involved headache, dizziness, visual disturbances, diarrhoea, and confusion, delirium, altered mental status, disorientation, nausea, and vomiting; about 17% to 18% of patients had microhaemorrhages, or small bleeds in their brain which can be fatal.

WHY THE DRUG BECAME SO CONTROVERSIAL?

Three reasons: First, Biogen halted two trials of aducanumab in March 2019 after independent monitors, looking at data during an interim analysis, concluded the drug was unlikely to benefit patients. A later analysis came to a differing conclusion, but an FDA advisory panel convened in November 2020 found the new, positive interpretation more unconvincing.

Second, the amyloid hypothesis, which outcasts the clumps of the toxic protein as the root cause of cognitive impairment, has yet to be proven. It’s not clear if amyloid plaques, or tangles of another protein called tau, are causes or side reactions of Alzheimer’s. The list of amyloid-targeting drug failures is often so paving a way for such controversies.

Third, some experts showed concern that the desperate need for new treatments would cause regulators to accept limited evidence of efficacy as grounds for approval

MANIFESTATIONS OF DRUG BEING A FUTURE PRECEDENCE

If aducanumab is ultimately found to be effective, many patients with early-stage Alzheimer’s will pull out the benefits in reductions in hospitalizations, doctor visits, nursing home costs and societal burden. And if it is the other case when aducanumab is found to be ineffective then too, Medicare, insurers and patients will have spent tens of millions of dollars on a drug that not only did not work but also exposed patients to adverse events, including the risk of bleeding in the brain.

Niveena - IInd Pharm- D

AFTERMATH OF COVID19 PANDEMIC

2021-06-03T22:30:00.011+05:30

The emergence of SARS-CoV-2 in December 2019 prompted consternation in many parts of the world. Due to its fast spreading, the World Health Organization declared a pandemic in March 2020.

In December 2019, a cluster of pneumonia cases was reported in the province of Hubei, China. It was then discovered that the infection was caused by a virus, named SARS-CoV-2. Subsequently, the illness caused by this virus was termed Coronavirus disease 2019 (COVID-19).

Unlike other virus outbreaks of the 21st century, such as SARS and MERS, which were primarily disseminated in hospital environments, COVID-19 is inimitable in the way it has spread far beyond health centres’ boundaries. With the entire population at risk, the necessary restricting measures have created a matchless scenario, dominated by Fear and Uncertainty. Even though fear is an essential adaptive mechanism that humans and other species have developed to cope with threats in the environment, it can only be supportive for those who feel capable of dealing with the menaces existing specifically to them. To those who consider themselves as unable to handle such risks, fear can trigger defence responses in a conjuncture where the fear is not only of death but also of the effects in a myriad of different spheres, community isolation, and economic values.

In the pandemic background, stressors must also be considered in the assessment of the emotional and neuropsychological impact. These mainly include COVID-19-related circumstances, such as potential exposure to the virus and loss of loved ones, as well as secondary adversities due to economic difficulties, unavailability of food, psychosocial effects, disruption of future plans and underlying physical and psychological conditions.

The ongoing pandemic caused by COVID-19 has set off a distinct economic crisis in all sectors and may inten-sify psychological disorders, for instance, anxiety, depression, PTSD, alcohol misuse, substance abuse, obsessive-compulsive behaviours, panic and wariness.

Anxiety, one of the main evaluated subjects has been significantly increasing in society during this pandemic. Especially, health anxiety. It is characterized mainly by catastrophic misinterpretations of bodily sensations, dysfunctional beliefs about health and illness and maladaptive coping behaviours and the consequence is the development of obsessive-compulsive symptoms related to their health status.

Another alarming condition that can be expected to increase is post-traumatic stress disorder. The adverse effects of this illness are not manifested immediately and mental health support must be prepared to deal with this issue in a few months and is more likely to take place after longer periods of social disconnection and it is associated with increased substance abuse, alcoholism, and suicide risk by 2–5 times.

In light of all the harmful complications that derive from the current COVID-19 pandemic, it is essential that the government, the health authorities and the population articulate to endorse preventive and supportive measures, not only for the transmission of the disease, but also for emotional, behavioural and psychological impact and it is important to include mental health professionals to manage the pandemic more broadly. Their knowledge and experience are crucial to monitor the situation and to coordinate supportive measures in order to prevent an even higher increase in psychological disorders including fear, anxiety, addiction, and post-traumatic stress disorder.

It is crucial that the health authorities, the government and the population articulate to assist the vulnerable groups and promote emotional and psychological support strategies. Moreover, it is fundamental that the entire population, particularly the vulnerable individuals are provided with accurate information, and support to alleviate the mental burden of COVID-19.

Sreelaksmi Sreekumar - IInd Pharm-D

COVID PANDEMIC:- PHARMACIST INTERVENTION IN DISEASE PREVENTION

2021-05-29T13:37:00.030+05:30

PHARMACIST INTERVENTION IN COVID-19 PREVENTION

The Pharmacist job incorporates guaranteeing satisfactory capacity and gracefully of proper supplies of pertinent prescriptions, and other clinical items and gadgets to flexibly the interest; giving awareness to general society about protection, measures and conduct insurances; and danger appraisal by giving early discovery and referral of people suspected to be at a higher danger of disease.
During pandemics, the role of pharmacists broadened from routine duties to preventive activities such as disease monitoring and surveillance, immunizations, and diagnostic testing.
Pharmaceutical care, medication therapy, infection control, and immunization are among the top listed duties delivered by the pharmacists during various epidemics.
The community pharmacists have reduced the burden on the healthcare system by diverting the influx of patients away from hospitals through triaging and screening patients.
The role of pharmacists is beneficial during the outbreak of vaccine-preventable diseases. One such role is the education of patients and the public regarding the importance of vaccines which resulted in increased vaccination rates increasing the protection of high-risk individuals
Pharmacists are often the first point of contact for the public, especially during pandemics. They are the most accessible healthcare practitioners, which is evident from their direct patient care provision despite restrictions imposed due to COVID19 pandemic.
As outlined by the International Pharmaceutical Federation, community pharmacists have an important role in public health, during this COVID19 public health emergency.

Following are the potential roles of the pharmacist at the community level to serve the public in the current circumstances.

INTERVENTION OF PHARMACIST AT COMMUNITY LEVEL

Education for disease prevention & counselling-. Counseling will help the patient to understand the point or time when medical attention is needed. Community pharmacists can educate the public about the differentiating symptoms, thereby reducing the unnecessary visits and rush to the emergency departments.
Education on hand & respiratory hygiene and provision of facial masks -Pharmacists can arrange hand sanitizers and masks at all patient counters and should practically demonstrate the correct method of hand sanitization and use of mask through Educational presentations in video formats, posters, flyers, or hangings.
Breaking the Myths and eliminating the confusing narratives- Pharmacies can make pamphlets on prevailing myths and can distribute to each customer attending the premises which prevents self-medication .The WHO has issued various videos and images which can be utilized in the pharmacy premises.
Telepharmacy Services-. Telemedicine provides electronic consultations and has reduced the risk of transmission by reducing in-person contact among people. Telepharmacy will also reduce the volume of patients seeking care at health facilities by providing medication counseling through real-time audio-video conferencing technology to the COVID-19 patients but also for chronic patients and the general community experiencing the restricted movements amid lockdown.
Extemporaneous Preparation of Sanitizers and Disinfectants- Either due to increased consumption or disruption of raw material supply, the COVID-19 pandemic has caused shortage of hand sanitizers in many countries. Pharmacists can also prepare disinfectants according to national legal provisions.
Ensuring Appropriate Medicine Inventory :-The management of inventory comprises a large portion of the pharmacy technician’s responsibilities. It is essential to ensure there is an adequate stock of medications and supplies to serve the needs of the patients a pharmacy serves, and careful inventory management can also increase the profitability of a pharmacy.
Effective Medicine Supply System to Customers- In order to ensure appropriate supply of medications especially in small towns where local pharmacies may have closed, community pharmacists can arrange home deliveries or an electronic prescription refill system and even home delivery services will prove to be very helpful for people in quarantine as well as for those with weak immunity, i.e., the elders.
Medication and Disease Management-Disease management (DM) is a comprehensive approach to preventing and treating disease that: (1) targets patients with specific diseases; (2) provides integrated services across organizational and professional boundaries; (3) utilizes services based on the best scientific evidence available; and (4) focuses on outcomes.

HOSPITAL PHARMACISTS AND THEIR ROLE

Inventory Management-The goal of inventory management is to reduce costs and improve operational efficiency. To do this, pharmacies need complete visibility into their existing inventory levels in order to take some of the guesswork out of maintaining ideal supply levels. This involves being able to track inventory stores, orders being generated, inventory receiving – and all in real time.
Pharmacovigilance at the Hospital Level Although many national pharmacovigilance programs are largely based on ADE reporting, a comprehensive system should encompass monitoring of medication errors and therapeutic ineffectiveness, product quality problems, and communication of such information to health care professionals and consumers for risk-benefit decision making .
Drug Utilization Evaluation & Active Member of the Clinical Trial Team (DUE)-DUE, a system of improving the quality of medicine use in hospitals and clinics, is an ongoing, systematic, criteria-based program of medicine evaluations that will help ensure that appropriate medicine use is provided. A DUE can be structured so that it will assess the actual process of administering or dispensing a medicine. The primary areas in which pharmacists can work include safety and efficacy evaluation, provision of drug or placebo, and follow-up of patients to ensure optimal therapy.
Development of Clinical Guidelines and Treatment Algorithms- Hospital pharmacists can prepare dosage guidelines, precautionary notes, and list of potential drug interactions, adverse drug reactions, and contraindications according to rapidly changing and evolving with ongoing research
Provision of Authentic and Updated Research Data & Hospital Pharmacists' Educational Services- Pharmacists can communicate to healthcare providers regarding potential medication-related problems (MRPs) of repurposed drugs in order to ensure the drug safety and optimal therapy. This service can be utilized to educate patients regarding precautionary measures in order to prevent the acquisition of infection.
Disinfection and Sterilization Services-Hospital pharmacists are responsible and strictly advised to adhere to the regulations for infection prevention and control in hospitals and medical institutes. Safety measures aid to protect both the pharmacy staff and patients from infections.

ROLE OF INDUSTRIAL PHARMACISTS AND DRUG REGULATORY AND ADMINISTRATIVE PHARMACISTS

Improving Access to Medicines-Industrial pharmacists must be fully prepared and should develop a contingency plan to avoid any sort of shortages. However, various health regulatory agencies have spared and relaxed the manufacturers from the fulfillment of conventional regulations and granted the priority approvals for the repurposed and experimental drugs
Monitoring of Reported Adverse Drug Reactions (ADRs)-It is the fundamental responsibility of the pharmacist to update these events in the National Pharmacovigilance Database. Pharmaceutical organizations and industrial pharmacists producing investigational drugs should ensure safety reporting according to national legal requirements. Pharmacists should develop a smooth and convenient reporting tool for the adverse events.
Urgency to Comply With Legal Requirements-Industrial pharmacists need to adopt proactive and active measures to fulfill the legal requirements of production and supply. Since regulatory authorities in many countries provided legal flexibilities, pharmacists should ensure that drug supply should not be disrupted merely due to legal procedures.
Adequate Drug Supply-Drug administrative authorities should highlight alternative vendors to make sure the availability of life-saving drugs.The administration can ask federal health authorities to safeguard the drug supply which will help in maintaining transparency in the supply chain.
Ensuring Good Selling Practices (GSPs)-Pharmacists at the administrative levels along with community pharmacist should make sure the pharmaceutical companies and other stakeholders realize their duty and make sure the availability of the drugs to those who need them the most.
Administrative Actions Against Secondary Wholesalers-In the best interest of patient care, pharmacists and clinicians must be able to access the medication and supplies they need during the outbreak. Personal protective equipment commonly employed in healthcare facilities are now a scarce commodity.
Occasional Quality Testing Through Drug Testing Laboratories (DTLs)-Considering the occasional testing of medications through drug testing laboratories will shorten the time span of drug availability in the market. Such sort of regulatory relaxations will be beneficial for alleviating the shortage of medicines.
Mandatory Actions Against Unregistered Drugs, Sanitizers, and Disinfectants-Drug inspectors and drug monitoring teams should be authorized to seize and impede the sale of any unregistered drug.
Ease Operational Barriers-Drug administrative authorities can allow a grace period in the renewal of licensures during emergency period. They should also waive some restrictions of good manufacturing practices thus making sure the timely availability of the medicines.

