List of Most Significant Publications of Waclaw Szybalski

Professor Wacław Szybalski’s most significant scientific achievements are listed below in twenty-three points. He has authored over five hundred publications in the fields of chemistry, microbiology, molecular and synthetic biology, genetics, mutagenesis, and genetic engineering. Many of Professor Szybalski’s discoveries resulted from him first developing a series of original research techniques that then gave rise to new fields of science and novel concepts such as synthetic biology, gene therapy, and multiple drug therapy. The Web of Science, the most important database of scientific publications, lists 265 publications by Professor Szybalski that have been cited by other scientists over 12,000 times; his Hirsh index is 56, showing the strong impact of his work on science.

Assessment of Causality, Preventability and Severity of Cutaneous Adverse Drug Reactions: A Prospective Observational Study

Background: All drug regulatory authorities have to ensure the safety, efficacy and quality of all the marketed products. Quality and efficacy can be determined by the data from preclinical and clinical trials. In clinical trials at the pre-marketing stage, it is challenging to identify rare Adverse reactions (ADR) and delayed side effects or effects due to long-term exposure because of lack of follow-up. In this case, pharmacovigilance comes into picture where it plays a significant role in marketed drugs safety profile establishment. Aim: This study helps in safety profile establishment for drugs. Methodology: It was conducted by the Department of pharmacy practice at drug information Centre in collaboration with Department of pharmacology at private multi-specialty Hospital. ADR reporting forms of the Central Drug Standard Control Organization has been used for collecting the data, and this form includes patient demographic details like clinical history, co-morbid conditions like Diabetes mellitus, Hypertension, Asthma, history of any drug allergies etc. were collected. The chance of preventability modified Schumock and Thornton criteria was found to be very less, and it was evident that most of them were not. By using Hartwig et al., scale, the severity of ADRs were of moderate severity. The reason behind this moderate severity was a history of allergy and multiple drug therapy. Result: It was observed that preventability 86% were not preventable whereas 14% were preventable as per Schumock and Thornton scale. In these cases of definitely preventable cases were due to history of reaction upon administration of the same drug. It is advised that in such cases usage of drug alert card is preferred. Conclusion: The major risk factor for the development of ACDR includes self-medication, patients’ lack of awareness regarding the dose and frequency of administration, polypharmacy. This can be avoided by prescribing the required drugs only and by educating the patients regarding the drugs.

Idiopathic gigantomastia in a patient on polypharmacy

Gigantomastia is an uncommon benign condition characterized by massive breast enlargement. It is most often due to hormonal imbalance secondary to puberty or pregnancy, or induced by a pharmacological agent but can also be idiopathic. Herein, we report a rare case of idiopathic gigantomastia in a 46-year-old female on antiepileptic multiple-drug therapy who underwent total bilateral mastectomy to relieve associated pain.

Effects of Evogliptin as Add on in Type 2 Diabetes (T2DM) Subjects Inadequately Controlled With Metformin and Glimepiride Combination

Objective: To achieve targeted glycemic control people with diabetes required multiple drug therapy. We retrospectively studied effect of adding newly approved DPP4i evogliptin in T2DM subjects having high HbA1c value despite being on tolerable stable doses of Metformin and Glimepiride. Methods: We retrospectively analysed the effects of evogliptin 5 mg OD over 6 month preriod when added to patients who were initially having HbA1c ≥ 7.5% on on stable fixed dose combination of Metformin (1000 -2000 mg/day) and glimiperide (2 - 4 mg/day) at least from 3 months prior. Any patients who were other OHA drugs or in Insulin of have been up or down titrated of the studied drug were excluded. We compared HbA1c, fasting (FPG), postprandrial (PPG) plasma glucose, total cholesterol (TC), triglyceride (TG), HDL, LDL at baseline and after 6months of evogliptin initiation. Self-monitored blood glucose (SMBG) was performed using the patients’ own BG meter. Physicians gave all patients training to ensure they could perform SMBG correctly and accurately. Results: Data of 185 subjects [85(46%) females, Mean age 52.3±2.8 years, mean duration of diabetes 8.2±1.9], who met the inclusion criteria were extracted for analysis from the hospital and clinics records. A drop in HbA1c from 8.8±1.1 to 7.8±0.5% (p<0.05) were resulted after addition of evogliptin. FPG decreased from 159.2±13.5 to 128.3±11.2 and PPG from 238.2±28.7 to 188.1±22.6 respectively (p <0.05). Total cholesterol (TC), triglyceride (TG) were significantly improved after addition of evogliptin, whereas little effect on LDL and HDL. There was no incidence of severe hypoglycemia, though 7 (3.8%) cases of suspected hypoglycemia were managed at home. Conclusion: Evogliptin is a suitable add-on option for those with high HbA1c values as it offer low risk of hypoglycemia despite significant improvement in glycemic parameters.

