Qualification: 
M. Pharm.
Email: 
lakshmir@aims.amrita.edu

Lakshmi R. joined as Lecturer in the Department of Pharmacy Practice, Amrita School of Pharmacy in February 2012. She completed her Bachelor's Degree in Pharmacy from Pushpagiri College of Pharmacy, M.G University and her Master's Degree in Pharmacy Practice from Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham. She started her career in teaching in the year 2012. She has more than 5 years of teaching and research experience and has several publications in national and international journals. Ms. Lakshmi's current research focuses on Pharmacovigilance, Pharmacoeconomics, Anticoagulation Management, Clinical Research etc. She is presently supervising M. Pharm. and Pharm. D. students in their research projects on patient outcome improvement.

Publications

Publication Type: Journal Article

Year of Publication Publication Type Title

2017

Journal Article

L. Sunny, Lakshmi R., and Vijayakumar, M., “ Evaluation of Antimicrobial use in Ventilated Patients in Coronary Care Unit of a Tertiary Care Hospital”, Research Journal of Pharmacy and Technology , vol. 10, no. 1, pp. 05-10 , 2017.[Abstract]


In developing countries, excess and indiscriminate use of antibiotics in community and hospital settings can lead to adverse effects primary to prolongation of therapy, harbour antibiotic resistance bacteria, rise in health expenditures and decrease quality of life. Antimicrobial resistance in the intensive care unit (ICU) has emerged as an important problem in this scenario. Recent studies revealed that antibiotic use is roughly ten times larger in ICU than in general wards. Research studies are required to gain suitable information concerning the use of antimicrobials (AMA) in ventilated patients which helps in improving the prescribing pattern of antimicrobial and also in executing infection control strategies in the therapy modification of such patients. There is barely limited data on antibiotic prescribing pattern in ventilated patients from India hence this study was carried out with an objective to know more about the antibiotic prescribing pattern and to analyze rationality among the prescriptions. This retrospective study was conducted in the Coronary care unit (CCU) of tertiary care hospital in South India from June 2014 to December 2014. The prescribing pattern of antimicrobials in patients aged between 10-90 years was studied. Total 33 AMA preparations were used either single or in combination. In the study, the commonly used AMAs were beta-lactam antibiotics, particularly ceftriaxone, levofloxacin followed by piperacillin + tazobactam (extended –spectrum penicillins + ß-lactamase inhibitor) as single or combination therapy. Combination of AMAs was used in 54.3% of patients. In order to achieve good outcome right use of antibiotic at right time and right dose is required, based on general AMAs prescribing pattern and susceptibility pattern of pathogens, which aid to minimize the irrational employ of antibiotics and extra pressure for resistance. More »»

2017

Journal Article

T. C. Abraham, James, G., Thomas, A., and Lakshmi R., “Sodium valproate induced hyperammonemia with normal liver function: A case report”, Journal of Pharmaceutical Sciences and Research, vol. 9, pp. 822-823, 2017.[Abstract]


Sodium salt of valproic acid is a commonly used antiepileptic drug also used in the treatment of migraine headache prophylaxis, neuropathic pain, restless leg syndrome, dementia related agitation and social anxiety disorders. The most common adverse effects of sodium valproate are change in appetite, nausea, vomiting, diarrhea, dizziness, hair loss, gingival hyperplasia, abnormal liver function etc. Sodium valproic acid induced hyperammonemia are often seen in hepatic failure but it rarely occur with normal liver function and it is fatal. There is only less than 1% incidence rate for sodium valproate induced hyperammonemia. This is a case of sodium valproate induced hyperammonemia with normal plasma sodium valproate level (44.5mcg/ml) and with normal liver function. A 37 year old male who was admitted to the psychiatry department with reduced sleep for 4 days and anger. He had a history of Bipolar Affective Disorder, current episode mania with psychotic symptoms and Crohn’s disease. Patient was on Tablet Sodium valproate 500mg Once Daily for the past one year as a mood stabilizer. He was admitted on 11-12-2015 in the psychiatry department and continued to take Tablet Sodium valproate 250 mg Twice Daily. After few days he was found to be disoriented. Hence ammonia levels was measured on 14 -12-2015 and it was found to be 100.3umol/L (normal range 10-48umol/L). Ammonia level returned to normal after the withdrawal of the sodium valproate. He also developed gingivial hyperplasia as a side effect of the sodium valproate. This case has the causality score of 5 (hyperammonemia) and 6 (gingivial hyperplasia) using NARANJO probability scale and causality of both Adverse Drug Reactions was found to be probable. © 2017, Pharmainfo Publications. All rights reserved.