ELIZABETH RACHAL JAMES, LINETTE SABU - II^ndPHARM-D

JAK-STAT Pathway Inhibition And Their Implications: In COVID-19 Therapy

2021-04-28T19:19:00.001+05:30

The emergence of SARS CoV-2 in December 2019 in Wuhan city, Hubei province, China is the present global pandemic. SARS CoV was the first CoV to be outbreaked on 2003 in China with fatality rate of 9.5%.According to WHO’s coronavirus situation reports of August 10, US (United States), Brazil and India remained to be the top 3 countries for past 7 days, being affected with COVID – 19. The onset of COVID- 19 is sudden, 2-4 days after exposure is considered as the incubation period and takes about 2-8 weeks for recovery, where the patient is presented with symptoms like fever, cough, shortness of breath and more.

Major cells involved in SARS –COV-2

1.Pneumocytes

Ø SARS-COV-2 infects type 2 pneumocytes in the alveolar epithelium, since they are rich in ACE-2 in the lung tissue

2.Endothelial cells

Ø SARS CoV resulted in endothelial cell dysfunction leading to micro circulation disorder

Ø Capillary leak, hemodynamic instability and consumptive coagulopathy occurs as a result of endothelial activation in CSS

3.Macrophages, Monocytes and Neutrophils

Ø Macrophage is the potent source of inflammatory cytokine

Ø Macrophages and neutrophils are responsible for the destruction and phagocytosis of infected cell. Neutrophils entrap and kill microbes through neutrophils extracellular traps (NET) and this leads to demise of neutrophil., which is called “NETosis.”

4.Lymphoctes

Ø In COVID-19 patients 80% of them revealed peripheral blood lymphopenia and unexpected infiltration in the airways due to the dysfunction of innate T cells

5.NK Cells and Dendritic Cells

Ø In severe COVID-19 patient, NK cells in peripheral blood were declined

Ø NK cells destroy virus infected cells by degranulation, receptor mediated apoptosis, and antibody-dependent cell-mediated cytotoxicity

Ø Dendritic cells help to release pro-inflammatory mediators like TNFα, and aid in activation of T Lymphocyte and B Lymphocyte

SARS-CoV-2 and cytokine storm

Cytokines are necessary for combating viral infections but hyper inflammation conditions created by SARS-CoV-2 infection due to cytokine storm could lead to ARDS and even death. Cytokine storm created by SARS-CoV-2 infection also known as cytokine release syndrome (CRS)/hypercytokinemia characterized by the hyper production of inflammatory cytokines which results in the immune cells biological activity(infection) and at the same time, immune systemic negative feedback gets lost. Cytokine storm releases inflammatory responses that results in local initiation, systematic spreading, and tissue damage.

COVID -19 patients are identified with CSS, based on:

(i) Unexpected or quick development with multiple organ collaboration (liver, Cardiac, renal injury);

(ii) Systematic inflammatory indicators (serum ferritin, ESR, CRP) gets elevated considerably;

(iii) Remarkable deterioration of peripheral blood lymphocyte counts; and

(iv) Multiple cytokines (IL-1b, IL-2R, IL-6, IFN-c, IP-10, MCP-1, TNF-a) gets upraised

Small Molecules Modulating Jak/Stat Signaling Pathway

Manipulation of JAK/STAT pathway with specific inhibitors or drugs for its regulation is a promise for the upcoming therapeutic intervention for the treatment of numerous diseases.Various regulatory agencies now uphold JAK inhibitors (JAKinibs) for the treatment of immune mediated diseases. It is FERM and SH2 like domains of JAKs that regulate the kinase activity whereas classic transcription factors STAT1-4, STAT5A, STAT5B, STAT6 modulate gene transcription. Inhibitory mechanism of SOCS protein family or auto inhibition of JH1-JH2 interactions are few driving techniques in controlling the anomalous activation of the pathway. Another mechanism of regulation includes the dephosphorylation of activated JAKs and STATs by multiple Protein Tyrosine Phosphates (PTP) including SHP1; SHP2 (both activator and suppressor) and TC-PTP for STAT1, STAT3, STAT5; PTPRT for STAT3; CD45 for JAKs. Upon evidence, inhibition of activated STAT dimers by Protein Inhibitors of Activated STATs (PIAS)- PIAS1, PIAS2 (PIASx), PIAS3, PIAS4 (PIASy)- also play an important role in modulating JAK/STAT signaling. Existing evidence suggest that both activating and inactivating mutation of JAKs and STATs can impair the pathway resulting in numerous pathological conditions including malignancies and immune mediated diseases.The role of cytokines in COVID-19 has been a contributor to the worsening of the disease and inhibiting these cytokines to reduce inflammation has been a strategy to keep the disease under check.The JAK/STAT signaling inhibition looks to be a promising approach to reduce inflammation in COVID-19 patients yet falls short of concrete conclusions due to a lack of understanding of mechanism occurring at molecular levels thus warranting further studies.

Ruxolitinib, Baricitinib, Tofacitinib In Clinical Trial Against Covid-19

Ruxolitinib : It is both JAK 1 & JAK 2 inhibitor that act by terminating the kinase activity, thereby preventing nuclear translocation and STAT activation. Studies proved that inhibition of IL6/JAK/STAT3 pathway by the same can result in significant reduction of IL-6 level. Side-effects like purpuric lesions on the skin of limbs and erythrodermic rashes were identified from the examination of two SARs-Cov-2 infected patients. Anemia was also observed. Common side effects include black tarry stools, bladder pain, bleeding gum, blood in the urine or stool, coughing up blood and more.

Baricitinib is a kinase inhibitor that competes with ATP to effectively and reversibly inhibit both JAK1 and JAK2 with high selectivity hindering the pro-inflammatory signals of several cytokines like IL-6, IL-12, IL-23. It also plays a vital role in blocking proteins of the host cell responsible for the viral reproduction, and being an anti-inflammatory agent, also reduces the inflammation in ARDS patients as well. Side effects like headache, upper respiratory tract infection, nasopharyngitis are common. Long term use may increase the risks of developing serious infections and thromboembolic events in patients.

Tofacitinib inhibits JAK1, JAK3 initially & then JAK 2 at a lesser extent to modulate both immune &inflammatory responses. Common side effects include Abdominal pain, acne vulgaris, anemia, angioedema, diarrhea, dehydration, dyspepsia, headache, hepatotoxicity, hyperlipidemia, hepatitis, lymphoma, lymphopenia, nausea, neutropenia, pulmonary embolism, rashes, vomiting, blood clots, GI perforations.

Ms. ROSHITHA ANN SHAJI, AAJA ALOSIOUS, MARIYA LUVIS- Vth PHARM -D

POST COVID COMPLICATIONS

2021-04-20T21:30:00.000+05:30

Corona is a pandemic that we are going through this situation. The pandemic has affected the worldwide so adversely that not having much protection poses a great risk for all. The vaccine has been developed and been used widely to provide immunizations. Almost 95% of immunization is provided by these vaccines. But unfortunately, the nation is now facing a 2^nd wave which happens to be a mutant species of the SARS CoV- 2.

The real question is whether we are still in danger after the infection? And sadly, the answer is yes, we are still in danger. This is the basis of the topic “post covid complications.” The coronavirus almost affects all the organs in our body from the brain to the skin due to which the risk of facing a lot of post covid complications rises.

The pathophysiology of corona virus involves the target receptor ACE2. Upon entering the healthy human body via the infected air droplets released from a sick patient, the corona virus penetrates the cell after fusion with the ACE2 receptor. The corona virus consists of spike glycoproteins on its cell surface, which helps in the penetration. There are two subunits S1 and S2. The S1 subunit gets cleaved by the TMPRSS2 and the S2 subunit fuses with the fusion protein on the ACE2 receptor. This helps the genetic material of the virus to be transferred into the cell membrane of the human host. The genetic material of the virus is recognized as its own by the human cell. The process is proceeded by the formation of new viral RNA and its package to form new viruses. It then gets released out to the cell and infects other cells and organs, thus resulting in the proven signs and symptoms and leading to a variety of complications.

Let’s begin with Neurologic complications: The coronavirus affects the brain by two hypothesized mechanisms.:

1. Via the olfactory nerve: the olfactory nerve is the only cranial nerve which is exposed into the environment, which makes it the perfect route through which the virus gains entry to the brain. Upon entering the brain, the virus interacts with the ACE2 receptor and causes inflammation.

2. Via blood brain barrier: the endothelial cells consist of ACE2 receptor and hence after interacting with the receptor, the virus gets transported into the brain, crossing the BBB.

After entering the brain, the virus goes on to infect the brain cells causing brain encephalitis, stroke, hallucinations, delirium, Seizures, brain fog, anosmia, ageusia, and in rare cases gullian barre syndrome and bell’s palsy.

Next, we have Respiratory complications: acute respiratory distress syndrome and post covid fibrosis.

The SARS- CoV2 affects the lungs by interacting with the ACE2 receptor and causing inflammation of the lungs. This leads to the decreased production of oxygen, because of which the infected person has to breath frequently to cope with the lack of oxygen, which results in symptoms like breathlessness. Increased inflammation leads to scarring of the lungs which causes fibrosis and accumulation of fluid in the air sacs of the lungs leading to ARDS.

Cardiopulmonary Complications

The corona virus is known to cause a lot of cardiological complications ranging from heart attack to myocardial infarction. The mechanism by which the SARS- CoV 2 causes these complications is due to its interaction with the ACE 2 receptors present in the heart cells. The virus causes inflammation in the heart muscle, decreasing its capacity to pump the blood efficiently, disruption in the heart signalling, interfering with the conduction of abnormal heart rhythms, leading to arrythmia or worsening of the pre-existing condition. When the lungs get inflamed due to the infection, which decreases the amount of oxygen for respiration. This leads to increased burden for the lungs which pumps more rapidly to cope up with the decreased oxygen. This results in the inflammation of the heart cells. Also, the upon interacting with the endothelial cells, there occurs the formation of blood clots which goes on to clog the blood vessels leading to myocardial infarction.

Renal Complications

The corona virus infection leads to acute kidney injury. This is due to the interaction of the virus with the ACE 2 receptors in the tubular epithelial cells, podocytes, and endothelial cells which gets inflamed and lead to acute tubular necrosis (ATN), collapsing focal segmental glomerulonephritis (FSGS) and endotheliitis of the glomerular capillaries respectively. All these eventually lead to acute kidney injury.

Hepatobiliary Complications

Although its known that the covid usually affects the lungs, it can also lead to liver inflammation. The virus affects the liver since there are ACE 2 receptors present in the liver. The liver inflammation in signified by the elevation in the liver enzymes such as ALT and AST.

Musculoskeletal Complications

Although not much has been studied about the musculoskeletal complications, but it has been hypothesised that due to the pulmonary inflammation it can lead to systemic inflammation and release of chemokines and cytokines like CXCL 10, IFN gamma, IFN 1 beta, IL 6, IL 8, IL 17, TNF alpha …etc. This can lead to skeletal muscle and bone and muscle complications like myalgias, atrophy, weakness, fatigue, bone mineral loss, osteonecrosis and chondrolysis. It has also been reported that rhabdomyolysis may occur as a result of acute kidney injury.

Dermatologic Complications

Most reported complication is the incidence of covid toes post infection. It is a chilblain like skin infection which not only occur in the toes but also other extremities like the finger. Covid toes begin with a red coloration on the fingers and toes which then gradually turns purple in colour.it can also form blisters, itch or pain. Some people develop painful raised bumps or areas of rough skin. Sometimes there can be pus under the skin.

Ms. ANJALI AMBROSE, Vth PHARM-D

RESISTANT STARCH: An Ameliorating Substance

2020-11-09T20:11:00.003+05:30

Starches are long chains of glucose that are found in grains, potatoes and various foods but not all of the starch you eat gets digested, certain starches are resistant to digestion. Resistant starch is a carbohydrate that resists digestion in the small intestine and ferments in the large intestine. As the fibres ferment they act as a prebiotic and feed the good bacteria in the gut. Since resistant starch is not digested in the small intestine, it doesn’t raise glucose. Gut health is improved as fermentation in the large intestine makes more good bacteria in the gut which eventually improves glycaemic control. Other benefits include increased feeling of fullness, prevention of obesity, weight management, treatment and prevention of constipation, decrease in cholesterol levels and lower risk of colon cancer. In short, the inclusion of resistant starch in diet induces complex interactions between microbiota, dietary components, colonic epithelium, the immune system and the nervous and endocrine systems.

