WHO Temporarily Pauses Hydroxychloroquine Trials Owing to Safety Concerns

Hydroxychloroquine trial has come to a standstill while WHO is reviewing the data collected from the ongoing trials and studies on the benefits and harms of hydroxychloroquine sulfate, an anti-malaria drug in the treatment of COVID-19.

During a press conference, WHO’s Director-General Tedros Adhanom said, "The Executive Group of the Solidarity Trial, representing 10 of the participating countries, met on Saturday and has agreed to review a comprehensive analysis and critical appraisal of all evidence available globally."

In the international solidarity trial, WHO has been studying the efficacy of various medications like remdesivir, hydroxychloroquine, lopinavir ritonavir in fighting off COVID-19.
As per Lancet observational study on May 22, over 100,000 coronavirus patients who were treated with hydroxychloroquine showed no signs of recovery and were even at a higher risk of death and irregular heartbeats.

The final word on the benefits and side effects of hydroxychloroquine will be put out once the Data Safety Monitoring Board has reviewed the available data and evidence.
For the patients who were randomized to HCQ treatment will continue to take the medicine until they finish their course of therapy. This drug is considered to be safe to use on patients with malaria or autoimmune diseases.

The medical community also stands divided in this matter. While some countries are reporting more evidence on the potential harms and limited benefits of hydroxychloroquine, countries like Brazil, the US, and India are continuing with its widespread use. US President Donald Trump sought supplies from India and uses HCQ as a preventive therapy against coronavirus.

On the same day as the Lancet study was published, the clinical research body of India ICMR explained the use of hydroxychloroquine as prophylaxis against COVID-19. They recommended the use of HCQ for frontline workers, healthcare workers, and policemen as a preventive therapy. However, keeping the contraindications in mind, they suggested one EPG during the course of therapy. ICMR also presented three observational studies from government hospitals showing that the healthcare workers who took HCQ had fewer chances of developing SARS-CoV-2 infection in comparison with those who were not on prophylaxis.

WHO has warned physicians against the use of unproven medication medications on the COVID-19 patients and also cautioned people not to use any medications either.

However, WHO has not prohibited the countries from using such drugs. Every country is free to act how they want but must follow the guidelines of their respective health ministries.

There are probably more than 150 case studies and trials going worldwide to determine the efficacy of hydroxychloroquine sulphate in COVID-19 treatment.

As a part of WHO’s international Solidarity Trial, more than 3500 patients have been recruited from over 17 countries. Around 400 hospitals are recruiting patients daily to perform the trial. The largest trial is going in the United Kingdom that is examining the possible effects of HCQ on the death risk in COVID-19 patients.

The final decision of the Data Safety Monitoring Board on the use of hydroxychloroquine may be out by mid -June.

Read:- Brief on Hydroxychloroquine sulphate

Multiple Myeloma: Everything You Need to Know About the Cancer of Plasma Cells

Multiple myeloma is a type of blood cancer that forms in plasma cells found in the bone marrow. Plasma cells are a type of white blood cell that produces antibodies in the bone marrow to help your body fight infections and diseases.

While there is no cure available for this disease, you can use multiple myeloma medications to ease the pain or slow down its progression.

In multiple myeloma, plasma cells become abnormal and reproduce very quickly. The rapid multiplication of these cancerous cells overwhelms the production of normal cells in the bone marrow. Unlike healthy cells, the cancer cells do not mature and die on their own. Eventually, they accumulate in the bone marrow producing abnormal antibodies called M proteins that cause kidney damage and other complications.

The cause of this disease is still unknown. What is known is that myeloma starts with the development of one malignant plasma cell. Targeted therapy destroys the protein in the cancer cells using a list of multiple myeloma medications and causes them to die.

Symptoms

The symptoms of myeloma can vary from person to person and the initial symptoms may not be even noticeable. However, as cancer progresses, one may experience any of the following major symptoms:

• Calcium (elevated)
• Renal failure
• Anemia
• Bone lesions

Other symptoms may include:

• Nausea
• Constipation
• Loss of appet
• Fatigue
• Frequent infections
• Excessive thirst
• Weakness or numbness in legs
• Weight loss
• Vomiting
• Problems in urinating

If these symptoms persist, make an appointment with your doctor or schedule a checkup.

