Pharmacy students and Publications

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Pharmacy students and Publications: Pharmacy, academics, journals, science

A New One-Pill-a-Day Treatment for HIV has been approved

As expected, there’s a new single pill regimen for HIV, this one containing abacavir (ABC)/lamivudine (3TC)/dolutegravir (DTG), and it’s called Triumeq. 

The most important study for this combination was the SINGLE study, which showed that ABC/3TC + DTG (given as two pills) was superior to TDF/FTC/EFV (given as one), the difference based primarily on tolerability advantage of the former. It was a novel double-blind study, as all three drugs were different in each treatment arm.

Another benefit DTG-based regimens — whether given with ABC/3TC or TDF/FTC as separate pills — is that to date, no treatment-naive patient with virologic failure has developed resistance to DTG. I suspect it will happen one of these days, but the data thus far suggest at the very least DTG resistance will be a rare event.

Needless to say, but will say it anyway for emphasis, all patients starting this regimen will need to be tested for HLA-B*5701 and found to be negative. Wonder if pharmacies will enforce this, or whether it will be left up to the prescribers. Here’s the landmark study that proved this testing essentially excludes severe hypersensitivity to ABC, quite an amazing story in pharmacogenomics.

An unresolved question is whether ABC is associated with an increased risk of cardiovascular disease. This FDA meta analysis of randomized clinical trials didn’t think so, but around half of the observational studies did, including the updated DAD study. NA-ACCORD data will be of great interest, whenever they appear.

As of Sunday, August 24, the price of ABC/3TC/DTG is not known (at least to me) — and it could be a real game changer, since both ABC and 3TC are already generic. Says Ben Young over on TheBody: “If ViiV Healthcare manages to set the price of Triumeq in accordance with the generic status of abacavir and lamivudine, the cost should be substantially lower than the price of the other single-tablet regimens that contain all on-patent components.” Yep.

I suspect people will call it “Trii” (rhymes with “Cy”, as in “Cy Young”) for a while, just like they called TDF/FTC/EVG/COBI “Quad”.

So what are some upcoming single-tablet regimens? Tenofovir alafenamide (TAF) with FTC/EVG/COBI. TAF/FTC/DRV/COBI. DTG/rilpivirine. And inevitably, generic TDF/3TC/EFV, which is widely available globally.

Regardless, sure beats the old days.

Know more how to improve adherence to HIV patients: MEDICATION ADHERENCE COUNSELING FOR HIV PATIENTS BY PHARMACIST

by
Dr.Akshaya Srikanth, PharmD.

Act Now, or Face Aatastrophic Post-Antibiotic Era

The Antibiotic Resistance Coalition, comprising civil society organisations and stakeholders from multiple sectors on six continents, has called on World Health Organization (WHO) Member States to pass a critical resolution (Combating antimicrobial resistance, including antibiotic resistance) at the 67th World Health Assembly that would spark concerted global action to control the escalating antimicrobial resistance crisis.

“Antimicrobial resistance—and particularly antibiotic resistance—is the most pressing public health issue facing the global community,” said Otto Cars, founder of ReAct (Action on Antibiotic Resistance). “If the resolution is not passed, and the WHO and its Member States do not act quickly, there will be disastrous global health consequences.” Public health researchers estimate that, each year, millions of people around the world are infected with antibiotic-resistant bacteria, and hundreds of thousands of them die. Without immediate action, that toll is expected to worsen.

“We are on the precipice of a post-antibiotic era,” said Tim Reed, executive director of Health Action International. “Without a radical shift in the way antibiotics are marketed and used—and unless we overcome the gap in antibiotics discovery—antibiotic resistance will continue to become one of

the greatest threats to humankind.”

The Antibiotic Resistance Coalition, in its declaration released today, asserts that consumer protection and public health must trump the pursuit of profit, and that effective antibiotics are global public goods. The

Coalition also calls for international leadership and action to, in part:

• Prohibit the promotion and advertising of antibiotics;

• Promote new, needs-driven and open research and development models based on the principle of de-linkage (divorcing price from research and development costs and sales volumes);

• Phase out the use of antimicrobials for routine disease prevention in livestock, and end their use, altogether, for growth promotion;

• Build robust systems, in all countries, to monitor and report antibiotic use and resistance trends in humans and animals; and

• Improve public awareness to support an ecological understanding of human-bacteria interaction and behaviour change around antibiotic use.