Foods that contain resistant starch include:

· Plantains and green bananas (as a banana ripens the starch changes to a regular starch)

· Beans, peas, and lentils (white beans and lentils are the highest in resistant starch)

· Whole grains including oats and barley

· Cooked and cooled rice

The amount of resistant starch changes with heat. Oats, green bananas, and plantains lose some of their resistant starch when cooked as another type of resistant starch is made in the cooking and cooling process. Cooked rice that has been cooled is higher in resistant starch than rice that was cooked and not cooled.

TYPES OF RESISTANT STARCH

There are currently 5 types of resistant starch. More than one type of resistant starch can be present in a single food.

Type I Starch is synthesized in the endosperm of cereal grains or seeds and starch granules are surrounded by protein matrix and cell wall material. These physical structures prevent water penetration into the starch in the matrix. Therefore, the starch does not have adequate moisture to readily gelatinize and swell. Without proper swelling to expose the starch molecules, the starch is not readily susceptible to enzymatic hydrolysis

Type II Uncooked potato starch, green banana starch, gingko starch, and high-amylose maize starch, which display the B- or C-type polymorph, are highly resistant to enzymatic hydrolysis. High-amylose starch produced by mutation of the amylose-extender gene and the gene encoding starch branching-enzyme I, this starch displays a high gelatinization temperature, above the boiling point of water. After boiling or cooking at a temperature below its gelatinization temperature, this type of starch retains its crystalline structure and remains resistant to enzymatic hydrolysis.

Type III resistant starch (RSIII) is retrograded amylose and starch .Because amylose molecules have linear structures, they have a great tendency to form double helices, particularly near refrigeration temperatures (4–58 °C) and with adequate moisture content and also has high gelatinization temperatures, up to 170 °C. Starchy foods are stored, particularly in a refrigerator, amylose molecules and long branch chains of amylopectin form double helices and lose their water-binding capacity. The double helices of starch molecules do not fit into the enzymatic binding site of amylase, thus they cannot be hydrolysed by this enzyme.

Type IV resistant starch (RSIV) is a chemically modified starch, formed either by cross-linking or by adding chemical derivatives. Adding a chemical derivative to starch, such as octenyl succinic groups or acyl groups, changes the structure of the starch and partially restricts the enzymatic hydrolysis of the starch molecule, resulting in resistant starch. A region of the starch without the derivative can be hydrolysed by bacteria amylases and fermented to produce short-chain fatty acids.

Type V. When starch interacts with lipids, amylose and long branch chains of amylopectin form single-helical complexes with fatty acids and fatty alcohols. When the linear starch chain is in a helical-complex structure with the complexed fatty acid in the cavity of the helix, starch binding and cleavage by amylase are prevented.

HEALTH BENEFITS OF RESISTANT STARCH

One of the main reasons why resistant starch improves health is that, it feeds the friendly bacteria in your intestine and increases the production of short-chain fatty acids like butyrate.

Prevention of colon cancer

Resistant starch has received attention for potential prevention of colon cancer and inflammatory bowel diseases,consumption of diets with abundant fibre is believed to protect against colorectal cancer .The most common hypotheses by which colon carcinogenesis may be altered by resistant starch focus on the alteration of the water-holding capacity of the fecal stream, modification of the microbiota, and increasing SCFA ( short chain fatty acid) production. This seems to be the most promising theory on the impacts of dietary resistant starch on the production of SCFAs and changing the microbiota. SCFAs (acetate, propionate, and butyrate) are increased in amount , these are important metabolites in maintaining intestinal homeostasis .

Butyrate, an end-product of microbial fermentation of resistant starch and the primary energy source for colonocytes, is actively transported into cells by a Na+ -dependent cotransporter . This cell membrane transporter serves as a tumor suppressor gene and is epigenetically silenced by hypermethylation in human aberrant crypt foci (a precancerous lesion) and colorectal cancer . Butyrate has been of particular interest because of the role this molecule plays in colonic epithelial metabolism and differentiation and its influence on signaling pathways that regulate mucosal physiology it have the ability to modify expression of genes that control cell cycle and apoptosis and function to suppress the development of pre-neoplastic and neoplastic phenotypes in vitro Furthermore, butyrate exerts protective effects against intestinal mucosal inflammation, a component of inflammation-mediated colorectal cancer, through apoptosis of T lymphocytes and inhibition of inducible nitric oxide synthase in colonic epithelium.

PREVENTION/ THERAPY OF METABOLIC DISEASES

DIABETES

Lifestyle modifications are found to be more effective than pharmacological interventions in delaying the onset of type 2 diabetes . One such lifestyle change is the replacement of ordinary starch in foods with resistant starch, owing to its low glycemic index. Moreover, consuming less digestible starches may decrease glycemic response to a subsequent meal, the “second meal effect.” Ten healthy individuals who ate high-amylose starch at breakfast showed decreased blood glucose response to a lunch containing highly digestible carbohydrate, compared with eating high-amylopectin starch at breakfast . Consequently, replacing ordinary dietary starch with resistant starch contributes to diabetes management.

OBESITY

Overconsumption of energy is proposed to be responsible for the obesity. Increasing consumption of resistant starch are proposed to provide many of the benefits of dietary fiber thus also aid weight management and beneficially influence body composition .Accumulating evidence from rodent studies suggests that replacing rapidly digestible starch with resistant starch reduces body weight. First, because of the lower calorie content, replacing rapidly digestible starch with resistant starch reduces the energy density of the diet . Second, incorporating resistant starch into a meal may augment feelings of satiety . In rodent models, adding resistant starch to the diet increased secretion of the putative satiety hormones GLP-1 and PYY, suggesting that it might augment satiety. Third, resistant starch may influence body weight by increasing energy expenditure or fat oxidation. However, currently, little evidence supports this hypothesis and several studies have failed to show that resistant starch increases energy expenditure or fat oxidation.

Addition of resistant starch to the diet have enormous ameliorating health effect. However, it is important to note that it may take 2–4 weeks for the production of short-chain fatty acids to increase and to notice all the benefits .Thus, there’s no point in taking much excess amounts .

Miss: AAN MERY BOSCO, III PHARM.D

OBESITY AND ITS IMPACTS ON HEALTH

2020-10-22T20:50:00.009+05:30

The dramatic increase in the prevalence of overweight and obesity in most countries has been a great concern globally. However despite the urgency of this problem still there are some loopholes about this subject. The instance prevalence of obesity is often estimated based on surveys or population studies. The increase in body mass presents public health challenges because of the attractive physical appearance of Normal bodies and poor health outcomes of overweight and obesity

PHYSICAL HEALTH IMPACTS

Health condition of obese person often worse than people with normal weight and the life span of obese people is an average is shorter by 2 years .. obesity along with a lot of health impacts some of the co-morbidities related to overweight and obesity include cancers type 2 diabetes, hypertension, stroke, coronary, artery diseases, congestive heart failure, asthma, chronic back pain, osteoarthritis, pulmonary embolism, gall bladder disease and also an increased risk of disability. All this leads to more than three million deaths worldwide annually. Studies have confirmed that obesity is a major public health problem which results in decreased life expectancy, especially in younger age groups.

IMPACT ON MENTAL HEALTH

Relationship between obesity and mental health disorder is something which has a great impact.. overweight is a stigma and obesity discrimination can lead to some mental disorder. Scientific evidence lays emphasize on an increased risk of low self-esteem mood disorders motivational disorders eating problems impaired body image interpersonal communication problems and all these directly or indirectly affect the quality of life, on the other hand, it also lead to the development of psychopathology and poor health behaviour that through a viscous cycle will enhance their overeating bulimia or other related problems obese individuals attribute to their appearance and their weight and encounter frequent difficulties in their sexual activities. Sexual activity and sexual health outcomes such as sexual satisfaction unintended pregnancy and abortion have been mentioned as relevant issues as such we need to emphasize on more comprehensive population-based studies to find out the impact of overweight and obesity on different aspects of mental health including mood disorders communication problems .. self-satisfaction and it's effect on sexual health besides different aspects of quality life.

IMPACT ON SOCIAL ASPECTS

Consequences of obesity-related physical comorbidity include psychological impairments and stigmatization experienced by obese patients. The overweight stigma and attributable discrimination is documented in all the key areas of living .. including growth and development. Educational process, employment structure, and provision of health care. The obese individuals are most often ridiculed by their teacher's physicians and public, at times they also suffer from discrimination ridicule social bias, rejection and humiliation. Even specific obesity diagnostic or therapeutic procedure such as related anthropometric assessments could potentially affect their care considering the importance of health risks of overweight and obesity and it's increasing prevalence all over the world there is a need for well-defined programs on control and prevention which should be a priority on the political health agenda. If this increase in its prevalence continues. It could lead to serious health-related outcomes and consequences. However, so far only a few comprehensive preventive programs have been developed with little reported success.

Ms. Kavya E.M, 5th semester B.pharm

SAFEGUARD YOUR HEART- LET IT’S LUB-DUB ECHO WITH THE PHARMACIST’S SIGNAL……

2020-10-15T21:29:00.002+05:30

The human heart is an organ that pumps blood throughout the body via the circulatory system, supplying oxygen and nutrients to the tissues and removing carbon dioxide and other wastes. The tissues of the body need a constant supply of nutrition in order to be active," said Dr Lawrence Phillips, a cardiologist at NYU Langone Medical Center in New York. "If the heart is not able to supply blood to the organs and tissues, they'll die."

The pharmacist, the drug expert plays a relevant role in primary and secondary prevention of cardiovascular diseases, mainly through patient education and counselling, drug safety management, medication review, monitoring and reconciliation, detection and control of specific cardiovascular risk factors (eg, blood pressure, blood glucose, serum lipids) and clinical outcomes.

In addition to medication dispensing, the pharmacist can provide more direct interventions (eg, medication education and disease management), as a support to the physician’s action, in order to improve medication adherence, to achieve the goals of desired therapeutic outcomes and to improve safe medication use and humanistic control. The direct pharmacist’s intervention in patients’ care, in alternative to the conventional approach, has proved to favourably affect therapeutic and safety outcomes in different diseases or conditions including diabetes, dyslipidaemia, arterial hypertension, obesity, asthma or chronic obstructive pulmonary disease, infective diseases (including influenza immunisation),

psychiatric conditions and osteoporosis prevention. A recent overview of systematic reviews has documented a positive impact on patients’ outcomes (blood pressure and haemoglobin A1c reduction) of clinical pharmacy services targeting specific cardiovascular conditions, such as hypertension or diabetes mellitus.

Patients with multiple risk factors for coronary disease: The effectiveness of the pharmacist’s intervention to reduce risk behaviours and risk factors for coronary heart disease such as smoking, alcoholism helped to manage the lipid levels.

Effectiveness of the pharmacist’s intervention in diverse cardiovascular conditions

Hypertension: Community pharmacies may represent the ideal site for implementing community-based self-screening to detect hypertension in the population

Dyslipidaemia: common interventions included education, followed by drug therapy recommendations and adherence –lead to the decrease in LDL cholesterol.

Diabetes: Wubben and Vivian performed a qualitative meta-analysis of 21 studies (9 randomised controlled studies, 1 controlled clinical trial and 11 cohort studies) including 3981 diabetics. All interventions involved additional visits by pharmacists with expanded roles to care for adult patients with diabetes. An overall improvement in haemoglobin A1c was observed in different settings and across multiple studies designs: the differences in change for haemoglobin A1c ranged from an increase of 0.2% to a decrease of 2.1%.Diabetes education (69% of cases, consisting of verbal instructions on diet, exercise, drug therapy and the disease itself) and medication dosage adjustment (61%) were the most frequently used interventions

Heart failure: A first systematic review was published by Ponniah et al and evaluated the prognostic impact of pharmacy services on post-discharge patients with heart failure: in six of the seven included studies positive outcomes, such as decreases in unplanned hospital readmissions, death rates and greater compliance and medication knowledge were demonstrated.

Pharmacy services for cardiovascular prevention and management

Ø Educational activities directed at patients

oPatient education and counselling

oDrug safety management

Ø Informative activities directed at healthcare professionals

oDocumenting adverse drug reactions occurring to the patient

oMonitoring patient’s adherence to physician’s prescription

Ø Direct intervention in a multidisciplinary team

o Collaborative medication management (including drug administration)

o Medication review and dose adjustment or titration

o Medication monitoring and reconciliation

o Definition and application of disease management pathways and protocols

o Detection, prevention or control of specific cardiovascular risk factors

Actionable tips you can do now to improve your heart health

1.If you presently require heart medications, develop memorably habits to consistently take your medications as your physician has directed. Monitor your blood pressure regularly, and get cholesterol screenings on a regular basis.