Diagnosis

Your doctor may even detect the presence of this disease accidentally when you undergo a routine checkup or blood test. Your doctor will decide when you need the treatment based on your signs and symptoms.

Here are the tests that can diagnose multiple myeloma:

• Blood tests
• Urine tests
• Imaging tests
• Biopsy
• Staging
• Bone marrow examination

Risk Factors

People are more likely to develop this disease if they are in the following categories:

• Male
• Black race
• Over the age of 50
• Overweight or obese
• Have a family history of multiple myeloma
• Have a history of MGUS (monoclonal gammopathy of undetermined significance)

Multiple Myeloma Treatment

If the disease progresses and the symptoms get worse, your doctor will have to choose from the following treatment options:

Chemotherapy
It is an aggressive form of therapy in which high doses of anti-cancer drugs are given to the patient. These medications help in killing fast-growing cells and are given before performing bone marrow transplant surgery.

Targeted therapy
This treatment primarily focuses on the substances within malignant cells that cause them to survive. Drugs like bortezomib and carfilzomib injection are used to break down the protein and kill the cancer cells. You can either take these drugs in the form of pills or inject them in your body through the veins in your arms.

Radiation therapy
Strong energy beams like protons or X-rays are used to damage myeloma cells in a specific area of the body and inhibit their growth.

Biological therapy
This therapy includes using your immune system for attacking myeloma cells. Thalidomide, lenalidomide, and pomalidomide are some of the biological therapy drugs that help in boosting your immune system.
Taking lenalidomide 25 mg with dexamethasone is more potent than thalidomide and also has fewer side effects.

Corticosteroids
Corticosteroid drugs like prednisone and dexamethasone can balance your immune system by lowering inflammation. They work as active agents to destroy myeloma cells and can be taken in pill form.

Bone marrow transplant
It is a treatment in which unhealthy bone marrow is replaced with a healthy one. This procedure is also called a stem cell transplant. Before the transplant, the doctor collects healthy blood-forming stem cells from your blood. You are then given high doses of chemotherapy drugs to attack the deceased bone marrow. The collected stem cells are infused in your blood from where they travel to the bones and start rebuilding a healthy bone marrow.

FAQ's

Is multiple myeloma cancer?

Multiple myeloma (MM) specifically is a sort of blood cancer. It basically affects plasma cells, which are a type of WBC that grow in the bone marrow. Healthy plasma cells form antibodies in order to help your body fight infection. Cancerous myeloma cells usually grow out of control in the bone marrow, making tumors that kill bone tissue. The overproduction of the myeloma antibodies may clog the circulation (hyperviscosity syndrome). The myeloma cells may also form tumors in the other body tissues.

What causes multiple myeloma?

Like most other existing cancers, it is not fully specified what causes MM. It begins with the plasma cells multiplying quicker than normal. Genetic changement in the cells may be responsible for triggering quickly and out of controlled growth, but the reason these DNA changes appear is unspecified.

Is multiple myeloma hereditary?

A family history of MM in a parent/sibling is a risk factor for the MM, indicating heredity plays a crucial role. Although, having a family history of multiple myeloma does not mean you will develop this cancer for sure. It means that you inherited a genetic predisposition in order to develop it. One of the major risk factors for this cancer is age. Multiple myeloma most commonly affects people aged 65 years and older. There are also certain other risk factors, which may include:

• African American race
• Exposure to radiation or certain chemicals
• Male gender
• Obesity
• Other plasma cell diseases that may be precursors to myeloma including MGUS. 

Ensure, having all these risk factors does not spontaneously mean you will have MM.

And people without any certain risk factors may develop this cancer. Discuss with your healthcare practitioner in order to learn about your risks.

Is multiple myeloma curable?

