Symposia on symptomatic management of viral Infections, Diabetes and Hypertension

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PSIM Mid-Summer meeting at Swat
Symposia on symptomatic
management of viral Infections, 
Diabetes and Hypertension

SWAT: Prof. Sajid Abaidullah Prof. of Medicine at King Edward Medical University was one of the guest speakers at the Searle sponsored symposia during the PSIM Mid-Summer meeting held here recently. He spoke on symptomatic management of viral infections. He highlighted the safety and efficacy of Neubrol in Fever and Myalgia.

His presentation was based on an observational study. Myalgia and other viral conditions, he said, are very common infections. They are associated with fever and body aches. This was an investigator initiated study. It included three hundred patients in six cities at seventeen sites. Fifty patients were enrolled at each site and the objective was to see the safety, tolerability of this drug which is a combination of orphenadrine and paracetamol. One hundred sixty eight patients were male and one hundred thirty two were female. Maximum number of patients ninety five was enrolled from Lahore followed by eighty from Bahawalpur. The symptoms included flu in two hundred forty patients; thirty six had chickengunia, and nine patients with dengue. The co-morbidities included diabetes mellitus, hypertension, HCV. After five days treatment, two hundred ninety nine patients were aferbile. The pain intensity and fever decreased using the therapeutic combination. On follow up visit, 80% of the patients had no pain while 19% reported mild pain. Fever subsided in almost 99.6% of patients in four to six hours by second visit. His conclusions were that this combination of Orphenadrine/Paracetamol is safe and effective in the symptomatic management of myalgia and fever in viral conditions.

During the discussion it was pointed out that one has to be careful while using this drug in elderly patients due to prostate problems. LFTs also need to be monitored in some cases. By large there are no serious side effects. Dr. Bilal Mohyuddin remarked that generation of local data is desirable but cautioned that in de-compensated liver disease, this drug should be avoided. It was also stated that it is safe in cirrhotics. One can use it in chronic hepatitis but in acute hepatitis it should be avoided. One of the participants opined that there may also be a placebo effect as fever in such conditions usually subsides in couple of days. Prof. Sajid Abaidullah remarked that we have no comparison which was a weakness of this study. We had a limited scope but more studies are needed to further observe the safety of this drug. It was also pointed out that it has a muscle relaxing effect which is very helpful in managing such patients. Prof. Javed Akram pointed out that it is interesting to note that this study was submitted on June 28th 2018, was accepted on July 31st and got published the same day in Journal of Drug Design and Research.

Dr. Taj Jamshed from Sharif Medical City was the next speaker in this session who spoke about management of diabetes. He pointed out that diabetes is very common and any anti diabetic drug must have cardio protective effect. We are concerned with not only lowering of HbA1c but the drug must have effects beyond that. With diabetes there is 2.4% increase in cardiovascular disease and it is the leading cause of blindness. For the management of diabetes some of the agents used include Metformin, sulphonylureas, insulin and SGLTs. Our treatment aim is to reduce the HbA1c level and reduce complications. Metformin remains the basic drug in this treatment. Any other drug used for the management of diabetes must also provide cardio protective benefits as well. He then referred to the safety and efficacy of EMPA Glifozin SGLT2, its safety and efficacy. Studies have shown 38% reduction in mortality, only 35% of the patients needed hospitalization. It is a good drug to be used in Ramadan. However, more cases of UTI were seen. In patients with GFR below 40, it should not be used.

During the discussion Prof. Javed Akram stated that that we should encourage people to undertake local studies to generate local data. He also cautioned that one should be careful while using this drug in elderly as there are cases of hponatremai. Prof. Bilal Bin Younis opined that we have to be extremely careful with any new drug. Moreover it is a very expensive drug and not many patients can afford it. Those patients who are well controlled, this drug will not do any good to them. However, it is useful in patients who are not controlled. This drug offers cardiac safety. Dr. Somia Iqtidar said that it can be used in Type-1 diabetes mellitus. One has to do weight control as this drug will not work as an anti obesity drug, she remarked.

Prof. Muneer Azhar from Quaid-e-Azam Medical College Bahawalpur also briefly talked about management of hypertension. The therapeutic options, he said, includes beta blockers, diuretics, selective beta blockers, calcium channel blockers, ACE Inhibitors and ARBs. JNC-8 Guidelines on management of hypertension suggest individualized treatment for every patient. Age and gender of the patient also matters. Combination therapy is preferred, he added.

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