2.Get active. Just 10 minutes of physical activity daily can lower your risk of having a heart attack significantly. Aiming for 30 minutes a day lowers your risk even more. If you sit much of your day, take a walk on your breaks, and possibly stand at your workstation part of your day if possible.

3.Don’t wait until you’re older to address heart health. High obesity rates, high blood pressure and type 2 diabetes are happening at increased rates in our younger population, putting them at risk of heart disease earlier in life.

4.Let’s get personal. Watch your stress level as it leads to heart disease. Practice deep breathing to relieve stress, keep anger in check, and laugh more. Laughter helps your blood vessels to relax and expand, keeping your heart working properly. Get enough sleep too, as it lowers stress and your risk of heart disease.

5.Stop smoking. Smoking damages blood vessels and can cause heart disease. Ask for help if needed.

6.Maintain – or work toward – a healthy weight with diet and exercise. Develop heart-healthy eating habits low in trans-fat, saturated fat, added sugar, and sodium. As a rule of thumb fill at least half your plate with vegetables and fruit, and pick low sodium options.

As Helen Keller said, ”The best and most beautiful things in the world cannot be seen or even touched- they must be felt with the heart”.

Let’s focus on the instructions given by the Pharmacist and other healthcare providers and protect our most vital organ –‘ THE HEART ’

Ms. ASHLEY ANN DILIP, PHARMD FOURTH YEAR

ST JOSEPH’S COLLEGE OF PHARMACY, CHERTHALA

(This Blog article secured first prize for Blog writing competition conducted by College in association with World heart day)

Insight into COVID-19 & its Socio-economic Impact

2020-10-08T00:00:00.002+05:30

Coronavirus is a large family of viruses that are zoonotic in nature that is, transmitted from animals to humans. The first case of COVID-19 infection was reported in Wuhan and the studies state that it was an animal sold at the seafood market which is considered to be the host of COVID-19. The 2019 novel coronavirus was recognised as the causative pathogen of coronavirus outbreak in 2020. There were previous outbreaks of coronavirus infection; it was SARS (Severe Acute Respiratory Syndrome) which was emerged in the year of 2002 in Guangdong, China and MERS (Middle East Respiratory Syndrome) in 2012 in Saudi Arabia which was also known as atypical pneumonia. SARS-Cov has an affinity towards Angiotensin-Converting Enzyme-2 receptor (ACE-2) and Dipeptidyl peptidase-4 (DPP-4) is the receptor to which MERS-CoV is having the highest affinity. The mode of transmission these viruses was known to be: via the bat, the outbreak of SARS-CoV was originated and MERS-CoV has emerged through transmission from dromedary camels.

Description of Coronavirus

The coronavirus belongs to the family Coronaviridae and the subfamily Orthocoronaviridae. 2019-n-CoV has virions which measure approximately 50-200nm in diameter_. The n-CoV is consisting of a single positive RNA genome which has a size approximately from 27 to 34 kilobases. As in fig.1, coronavirus has a crown-like a shape due to the presence of club-shaped glycoprotein spikes on the envelope of n-CoV. It is this spike protein which plays a major role in the pathogenicity of coronavirus infection. There are certain structural proteins like M-protein, N (Nucleocapsid) protein, E protein which is involved in the virulence of COVID-19. The N protein is related to the replication of coronavirus and host cellular response against the infection. M protein defines the shape of the viral envelope and it is the centre of coronavirus assembly. The E protein which is the smallest structural protein that contributes to replication and E protein together with M protein makeup virion release. Similarly, when M protein binds with N protein, it stabilises the N protein. The 2019-n-CoV has a high affinity to ACE-2 receptors.

The virion RNA seems to be infectious which serves as both genome and viral messenger RNA. The pathogenic effect is exerted by n-CoV through various steps: 1) Attachment of viral spike protein to the host receptors by the process of endocytosis. 2) Fusion of viral membrane to endosomal membrane. 3) Proteolytic cleavage occurs. 4) Release of new virions after replication. The COVI-19 infection is having uniqueness compared to other viral infection. Patients with respiratory diseases, cardiovascular diseases and along with other comorbid conditions are more prone to COVID-19. The entry of virus can cause the release of cytokines leading to cytokine storm resulting in an imbalance between TH1 &TH2 immune responses. The increased levels of neutrophils, leucocytes, SGPT, SGOT, and decreased levels of haemoglobin, prothrombin time etc. can be observed in laboratory investigations. Elevation in infection biomarkers like procalcitonin, IL-6, serum ferritin can also occur_.

This virus can spread through respiratory droplets. The causative agent is present within the respiratory droplets which have the capability to cause the infection. Rarely, the transmission can occur through the faecal matter. The airborne transmission can also occur during mechanical ventilation, manual intubation, nebulizing treatment for patients, non- invasive positive presence ventilation. Novel coronavirus can spread in following ways: coughing and sneezing without covering the mouth can result in the transmission of respiratory droplets into the air, touching/ shaking hands with an infected person, then making surface contact with objects that has the virus and then touching the eyes or nose with same hands. The symptoms of COVID-19: systemic symptoms include fever and fatigue, kidney failure, diarrhoea, respiratory symptoms like sneezing, runny nose, dry cough & dyspnoea

How to overcome COVID-19

Antiviral treatment of duration 3 to 14 days or antibiotic treatment of duration 3 to 17 days are given to the patients. Antiviral drugs include oseltamivir (75mg every 12hours), ganciclovir, lopinavir, and ritonavir tablets (500mg BD) which are given orally. The antibiotics like cephalosporin, quinolones, linezolid, tetracycline etc. Lopinavir drug seems to be useful for SARS-CoV_. The combination of lopinavir-ritonavir show some adverse effects like diarrhoea, inflammation GIT. The arbidol and arbidol mesylate are more effective than ribavirin in suppressing viral replication. Favilavir was an FDA approved drug, it is an antiviral drug which can be used to treat COVID-19. Chloroquine and Remdsivir are other drugs which are used as treatment options for COVID-19. Plasma therapy is a method in the blood plasma of patient recovered from this infection is infused into the victim as the blood of recovered patient contains antibodies against the virus and boost up the immune system of the victim. The DNA vaccines and recombinant measles virus vectored vaccines are under process of development. Protease inhibitors, replicase inhibitors, host-based anti-CoV, membrane-bound viral RNA synthesis inhibitors are also the upcoming treatment options. The preventive measures against COVID-19 infection: wash hands regularly with soap and water, do not touch or shake hands with others, cover the mouth while coughing or sneezing with a disposable tissue or flexed elbows. The health professionals should have to wear personal protective equipment to protect from the infection.

Socio-economic impacts of COVID-19

COVID-19 has a greater impact on different aspects of life. There is a global effect happening due to pandemic condition of COVID-19. The economy, environment, social impact is present in our society. Considering the impact on the economy, the countries globally have decided to undergo complete lockdown. And due to this, the transportation becomes suspended, that is, all the domestic flights, railway services, bus, truck & vehicle transportation were closed. So that all the types of business transports have been deferred amid different countries. India’s growth in the fourth quarter of the fiscal year 2020 went down to 3.1% according to Ministry of statistics. The major outcomes of lockdown in India are sharp rise in unemployment, stress on the supply chain, decrease in government income, the collapse of the tourism industry, reduced consumer activity, plunge in fuel consumption, rise in LPG sales etc. Studies state that unemployment rose from 6.7% on 15Marchto 26% on 19 April. 140 million people lost their jobs while salaries were cut for others. Major companies in India are temporarily suspended.

Partial or complete shutdowns will be felt across the economy: Selected G7 countries, in % of GDP at constant prices.

The primary sector includes economy, agriculture, petroleum & oil etc. There is a drop in demand from hotels for the agricultural commodities. The countries are going through protective measures like social distancing, avoiding unnecessary travel & a ban on congregations. Self-isolation is also been practised. So the transportation of agricultural products is stopped. The markets are closed. “Panic buying” is further complicating shortages beyond supermarket shelves. The viral outbreak is dampening the demand for oil and this war have grave implications for global economy any increase to consumer activity is likely to be outweighed by damage caused to population reliant on revenue from other forms of energy such as Shale gas. The secondary sector includes manufacturing industries. Over 80% of respondents anticipated a decline in turnover over the next 2 quarters, with 98% admitting concern about the negative impact of the pandemic on business operations. Since the transportation is been suspended it leads to importation issues & staffing deficiencies are the key concerns for business and it is not a viable option for working from home in the case of manufacturing industries. COVID-19 has affected all levels of the education system. COVID-19 has an impact on social mobility whereby schools are no longer able to provide free school meal for children from a low-income family. The impact on postgraduate’s research community is different as it gives many opportunities to work on COVID-19 related issues. Many of the conferences have been cancelled, these conferences are key to scientific research in many disciplines, allowing dissemination of research as well as providing networking opportunities for collaborations and job seeking. COVID-19 has affected communities, business & organisations globally, inadvertently affecting the financial markets and the global economy. In China, there is reduced production of goods from factories while quarantine and self-isolation process, decreased demand, consumption and utilisation of products. 10 years US Treasury bond yields have dropped to 0.67%. There is sharp in the well-being and economics status of financial companies worldwide. There are unprecedented challenges for healthcare system globally. The healthcare workers are the most vulnerable group for this pandemic condition. The health professionals are guided to use personal protective equipment (PPE) but the shortages of PPE including the N95 facemasks, low number of ICU beds in hospitals is leading to a weakened healthcare control system. Profound changes to the dynamics of healthcare are likely to ensue leading to massive investment into disease prevention infrastructure and the accelerated digital transformation of healthcare delivery. In the US active pharmaceutical ingredients are imported largely from India (18%), EC (26%) & China (13%). Hospitality, tourism & aviation have perhaps been most hard-hit. Since the hotels are temporarily suspended there is a greater impact on hotel industries. Tourism had a greater impact on travel supply and demand. The tourism sector had to implement urgent measures such as temporary state aid for tourism from the national government as well as fast and easy access to short & medium terms loans to overcome liquidity shortages, including funds made available. Since all the airports were closed and the reduction of unnecessary travel globally produced an impact on aviation. There are many daily wages workers or business persons depending on the real state or housing sector who become unemployed through these times. The sporting events had also been postponed due to COVID-19 which was a way to figure out the new talents in the world. The IT, media research & development are giving update information regarding this pandemic condition. With the WHO raising COVID-19’s status to a pandemic, 35 companies and academic institution are racing to develop an effective vaccine. Food distribution and retailing is under strain due to panic buying & stockpiling food by people. Considering the social impact, there are increasing fears of domestic violence which can be physical or emotional. UK’s domestic abuse charities reported a 25% increase in such cases. But the lockdown period helps to bring out new talents hidden inside people which can be considered as a positive impact of COVID-19.

Conclusion

COVID-19 is an epidemic disease which is the rising threat worldwide with many social and economic impacts globally. So the preventive measures as well as the treatment options can be used for controlling the spread of COVID-19. Thereby we can reduce the mortality rates day by day.

Miss Camila .A. Carlman, III Pharm.D

TRIPLE THERAPY FOR ASTHMA

2020-10-01T00:00:00.002+05:30

To breathe we do not need only air and lungs, but also the freedom. Yes, I actually support the above statement. How many of you think that you have the freedom to take a breath? The majority opinion for the restriction is, we humans itself and finally get diseased.

In respiratory medicine, the term overlap syndrome has been applied both to the association between obstructive sleep apnea and chronic obstructive pulmonary disease (COPD) and to patients with features of both asthma and COPD (asthma–COPD overlap syndrome – ACOS). Asthma and COPD are major public health problems. Asthma is a condition in which the airways narrowed, swelled and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound when we breathe out and shortness of breath.

COPD is defined as a common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory responses in the airways and the lungs to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. Certain studies have proved that asthma and COPD may coexist or at least one condition may evolve into the other creating a condition commonly described as Asthma COPD Overlap Syndrome. It is a syndrome in which older adults with a significant smoking history have features of asthma in addition to their COPD or non-smoking asthmatics have persistent airflow obstruction. According to GINA 2016, ACOS is characterized by persistent airflow limitation with several features usually associated with asthma and several features.

