Sam Johnson Udaya Chander J.

Surgery is increasingly recognized as a complex, longitudinal therapeutic process spanning preoperative preparation, anesthesia, intraoperative care, and postoperative recovery rather than an isolated operating room event. Because this continuum is highly medication-intensive and subject to challenges like polypharmacy, rapid drug administration, physiological instability, multiple transitions of care, and communication failures, the perioperative environment carries a high risk for preventable medication errors. This review explores the evolving role of the clinical pharmacist, transitioning from a passive dispenser to an active, multidisciplinary collaborator throughout the surgical pathway. In the preoperative phase, clinical pharmacists improve patient safety by constructing a best possible medication history, clarifying continuation or cessation plans for high-risk home therapies (such as anticoagulants and antidiabetics), and delivering patient education to reduce morning-of-surgery non-adherence. In the intraoperative phase, they support anesthesia providers through system-level and case-level interventions, including the standardization of medication trays and labeling, antimicrobial prophylaxis stewardship, and multimodal analgesic design. Postoperatively, pharmacists collaborate with anesthesiologists to optimize acute pain management, support opioid stewardship, manage thromboembolism prophylaxis, and coordinate comprehensive discharge reconciliation to prevent drug duplication or omission. Collaborative models-such as joint acute pain services and pre-anesthesia consultations-render medication reviews clinically actionable and significantly enhance therapy optimization. Although challenges like staffing constraints, training gaps, and inconsistent clinical integration persist, the future of perioperative pharmacy lies in proactive, technology-enabled care incorporating clinical decision support, barcode administration, and artificial intelligence to solidify clinical pharmacists as core contributors to surgical patient safety.

Background: Methylcobalamin is a naturally occurring, active form of Vitamin B12. Vitamin B12 is essential for the growth and development of healthy nerves and red blood cell production. Usually, the requirement of vitamin B12 is increased in thyrotoxicosis due to increased utilization and accelerated turnover imposed by increased metabolism. Vitamin B12 is generally well-tolerated and widely used in clinical settings. Parenteral vitamin B12 treatment in hospitalized patients is considered an effective therapy regardless of its etiology. Case Presentation: Herein, we report the case of a 26-year-old female patient admitted to the Obstetrics and Gynaecology department. She received a slow intravenous methylcobalamin injection on the 4th day of admission for his complaints. Then, she was administered with 2nd dose of intravenous methylcobalamin, after which she developed anaphylactic shock immediately. To address these serious adverse effects, the patient was administered Critical care with cardiopulmonary resuscitation without further delay. The patient had a spontaneous return of circulation within a few minutes of high-quality cardiopulmonary resuscitation. After treatment, the patient recovered and was discharged from the hospital. Conclusion: Anaphylactic shock, after slow intravenous methylcobalamin injection, is an uncommon but potentially serious adverse effect. The purpose of this case report is to highlight the importance of this rare but serious life-threatening adverse effect. To our knowledge, this is the first reported case of intravenous methylcobalamin-induced anaphylactic shock. Physicians and healthcare teams should be cautious while administering methylcobalamin to patients, especially via the intravenous route.

The liver plays a dynamic role in detoxification, metabolic regulation, and maintaining physiological balance, yet it is highly prone to damage from drugs and toxic substances. Paracetamol overdose is a well-known cause of drug-induced liver injury (DILI), emphasizing the importance of finding effective protective compounds. Proline has shown promise in protecting the liver due to its antioxidant properties and ability to preserve mitochondrial function. This study inspects the liver-protective potential of a synthetic proline-based compound, 1-[(2-hydroxyanilino) acetyl] pyrrolidine-2-carboxylic acid, through computational and animal model approaches. Molecular docking revealed robust affinity for gamma-glutamyl transpeptidase, a key enzyme in glutathione regulation. Animal studies in rats implied that the compound significantly lowered liver enzyme levels, reduced oxidative stress, and minimized liver tissue damage caused by paracetamol. Additionally, the proline derivative enhances glutamate production, thereby amplifying the glutathione synthesis pathway, further supporting its potential as a hepatoprotective agent.

