Browsing by Author "Kumudini Acharya"

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A Real-world Pilot Observational Study of Neuropathic Pain Medications in Older Adult Patients in North India
(Bentham Science Publishers, 2022) Upinder Kaur; Vandana Dwivedi; Alok Singh; Amit Singh; Arun Raj Pandey; Kumudini Acharya; Sankha Shubhra Chakrabarti
Aims: This pilot study aimed to make head-to-head comparisons of multiple classes of drugs used in the management of neuropathic pain in North Indian older adult patients pre-senting to the geriatric clinic of a tertiary medical institution. Background: Chronic neuropathic pain is a condition affecting nearly one third of older adults. There is paucity of data on head-to-head comparisons of drugs used in neuropathic pain in older adults. Real world studies may be a useful tool to study diverse neuropathic pain medications in this population. Objectives: The study objective was to measure NPRS (numeric pain rating scale), GDS (geri-atric depression scale), IADL (instrumental activities of daily living), HMSE (Hindi mental state examination) scores at baseline, and 4-and 12-week follow-ups in all older adult patients receiving neuropathic pain medications. Methods: A prospective observational study was conducted involving older adult patients ≥ 50 years of age with painful peripheral neuropathy of any etiology (n=60; mean age 63±8.4 years). The patients received either gabapentin, pregabalin, duloxetine, amitriptyline, or me-thyl-cobalamin complex. NPRS, GDS, IADL, and HMSE scores were measured at baseline and post-therapy. Results: All groups except amitriptyline showed statistically significant improvement in NPRS at 4 weeks and 12 weeks compared to baseline. 30% response rate at 4 weeks was maximum for pregabalin (72%) and 50% response rate at 12 weeks was maximum for gabapentin (58%). Numerically maximum improvement in depression was seen with duloxetine. There was no statistically significant difference in the measured parameters between the drug groups across time. Mean daily dose was 172 mg (gabapentin group), 75 mg (pregabalin group) and 20 mg (duloxetine group). The adverse drug reaction rate was 10.5%. Conclusion: All drug groups showed beneficial effects on neuropathic pain at much lower doses than those described in the literature. The effectiveness at these low doses and the lower rates of adverse effects sets the foundation for larger studies in the future in diverse ethnic and aged populations. © 2022 Bentham Science Publishers.
Levosulpiride associated neuroleptic malignant syndrome in an elderly patient: a tale of confusing brand names
(Springer Science and Business Media Deutschland GmbH, 2022) Upinder Kaur; Kumudini Acharya; Amit Singh; Indrajeet Singh Gambhir; Sankha Shubhra Chakrabarti
[No abstract available]
Should ACE2 be given a chance in COVID-19 therapeutics: A semi-systematic review of strategies enhancing ACE2
(Elsevier B.V., 2020) Upinder Kaur; Kumudini Acharya; Ritwick Mondal; Amit Singh; Luciano Saso; Sasanka Chakrabarti; Sankha Shubhra Chakrabarti
The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) has resulted in almost 28 million cases of COVID-19 (Corona virus disease-2019) and more than 900000 deaths worldwide since December 2019. In the absence of effective antiviral therapy and vaccine, treatment of COVID-19 is largely symptomatic. By making use of its spike (S) protein, the virus binds to its primary human cell receptor, angiotensin converting enzyme 2 (ACE2) which is present in the pulmonary epithelial cells as well as other organs. SARS-CoV-2 may cause a downregulation of ACE2. ACE2 plays a protective role in the pulmonary system through its Mas-receptor and alamandine-MrgD-TGR7 pathways. Loss of this protective effect could be a major component of COVID-19 pathogenesis. An attractive strategy in SARS-CoV-2 therapeutics would be to augment ACE2 either directly by supplementation or indirectly through drugs which increase its levels or stimulate its downstream players. In this semi-systematic review, we have analysed the pathophysiological interplay between ACE and ACE2 in the cardiopulmonary system, the modulation of these two proteins by SARS-CoV-2, and potential therapeutic avenues targeting ACE-Ang II and ACE2-Ang (1–7) axes, that can be utilized against COVID-19 disease progression. © 2020 Elsevier B.V.