ACOS is characterized by TH2-mediated eosinophilic inflammation, bronchodilator reversibility and corticosteroid responsiveness in a COPD a subset, even in the absence of a clinical history of asthma. A subset of treated non-smokers with moderate to severe asthma has persistent expiratory airflow limitation, despite partial reversibility. This is attributed to large and especially small airway remodelling and recently the theory of reversible loss of lung elastic recoil leading to hyperinflation and centrilobular emphysema has been proposed. However, the mechanism(s) responsible for the loss of lung elastic recoil and persistent expiratory airflow limitation in non-smokers with chronic asthma consistent with ACOS remain unknown in the absence of structure-function studies. Both asthma and COPD are heterogeneous diseases and comprise various phenotypes.

The pharmacotherapeutics consideration requires an integrated approach, first to identify the relevant clinical phenotypes, then to determine the best available therapy.

Mild intermittent patients, those who have symptoms infrequently would benefit from as needed albuterol triple combination asthma medication would be most appropriate for moderate to severe asthmatic patients. If symptoms become more persistent your doctor may use an inhaled steroid. If the asthma is still not controlled, adding a LABA is an option. If all of that doesn’t work, a combination medication like Trelegy would be a possibility. This medication would be most appropriate for moderate to severe asthmatic patients. Triple therapy / Trelegy is approved for people with COPD, including those with chronic bronchitis and emphysema. It combines three inhaled COPD drugs: a corticosteroid to bring down the swelling in your airways, a long-acting beta-agonist to relax the muscles around your airway and an anticholinergic drug to widen the large airways. It is a new asthma medication by GlaxoSmithKline (GSK) is currently being developed for the treatment of asthma and COPD and consist of 3 medications, fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI). The medication will be delivered once daily as a dry powder inhaler.

There is an urgent need for more research on this topic, in order to guide better recognition and appropriate treatment. This should include a study of clinical and physiological characteristics, biomarkers, outcomes and underlying mechanisms, starting with broad populations of patients with respiratory symptoms or with chronic airflow limitation, rather than starting with populations with existing diagnoses of asthma or COPD. Further research is needed to inform evidence-based definitions and a more detailed classification of patients who present overlapping features of asthma and COPD and to encourage the development of specific interventions for clinical use.

Ms. BENITA JOHN, III rd PHARM D

Yoga for Rebuilding Trust in Your Body

2020-09-23T22:05:00.002+05:30

Discover the tools you need to form a deeper connection with your body and find your way back to health- By Susi Amendola

After a heart attack, it can be hard to regain trust in your heart, and for that matter, your entire body. Even though you may have overlooked the care of your body in the past and feel afraid of the future, it’s important to focus on rebuilding a trusting, compassionate and a healthy relationship with your heart.

It’s a process of befriending and rebuilding trust and compassion for your body. Paying attention to our nutrition, fitness and relationships all play an important role in finding our way back to health. There are also important stress management techniques that offer us powerful tools for trusting our bodies and mending and befriending our hearts.

Foster Deep Listening: When we step onto our yoga mat, we also step into a relationship with our body that is focused on deep listening and conscious responding. We start to pay attention to our body’s language and we become an advocate for that voice by honouring what it’s telling us about ourselves.

Tools For Listening:

Move More Slowly in Your Postures.: This is so you can hear and feel what the body is saying. If we move too quickly, we can get lost in letting our mind overpower, or even bully, our body into a position. When we slow down we are better able to listen to that first small signal that tells us we are nearing our edge of discomfort. When we notice that edge, we can pause to see if we can maintain our breathing and balance. Then we can ask ourselves these questions:

“Should I pull back a little or is there room for me to soften right where I am?”
“Is there anything I am willing to let go of (physical or emotional) that isn’t necessary for the maintenance of this pose?”
“Could I stay here and breathe or does it feel better to come out just a little?”
“If there is a way to let go, does it allow me to move in just a little deeper to the next edge, or is staying here on this edge enough?”

We must ask and we must listen. As we develop the conversation with our own bodies, we start to trust what it is telling us and we begin to honour the intelligence and wisdom it offers. We not only honour our body, but we may even expand our capacities in a gentle way. We move on the mat with this awareness and wisdom, and we can then bring these methods to our lives off the mat by learning to respect and honour our limits and capacities.

Talk to Your Heart
We can do this anytime and anywhere, but it may be most effective when we are lying down or sitting quietly with our eyes closed. This is when our body can relax and our mind rests in our heart. In our gentlest internal voice, we can start to befriend our heart. We might start the conversation by saying.

“You are such a wise and loving heart. I am so grateful for you.”
“What is it that you need from me to be healthy and whole? What can I do to help you heal?”
“Is there anything you want me to pay attention to that I may be missing or overlooking?”

These questions can be followed with a moment of silence and deep listening. The heart may not answer in words, but it may send a feeling or image, or sense of knowingness. Sometimes it doesn’t respond at all, but you may get an answer later. What matters most is the process of asking and listening. This is what strengthens your relationship to your own heart and your inner healer. In time it allows you to begin to trust the wisdom of your own heart.

Foster A Grateful Heart

The more we look to the positive qualities of our own hearts, the more focus and attention we bring to those qualities, and the more trust we gain in our heart. A 2015 study published by the American Psychological Association found that that a more grateful heart was indeed a healthier heart. Researchers at the University of California said that patients with asymptomatic heart failure who recognized and were grateful for the positive aspects of their life displayed better mood, better sleep, less fatigue and lower levels of inflammatory biomarkers related to cardiac health.

In addition, researchers at the University of Connecticut found that gratitude can have a protective effect against heart attacks. Studying people who had experienced one heart attack, the researchers found that those patients who saw benefits and gains from their heart attack—such as becoming more appreciative of life—experienced a lower risk of having another heart attack.

These practices quietly transform the heart that once seemed as if it was our enemy into a loving and faithful friend.

Ms. Geona Tomy IIIrd B.Pharm

STRESS- THREAT TO LIFE

2020-09-17T16:25:00.001+05:30

Stress is actually a normal part of life. At times, it serves a useful purpose. But if you don't get a handle on your stress and it becomes long-term, it can seriously interfere with your job, family life, and health. According to surveys, 40% of people experience work stress as a major threat. Life stresses also have a major impact just like some past accidents due to which, faced trauma have a high risk to suffer from post-traumatic stress disorder.

Intensive thinking leads to stress. Is it really worth to worry about things that have no control over. Stress makes one feel burdened deep inside which leads to insomnia, anxiety, depression, etc. It is said that life is 10% of what happens and 90% how we react; it depends on the person how well he or she handles the situation. It’s difficult to completely get rid of stress but can reduce it to some extent. Firstly, you need to know whether these thoughts are for real or are the worries are just illusions and will it cause any harm. Secondly, if it causes any harm always believe that you can handle the things; be optimistic. Thirdly, keep some time for yourself, like doing things that make you feel happy with no pressure i.e. listening songs, reading comics, distract yourself at least for a short span of time. Try to share your burden with someone trustworthy or consult psychologist, here, never pretend to be strong the main point is to open up yourself. These may help up to some extent to overcome stress.

Don‘t push yourself hard, it’s better to move with the flow. Stress is what a person feels when he or she has high hopes with life, work-related matters. Time and happiness is the only way to heal. Keeping a healthy mental state is necessary, so meditate, and exercise.

Ms. Elmy IInd Pharm.D

THE POWER OF MIND OVER MEDICINES: THE PLACEBO EFFECT

2020-09-10T00:00:00.002+05:30

All of us have come across the detail of stress being a risk factor for the majority, almost all, of the health conditions. To our knowledge, we know that this is due to the release of inflammatory mediators by our body, under the influence of stress leading to the development of such pathological conditions. If stress, by modulating our mind, can produce this effect on our body, what truly is the power our mind has over our body?

The idea of the power the mind has over the body has been an undeniably fascinating topic for the scientist around the world. The body and the mind have been divided into two separate entities for the sake of administering treatment for various illnesses the body has to go through. However, it is only rational to know that the mind and the body interact, for e.g.: when you are confronted with unfortunate news, you can feel your heart skip a beat. For ages, the idea of “healing through thoughts” has been enchanting, but when it comes to the real scenario, when we hear of such claims from therapists stating the cure for cancer by controlling the mind or the cure of paralysis, we are inclined to dismiss these statements are mere bizarre and grotesque. Recently a group of scientific researches suggest that our mind can, in fact, play an important role in healing our body.

So what’s the deal?

Your mind can be a powerful healing tool when given the chance. The idea of “placebo- effect” the tricking of mind into thinking that it has been treated with an actual medicine rather than a fake one and thus stimulating healing has been proven to be as effective as traditional medicine under the right circumstances. “The placebo effect is more than just positive thinking; believing a treatment or procedure will work, creating a stronger connection between the brain and the body and how they will work together” as stated by Professor Ted Kaptchuk of Harvard-affiliated Beth Israel Deaconess Medical Centre, whose research focuses on the placebo effect. People often believe that treatments such as acupuncture, reiki have produced a reformation in their health even though these treatments are not backed up with scientific evidence. The scientific explanation for the benefits the people experience has been postulated to be because of the interplay of factors such as social support, positive expectations from the treatment that can trigger physiological changes that can ease the symptoms. In a study concerning the placebo effect, testing how people reacted to the pain medication, one group had received the real pain medication and the other group did not. In the following days both the groups were given placebos and it was found that the group that had received the pain medication earlier had been to tolerate pain more effectively than the other group. This type of learned response after a personal experience is call conditioning effect, which seems to be a part of the so-called placebo effect. Many ancient cultures depended on mind-body connections to treat illness. The people treating the diseases may not have viewed their treatment s as placebos but could have produced healing effect through the strong belief of the patient or it could have been the case of a patient who was going to get better anyway. Another potential area where a placebo has proven its efficacy is in the immune response. Here when we take the drug for a few days the body learns the relationship between the drug and our suppressed immune system. So after a few days of treatment, if we continue by taking placebos, our body responds to it by producing the same suppressed immune response. This effect had happened by the mere action of only taking a pill and not because of the drug, which must have imparted a feeling of safety and support and a feeling that their condition is going to improve. This phenomenon can also be attributed to biological conditioning.

What could have been the mechanism behind this effect?

The role our mental state plays in perceiving the extend of the symptoms such as pain, nausea, fatigue we experience is critical. Taking a placebo painkiller can actually cause relief of pain to some to extend as the brain is tricked into thinking that it has been given some treatment. It responds by releasing endorphins that can elevate the pain we feel. Why is this so? Because the entire process, i.e. the feeling of pain to its perception and the elevation of pain is all controlled by our brain. So when we trick it into thinking that it has been given treatment, it produces a proportional result. The same can be explained by a simple daily life example: when we feel stressed, alone or under threat, our brain starts releasing warning signals and when we get out of the situation or when we feel supported and cared for, the feeling of optimism and safety floods us as the warning signals issued by the brain ease off once the crisis is over. Similarly, the experience of receiving medical attention-whether real or fake- can have this effect on our brain and can reduce the symptoms. Although the mechanism of action of placebos are not fully understood it is said to involve a complex biochemical neurobiological reaction that ranges from the release of endorphins and dopamine to greater activity in the certain regions of the brain linked to moods, emotional reactions, and self-awareness. All of this can have some therapeutic effect.

The placebo effect, however, has not shown any significantly relevant changes in the condition of the patients taking chemotherapy for cancer, statins or that of diabetes. Here there is an absolute need of a chemical agent.

How can we make use of the placebo effect?

The ethical obstacle being faced with the use of placebos is that it gives an idea that the patient is being fooled as they are thinking that they’ve received a true drug when in reality they are not. But there are interesting researches going on with the use of placebos with complete awareness of the patient as the placebos have shown to work with the patient even though the patient is fully aware that it is a placebo. The effect is not as comparable with that of the drug itself but significant results can be provided. Trials done in irritable bowel syndrome, depression etc has shown that. Since the act of taking medicines can provide significant results, it can be said that the effect of a drug can be attributed to its chemical entity as also partly to the placebo effect. Hence in all the trials where the patient is well aware that it is a placebo, there can still be significant results. We can, therefore reduce the dose of the drug by means of placebo and still achieve the benefits. It could also reduce the incidence of tolerance, toxicity as well as to attain cost reduction.