Prescribing patterns in the management of arthritis in a rural tertiary care teaching hospital

Background: Based on 2003 National Health Insurance Scheme (NHIS) data, a projected 67 million (25%) adults aged 18 years or older will have arthritis and 25 million (37%) of those will have arthritis-attributable activity limitations by the year 2030. Objective of this study is to know the prevalence of different types of arthritis, current trends of drug prescribing patterns in its management and to create awareness about rational use of drugs in a rural tertiary care hospital.Methods: This was an observational study of drug prescriptions among 100 arthritis patients in a tertiary care teaching hospital, India. Patients diagnosed with arthritis with or without co-morbidities were enrolled in the study considering the inclusion and exclusion criteria with a verbal informed consent.Results: Out of 100 arthritis cases, prevalence of Osteoarthritis (OA) was seen more than Rheumatoid arthritis (RA). Osteoarthritis was more commonly seen in males and RA in females. Arthritis was more prevalent in the age group of 36-65 years. Oral route was the most preferred route of administration of drugs and Nonsteroidal anti-inflammatory drugs (NSAIDs) were the first choice. Vitamin D3+ calcium was the most commonly prescribed drug in arthritis. Diclofenac was the most commonly used drug for monotherapy in OA and methotrexate in RA.Conclusions: In this study, some patients diagnosed with RA were treated with NSAIDs as first line and no Disease Modifying Anti-Rheumatic Drugs (DMARD) were given. This irrational prescribing trend should be changed. Non-pharmacological treatment has a qualitative role in treating arthritis and should be advised instead of multiple drug therapy.

Drug utilization study of antihypertensive drugs used in the treatment of second and third trimester of pregnancy in tertiary care hospital

Background: Hypertensive disorders are major cause of the perinatal and maternal mortality and morbidity worldwide. Aim of study was to evaluate current trend of antihypertensive drugs and to assess frequency and distribution of antihypertensive drugs in pregnancy.Methods: A retrospective observational study was conducted in a tertiary care hospital for period of six months in collaboration with department of obstetrics and gynaecology. Patients data recorded in case report form and analysed to study prescription pattern and related information.Results: Total of 104 cases were enrolled in this study. Prescribed antihypertensive drugs in pregnancy were Labetalol, Nifedipine, MgSO4 and furosemide. Most commonly prescribed drug was labetalol. In this study, Gestational hypertension was most common diagnosis in hypertensive disorder. Majority of drug prescribed from category C and A. In present study, Single drug therapy was most commonly prescribed for hypertension in pregnancy was 64.42% whereas multiple drug therapy was 35.57%. Most common maternal complication was anaemia i.e. 54.05% followed by placental abruption in 24.3%. Neonatal outcome was low birth weight i.e.36% followed by preterm birth i.e.24%.Conclusions: Labetalol found to be most common prescribed drug. Single drug therapy prescription was high as compared to multiple drug therapy prescription in hypertensive disorders in pregnancy. Gestational hypertension was most common cause of hypertensive disorder. Anaemia was found to be most common maternal complication encountered in hypertensive disorders in pregnancy. Most common adverse neonatal outcome was low birth weight.

Management of Extrapulmonary Nontuberculous Mycobacterial Infections

Extrapulmonary disease occurs in a minority of nontuberculous mycobacterial (NTM) infections. The pattern of disease tends to be multifocal in immunocompromised individuals and localized in the immunocompetent. There is increasing recognition of disseminated Mycobacterium chimaera infection, as a complication of cardiac surgery, and focal infections due to rapidly growing mycobacteria. Microbiologic diagnosis requires detection of NTM in blood or tissue samples by microscopy, culture, or molecular methods. Management of extrapulmonary NTM infection requires prolonged, targeted multiple-drug therapy and, in some cases, aggressive surgical intervention. The optimal treatment approach is often unknown. Despite combined medical and surgical therapy, outcomes may be poor. A high degree of clinical suspicion and early diagnosis are required to maximize chances of a positive outcome.

Medically Significant Hypersensitivity Reaction to Dapsone: A Case Report

The drug Dapsone is a component of the World Health Organization multidrug therapy being used against leprosy. Although it has shown a good efficacy during the years, a few subjects develop adverse drug reactions associated with dapsone .We report a case of a patient who was prescribed dapsone as part of multiple drug therapy for leprosy following which he developed Dapsone induced Hypersensitivity Syndrome (DHS). He was prescribed steroids with a tapering dose. His condition worsened after weaning of the oral steroids. He also developed steroid-induced diabetes which was stabilized using anti-diabetic drugs.