Browsing by Author "Noti Taruni Srija Reddy"

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Dopaminergic Drugs and Valproate-associated Refractory Hyponatremia Over Levosulpiride-induced Parkinsonism in an Elderly Female Patient When Deprescribing was the Only Therapy
(Bentham Science Publishers, 2025) Amol Dehade; Sankha Shubhra Chakrabarti; Noti Taruni Srija Reddy; Upinder Kaur
Introduction: Prescribing cascade is a condition in which a drug administered to a patient causes an adverse reaction that is misinterpreted as a new condition, resulting in the addition of a new drug. Case Presentation: Here, we report the case of an elderly female patient who suffered from metabolic, neurologic, and urinary consequences of a prescribing cascade of antiemetic, antiepileptic, and dopaminergic drugs. While levosulpiride caused Parkinsonian symptoms, the dopaminergic drugs and valproate caused refractory hyponatremia followed by altered sensorium, and clidinium contributed to urinary retention. Conclusion: The case highlights the need to be vigilant for adverse consequences of the prescribing cascade, especially for antiemetic drugs, such as levosulpiride, because of its propensity to induce extrapyramidal reactions in older patients. In cases of refractory hyponatremia, a trial of de-challenge of valproate and dopaminergic drugs should be considered. The identification and removal of the culprit drugs can rescue the patient from a disabling cycle of adverse drug reactions. © 2025 Bentham Science Publishers.
Late-Onset Inflammatory Bowel Disease and Flares in Adenoviral and Inactivated Coronavirus Vaccine Recipients
(Lippincott Williams and Wilkins, 2024) Upinder Kaur; Dondapati Venkata Vamshi Krishna; Jaideep Reddy; Noti Taruni Srija Reddy; Amol Dehade; Sankha Shubhra Chakrabarti; Dawesh Prakash Yadav
[No abstract available]
Patterns and outcomes of late onset thyroid disturbances after COVID-19 vaccination: A report of 75 cases
(John Wiley and Sons Inc, 2024) Upinder Kaur; Noti Taruni Srija Reddy; Jaideep Reddy; Dondapati Venkata Vamshi Krishna; Amol Dehade; Neeraj Kumar Agrawal
Isolated cases of subacute thyroiditis exist in the early period of COVID-19 vaccination, largely after mRNA vaccines. Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID-19 vaccination. Seventy-five patients with post COVID-19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty-one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose. Most cases occurred after ChAdOx1-nCoV-19, which was the commonest vaccine employed in mass roll out in India. Significant improvement was observed in majority, after a median follow up of 22–26 weeks. New onset health issues persisting for ≥4 weeks were reported in 37.3% and were common in individuals with history of COVID-19 before vaccine. New onset metabolic, musculoskeletal, and reproductive disorders were the common health complaints. Active monitoring is warranted for late onset adverse events after COVID-19 vaccines of all types. Larger studies with involvement of unvaccinated individuals are required to understand the incidence and causality of late onset thyroid disturbances after COVID-19 vaccines. © 2023 John Wiley & Sons Ltd.
Patterns, outcomes, and preventability of clinically manifest drug-drug interactions in older outpatients: a subgroup analysis from a 6-year-long observational study in North India
(Springer Science and Business Media Deutschland GmbH, 2025) Upinder Kaur; Jaideep Reddy; Noti Taruni Srija Reddy; Indrajeet Singh Gambhir; Ashish Kumar Yadav; Sankha Shubhra Chakrabarti
Older adults are vulnerable to adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Evidence on clinically manifest DDIs in older outpatients is scanty. The present study aims to report clinically manifest DDIs, their risk factors, and preventive measures. A subgroup analysis of a 6-year (2015–2021) long prospective study was conducted in a tertiary hospital in North India. Older outpatients with ADRs constituted the study participants. Among 933 ADRs reported in 10,400 patient registrations, clinically manifest DDIs were involved in 199 (21.3%). DDIs accounted for 29.9%, 26.5%, and 21.3% of drug-related metabolic, vascular, and nervous system disorders, respectively. Movement disorders (n = 18), hypotension (n = 16), and hypoglycemia (n = 15) were the most common manifestations. Eighty-six percent of DDIs were of the pharmacodynamic type, and 13.1% were immune-mediated. Around 35% of DDIs resulted in hospitalization, with hyponatremia, movement disorder, and renal impairment as the common reasons. Older adults with Parkinsonism, infection, coronary artery disease, neuropsychiatric disease, and diabetes mellitus, respectively, had 3.28, 2.85, 1.97, 1.76, and 1.80 times higher odds of DDIs. Those receiving ≥ 10 drugs had 5.31 times higher odds of DDIs compared to individuals receiving 1–4 drugs. “Avoiding the causative drug,” “optimal monitoring of the patient,” and “start-low and go-slow” policy together could prevent 85% of DDIs. In conclusion, every fifth case of ADRs and nearly one third of ADR-related hospitalizations in older adults are related to DDIs. Movement disorder, hypotension, and hypoglycemia are the common manifestations. A holistic approach with drug omission, optimal patient monitoring, and slow titration of therapy can prevent significant DDIs in older adults. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