Researches in settle have developed a virtual reality landscape called Snow World. It is meant to work as a painkiller, based on the fact that the brain has a limited capacity for attention and hence if the virtual reality has claimed the attention, there is very little capacity left for experiencing pain. Researches like this explore the psychological approaches one can take to handle or treat pain; thereby maximizing the effectiveness of drugs and in some cases to replace them.

Give yourself a placebo.

How can we do this without taking a pill? Practising self- help: engaging in healthy living- eating healthy, exercise, meditation, yoga, quality time with people can all add up to the placebo effect. These practices can act as a positive interaction with oneself thereby providing us with emotional support and attention that can go a long way.

Ms.Aneeta Jeeson, 3^rd PharmD

CREATING A COVID-19 VACCINE IS HARD, BUT DISTRIBUTION MAY BE MORE DAUNTING!

2020-09-03T00:00:00.002+05:30

The entire world, craving to return to normal from COVID-19, is on a race to develop a safe and effective vaccine. The pandemic has definitely created a buzz within the scientific community. A number of vaccines are being attempted in ways that have never been deployed before. As Chandrakant Lahariya, a New Delhi based epidemiologist, vaccine expert and public health specialist said, “The scientists can be compared to the 15th-century sea explorers who went on a voyage to find the ‘new world’. All the routes were tried at and whoever was lucky found a new place. Vasco da Gama arrived in Goa and Christopher Columbus ended up on the shores of what we call today the US, thinking he had reached India. The scientific community is following a similar approach to find a vaccine for Covid-19. All of us hope that more than one of them succeeds.”

With the development of potential vaccines for Covid-19 coming into the picture, it’s time to plan and invest in infrastructure for the distribution and delivery of the vaccine. In this context, the policymakers must consider two key questions, how will their country get access to a COVID-19 vaccine? And if it does how to ensure fair and equitable distribution among its population? The answer to this is a rational and objective strategy that ensures an effective timeframe for availability and addresses the challenges which could be faced pertaining to the logistics and distribution which should be carefully planned and worked out. As Bill Gates rightly said, “During a pandemic, vaccines and antivirals can’t simply be sold to the highest bidder. They should be available and affordable for people who are at the heart of the outbreak and in greatest need. Not only is such distribution the right thing to do, it’s also the right strategy for short-circuiting transmission and preventing future pandemics.”

It is likely that after a Covid-19 vaccine becomes available, initially the vaccine will not be available for everyone, and will only be offered to high-risk individuals such as health workers, elderly and people with co-morbidities. Even to cater to this small population, billions of doses will need to be manufactured, meaning collaboration between industry, regulators and the scientific community will be pivotal. Moreover, since we need to get them out to every part of the world, and we need all of this to happen as quickly as possible, global coordination is very crucial. Keeping this in mind, establishment of manufacturing plants and maintenance of reliable supply chains is a must. Since most vaccines need to be kept between two and eight degrees Celsius. New technologies such as solar direct drive refrigerators can help especially in places where the electricity sources are unreliable. Accordingly, there needs to be a global agreement on distributing stocks to countries around the world and if that doesn’t happen, the result will be political tensions like those currently prevalent in the world over the allocation of personal protective equipment, ventilators, and test kits.

Therefore, the only way to ensure a robust production and a universal administration of the vaccine would be by mapping out effective distribution policies and protocols. As Seth Berkley, CEO of vaccine alliance GAVI has said, “We have a global problem that requires a global solution. We need the best science in the world. We need the best manufacturing in the world. And obviously we need industries from around the world to engage. If we have anybody left over anywhere as a reservoir of virus, it not only threatens them, but threatens the world.” So, while we keep our fingers crossed for the much awaited miracle, that is, a safe and effective vaccine, we need to continue to take preventive measures such as wearing face masks in public, regularly washing our hands with soap (or sanitise with alcohol-based disinfectant), following cough etiquettes and maintaining social distancing, which would continue to be key weapons in our fight against the Covid-19.

Ms. Christy Sojan, III PharmD

OUR BRAIN IS AFFECTED BY WHAT’S ON OUR PLATES????

2020-08-27T00:00:00.002+05:30

For decades we have been surrounded by sweet and fatty foods. And the body has not been dealing well with these eating habits. But what about the brain?

Do our mental health, our moods, and our brain abilities suffer from the wrong kind of nutrition?

We know that junk food is making us fat, but science is telling us now that it might also be shrinking our brains. Habitual intake of foods high in fat and sugar results in reprogramming of the brain. In short, our brain is affected by what’s on our plates. It all starts with our very first meals, even before birth. The brain is built up during pregnancy and its functioning, later on, depends on how it has been nourished by the expectant mother’s diet over nine months. A number of consequences of poor nutrition during gestation have been known for a long time. Mothers who ate more junk and processed foods during their pregnancy had children with more of these behaviours such as aggression, anger, and tantrums. This disquieting correlation suggests that the mother’s diet impacts the mental development of the infant.

The brain is an organ which is rich in PUFA or omega-3. Omega-3 is indispensable because the body cannot make it so it has to come from the diet. The amount of omega-3 that enters the brain is crucial for making brain cells more efficient because when these fatty acids are incorporated into the membranes of nerve cells, they improve their electrical properties. In omega 3-rich neurons, the signals propagate faster and the network is more efficient. Depriving the brain of omega-3 is linked to a risk that it will function less. The general population is deficient in omega-3 due to its insufficient, so it's important to pay attention to it especially in the prenatal developmental period when omega-3 is incorporated in large quantities into the brain. Also, in adolescence, since it is a particular time of change of diet. And, during ageing where the incorporation of omega-3 into the brain tends to be less effective, so we must increase its intake.

The first rule for a brain to run at full speed is to avoid deficiencies. But good nutrients and a varied diet should be available. The amino acid is one building-block of a protein that is key to brain function. Dopamine molecule ensures communication between neurons involved in motivation and risk-taking. The results of the blood analysis show that subjects with higher levels of tyrosine

in their blood are more willing to accept the unfair offer. In other words, what we eat can subtly alter the chemistry of the brain within hours and thus the communication between the neurons;

enough to guide some of our decisions. Since we eat three times a day, every day, we realize that food has enormous power, modifying and shaping us. So it’s important to think about how we can use food to promote our well-being and optimize our mental state. Not only does an unbalanced diet affect our brain functions and behaviour, and our meal plan interferes with everyday decisions, it is also becoming increasingly clear that diet plays a decisive role in our mood and possibly mental health.

But what about junk food, dripping with sugar and bad fats? What would happen if we ate more of that?

Recent studies show that in humans that an energy-rich diet also interferes with the hippocampus.

We see for example, that the quality of people’s diets is related to the size of their hippocampus. An overly rich diet confuses the immune system. It responds by triggering an inflammatory reaction, especially in fatty tissues. Our fat masses release substances that then propagate this inflammation throughout the body which may spread to the brain because the blood-brain barrier which normally protects the brain from inflammatory molecules may be impaired in fact by the diet and become leaky allowing traffic of molecules into the brain. The inflammation infiltrates the meninges and then triggers a surprising phenomenon

The reward circuit is a region of the brain that controls the feeling of pleasure. It is particularly responsive to sugar consumption. But eating too much ends up weakening its responsiveness

so that at the same dose, the sensations of pleasure are ultimately reduced. After a diet too rich in sugar, the brain becomes hypersensitive to images of food. The more and more you eat ice cream,

the more your reward circuitry is activated when you see an ice cream store or on television.

Scientists now consider the microbiome to be a kind of intermediary, a link between food and the brain. The main factor that influences the composition of microbes in the food we eat. Diet and the diversity of the diet is really important from the moment we’re born until we die, in shaping the composition of the microbes. So we’re beginning to realise the importance of what we eat has on what’s in our microbes, and how that’s influencing what’s going on in our brain. Our well-being depends, in one way or another, on our microbiome. A diet that is good for our mood is first and foremost a diet that is suitable for the bacteria in our intestines. Researchers are only just beginning to uncover the secrets of the remarkable relationship between nutrition and the brain. The ideal menu for our little grey cells is still largely unknown. But a balanced, diverse diet which does without processed food and sugar, and favouring fruits and vegetables, seems so far to be the best recipe for preserving the mental faculties.

My grandmother said “You are what you eat, so eat well.

Mr. GOPIKRISHNAN T.S., V Pharm. D

WHY DRUGS OFTEN HAVE DANGEROUS SIDE EFFECTS FOR WOMEN?

2020-08-20T00:00:00.003+05:30

We all go to doctors.

And we do so with trust and blind faith that the tests they are ordering and the medications they're prescribing are based upon pieces of evidence, evidence that's designed to help us. However, the reality is that it hasn't always been the case for everyone. What if I told you that the medical science discovered over the past century had pre-trailed indiscriminately one half the population?

Doctors order the same tests, and prescribe the same medication, irrespective of patients gender- male or female.

A recent Government Accountability study revealed that 80 per cent of the drugs withdrawn from the market are due to side effects on women. Why are they discovering side effects on women only after a drug had been released to the market?

So why are we discovering unacceptable side effects on half the population after all the clinical trials that had gone through?

Well, it turns out that those cells used in that laboratory for clinical testing were male cells and the animals used in the animal studies were male animals and the clinical trials performed were almost exclusively on men.

How is it that the male model became our framework for medical research?

Let's look at a case that was popular in the USA that had to do with the sleep aid Ambien (Zolpidem). Ambien was released in the market over 20 years ago and since then, hundreds of millions of prescriptions had been written, primarily to women, because women suffer more sleep disorders than men. But just this past year, the Food and Drug Administration recommended cutting the dose in half for women only, because they realized that women metabolized the drug at a slower rate than men which caused them to wake up in the morning with more of the the active drug in their system causing a drowsy feeling in them and in turn resulting in motor accidents. Imagine how many of the motor vehicle accident could have been prevented if this type of analysis were performed and acted upon 20 years ago when this drug was first released.

How many other things need to be analyzed by gender?

World War II changed a lot of things, and one of them was this need to protect people from becoming victims of medical research without informed consent. So some much-needed guidelines or rules were set into place, and part of that was this desire to protect women of childbearing age from entering into any medical research studies.

There was fear: what if something happened to the fetus during the study? Who would be responsible? And so, the scientists thought, that this, was a blessing in disguise. Men's bodies are pretty homogeneous. They don't have the constantly fluctuating levels of hormones that could disrupt clean data. It was easier, It was cheaper. Not to mention, that there was a general assumption that men and women were alike in every way, apart from their reproductive organs and sex hormones. So, it was decided, medical research was performed on men, and the results were later applied to women. What did this do to the notion of women's health?

Women's health became synonymous with reproduction: breasts, ovaries, uterus, and pregnancy. It's this term we now refer to as "bikini medicine.”And this stayed this way until about the 1980s.when this concept was challenged by the medical community and by the public health policymakers. Virtually nothing was known about the unique needs of the female patient. Since that time, an overwhelming amount of evidence had come to light that showed us just how different men and women were in every aspect.

There is a saying in medicine:

Children are not just little adults which reminds us that children actually have a different physiology than normal adults. And it's because of this that the medical speciality of paediatrics came to light. And now researches are conducted on children in order to improve their lives.

Same thing can be said about women. Women are not just men with a different reproductive organ. But they have their own anatomy and physiology that deserves to be studied with the same intensity.

Let's take the cardiovascular system, for example.

This area in medicine has done the most, to try to figure out why it seems men and women have completely different heart attacks. Heart disease is the number one killer of both men and women, but more women die within the first year of having a heart attack than men. Men will complain of crushing chest pain like an elephant is sitting on their chest which is called typical.

Women have chest pain, too. But more women than men will complain of "just not feeling right," "can't seem to get enough air in," "just so tired lately. “Which for some reason is classified as "atypical", even though, as mentioned, women do make up almost half the population. And so, what are some of the evidence to help explain some of these differences?

If we look at the anatomy, the blood vessels that surround the heart are smaller in women compared to men, and the way that those blood vessels develop the disease is different in women compared to men. And the tests that we use to determine if someone is at risk for a heart attack, which was initially designed, tested and perfected in men aren't as good at determining that in women.

What this is doing is merely telling us that we are scratching the surface. It's about training future health care providers correctly. Because this cannot just be left up to the health care leaders. We all have a role in making a difference. But it is not so easy.

The first step towards change is awareness. This is not just about improving medical care for women. This is about personalized, individualized health care for everyone. This awareness has the power to transform medical care for men and women. The conversation has begun, and together we can all learn.