“Member States must deliver a strong mandate to the WHO to not only develop a pressing action plan on antimicrobial resistance, but also to ensure that public health is prioritised over commercial interests,” said Yoke Ling-Chee, program director with Third World Network. “Access to affordable and effective antibiotics is of particular importance for developing countries.”

The Antibiotic Resistance Coalition will deliver an intervention to the World Health Assembly prior to the vote. The Antibiotic Resistance Coalition is also inviting other civil society organisations around the world to sign its declaration, which is available at www.reactgroup.org/arcdeclaration 

Antimicrobial resistance is a general term that refers to resistance to a compound that kills or stops the growth of microorganisms, including bacteria, fungus, parasites and viruses. Antibiotic resistance refers specifically to resistance to anti-bacterial agents.

The Antibiotic Resistance Coalition consists of numerous civil society organisations and stakeholders from six continents working in the health, agriculture, consumer and development sectors. It advocates for policy change and action to prevent the post-antibiotic era from becoming a bleak reality. 

by 

Dr.Akshaya Srikanth, PharmD.

HYDROGEL: A New way to heal Knees ?

Bad or painful knees are one of the most common causes of pain in the elderly, and can start at quite an early age due to extra stress on the cartilage or due to injury. This damage is rarely healed by the body. 

Part of the reason this damage doesn't heal well is because the cartilage in the knee gets very little blood flow, which body parts need to fix problems on a cellular level. Part of the standard treatment for knee cartilage healing is to make tiny holes in the area and let the blood pour in to encourage a healing process.

There are two problems with this method. The first is that the new tissue rarely replaces all of the damaged tissue, meaning it is never a complete replacement. The second is that the space may fill with scar tissue instead of new cartilage, which isn't really a solution.

But a new method is seeing light recently, as published in the journal of Translational Medicine, scientists, including biomedical engineer Jennifer Elisseeff from Johns Hopkins University. This method proposes the use of a replacement material, a hydrogel with some special properties.

The gel, which looks a lot like jell-o and behaves a lot like it too, is injected into the knee as liquid. However, once it is exposed to UV light, it hardens, providing a sort of scaffold for stem cells to attach to and grow on. The way it is built involves many bindings and criss-crossing fibers, to provide a very strong and stable structure. 

To test this, Elisseeff and team tried the method on 15 patients. They poured the liquid hydrogel into the patients' torn cartilage. After that, the surgeons shined the UV light and hardened the polymers in the gel.

The results were very promising, the new cartilage filled 86% of the torn area. This was compared to 3 subjects who were treated in the standard way - for them, only 64% of the torn area was filled. 

In addition, the patients who got the hydrogel treatment reported considerably less pain than the control group patients. 

At the moment, larger studies are being held testing this method, but results seem promising, says Farshid Guilak, an orthopedic surgeon at Duke University, and adds that with the advance of stem cell treatments, the efficiency of this system will only grow, as we will be able to use the body's own cells to facilitate faster growing of cartilage, and get more people out of pain and on their feet.

by

Dr.Akshaya Srikanth, Pharm.D

Pharm.D India

Protect your BONES

Osteoporosis is a disease that damages the bones, weakens them and makes them brittle and breakable. There is a significant decrease in bone density, and this causes the bone to weaken and increases the risk of fractures.

Our bones are always building and breaking down bone tissue, when the balance between building and breaking is changed, then the bone density goes down. With age, this problem has a horrible way of increasing in occurrence.

Before you are 10 Golden Rules for the treatment and prevention of decreasing bone density:

1. Yes, you guessed it - Physical activity.
Physical activity, besides being the best thing you can do for yourselves, helps the bones become denser by putting pressure on them, which may prevent the disease to begin with. We recommend using weights.

2. Increase your calcium intake - Good sources: Green leaves, soy, sardines, broccoli and nuts. Regular bovine milk isn't that good a source of calcium because of its low absorption rate.

3. Increase your omega 3 intake - These fatty acids can be found in flax seeds of fish: Salmon, cod, and halibut - and are essential to keeping your bones strong.

4. Reduce caffeine and alcohol intake - Sorry, but coffee and alcohol 'release' calcium from the bones and damage the hormonal balance in the body important to keep them strong.