Every disease has a cure, and the multiple myeloma is often controllable. By considering stem cell transplant and maintenance therapy it is possible to eliminate the cancer, temporary. Sometimes, this temporary remission may even last for several years. But eventually, the myeloma will return. Goal of the maintenance therapy is basically to prolong the period of time patients are free of myeloma, preserve a standard quality of life, and ultimately, increased survival.

What is new in MM research?

There are numerous currently active areas of research in MM as well as its treatment. The scientists continuously study the disease process in order to understand how myeloma begins and invades. This research is helping in order to identify new targets for medication therapy. Researchers are also evaluating the genetics of the myeloma cells and how they can be hazardous for the immune system to fight them. Additionally, findings are looking at the better ways in order to use drugs and stem cell transplants to increase response as well as remission. Apart from that, there are also several new medications in multiple phases of the clinical trials.

If you are looking forward to participating in a clinical trial, discuss with your healthcare practitioner. 

NOTE: The piece of information provided about "Multiple Myeloma: Everything You Need to Know About the Cancer of Plasma Cells" in this article is for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis of an experienced or qualified healthcare professional.

Read:- How Fatal is multiple myeloma

HIV vs AIDS

One of the main differences between HIV and AIDS is that, one is a virus, and the other one is a condition. A person who is with HIV may or may not have AIDS. On the other hand a person with AIDS will always have HIV in the blood.

HIV:

• HIV is a virus.
• HIV has no symptoms.
• A person who is HIV positive does not yet have AIDS may seem to be perfectly healthy.
• A person who is HIV positive does not have AIDS may have an effective as well as active immune system.
• An HIV positive person who does not have AIDS can work and support his or her family.
• Although HIV is of two types HIV-1 and HIV-2

AIDS: 

• AIDS is a disease.
• A person with AIDS may have the symptoms of various diseases which he has acquired, such as TB, meningitis, and cancer.
• A person who carried AIDS may be thin and weak. He or she may feel and look sick.
• The immune system of a person who is with AIDS is rapidly decreased and becomes less effective in order to protect his or her body.

What kind of infections does a person get as HIV begins leading to AIDS?

We are surrounded by disease-causing viruses, fungi, bacteria, and other germs. Some of such even present within our bodies, even without causing any illness. For instance, numerous people carry the latent TB germ in their bodies. However, these germs will not be successful in causing a disease in a person with a healthy immune system. It is only when the immune system is weakened by malnutrition, illness, or a condition like HIV infection, that these germs find an opportunity to cause disease. Such infections are called opportunistic infections.
Some OIs (opportunistic infections) that could be occur as HIV progresses to AIDS include:

• Encephalitis (inflammation in the brain)
• Candidiasis (or thrush, a fungal infection of the mouth or vagina)
• Gastroenteritis (a digestive illness)
• Meningitis
• Pneumonia
• Herpes
• Kaposi’s sarcoma ( a kind of skin cancer)
• Tuberculosis

Important Information: 
People with HIV, who pay attention to their nutrition needs and eat a balanced diet are more likely to develop AIDS later, and also such patients die later than those who are malnourished.
A person who is HIV positive should get information on nutrition from many sources, should discuss with others living successfully with HIV, and talk to the healthcare professionals before deciding what would be the best diet for her/him.

Read:- What are the symptoms of HIV and how to control HIV

Voriconazole administration and its side effects

Voriconazole is an antifungal medication that is used in the treatment of fungus infection.  Along with fungus infection treatment, it is also helpful in preventing the fungal infection in patients with an undergoing BMT. Voriconazole is the most recommended medication used in the treatment of CNS fungal infections that is transmitted by the injection of contaminated steroids.

Voriconazole medication was approved in the United States in 2002 for medical use. Voriconazole is one of the safest and effective medicines. It is also in the list of the World Health organization's list of essential medicines.

Dosage and administration: 

Voriconazole is present in three different forms which are mentioned below:

• Tablets: 50mg, 200mg
• Injections : 200mg
• Oral suspensions: 45mg

Tablets: Each tablet of voriconazole contains 50 mg or 200 mg of active ingredient (Voriconazole). Other inactive ingredients are lactose monohydrate, starch, magnesium stearate, pregelatinized starch, etc.