Persistent Health Issues, Adverse Events, and Effectiveness of Vaccines during the Second Wave of COVID-19: A Cohort Study from a Tertiary Hospital in North India
(MDPI, 2022) Upinder Kaur; Sapna Bala; Aditi Joshi; Noti Taruni Srija Reddy; Chetan Japur; Mayank Chauhan; Nikitha Pedapanga; Shubham Kumar; Anurup Mukherjee; Vaibhav Mishra; Dolly Talda; Rohit Singh; Rohit Kumar Gupta; Ashish Kumar Yadav; Poonam Jyoti Rana; Jyoti Srivastava; Shobha Bhat K; Anup Singh; G. Naveen Kumar P.; Manoj Pandey; Kishor Patwardhan; Sangeeta Kansal; Sankha Shubhra Chakrabarti
Background There is paucity of real-world data on COVID-19 vaccine effectiveness from cohort designs. Variable vaccine performance has been observed in test-negative case-control designs. There is also scarce real-world data of health issues in individuals receiving vaccines after prior COVID-19, and of adverse events of significant concern (AESCs) in the vaccinated. Methods: A cohort study was conducted from July 2021 to December 2021 in a tertiary hospital of North India. The primary outcome was vaccine effectiveness against COVID-19 during the second wave in India. Secondary outcomes were AESCs, and persistent health issues in those receiving COVID-19 vaccines. Regression analyses were performed to determine risk factors of COVID-19 outcomes and persistent health issues. Results: Of the 2760 health care workers included, 2544 had received COVID-19 vaccines, with COVISHIELD (rChAdOx1-nCoV-19 vaccine) received by 2476 (97.3%) and COVAXIN (inactivated SARS-CoV-2 vaccine) by 64 (2.5%). A total of 2691 HCWs were included in the vaccine effectiveness analysis, and 973 COVID-19 events were reported during the period of analysis. Maximum effectiveness of two doses of vaccine in preventing COVID-19 occurrence was 17% across three different strategies of analysis adopted for robustness of data. One-dose recipients were at 1.27-times increased risk of COVID-19. Prior SARS-CoV-2 infection was a strong independent protective factor against COVID-19 (aOR 0.66). Full vaccination reduced moderate–severe COVID-19 by 57%. Those with lung disease were at 2.54-times increased risk of moderate–severe COVID-19, independent of vaccination status. AESCs were observed in 33/2544 (1.3%) vaccinees, including one case each of myocarditis and severe hypersensitivity. Individuals with hypothyroidism were at 5-times higher risk and those receiving a vaccine after recovery from COVID-19 were at 3-times higher risk of persistent health issues. Conclusions: COVID-19 vaccination reduced COVID-19 severity but offered marginal protection against occurrence. The possible relationship of asthma and hypothyroidism with COVID-19 outcomes necessitates focused research. With independent protection of SARS-CoV-2 infection, and high-risk of persistent health issues in individuals receiving vaccine after recovery from SARS-CoV-2 infection, the recommendation of vaccinating those with prior SARS-CoV-2 infection needs reconsideration. © 2022 by the authors.
Risk factors of cardiovascular adverse events in ChAdOx1-nCoV-19-vaccinated priority groups in North India
(Elsevier B.V., 2025) Noti Taruni Srija Reddy; Mahek Rai; Sankha Shubhra Chakrabarti; Upinder Kaur
Rationale: Studies on determinants of cardiovascular adverse events (CVAEs) in ChAdOx1-nCoV-19 vaccine recipients are scarce. Methods: This is a subgroup analysis of our published one-year prospective study (February 2021 to April 2022) on the safety of the ChAdOx1-nCoV-19 vaccine. Healthcare workers and the elderly were the core study participants (priority vaccine recipients) who were followed up telephonically for one year after vaccination. Patterns of CVAEs and their risk factors were analyzed. Results: Out of 1650 enrolled participants, the data on CVAEs were available for 1525. Cardiac AEs and vascular AEs occurred in 1.4 % and 1.8 %, respectively. CVAEs were serious in 0.45 % of participants. Obese individuals had 3.8- and 2-times higher odds of cardiac and vascular AEs, respectively. Individuals aged 40 years and above had 3 times higher odds of vascular AEs. Cardiac AEs were significantly more common after the first dose of the vaccine. No association was seen between CVAEs and COVID-19 before or after vaccination. The rates of persistent CVAEs were 2.4–3.1 %, 1.1–1.3 %, and 0.5–0.9 % in the Vaccine After COVID (VAC) group, COVID After Vaccine (CAV) group, and Vaccine NO COVID (VNC) group, respectively. Conclusion: The occurrence of CVAEs might be governed by the number of vaccine doses, age, obesity, and timing of the vaccine with respect to natural SARS-CoV-2 infection. While no causality can be established between the observed events and vaccination, individuals receiving any dose of vaccine after recovery from COVID-19 need extended monitoring for CVAEs. Larger studies including unvaccinated individuals are required to understand the predictors of CVAEs for the individualization of future vaccination policies. © 2025 The Authors