5. Reduce red meat - Seems like we're taking all the fun out of lunch, but eating red meat actually reduces the absorption of calcium in the body.

6. No smoking - Cigarette smoke damages bone density.

7. Eat nuts and almonds - These contain magnesium which is essential to the process of absorbing calcium.

8. Get at least 15 minutes of sun exposure a day - Exposing your skin to the sun a few minutes a day is the best way of getting your vitamin D, which function as a sort of glue and helps keep the bone density up.

9. Eat sunflower seeds - Contain zinc, a key mineral for maintaining strong bones.

10. Make sure you're not lacking in these elements, and take according to professional opinion: Boron, Silicone, vitamin C, vitamin D, calcium, magnesium, vitamin B12, vitamin B6 and folic acid.
by
Dr.Akshaya Srikanth, PharmD.

Young Indians at a greater risk of hypertension

A pan – India survey, conducted by Metropolis Healthcare Ltd ahead of ‘Hypertension Day’ showed a majority of people between 30 to 40 years have alarming LDL cholesterol levels. The survey conducted by Metropolis covered major cities like Delhi, Mumbai, Bangalore and Chennai. Out of the total 10738 lipid profiles done, 25% to 30 % have high Bad Cholesterol (Total Cholesterol, LDL and Triglycerides) and are at a higher risk of acquiring cardiovascular diseases. This could be partly attributed to corporate stress, unhealthy diet and sedentary lifestyle which reflect in the higher LDL cholesterol levels. Also observed was that a fairly substantial number of youngsters examined during the survey have showed the first signs of the onset of a heart ailment — hyper cholesterol and hypertension. 

Individuals have become more aware of the fact that heart disease is not just a disease of the elderly and are now a lot more determined to go a long-way in combating this disease. Calling for regular screening of unhealthy cholesterol and lipid levels, researchers at Metropolis said surveys such as the one conducted would help identify people who are at a greater risk of Hypertension. Preventive measures are required so as to reduce obesity, increasing physical activity, decreasing the salt intake of the population and a concerted effort to promote awareness about hypertension and related risk behaviours. 

The statistics below clearly indicate that young people in the age group 30-40 have high cholesterol, LDL and triglyceride levels and as a result are at a greater risk of hypertension.

by

Dr.Akshaya Srikanth, PharmD., MPH

HERBAL MEDICINE - WORTH HEALING

The herbalist had 23 wives and raised more than 200 children

According to the official records, herbalist Li Ching-Yuen was born in China in 1677 (although he himself claimed that he was born in 1736). Throughout his long life, he constantly practiced herbalism and martial arts. In 1930, the New York Times newspaper printed an article in which they published official Chinese government documents that were uncovered. These documents, dating back to 1827, contained official congratulations on Li Ching-Yuen's 150th birthday. Later documents, dating back to 1877, contained official congratulations on his 200th birthday.

How did he do that?

Li Ching-Yuen expressed his longevity formula in one sentence: "Retain a calm heart, sit like a turtle, walk swiftly like a pigeon, and sleep like a dog".

Let's add a few more interesting historical facts to this story. Chinese army general Yang Sen invited Li to visit him, and offered him an opportunity to teach Chinese soldiers martial arts. The general could not believe how youthful his guest was, even though he had reached an age of 250 years old.

Li Ching-Yuen died on the 6th of May in 1933. He told his students that he had completed all his tasks in this lifetime, and he was now ready to come home.

Is this a true story? No one knows the truth, but if you read this story using your heart and not a limited rational mind, then you can understand the subtle meaning of it and learn a lot more.

It is possible to find other interesting stories about Western health prodigies and Eastern Yogis who lived for over 100 years. Not only did they survive for this long, they also thrived—youthful, active, and full of enthusiasm. What could we learn from them?

Holistic medicine is all that we need

These days, even modern medicine agrees: 70% of all illnesses materialise because of negative thoughts or emotional stress. Illnesses attributed to this cause are called “psychosomatic,” and they are the biggest headache of the whole mainstream healthcare system.