Introduction: Bullous pemphigoid is the most common chronic recurrent autoimmune subepidermal blistering disorder most prevalent in geriatric population. It varies widely in clinical presentation ranging from tense bullae to intense generalized pruritus. It is immunologic in origin with the presence of IgG antibodies. Case Report: A 47-year-old female presented to the hospital with complaints of blisters in the lower limbs, which she was self managed with neem oil after which the blisters occurred over the body. The patient also experienced blisters over both upper and lower limbs, gluteal region, painful generalized uclers, necrotic patches, multiple erythematous blisters, ulcer erosions over bilateral legs and upper limbs with few lesions, which were foul-smelling and oozing. On second day of admission, the patient’s CRP and ESR levels were tested and the levels were 33.5 and 35mm/hr respectively. The patient was treated with injection meropenem 1 g three times daily, injection dexamethasone 4 mg once daily and injection ofloxacin 400 mg once daily. On the third day of admission, the patient complained of leg swelling and subsequently D-Dimer levels were checked which showed a value of 5,740 and was treated with injection enoxaparin 40 mg for same throughout the course of hospital stay A skin biopsy confirmed the diagnosis of bullous pemphigoid.. The culture test showed the growth of Klebsiella pneumonia and Acinetobacter baumani, which were resistant to most of the antibiotics. The patient was managed appropriately with modalities including antibiotics, anti-inflammatory agents, immunosuppressants, multivitamins, fluids, and albumin. The patient responded well to the treatment without new lesions or fever spikes. There was presence of necrotic patches of old lesions alone at the time of discharge. Conclusion: This case report was done with the purpose of presenting an exemplary case of bullous pemphigoid aggravated by the application of neem oil and emphasizing the inappropriate use of folk medicine in an autoimmune disease like bullous pemphigoid

Diastolic dysfunction represents a combination of impaired left ventricular (LV) relaxation, restoration forces, myocyte lengthening load and atrial function culminating in increased LV filling pressures. Current Doppler ECHO cardiographic guidelines recommend using early to late diastolic transmitral flow velocity (E/A). Although has important diagnostic and prognostic implications, they should be interpreted in the context of patients age and the rest of the echo-cardiogram to describe diastolic function and guide patient management. To investigate whether ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A) can be used as a tool to check the drug’s effectiveness and outcome of any intervention. To prepare a counseling plan to educate patients with reserved ejection fraction. To measure pharmacists’ intervention using E/A ratio. This is a retrospective and prospective, open-label, parallel-arm, randomized controlled study carried out in the Cardiology Department of a 1000 bedded multispecialty tertiary care private teaching hospital in Coimbatore on 80 patients for a period of six months. After the baseline measurements were carried out, the patients were randomized into either Usual Care Group or Interventional Group. The Usual Care Group is subjected to usual care by physician. The Interventional Group were counseled by the pharmacist in addition to the usual care provided by the physician. Statistical analysis was carried out using Student’s T test and One way ANOVA.A total of 80 patients were evaluated for change in the E/A ratios during their subsequent follow-up in a period of 3 months. The Usual Care Group totaled for about of 55% male and 45% female while the Interventional Group contained 65% male and 35% female. The patients were graded according to their respective E/A ratios at the baseline and 45% of the patients had normal E/A values, 47.5% of them with impaired filling and 7.5% had pseudonormal values in the Interventional Group whereas in the Usual Care Group 60% normal, 30% impaired and 10% pseudonormal. The patients were again graded according to the respective E/A ratios at the subsequent follow up after a period of 2 months and the values were found to be 77.5% in the Interventional Group, 17.5% impaired and 5% pseudonormal in the Usual Care Group whereas 80% normal and 20% impaired in Usual Care Group. The study was not able to demonstrate a significant difference between the grading of the ratios in the first and second reviews among both the groups. But the study demonstrated a significant difference in the E/A ratios of the two reviews and was better observed in patients of the Interventional Group when compared to those of the Usual Care Group.

Background: In March 2020, the World Health Organization declared the coronavirus disease 2019 as a global pandemic. Though antiviral drugs and antimalarial drugs are considered treatment options for treating coronavirus disease 2019 (COVID-19), no specific antivirals are currently available for its treatment. Efficient use of drug discovery approaches including repurposing or repositioning of drugs used in the treatment of severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) is considered recently. The widespread application of corticosteroid therapy in COVID-19 should be backed with careful documented pragmatic research of its use in this context. Main body: This article aims to analyze various trials registered across the globe providing an overall picture of the use of corticosteroids in the treatment of COVID-19. An extensive search was conducted on the clinical trial registries around the world to identify all the trials reporting information regarding the use of corticosteroids in COVID-19. Our initial search returned 231 trials, out of which 60 trials were finally included in the analysis. Fifty-six studies were interventional trials, and all the trials had clearly defined primary and secondary outcomes of interest, of which only 11 trials had evaluation of respiratory rate as one of their outcomes. Conclusion: Few preliminary trial findings show promising results and recommend the use of methylprednisolone and dexamethasone in the severe form of the disease; however, there is insufficient data to prove its benefits over its risks. Routine use of corticosteroids should be favored only after a better insight is obtained, with the completion of these trials.