Voriconazole is administered in the human body by intravenous infusion small vials containing 200mg voriconazole are supposed to be mixed with sterile water for injection.

The oral suspension of voriconazole contains 45 grams of powder that is suspended into the water to produce 40mg/ml voriconazole. The inactive ingredients of the oral suspension are colloidal Silicon dioxide, Titanium dioxide, sodium citrate dihydrate, sodium benzoate, citric sucrose, sucrose, natural Orange flavor.

Side effects: Some common side effects of voriconazole injection are:

• Rash
• Blurred vision 
• Headache 
• Vomiting
• Diarrhea
• Chills 
• Fever 
• Nausea

Some serious adverse reactions of voriconazole 200 mg injection are:

• Embryo-Fetal Toxicity: voriconazole should not be recommended to pregnant women as it may cause fetal damage
• The patient suffering from hereditary galactose intolerance Lapp lactase deficiency: this medication is not used in case of a patient suffering from the hereditary disease 
• Arrhythmias and QT Prolongation: potassium and magnesium concentration should be correct in the body.
• Infusion-related reactions: this medication may mainly cause severe infusions.
• Dermatological reactions: if any dermatological problems occur then the use of voriconazole should be discontinued.
• Skeletal Events: Fluorosis and periostitis may cause long term voriconazole medications.

Drug interaction: Voriconazole 200 mg interacts with many drugs in the body. Voriconazole is contraindicated to be used with rifampin, rifabutin, sirolimus, quinidine. Dose adjustment of voriconazole is done when coadministered with other drugs such as tacrolimus, fluconazole, cyclosporine, and warfarin.

Read:- About Sirolimus - A transplant medication

ALL YOU NEED TO KNOW ABOUT TACROLIMUS

Tacrolimus is an immunosuppressive drug that is used to suppress the immune system to avoid organ rejection mainly liver, kidney, or heart.  It is also used in the treatment of T cell-mediated diseases such as psoriasis, eczema, exacerbation of minimal change disease, severe refractory uveitis, and Kimura's disease.
Tacrolimus work by inhibiting the activity of calcineurin that is involved in the production of interleukin-2. Interleukin-2 helps in the proliferation and development of t cells which are the key function to strengthen the immune system.
Tacrolimus is recommended in the patient having liver for heart transplantation as sirolimus use is not approved in such cases.

Dosage and administration: 

Tacrolimus is available in two forms:

• Capsule: 0.5 mg, 1 mg and 5 mg  
• Injection: 5 mg/mL ( containing dehydrated and alcohol hydrogenated castor oil)      Tacrolimus injection before use must be diluted with 5% dextrose injection for 0.9% sodium chloride injection.

When the patient is injected with tacrolimus injection a constant Observation for at least 30 minutes should be kept off the infusion. if any symptoms of anaphylaxis occur then the infusion is stopped immediately and an aqueous solution of epinephrine is provided.

The dosage of tacrolimus capsules depends upon body weight, age, and type of transplantation.
The oral administration of tacrolimus should be taken with or without food. However, the availability of food may degrade the performance of tacrolimus.
Firstly the dose of tacrolimus is given in capsule form. When the patient is unable to take oral administration of tacrolimus then only tacrolimus is intravenously injected into the patient body. With the injection of tacrolimus, the whole body's blood transfusion is monitored.
Tacrolimus should not be injected into pregnant women as it may cause fetal damage or birth abnormality.

Side effects of Tacrolimus: 

Side effects in cases of different organ transplantation are mentioned below:

• Kidney transplantation: The most common side effects are hypertension, constipation, diarrhoea, headache, abdominal pain, Insomnia, urinary tract infection, hyperlipidemia, hypokalemia anaemia, hypomagnesemia, infection.
• Liver transplant: some adverse reactions of tacrolimus 1 mg are headache diarrhoea hypertension abdominal pain nausea abnormal knee renal function anaemia Insomnia fever pain paraesthesia hypokalemia hyperglycemia hypomagnesemia.
• Heart transplant: some common side effects are hyperglycemia, Diabetes mellitus, hypertension, abnormal renal function, leukopenia, bronchitis, hyperglycemia
• Some other severe side effects of tacrolimus 0.5mg are:
• Polyomavirus Infections: sometimes fatal outcomes such as polyoma virus-associated nephropathy(PVAN).
• Cytomegalovirus (CMV) Infections: Enhanced danger of CMV viremia and disease.
• Diabetes after transplant: blood glucose level is monitored constantly
• Neurotoxicity: acute or chronic nerve problem exists.
• Neurotoxicity: some neurologic abnormality is found such as the risk of posterior reversible encephalopathy syndrome.
• Hypokalemia: potassium level is monitored carefully
• Hypertension: may occur due to drug-drug interaction patients may require antihypertensive drugs.
• Myocardial Hypertrophy: May leads to dosage discontinuation or reduction.
• Pure red cell aphasia: discontinuation of tacrolimus is recommended.
• Immunization: use of live vaccines are avoided.

Drug interaction: 
The interaction of tacrolimus 5mg drug with other medications are listed below:

• Mycophenolic Acid Products: Can increase MPA exposure
• Nelfinavir and Grapefruit Juice: Increased tacrolimus concentrations.
• CYP3A Inhibitors: Increased tacrolimus concentration.
• CYP3A4 Inducers: Decreased tacrolimus concentrations

Tacrolimus uses are contraindicated with other medications as it is not used with a combination of other medications having the same substitute or same constituent of tacrolimus.

The cost of tacrolimus is quite decent and affordable. A respective patient can purchase it through any legitimate pharmaceutical company.

Read:- About Mycophenolate Mofetil a transplant medication

Indications of Abacavir Sulfate

Abacavir, a nucleoside analog reverse-transcriptase inhibitor (NRTIs), is indicated in antiretroviral combination therapy for the treatment of Human Immunodeficiency Virus (HIV) infection in adults, adolescents, and children.

The demonstration of the advantages of this drug mainly depends upon the outcomes of such studies which performed with a twice daily regimen, in treatment-naïve adult patients on combination therapy.
Before initiating treatment with abacavir sulfate, screening for carriage of the HLA-B*5701 allele (which is associated with drug-induced inflammatory disease of the skin) should be performed in such patients who are with HIV-infection, irrespective of racial origin. Individuals with B57 are more sensitive to the drug abacavir and should not be used this medicine in patients known to carry the HLA-B*5701 allele.

This medication should be prescribed by physicians experienced in the management of HIV infection. Abacavir 300 mg can be taken with or without food.

The administration should be performed by taking an entire dose, the tablet should ideally be gulped without crushing.
Oral solution of this drug is existing for use in such children who are over 90 days of age and weighing less than 14 kg.  It is basically recommended for those patients for whom the tablets are inappropriate.
Apart from this, for such patients who are not able to gulp tablets, the tablet can be crushed and added to a small amount of semi-solid liquid or food, all of which should be taken immediately.

How Does it Work:
Abacavir is an NRTI which is a potent selective inhibitor of Human Immunodeficiency Virus-1 (HIV-1) and Human Immunodeficiency Virus-2 (HIV-2). Abacavir mainly metabolised intracellularly to the active moiety, TP (carbovir 5’- triphosphate). In vitro observations have specified that its mechanism of action in relation to Human Immunodeficiency Virus is inhibition of the HIV reverse transcriptase enzyme, an event which demonstrates in chain termination as well as interruption of the viral replication cycle. The existing antiviral functions and activity of this medicine in cell culture was not antagonized when come with the NRTIS (nucleoside reverse transcriptase inhibitors) emtricitabine, didanosine, lamivudine, stavudine, zidovudine or tenofovir, the NNRTI (non-nucleoside reverse transcriptase inhibitor) nevirapine, or the PI (protease inhibitor) amprenavir.

Common Side Effects: The most common symptoms of Abacavir 300 mg are: Fever (high temperature) and skin rash.
Other common symptoms are nausea (feeling sick), vomiting (being sick), diarrhoea, abdominal (stomach) pain and severe tiredness.
Some other possible symptoms include Pains in the joints or muscles, swelling of the neck, shortness of breath, sore throat, cough, occasional headaches, inflammation of the eye (conjunctivitis), mouth ulcers, tingling or numbness of the hands or feet and low blood pressure.
.