Martin Luther King, Jr. had said, "Change does not roll in on the wheels of inevitability, but comes through continuous struggle."

Ms. OLIVIA SUNNY, Pharm.D Intern.

THE RISE OF THE TICK-BORNE VIRUS IN CHINA!!

2020-08-12T12:30:00.004+05:30

An unnoticeable tick with a high fatality rate and severe symptoms?

YES…A bug responsible for a virus so bad that it can kill you.

A virus called SFTS (Severe Fever Thrombocytopenia Syndrome).

SFTS is a viral hemorrhagic fever caused by a "phlebovirus". It is transmitted from the Asian tick called Haemaphysalis longicornis, which is commonly found in the Americas, Asia, Africa, and the Mediterranean region. Scientists found that the tick-associated with severe fever is often passed on to humans from animals. And it also roams around forests. While the tick is the main vector of the virus, it may also be spread from person to person through blood, wounds or mucous.

There are many reasons to treat this seriously…but there is no reason to panic because this virus is not new. SFTS was first identified by a team of researchers in the Hubei and Henan provinces of China in 2009. As of 2016, SFTS like or confirmed SFTS patients has been reported in South Korea, Japan, UAE and United States outside China.

And now again in 2020, China found that SFTS infected 60 people in one area; and what’s so scary about it is that right now, up to 30% of the cases could die from it. The cases of SFTS virus first appeared in April and since then more than 37 people in East China’s Jiangsu Province have contracted with the virus and 23 people were found infected in East China’s Anhui Province. Seven people already died.

That’s why the World Health Organization listed it as one of its top 10 priority diseases.

All because of a TICK!!

And once it bites, we will experience unusual rashes and various other non-specific symptoms including respiratory tract symptoms, sudden onset of fever up to 38–41°C, headache, fatigue, myalgia, and gastrointestinal symptoms (loss of appetite, nausea, vomiting, and diarrhoea). Multiple organ failure develops rapidly in most patients (with raised concentrations of serum alanine aminotransferase, aspartate aminotransferase, creatinine kinase, and lactate dehydrogenase; and proteinuria and hematuria), and is usually accompanied by thrombocytopenia, leukocytopenia, and lymphadenopathy.

Currently, no vaccine or antiviral therapy is available to treat SFTS. The Chinese Ministry of Health initially approved the use of ribavirin to treat SFTS based on results of in vitro studies; nevertheless, the effectiveness of ribavirin to treat SFTS was evaluated in patients with a clinical diagnosis of SFTS, and no beneficial effect of ribavirin on platelet recovery or viral load reduction was noted. As a supportive measure, treatment with plasma exchange followed by convalescent plasma therapy from SFTS survivors, intravenous immunoglobulin and corticosteroids had also given.

Unfortunately, all these therapies have not shown any encouraging results. While new cases of the novel Coronavirus is still popping up in China, the country is facing yet another potentially contagious viral infection. This time, it's jumping from ticks to people.

The rapid urbanization, followed by widespread rural-to-urban migration of the human population, intensive long-distance trade, and explosive short-term travel for shopping, has led to substantial health risks including air pollution, occupational and traffic hazards, and altered diets and activity. All of these changes in human activity, together with increased contact between human beings and their pets and nature, have probably contributed to the increasing the abundance of tick exposures over there.

The virus could undergo rapid evolution by gene mutation, reassortment and homologous recombination in tick vectors and vertebrate reservoir hosts. And thus, the disease has become a substantial risk to public health, not only in China, but also in other parts of the world.

Since no specific treatments of SFTS are available, avoiding tick bites is the most important measure to prevent the infection and transmission of SFSTV. People are advised not to go into jungles and bushes during an outbreak since ticks are most commonly found in wooded areas. Check your body for ticks after being outdoors. Treat clothing’s and gear with products containing 0.5% permethrin.

These precautions should be strictly followed during the summer season, as ticks breed actively during that time. if not, A TINY BUG CAN BE SOMEBODY’S LAST TOUCH BEFORE DEATH!

May all these things that can take our lives remind us that life can be so fragile; we need to live our lives as if every day could be our last one.

Ms JEEVA ANN JIJU Pharm.D Intern

BCG VACCINE: A HYPE OR HOPE AGAINST COVID-19 FLAREUP?

2020-08-06T00:30:00.000+05:30

In the race against time, in the middle of death and devastation, many researchers are burning the candles on both ends in discovering an effective vaccine against COVID-19 and some have pinned their hopes on vaccines that already exist, the one that is right under our nose- the BCG vaccine as "The game-changer".

The Bacillus Calmette-Guerin (BCG) vaccine is administered to protect against tuberculosis by inducing an adaptive immune response in the body together with some non-specific effects. This knowledge has reciprocated to generate the conjecture that this vaccine can also offer protection against Severe Respiratory Syndrome Corona-virus 2 (SARS-CoV-2). BCG-induced innate immunity has shown a reduction of viremia with RNA viruses in experimental human models, reduction of the incidence and severity of respiratory infections, and exertion of other antiviral effects. Randomized trials in older adults and observational studies in children show that BCG markedly reduces acute respiratory infection. It induces genome-wide epigenetic reprogramming of innate immune cells leading to long-term functional changes and modulation of immunity.

Presently, WHO does not recommend the usage of BCG vaccination to treat COVID-19 because of the absence of any concrete evidence suggesting that the vaccine prevents the SARS-CoV-2 infection? But in contrast to this, there is evidence for the potential biological basis of BCG cross-protection from severe COVID-19. A strong correlation between the BCG index and COVID-19 mortality in different socially similar European countries has indicated that every 10% increase in the BCG index was associated with a 10.4% reduction in COVID-19 mortality. More broadly, countries with current BCG vaccination had lower deaths as compared to countries with lack of, or interrupted, BCG vaccination.

The silver lining is VPM1002, an improved Recombinant BCG with the Mycobacterium bovisurease C gene replaced by the listeriolysin O-encoding gene hly. Compared to the parent vaccine, the advantages of rBCG vaccine include safety, more important protective heterologous effects and scalability, which poses VPM1002 to be a promising intervention against SARS-CoV-2.Recent trials have shown that VPM1002 can also be effective against cancer and prevent recurrence of bladder tumours.

Thanks to its broad spectrum of protection and to the prompt availability of the product, showing the efficacy of VPM1002 as a fundamental step in flattening the curve of the current COVID-19 pandemic and will constitute a strategic advantage for the future: the mechanism of action of VPM1002 is thought to guarantee protection against future viral pandemics or in case of mutations in the current Sars-CoV2 virus, which might impair the efficacy of COVID-19 vaccines currently under development.

Finding a vaccine or a treatment against the new coronavirus is a race against time, but thankfully a lot of promising projects are already very advanced. Some promising candidates are The University of Oxford and AstraZeneca’s AZD1222 (ChAdOx1nCoV-19), Pfizer and BioNTech’s BNT 162, India’s indigenous Covaxin, etc.

One of the main reasons, why it is essential to stick to WHO's recommendation is that there might be a bare possibility that up-regulation of the immune system by BCG vaccination and its non-specific effects will aggravate COVID-19 in a minority of patients with severe ailments. Two clinical trials addressing this question are underway, and WHO will evaluate the evidence when it is available. As applying “QUICK FIX” and “SHORTCUTS” can lead to disastrous consequences, let’s rely on the results from clinical trials and find whether the BCG vaccine is a hype or hope against COVID-19.

Ms. Elza Baby, 7^th Semester B.Pharm

WHY DO WE GET GOOSE BUMPS?? EXPLORING THE SCIENCE BEHIND IT!!!

2020-07-30T00:30:00.000+05:30

Lots of things can make our hair stand on end, from a cool breeze tickling our neck to a sense of impending danger. We might also experience goosebumps when we hear an inspirational speech or song. Some unrelated events elicit goosebumps. The reason for this is the physiology of emotions!

Centuries ago, people believed that goosebumps made our hair grow faster. Today, we know this is not the case, but goosebumps still hold some mystery.

When we’re cold, or we experience a strong emotion, such as fear, shock, anxiety, sexual arousal or even inspiration, goosebumps can suddenly pop up all over the skin.

Goosebumps occur when the arrector pili muscles cause the hairs to stand up, making the skin look bumpy. The arrector pili are smooth, involuntary muscles that a person cannot voluntarily contract. Hence, people cannot voluntarily cause their goosebumps. When the hairs stand up on the skin, it is known as piloerection. Goosebumps are an involuntary reaction to certain kinds of stimulation.

In a new study, Harvard University scientists have discovered the reason: the cell types that cause goosebumps are also important for regulating the stem cells that regenerate the hair follicle and hair. Underneath the skin, the muscle that contracts to create goosebumps is necessary to bridge the sympathetic nerve's connection to hair follicle stem cells. The sympathetic nerve reacts to cold by contracting the muscle and causing goosebumps in the short term, and by driving hair follicle stem cell activation and new hair growth over the long term.

Published in the journal Cell, these findings in mice give researchers a better understanding of how different cell types interact to link stem cell activity with changes in the outside environment.

These bumps are caused by a contraction of miniature muscles that are attached to each hair. Each contracting muscle creates a shallow depression on the skin surface, which causes the surrounding area to protrude. The contraction also causes the hair to stand up whenever the body feels cold. In animals with a thick hair coat, this rising of hair expands the layer of air that serves as insulation. The thicker the hair layer, the more heat is retained. In people, this reaction is useless because we do not have a hair coat, but goosebumps persist nevertheless.

The medical terms for goosebumps are piloerection, cutis anserina, and horripilation. The term “goosebumps” is most widely used because it’s easy to remember: The little bumps that form on your skin when this phenomenon happens.

The presence of goosebumps with piloerection on the skin tends to suggest that a person is cold, scared, or having an emotionally intense experience. Neurological, endocrine, or other systemic issues may cause this symptom, so people should see a doctor for any unusual or worrisome goosebumps.

In addition to cold, the hair will also stand up in many animals when they feel threatened--in a cat being attacked by a dog, for example. The elevated hair, together with the arched back and the sideward position the animal often assumes, makes the cat appear bigger in an attempt to make the dog back off.

People also tend to experience goosebumps during emotional situations, such as walking down the aisle during their wedding, standing on a podium and listening to a national anthem after winning in sports or even just watching horror movies on television. Quite often a person may get goosebumps many years after a significant event, just by thinking about the emotions she once experienced, perhaps while listening to the romantic song to which she danced many years ago with the love of her life.

The reason for all these responses is the subconscious release of a stress hormone called adrenaline. Adrenaline, which in humans is produced in two small beanlike glands that sit atop the kidneys, not only causes the contraction of skin muscles but also influences many other body reactions. In animals, this hormone is released when the animal is cold or facing a stressful situation, preparing the animal for a flight-or-fight reaction. In humans, adrenaline is often released when we feel cold or afraid, but also if we are under stress and feel strong emotions, such as anger or excitement. Other signs of adrenaline release include tears, sweaty palms, trembling hands, an increase in blood pressure, a racing heart or the feeling of 'butterflies' in the stomach.

Factors trigger goosebumps

Goosebumps appear when the arrector pili muscles contract, pulling the hairs into an upright position. On areas of the body that do not have much hair or that only have light hair, a person might notice only the erect hair follicle and not the hair itself. Erect hair follicles look swollen and slightly bigger than usual. This enables them to hold the hair upright, and it also causes goosebumps. A number of specific factors can give rise to goosebumps. These include;

Extreme temperatures: Chills and cold: Goosebumps play an essential role in the body’s ability to regulate its temperature. Other mammals, including humans’ primate ancestors, have thick hair that keeps them warm. When the hair stands up, it offers more insulation.

Many people notice goosebumps when they are cold. They may also appear when someone thinks about being cold, such as when they witness a cold scene in a movie. Some people also get goosebumps when they have chills that they associate with an illness or fever. Goosebumps can be experienced in the presence of flash-cold temperatures, for example, being in a cold environment, and the skin being able to re-balance its surface temperature quickly. The stimulus of cold surroundings causes the tiny muscles attached to each hair follicle to contract. This contraction causes the hair strands to stand straight, the purpose of which is to aid in quicker drying via evaporation of water clinging to the hair which is moved upward and away from the skin.

Emotionally intense experiences: Some emotionally intense experiences cause the body to release certain chemicals that can trigger goosebumps.