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2017

Journal Article

S. R. Shajahan, Sadasivan, S., B. Rao, H., and Lakshmi R., “A new paradigm of an old disease: A case report”, Journal of Pharmaceutical Sciences and Research, vol. 9, pp. 1392-1393, 2017.[Abstract]


Anti-tubercular therapy (ATT) induced hepatotoxicity is a major cause of drug induced liver injury1. Most of the first line ATT drugs including Isoniazid, Rifampin and Pyrazinamide have proven hepatotoxic potential. The pharmacokinetic profile of these drugs albeit extensive, has failed to adequately explain their hepatotoxicity. Here, we report a case of ATT induced hepatotoxicity in a male, with pulmonary tuberculosis (TB) on ATT since 4 months with a causality score of five (PROBABLE) using Naranjo scale. His laboratory data showed Hyperbilirubinemia with elevation of liver enzymes. He progressively worsened during hospital stay and developed encephalopathy and coagulopathy. Hence, he was evaluated for Living donor liver transplantation (LDLT) which was done within one week of hepatic DE compensation. In patients post LT, a prudent approach would be to continue immunosuppression along with INH prophylaxis. Further investigation into prognostic risk factors and ideal management strategies are warranted. © 2017, Pharmainfo Publications. All rights reserved.

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2017

Journal Article

S. Sreeni, Zackariah, N. Muhammed, and Lakshmi R., “A case report: Morvan’s Syndrome”, Research Journal of Pharmacy and Technology, vol. 10, no. 4, pp. 1174-1178 , 2017.[Abstract]


Morvan’s syndrome is a rare autoimmune disorder showing peripheral nervous system hyperexcitability accompanied by autonomic and central nervous system (CNS) hyperactivity. Peripheral hyperactivity includes clinical and electrophysiological evidence of painful cramps, myokymia and neuromyotonia. Acquired neuromyotonia manifests clinically in cramps, stiffness and fasciculation. Autonomic symptoms include hyperhidrosis, fluctuations in blood pressure, tachycardia. CNS hyperactivity include insomnia, agitation, hallucination, confusion, anxiety. We present a case of 48 year old female with morvan’s syndrome with central, peripheral and autonomic hyperexcitability. Admitted with alleged history of seizure and was having memory disturbances, paraesthesia and perfused perspiration with palpitation. She tested strongly positive for CASPR2 antibodies and LHI1 antibodies. On the basis of symptoms like neuromyotonia, hyperhidrosis and insomnia with features of encephalopathy and indirect immunofluorescence the patient was diagnosed to have morvan’s syndrome. Treatment was started Inj. Methylprednisolone 1gm IV, during this treatment the patient restarted dysautonomia features then intravenous immunoglobulin (IVIG) and T. Cellcept (mycophenolate mofetil) 1mg BD was given. She was managed symptomatically over time.

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2017

Journal Article

P. C, Philip, J. Mary, George, C., and Lakshmi R., “Non pitting type pedal edema with lithium: a case report”, International journal of pharmacy and pharmaceutical sciences, vol. 9, no. 1, pp. 323-324, 2017.[Abstract]


Objective: To report a case of lithium induced bilateral nonpitting pedal edema.

Methods: The clinical data of a bipolar affective disorder patient with current episode of mania and psychotic symptoms who experienced bilateral non pitting pedal edema with lithium.

Results: The patient was a 29 yr old female who developed bilateral non-pitting type pedal edema with lithium therapy with normal plasma lithium level (0.72mEq/l). She is a known case of bipolar affective disorder (BPAD) was admitted to psychiatry department with episode of mania with psychotic symptoms. She had history of drug induced hypersensitivity reaction with eosinophilia and systemic symptoms (DRESS) with oxcarbazepine and so the drug was discontinued and was started on tablet lithium 400 mg twice daily. On admission here, the dose of lithium was increased to 1200 mg/day. The patient gradually improved but she developed bilateral non-pitting pedal edema. Serum lithium concentration was normal and there were no other early symptoms of lithium toxicity. But as the patient's distress further increased with increasing pedal edema, it was decided to stop lithium altogether and to maintain the patient on tablet quetiapine 800 mg therapy for BPAD. Within one week of stopping lithium the edema on both her feet decreased significantly. Causality was assessed by naranjo causality assessment scale and a probable relationship was obtained between lithium and pedal edema with a score of 6.