According to the Global Adult Tobacco Survey (GATS), there were 267 million tobacco users in India during 2016–2017. It is also estimated that about one million people die each year due to tobacco-related diseases in India. Tobacco cessation is the only way by which tobacco-related morbidity...

To assess the effect of micronutrients on health outcomes in patients with heart failure. Only randomized controlled trials testing the effectiveness of different micronutrients either singly or combined versus placebo in heart failure patients were included. We conducted a search in different databases such as Medline from PubMed, Embase and Scopus from Elsevier, and Google Scholar. The keywords used in the search were "Heart Failure" and its cognates, "Micronutrient," "Minerals," and names of individual micronutrients. Out of 3288 titles and abstracts reviewed, only 11 trials comprising 529 individuals were found to be appropriate to be included in the final review. It was found that micronutrients, either single or combined, improved the health outcomes of heart failure patients by improving exercise tolerance, functional capacity, left ventricular function, flow-dependent dilation, and inflammatory milieu, thereby improving the quality of life of health failure patients. Certain micronutrients also normalized endothelial dysfunction. Overall, this systematic review found sufficient evidence to support a large-scale trial on micronutrient supplementation in patients with heart failure.

Due to the lack of clear, comprehensive, and rational drug policy, the production of pharmaceutical preparations in India is distorted for the most part. Indian markets are flooded with more than 70,000 formulations, compared to approximately 350 formulations listed in the World Health Organization (WHO) Essential Drug List. Studies have indicated that majority of prescriptions in India are of drugs of “doubtful efficacy.” To promote rational drug use in developing countries, assessment of drug use patterns with the WHO drug use indicators is becoming increasingly necessary. The aim of this study was to assess the patterns of drug use by using WHO core drug use and complementary indicators. One thousand fifty-two patients were prospectively interviewed and their prescriptions analyzed according to WHO guideline five randomly selected busy community pharmacies in northern district of the State of Tamil Nadu, South India to analyze the WHO core drug use and complementary indicators using an investigator-administered data collection form. The main outcome measured is patterns of drug use measured using WHO core drug use and complementary indicators. The data obtained showed that, out of total drugs prescribed (3936), only 2.5 % (100) drugs were prescribed by generic name. Mean number of drugs per encounter was 3.7. Use of antibiotics was 22 %, percentage of encounters with an injection was 7.2 %, and the percentage of drugs prescribed from formulary was 99.8 %. Brand name prescribing is dominated even in rural India. There is a need to improve the availability of essential guidelines and key drugs in the stock in rural areas of India. Prescriptions studied were conforming to most indicators of WHO except the number of drugs prescribed & generic name prescription practice, which deviated. In India the healthcare is dominated by private practitioners at the primary level. Prescription practices of the individual community-based clinician needs consistent monitoring with respect to generic name prescribing habits as well as the number of drugs prescribed. The WHO drug use indicator guidelines need to be promoted amidst the primary care clinicians and should not be just limited to hospitals having a formulary. The data collected by this study can be used by policymakers to monitor and improve the prescribing and consumption of pharmaceutical products in Southern India.

Recently, the topic of Drug-Drug interactions has received a better attention from the regulatory, scientific, and healthcare community worldwide. Although it is impossible to present all the drug combination causing Drug-Drug Interactions (DDIs), this article will summarize the mechanism of action associated with DDIs. DDIs tends to be more common among certain patients with underlying diseases, co-morbid conditions, etc., and in specific clinical situations such as polypharmacy and usage of drugs with a narrow therapeutic range or low therapeutic index. Therefore, successful prevention requires knowledge on molecular mechanisms of drug interaction, severity classification, management and prevention of drug interaction and sources of information on drug interaction, coupled with vigilance, reporting of drug interaction and early intervention. Surprisingly, little information is available to guide us with respect to avoiding complications in critical situation. Therefore, it is necessary to focus more on the concept of drug interaction. Software checkers for identifying drug interactions are widely available. Since the sorting out of clinically significant drug interaction is impossible with these software's, it has limited clinical utility. As it is no longer practical for physicians to memorize the list of drug interactions to avoid potential drug interactions, it is an important part of clinical practice of knowing how drugdrug interactions occur and how to manage them. Hence, this review aims to present the conceptual framework of drug-drug interactions and their path physiology.