In an extremely stressful situation, the body can employ the "fight or flight" response. As the body prepares itself for either fighting or running, the sympathetic nervous system floods the blood with adrenaline (epinephrine), a hormone that speeds up heart rate, metabolism, and body temperature in the presence of extreme stress. Then the sympathetic nervous system also causes the piloerection reflex, which makes the muscles attached to the base of each hair follicle contract and forces the hair up. Likewise, intensely pleasurable experiences, such as listening to music or the gentle touch of a loved one, can cause the brain to release dopamine. Dopamine is a chemical that plays a role in motivation, reward, and pleasure. Experiences such as this can also cause goosebumps.

Music: Canadian researchers have suggested that when humans are moved by music their brains behave as if reacting to delicious food, psychoactive drugs, or money. The pleasure experience is driven by the chemical dopamine, which produces physical effects known as "chills" that cause changes in heart rate, breathing, temperature and the skin's electrical conductance. The responses correlate with the degree to which people rate the "pleasurability" of music. Dopamine release is greatest when listeners had a strong emotional response to music. "If music-induced emotional states can lead to dopamine release, as our findings indicate, it may begin to explain why musical experiences are so valued,” wrote the scientists.

Ingestion: Medications and herbal supplements that affect body temperature and blood flow may cause piloerection. For example, one of the commonly reported side effects of the intake of yohimbine is piloerection.

Drugs: Certain drugs may also cause goosebumps. For example, a 2016 study identified two sisters who experienced goosebumps after taking a medication called milnacipran hydrochloride. Taking drugs that stimulate activity similar to those chemicals in the body that normally cause goosebumps may also trigger the phenomenon. For example, a person experiencing an adrenaline-like rush when using methamphetamine may also have goosebumps. Withdrawal from some drugs, such as opioids, may also cause goosebump.

Opiate withdrawal: Piloerection is one of the signs of opioid withdrawal. The term "cold turkey" meaning an abrupt withdrawal from a drug, may derive from the goosebumps that occur during abrupt withdrawal from opioids; this resembles the skin of a refrigerated plucked turkey.

Voluntary control: Scientists generally agree that, in normal circumstances, goosebumps are involuntary. This is because the arrector pili muscles, which cause goosebumps, are smooth muscles. People cannot typically control smooth muscles, unlike skeletal muscles, which they voluntarily use, for example, to move their legs and flex their arms. However, there is some limited evidence to suggest that a small number of people may be able to exert control over the arrector pili muscles. This enables them to trigger goosebumps voluntarily. A 2018 analysis details a few cases of people who supposedly have control over their goosebump reaction. It seemed that none of the people with this ability learned it via conditioning or training, and doctors do not know what causes it.

Post-mortem goosebumps: After a person dies, the chemical adenosine triphosphate, which provides the energy to cells, depletes, and lactate builds up in the muscles. This process causes the muscles to stiffen, thereby triggering rigour mortis. As part of rigour mortis, the arrector pili muscles also stiffen, giving rise to goosebumps, in most cases, goosebumps are nothing more than a temporary nuisance. However, goosebumps can be a sign of a long-lasting or serious medical condition. For example, goosebumps can also be a sign of:

Keratosis pilaris: A harmless and common skin condition that creates the look of goosebumps on the skin for long periods of time.

Autonomic dysreflexia: An overreaction of the nervous system caused by a spinal cord injury.

Temporal lobe epilepsy: A chronic seizure disorder.

Chills: For example, those associated with fevers caused by influenza.

Goosebumps are not a medical disease. They do not require treatment, and no treatment can completely prevent a person from getting goosebumps. That said, people who feel self-conscious about goosebumps or want to avoid them can reduce their frequency by wearing warm clothing, especially when it is cool outside, avoiding drafts and heavy air conditioning, remaining calm during stressful or emotionally intense situations, avoiding illegal drugs. The right treatment can help manage the symptoms of keratosis pilaris. Some strategies that may help include: regularly moisturizing the skin with thick moisturizing cream, using chemical exfoliators, such as lactic acid or salicylic acid, to remove dead skin, trying laser treatment, if other strategies do not work.

Ms. Aleesha R, M. Pharm, Asst. Professor,

Dept. of Pharmacology, Nirmala College of Pharmacy, Muvattupuzha

ANTIBODY DEPENDENT ENHANCEMENT – WILL IT HAMPER THE COVID – 19 VACCINE DEVELOPMENTS?

2020-07-23T16:42:00.004+05:30

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a zoonotic the virus in the late 2019 and is the causative agent of COVID-19. Exposure to SARS-CoV-2 can result in a range of clinical outcomes, varying from asymptomatic infection to severe acute respiratory distress and death. SARS-CoV-2 has spread globally and was declared as a pandemic on March 11, 2020, by WHO. As of July 23, 2020, more than 15 million people globally have been infected with more than 6,23,66 deaths. No vaccines have been approved for the prevention of COVID-19. There are currently more than 137 candidates undergoing preclinical development and 23 in early clinical development, according to the WHO. Coronaviruses are enveloped; positive-sense single-stranded RNA viruses with a glycoprotein spike on the surface, which mediates receptor binding and cell entry during infection. The roles of the spike protein in receptor binding and membrane fusion make it an attractive vaccine antigen.

How the coronavirus the
vaccine will work?

Background on Antibody-Dependent Enhancement (ADE)

ADE is also known as immune enhancement or disease enhancement. It involves in the cascade of events whereby viruses may infect susceptible cells via interaction between virions complexed with the antibodies (complement component) and Fc (complement receptors) respectively which leads to the amplification of their replication and increases the infectivity and the virulence.

In the case of ADE, the normal mechanisms of antigen-antibody complex clearance fail and instead it provides an alternative route for host cell infection. ADE has been reported in – vitro in Ebola virus, Zika virus, HIV, SARS and MERS. ADE has been linked to the development of cytokine storm syndrome, which occurs in the most severe cases in the SARS, MERS and the current COVID-19 infections. ADE assays are used as a valuable tool to assess the capacity of antibodies to enhance the secondary infection related to SARS-COV-2 and provide valuable insights into the pathogenesis of the covid-19 infections as well as the vaccine against the coronaviruses.

Viruses can acquire mutations that change the surface proteins, leading to distinct viral serotypes. After getting infected with one viral serotype, the host will produce antibodies to that particular serotype and this protects from the reinfections. The development of antibodies to one serotype doesn’t protect from the second serotype, even if the antibodies produced to the second serotype has the non-neutralizing capacity of the antibodies. Antibodies produced against one viral serotype not only fail to protect against the second viral serotype but actually do harm. These antibodies drive uptake of a newly infecting serotype into immune cells, promoting viral replication and similarly exacerbate the immune response.

ADE and Dengue Virus (DENV)

Dengue is one of the examples of an ADE seen in communities with multiple viral strains circulating. Antibodies developed against the first viral serotype only binds to the next serotype without neutralizing it. DENV can use Fc receptor to infect cells. Immune cells like macrophages dock onto tail ends of the antibodies using the Fc receptor. The antibodies that simply bind to the pathogens will actually end up helping the virus to enter the macrophages to detect the cells.

It was not just the non – neutralizing characteristic of the antibodies but also the neutralizing antibodies which were not numerous enough to block all the key proteins across the virus surface can cause ADE.

ADE and coronavirus

Coronaviruses mainly infect humans that cause the common cold, so anti–coronavirus antibodies are likely to be present in many people. Several groups have suggested that prior infection with non – SARS coronaviruses promoted severe SARS in 2002–2004. Now the ADE is speculated to be responsible for severe COVID–19. Prior to the infection resulted in a sub–neutralizing level of coronavirus antibodies that enhances SARS–COV–2 replication and promotes the inflammation. It is theoretically possible, but there is little evidence for this so far and in principle, some COVID–19 patients could develop antibodies that don’t neutralize or produce neutralizing ones at insufficient concentrations and then develop severe symptoms if they get re-infected for the second time. But a handful of reported COVID–19 re-infections has found due to flawed tests. In the U.S, patients who received an antibody-containing blood plasma transfusion from COVID-19 survivors, the treatments did not make the situations worse, which is against the ADE.

ADE’s role in vaccine development

Even though it is a theoretical concept, ADE is a possibility that vaccine tested against flu-like infections, peritonitis, and coronavirus disease in cats. The vaccinated kittens died much sooner than the unvaccinated ones. One explanation for this was the proposed ADE; this could have produced antibodies that target parts of the virus without blocking the specific site on its spike proteins which it uses to infect cells – the Receptor Binding Domain (RBD).

The cellular entry of SARS-COV-2 occurs by the interaction between the receptor-binding protein in the spike region (RBD) and the angiotensin-converting enzyme₂ (ACE₂) binding cell receptor. If the immune system gives with the only choice of making an antibody to the RBD, it can drastically limit the possibility of ADE.

ADE is a concern for the monoclonal antibodies (m Abs) too, because the antibodies that fail to neutralize the virus also facilitate the virus entry into the cells. An antibody lacking Fc receptor can’t bind the macrophage and thus can’t cause ADE. That is why some companies are advancing monoclonal antibodies which lack the Fc region. A successful vaccine for prevention of SARS-CoV-2 infection probably needs to incorporate T-cell epitopes to induce a long term memory T-cell immune response to the virus.

The recent Oxford vaccine was found to be safe, tolerated and it produced a humoral immune response to both the spike and the RBD by day 28 of the post-prime and cellular immune response (T-cell) were induced by day 14. Neutralizing antibodies were induced in all participants after the second dose of the vaccine. However, a boost in the cellular responses was not observed following the second dose.

The degree of ADE in coronavirus vaccine is unknown. There are several ongoing clinical trials to check the safety, tolerability and immunogenicity of the coronavirus vaccines. These developing vaccines may give a temporary wave against the SARS-COV-2 as till now there is no study pointing out how long these neutralizing antibodies will be present in our body once we are vaccinated. Neutralizing antibodies from the coronavirus the vaccine will help the host body to develop memory T-cell immune responses which protects from the viral attack of the primary serotype. If in case of an entry of the second viral serotype, the neutralizing antibodies from the vaccine will not be able to produce antibodies against the new antigen from the second viral serotype and hence results in the exacerbated immune responses from the second viral serotype as well as from the neutralizing antibodies of the primary viral serotype. Once the effect of the coronavirus vaccine decreases with the time, the amount of these neutralizing antibodies also gets depleted which point outs the risk for an ADE as well as the re-infection from the second serotype and thus further studies are mandatory to avoid ADE and re-infections. Frequent booster doses of the vaccine can reduce the risk for the re-infections and the ADE as it can boost up the level of the neutralizing antibodies, if so the dose of the booster vaccines and the frequency of administration should be taken into consideration, if not in future if the ADE as well as the re-infection from the coronavirus vaccine can lead to an exacerbated immune response for the vaccinated population than the non-vaccinated ones.

Ms. Helan Kurian, Pharm.D Intern

VIRTUAL TRAVEL: A VIRTUAL REALITY ASSISTED TOOL FOR STRESS RECOVERY

2020-07-16T10:12:00.005+05:30

As efforts to contain the effects of COVID 19 crisis ramp up, millions of people across the globe are stuck at their homes. The chaos put forward by COVID 19 has struck the whole idea of ‘travelling’. Countries across the globe have closed their borders to further contain the spread of coronavirus. This unpredicted situation demanded the introduction and adaption of newer technologies to tackle and resume pre-COVID times.

Researches have proved that travelling results in the so-called ‘Stress Recovery’. Stress recovery refers to the process during which an individual’s functioning returns to its pre-stressor level. Leisure trips of pleasure of travelling can help an individual recover from work stress and hence increase their psychological well-being. None of these principles really could be applied under the current circumstances of COVID 19. But technology has actually paved its way to the solution in VR or virtual reality, by which you can travel across the globe from the comfort of your home or workspace.

The VR the environment is a fully immersive experience, where the user actually enters a virtual reality room and gets a fully 3-dimensional feeling, where they are free to explore which gives them a strong sense of presence and realism. Studies have proven that the virtual travel experience created through virtual reality can reduce stress and individual well-being, hence better productivity. The pandemic of COVID 19 has drastically digitalised the whole world within the last few months. This rapid digitalisation brought up VR technology as a new tool to resume the concept of travelling, which ultimately is an option for ‘Stress Recovery’.
The world itself is being pushed to a virtual world, like the virtual classrooms, virtual workspaces, virtual meetings and virtual discussions. A new global concept is on a rise: ‘Virtual is a new reality’. This technology of Virtual reality will help us to presume our travel explorations, which ultimately was one of the best options for Stress recovery.

Mr Jude James, Pharm.D Intern