Vandana Tayal

Vitamin D is a fat-soluble secosteroid that has a major role in calcium homeostasis in humans. The non-calcaemic roles of vitamin D have been extensively studied in the past few decades, and it is associated with various diseases, including cardiovascular, central nervous system, respiratory, infectious, autoimmune, metabolic disorders, and carcinomas. This review aimed to analyse the available evidence on non-calcaemic roles of vitamin D. We found that most observational studies concluded that low levels of vitamin D are associated with the incidence of many diseases, and some of the interventional studies supported this by positive outcomes after vitamin D supplementation. However, most of the systematic reviews and meta-analyses concluded that vitamin D supplementation has no therapeutic benefit, although these had limitations of heterogeneity of studies and inclusion of low-quality studies. We conclude that further high-quality randomized controlled trials with vitamin D supplementation should be conducted in diseases where there is a strong association between low levels of vitamin D and disease incidence in large observation studies.

Human immunodeficiency virus (HIV) entry inhibitors are potential treatments for drug-resistant HIV in India. HIV drug resistance is increasing globally and in India, necessitating new treatment options. The current management strategies for resistant HIV cases have limitations, including emerging resistance to dolutegravir. Four Food and Drug Administration (FDA)-approved entry inhibitors are examined: Enfuvirtide, maraviroc, ibalizumab and fostemsavir. Their mechanisms of action, dosing regimens and efficacy from key clinical trials are presented. These inhibitors are effective against resistant strains and have a high genetic barrier to resistance. However, they also have limitations, such as parenteral administration requirements and high costs. Data suggest that despite higher initial costs, entry inhibitors can be cost-effective by reducing hospitalisations and long-term healthcare costs for managing drug-resistant HIV. HIV entry inhibitors have the potential to address drug resistance challenges and improve HIV treatment outcomes in India. Recommendations for India include considering the inclusion of enfuvirtide and maraviroc in national treatment guidelines for heavily treatment-experienced patients with resistant HIV.

BACKGROUND Epilepsy impacts millions of people, with many not responding to existing treatments. Some evidence links neuroinflammatory processes to epilepsy. Statins exhibit anti-inflammatory and neuroprotective properties, potentially offering antiepileptic effects. AIM To evaluate the anticonvulsant effects of rosuvastatin in animal models of epilepsy. METHODS Ninety-six albino mice were divided into 16 groups. In the maximal electroshock seizure (MES) model, eight groups received intraperitoneal vehicle, carbamazepine, rosuvastatin, or a combination. Outcomes measured included seizure protection [tonic hind limb extension (THLE)], duration of THLE, seizure duration, and mortality. In the pentylenetetrazol (PTZ) model, eight groups were pretreated with vehicle, valproate, rosuvastatin, or a combination, with outcomes measured as seizure latency, seizure duration, and mortality. RESULTS In the MES model, rosuvastatin exhibited protection against THLE in a small percentage of mice. Rosuvastatin shortens the duration of THLE in a dose-dependent manner. However, none of these were statistically significant compared to the control group. The combination of rosuvastatin 10 mg/kg with carbamazepine 4 mg/kg resulted in a significant reduction in seizure duration compared to the control group, better than carbamazepine alone at 4 mg/kg and 6 mg/kg. In the PTZ model, rosuvastatin alone showed no significant effects on latency, duration of seizure, or mortality. However, rosuvastatin 10 mg/kg combined with valproate 100 mg/kg significantly delayed the onset of seizures, seizure duration and mortality percentage, better than valproate alone at 100 mg/kg. CONCLUSION Rosuvastatin enhanced the anticonvulsant effects of carbamazepine and valproate. Further studies are required to explore the antiepileptic potential of rosuvastatin at various doses, durations, dosage forms, routes and models.

A 19-year-old female, known case of bipolar disorder had history of amenorrhea (absence of menstruation) for three years. While other causes of amenorrhea such as CNS, pregnancy, other medications, and thyroid issues were ruled out, she was found to have hyper-prolactinemia. Although antipsychotic medications are known to cause amenorrhea due to dopamine receptor blockade, which may result in hyperprolactinemia, the patient’s symptoms began before she started these medications. Only drug that she was on for long period is lithium. Current literature shows mixed evidence about lithium’s impact on prolactin levels, which can affect menstruation. This case may represent the first report of lithium causing amenorrhea through elevated prolactin levels. Clinicians should be aware of this potential side effect and monitor patients accordingly. Further studies are needed to confirm and understand this potential link.

Hypertension is one of the most important risk factors for the development of ischemic heart diseases, stroke, disability, vascular dementia, heart failure, renal dysfunction, retinopathy, and premature death. Despite the use of two or more blood pressure lowering medications, a considerable proportion of patients show poor control. Current antihypertensive medications show the limitation of use and effect in obese population, certain races like black population and also in renal impairment. Thus, there is an impending need to develop novel classes of antihypertensive agents acting on new targets with diversified mechanisms of action to more effectively manage raised blood pressure. With the introduction of the recent concept of overactive brain renin angiotensin system in cardiovascular disorders, attempts have been made to identify a molecule with the potential of inhibiting aminopeptidases involved in the formation of Angiotensin III. A novel aminopeptidase A inhibitor, also a prodrug Firibastat is currently undergoing development in Phase III clinical trials for hypertension as well as chronic heart failure. We hereby, provide an updated summary of evidence generated so far with Firibastat and also a glimpse into the therapeutic potential of this novel candidate extending beyond the spectrum of essential hypertension

Introduction: In the light of the disruption caused by the coronavirus pandemic on medical education systems worldwide, several institutions switched to online mode of teaching-learning. Therefore, this study was planned to evaluate the perception, difficulties faced, and preference of second year medical/dental students and their teachers toward the online learning and live-streamed lectures during the COVID-19 pandemic. Methods: This was a cross-sectional, questionnaire based observational study. Data were collected by administering pretested, self-administered, online circulated, structured questionnaire via Google Forms. Descriptive statistics were used to summarize the study results. Results: In this study, 198 and 77 responses were obtained from MBBS and BDS students, respectively, and 14 responses from their teachers. Most students agreed that it was a good idea to conduct online teaching during lockdown. Majority of the students were able to adapt even without previous experience. “GoToWebinar” and “Cisco Webex” were reported as good online teaching platforms. Smart phones or tablets were most commonly used to attend classes. Major challenges reported were related to lack of skills, interest, attention, time management, resources (including internet connectivity), and poor communication among others. The students felt that the optimum duration of lectures should be 30 to 45 minutes. Majority of students and teachers alike felt that online teaching is a good option to be adopted for repeat classes or to gain extra knowledge in the future. Overall rating of online teaching (out of 10) was reported as good by both students (MBBS students mean score: 7.49 ± 1.57) and teachers (mean score: 7 ± 1.58). Conclusions: The situation arising out of the pandemic gave rise to a situation where online resources had to be used for teaching. The shift of medical education to online platforms presented a spectrum of issues for educators and students alike. It would be worth considering addressing these issues, so as to strengthen electronic learning processes in the institute.