Check detailed about side effects of Abacavir Sulfate

All you need to know about Mycophenolate mofetil

Mycophenolate Mofetil Tablets are used to prevent your body from rejecting a transplanted kidney, heart, or liver. Mycophenolate Mofetil is used together with other medicines known as ciclosporin and corticosteroid.

How to take Mycophenolate Mofetil Tablets: 

Always take Mycophenolate Mofetil exactly as your doctor has told you. Tablets must be swallowed whole with the glass of water. Do not break or crush them. The amount you take depends on the type of transplant you have had. The usual doses are shown below. Treatment shouldn't be interrupted for as long as you need to prevent you from rejecting your transplant organ.

Adults with Kidney transplant:

• The initial dose should be given within 3 days of the transplant operation.
• Daily dose should be 4 tablets and should be taken as 2 separate doses.
• Take 2 tablets in the morning and then 2 tablets in the evening.

Children (aged 2 to 18 years) with Kidney Transplant: 
The dose should vary depending on the size of the child.
Your healthcare professional will decide the most appropriate and precise dose based on your child’s height and weight.

Adults with a Heart transplant: 

• The initial dose should be given within 5 days of the transplant operation.
• The daily dose should be 6 tablets, should be taken as 2 separate doses. 
• Take 3 tablets in the morning and then 3 tablets in the evening.

Children with a Heart transplant:
There is no information for the use of Mycophenolate 250 mg in children with a heart transplant.

Adults with Liver transplant: 

• The initial dose of Mycophenolate Acid should be taken at least 4 days after the transplant operation and when you are able to swallow oral medicines.
• The daily dose should be 6 tablets, taken as 2 separate doses. 
• Take 3 tablets in the morning and then 3 tablets in the evening. 

Possible Side Effects of Mycophenolate Mofetil:

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Very common: These side effects are as follows:

• Feeling sick (nausea)
• Vomiting
• Fewer white cells or red cells in your blood
• Stomach and gut infections
• Urinary system infections
• Mouth infections

Common: 
Common side effects with Mycophenolate Tablets medication may occur as:

• Lung infections
• Skin infections
• Cancer of the lymphoid tissues and skin.
• Fever, feeling very tired, difficulty sleeping
• Stomach pain, chest chest, joint or muscle, pain on passing urine. 
• Headache, flu symptoms and swelling.
• Acne, cold sores, shingles, skin growth, hair loss, rash, itching.
• Kidney problems or the urgent need to pass water (urine).
• Swelling of the gums and mouth ulcers
• Inflammation of the pancreas, colon or stomach
• Gut problems including bleeding, liver problems 
• Constipation, indigestion, loss of appetite, flatulence, diarrhoea
• Feeling dizzy, drowsy or numb 
• Tremor, muscle spasms, convulsions 
• Feeling depressed or anxious. 
• Changes in your mood or thoughts.
• Weight loss, gout, high blood sugar. 

FAQ:

If I take an overdose of Mycophenolate Mofetil Tablets then what will happen?

Ans:-
If you take more Mycophenolate 500 mg tablets than you have been told to take, or if someone else accidentally takes Mycophenolate Mofetil Tablets, immediately connect with a doctor or go to a hospital straight away. Take the medicine pack with you.

If I forget to take a dose of Mycophenolate then what should I do?

Ans:-
If you forget to take Mycophenolate 500 mg tablets at any time, take it as soon as you remember, then continue to take it at the usual times. Never takes a double dose to make up for a missed dose.

How to store Mycophenolate Mofetil Tablets?

Ans:-
Do not store above 25°C. Always should be protected from light. Do not use Mycophenolate 500 mg medicine after the expiry date, which is stated on the carton (EXP). You shouldn't throw away any of your medicines via household waste or wastewater. Discuss with your healthcare providers how to throw away drugs you no longer use. These measures will help in order to protect the environment.