Sometimes several days of elevated stress is all that is needed to open up a gastric ulcer. Sometimes several years of it is all it takes to develop diabetes or heart disease, not to mention poor general health, lowered productivity, and lack of happiness. Doctors and scientists unanimously agree that our thoughts directly affect the activity of our organs and the state of our bodies in general. Ancient medicine is classified as holistic, because it takes care not only of the physical body, but also of the psyche, as well as one's personal lifestyle. This method allows one to remove the cause of the illness, rather than merely treating the symptoms, therefore stopping it from reappearing. Modern medicine, on the other hand, deals with the consequences of the illness—bodily ailments. This is why the illness often comes back, since the cause of the illness is not actually being treated.

This is where one of the biggest secrets to health reveals itself—our thoughts can heal us. There are multiple recorded stories that discuss people who were severely ill and healed themselves with the power of thought, despite doctors losing all hope. One of such impressive story tells us about Morris Goodman, who, in 1981, was involved in a plane crash and was supposed to die due to irreversible spine damage and a punctured diaphragm. The man's life was supported by a breathing ventilator, and the only movement he could do was blinking. However, this man was aware of the power of thought, and in just a few days successfully regenerated his own diaphragm and could breathe independently. He also consciously regenerated his damaged spinal cord and started to move all of his limbs. Doctors could not understand the situation at all because this just “could not be happening.” After a few months, however, Morris Goodman began to walk again, and eventually fully recovered. This is only one of many cases that are happening all around us. Thoughts cannot only make the body ill, but can also help it recover from incurable diseases.

Causes of hard to cure diseases from a different angle

The ancient ayurvedic health sciences not only prove the existence of psychosomatic illnesses, but also present a list of specific illnesses caused by specific character traits. What else could the thoughts be dependent on if not on the character?

Here are a few examples that could explain the causes of disease you or your loved ones may be suffering from:

1. Jealousy - causes oncological diseases, weakens the immune system.

2. Vengefulness - causes insomnia and throat diseases.

3. Inability to find a solution to a situation - causes lung diseases.

4. Lacking moral principals - causes chronic diseases, infections, and skin diseases.

5. Being too categorical or unwavering in beliefs - causes diabetes, migraines, and inflammations.

6. Lying - causes alcoholism, fungal infections, and weakens the immune system.

7. Aggressiveness - causes gastric ulcers, acid reflux, and warts.

8. Reticence - causes schizophrenia and kidney diseases.

9. Cruelty - causes epilepsy, asthma, and anemia.

10. Seeking conflicts - causes thyroid enlargement.

11. Apathy - causes diabetes.

12. Inconsistency or being fickle - causes infertility.

13. Being rude or insulting - causes diabetes and heart diseases.

14. Anxiety - causes digestive system disorders, heart, and skin diseases.

15. Greed - causes oncological diseases, obesity, and heart diseases.

How can we know this is truth? Many great things in this world can only be tested by experience and not by thinking about them. Ayurveda is an ancient science that still works today and is used by many great people.

An interesting fact is that it is enough to cure your character, and the relevant diseases go away permanently. This is especially important to know for those who suffer from diseases such as diabetes and cancer, for which modern medicine does not have a cure yet.

Three ways to live healthfully and truly feel good. It will involve working on yourself—however, this investment will pay off greatly in the long run. Here are three methods, tested throughout three millenniums:

1. Start monitoring your thoughts. Spend five minutes every evening writing down how you felt that day. Remember the situations you encountered and emotions you felt. What negative character traits does that uncover? What do you plan to do tomorrow to start improving yourself and to change those particular character traits? It is very important to write everything down.

2. Try to think more about things that make you happy. This is the miracle of positive thinking. When you concentrate on the things that you like, it's as if you move to a different frequency of vibrations, and the body starts to heal itself. Even better, there will be a greater number of good things in your life, because everything you think about becomes reality, including the problems that bother you. Concentrate on things you enjoy and watch how everything begins to change.

3. Try out meditation. During meditation, the body and mind rest and heal themselves. You can read more about meditation in the article “How To Own A New Ferrari And Be As Smart As Einstein, Just By Calmly Sitting On Your Couch”.

Illness is simply our body's signal about an incorrect (or, rather, non-beneficial) lifestyle. Firstly it manifests as anxiety, fear, and negative thoughts. Only then, if no effort is made to work on oneself, the body sends a more powerful signal to get your attention and make you think about what you are doing wrong, in the form of physical symptoms.

Leave only the useful and meaningful things in your life. Because everything that is useful to you is always useful to others.

by

Dr.Akshaya Srikanth, 

Pharm.D India