Abhijit Anil Trailokya

Atrial fibrillation (AF) is considered as one of the most common cardiac arrhythmias worldwide and is always associated with a significantly increased risk of stroke and thromboembolism. VKAs (Warfarin & Acenocoumarol) are highly effective in reducing the risk of stroke in patients with AF, but bleeding issues & disutility sparked the development of direct oral anticoagulants (DOACs) or NOACs (Novel oral anticoagulants). These drugs, offer the convenience of once or twice daily dosing without the need for laboratory monitoring of coagulation activity (PT/ INR) or routine dose adjustment. Various clinical trials proved their non-inferiority to warfarin (VKA) in reducing the risk of stroke or systemic embolism, and each was associated with markedly lower rates of ICH than well-adjusted warfarin. Yet there are no direct head-to-head comparative trials for the efficacy & safety of NOACs. In this review we try to provide patient centric approach to assist Indian physicians in selecting right OAC therapy for SPAF with respect to best possible evidence and recommendations available worldwide. Keywords: Anticoagulation, NOACs, SPAF, Apixaban, Dabigatran, Rivaroxaban, Atrial fibrillation (AF)

The immune system is a fundamental part of human protection against infection and disease.The immune system can occasionally lead to unfavourable reactions in the host which are known as hypersensitivity reactions. The exaggerated immune reactivity (hypersensitivity) to certain environmental substances (allergens) like airborne pollens, dust, mites, pet dander, and reactions to certain foods that normally have little effect on most people is known as allergy. The incidence of allergic disease like allergic rhinitis (AR), food borne allergy, asthma and anaphylactic reactions are prevalent in 25% of populations predominately in adolescents and adults in industrialised countries. Bilastine is a novel second-generation non-sedative, highly selective histamine H1 receptor antagonist that suppresses some allergic inflammatory processes that inhibits the release of histamine from mast cells and is approved in the treatment allergic rhinitis, urticaria and pruritus associated with skin diseases. This review covers the safety, efficacy and pharmacological aspects of Bilastine as an important product for treatment of allergic rhinitis.   Keywords: Allergic rhinitis, Bilastine, Urticaria

Aim: This study aimed to assess effectiveness of Evogliptin 5 mg through continues glucose monitoring (CGM) in patients with T2DM in retrospective observational real world settings. Materials and Methods: Overall 6 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. FreeStyle Librepro 1.0.6 was used for CGM. CGM was done 15 days prior to adding Evogliptin and repeated immediately after that for next 15 days. Mean BG level, Percentage time in target range (80-140mg/dl), Percentage time above target and Percentage time below target were assessed prior and after adding Evogliptin in existing treatment regimen. Results: Significant reduction in Mean blood glucose level seen after adding Evogliptin in existing treatment regimen from 215 mg/dl to 138 mg/dl (-77 mg/dl P=0.006). Significant improvement seen in Percentage time in target range (80-140mg/dl) from 17% to 44% (27% P value 0.007) and in Percentage time above target from 81% to 43% (- 38%, P valve 0.003). 13.5 % of the patients seen below target. Conclusion: Evogliptin was found to be effective when added to the patients who were uncontrolled on other oral anti-diabetic medications. It effectively showed improvement in continues glucose monitoring (CGM) parameters like Mean blood glucose, more number of patients were in Time in Target range i.e (80-140mg/dl) after adding Evogliptin to existing anti-diabetic medications & well tolerated. Limitations: Small sample size and retrospective study Keywords: Real world study, Evogliptin, Retrospective, CGM, Time in target, Add on therapy

Surgical site infections (SSIs) are serious postoperative complications reported globally, which lead to perioperative antibiotics use during routine practice in surgical procedures. Selection of appropriate antibiotic/s for prophylaxis is a vital step in the management and care of invasive surgical procedures. This expert opinion review was developed based on expert discussion and literature search on scientific databases with special emphasis on cefuroxime in surgical prophylaxis for general surgeries. Cephalosporins are globally considered to be the drugs of choice for surgical prophylaxis in general surgeries owing to good safety, bactericidal activity, penetration to critical tissues, and proven efficacy in clinical trials. Cefuroxime, a 2nd generation cephalosporin, is an effective, safe and low-cost antibiotic for surgical prophylaxis in general surgeries, in particular for patients who need sequential antibiotic therapy. Cefuroxime can be administered alone or in combination with other classes of antibiotics based on clinical characteristics of individual patients and surgeon’s discretion to reduce the risk of postoperative SSIs, abscess, septicemia, and microbial growth. Key Messages: Cefuroxime can be administered alone or in combination with other classes of antibiotics based on clinical characteristics of individual patients and surgeon’s discretion to reduce the risk of postoperative SSIs, abscess, septicemia, and microbial growth. Keywords: Cefuroxime, Surgical wound infection, Cross infection, Anti­bacterial agents, Abscess, Sepsis.

Aim: This study aimed to assess effectiveness and safety of Evogliptin 5 mg in patients with T2DM who were prescribed Evogliptin alone or with other oral hypoglycemic agents in real world scenario. Materials and Methods: Overall 20 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. Primary endpoint was mean changes in HbA1c from baseline to weeks 24 and secondary endpoints were Change in HbA1c from baseline to weeks 12 Change from baseline in FPG & PPG at weeks 12 & 24. Results: Significant reduction in HbA1c at the end of 12 and 24 weeks of Evogliptin therapy was - 0.9% and -1.45% respectively from the baseline of HbA1c 8.6% (p value At the end of 12 and 24 weeks of addition of Evogliptin, significant reduction in FBG were seen i.e -49.5 mg/dl and -90.7mg/dl respectively from base line of 182 mg/dl and reduction in PPG was -79.4mg/dl and -116.6mg/dl respectively from base line 277 mg/dl (p value Conclusion: Evogliptin was found to be effective when added to the patients who were uncontrolled on dual / triple oral anti-diabetic medications and even in treatment naïve patient. It effectively showed reduction in HbA1c, FBG and PPG and the end of 12 and 24 weeks when added to existing anti-diabetic medications & well tolerated in type 2 diabetes Indian patients. Limitations: Small sample size and retrospective study Keywords: PPG, FBG, DPP-4, T2DM