Warfarin: Influence of Genetic Variations and Their Prevalence in Indian Population | Chapter 1 | Medicine and Medical Research: New Perspectives Vol. 1

 

Warfarin has been the most trusted but challenging anticoagulant in clinical practice for the last seven decades. The challenge is to manage its dose. A narrow therapeutic index and high inter- and intra-individual variability in drug disposition and response are the factors that shift the pendulum to adverse drug events from one end of fatal hemorrhage to the other i.e. thrombosis. The difficult task for clinical management is to maintain the required international normalized ratio (INR) with warfarin therapy. Factors responsible for this difficult task include both genetic and non-genetic. The predominant genes are those coding for vitamin K epoxide reductase complex (VKORC) subunit 1 (VKORC1; the target of warfarin and the enzyme of warfarin metabolism; cytochrome P450 enzyme 2C9 (CYP2C9). There is general agreement among published retrospective population studies that the combination of VKORC1 and CYP2C9 genotypes, together with gender, age, body mass index or height or weight and concurrent medications, predict approximately 50% of warfarin dose requirement. Thus, genetic testing will be able to predict and help in directing toward the correct dose and reduce the counts of trial and error as well as risks during therapy. Within the Asian population, Indian patients have been reported to require higher warfarin doses than others. Here we also review the prevalence of the genetic variations of VKORC1 and CYP2C9 associated with variable warfarin response in Indian populations from different regions and also depict studies that have aimed at analysing the influence of genotypic variations to the clinical dose of Warfarin in the Indian population.

 

 

Author(s) Details

Kavita Shalia
Sir H. N. Medical Research Society, Sir H. N. Hospital and Research Centre, Court House, L. T. Road, Mumbai 400002, India.

Sunila Raju
Sir H. N. Medical Research Society, Sir H. N. Hospital and Research Centre, Court House, L. T. Road, Mumbai 400002, India.

Amit Chandan
Sir H. N. Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Mumbai 400004, India.

 

Please see the link:- https://doi.org/10.9734/bpi/mmrnp/v1/1194

Determining Functional End Ranges of Lower Limb Joints in Positions Commonly Used for ADLs in India | Chapter 7 | Recent Developments in Medicine and Medical Research Vol. 10

 Background: In many Asian cultures, standing on the floor rather than sitting in a chair is preferred. Squatting and cross-legged sitting on the ground are common among the Indian population's traditional practises and daily duties. Squatting is a closed kinetic activity that involves several joint movements.

The goal of the study was to evaluate the functional end-ranges of the hip, knee, and ankle joints in healthy Indian volunteers in common ADL situations such as squatting and cross-legged sitting.

Methods: A total of 66 healthy participants, ranging in age from 30 to 50 years, were recruited from rural and urban populations. The Universal Goniometer was used to quantify joint ROM in the lower extremities. Squat and cross-legged stances were required of all subjects, which were graded.

The individuals in cross leg sitting grade 2 (independent CLS) had hip flexion ranges of 1150, hip abduction ranges of 410, hip external rotation ranges of 420, and ankle plantar flexion ranges of 460, p0.005. Grade 2 (independent squat) had hip flexion ranges of 1130, p>0.005, knee flexion ranges of 1200, p>0.005, and ankle dorsiflexion ranges of 150, p0.005.

Conclusion: The findings imply that squatting and cross-leg sitting several times a day can help prevent the early closure of lower limb end ranges. It's critical to understand why ranges are limited, as this has implications for clinical practise. By acknowledging such factors, future investigations may be piloted with a deeper knowledge.

Author(S) Details

Niketa Patel
College of Physiotherapy, Sumandeep Vidyapeeth, India.

Lavina Rajesh Khatri
College of Physiotherapy, Sumandeep Vidyapeeth, India.

Lata Parmar
College of Physiotherapy, Sumandeep Vidyapeeth, India.

View Book:- https://stm.bookpi.org/RDMMR-V10/article/view/4622