Conclusion: This case emphasises that regular physical examination and laboratory investigations are important for patients who are on lithium therapy. Clinicians should always be careful while initiating lithium treatment in a patient with respect to the initial dose and dose escalation even after a period of successful therapy with lithium, as minor dose escalation can cause major changes in the serum lithium concentration and thereby the patient’s tolerability to lithium.

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2017

Journal Article

S. Mohan and Lakshmi R., “A Case Report on Takayasu’s Arteritis”, International Journal of Pharmacy and Pharmaceutical Sciences, vol. 9, no. 3, pp. 296-297, 2017.[Abstract]


Takayasu’s arteritis (TA) is a rare large-vessel vasculitis that affects large arteries, mainly the aorta and its branches. It is also called a pulseless
disease because of diminished or absent pulses in the upper extremities of the patient. The coronary, pulmonary and renal arteries are also affected
in the progression of the disease. The prevalence of the disease is more in Asian countries and it has unknown etiopathogenesis. Here we discuss a
case of TA in a 15 y old girl who was admitted with moderate LV dysfunction. The diagnosis was carried out from the results of CT aortogram which
showed stenosis of right common carotid, left subclavian, left vertebral artery, right renal artery and lower lobe pulmonary arteries and other
clinical examinations. Treatment was initiated with methylprednisolone and cyclophosphamide along with symptomatic treatment. But the disease
progressed with the development of complications like peripheral leg ulcers. The patient was initiated palliative care in view of altered sensorium
and severe LV dysfunction, but the patient succumbed to a sudden cardiac arrest. Early identification and initiation of aggressive treatment can help
in symptom-free survival.

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2017

Journal Article

R. Krishna, Kumar, B. Santhosh, Krishnan, S., N, A. K., and Lakshmi R., “A Review of Novel Anticoagulants”, International Journal of Pharmaceutical and Clinical Research , vol. 9, no. 1, pp. 96-99, 2017.[Abstract]


The well-established indications for anticoagulant therapy include atrial fibrillation, venous thromboembolism (VTE) and mechanical heart valves. Vitamin K antagonists are the most common anticoagulants used in the outpatient setting. Two new classes of anticoagulants (direct thrombin and factor Xa inhibitors) have shown promise as alternatives to the vitamin K antagonists. Specifically, dabigatran, rivaroxaban and apixaban have been studied in comparison to warfarin for their use in preventing systemic stroke/embolism in patients with atrial fibrillation and for managing the recurrence of VTE. This article will review the literature on the efficacy of these agents, as well as the benefits and disadvantages of their use.

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2017

Journal Article

K. Raj, Iype, M. Shinu Mery, and Lakshmi R., “Chlorpromazine Induced Skin Pigmentation-A Case Report”, International Journal of Pharmaceutical Sciences Review and Research , vol. 43, no. 2, pp. 78-79, 2017.[Abstract]


Chlorpromazine is a low-potency typical antipsychotic drug, which is indicated for the treatment of acute psychosis and chronic psychosis which including schizophrenia and the mania of bipolar disorder. Chronic treatment with high dose of chlorpromazine is reported to cause pigmentation. Here we are presenting a case report of 17 years old female having recurrent depressive disorder with psychotic features for which chlorpromazine was initiated for sedation purposes, following which she was found to develop skin pigmentation after a period of 3 months. Dermatological consultation was taken and confirmed to be drug induced pigmentation.

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2017

Journal Article

R. Krishna, Kumar, B. Santhosh, Krishnan, S., N, A. K., and Lakshmi R., “Review on Noval Anticoagulants”, International Journal of Pharmaceutical and Clinical Research, 2017.

2016

Journal Article

Lakshmi R., R. Chandran, L., Baby, C., and K. Krishna, S., “A study on antibiotic prescribing pattern in obstructive lung disease inpatients”, Asian Journal of Pharmaceutical and Clinical Research, vol. 9, pp. 260-262, 2016.[Abstract]


Objectives: The main objectives of this study were to estimate the demographic details of patients with obstructive lung disease and to study the various organisms causing exacerbations and its resistance pattern and also to analyze the culture and sensitivity pattern in obstructive lung disease patients. Methods: It was a retrospective, observational study carried out for 1 year at the Department of Pulmonary Medicine of a tertiary care teaching hospital in Kerala, India. Total 200 patients who were admitted under the pulmonary ward during the time period from 1st June 2013 to 1st June 2014 and who satisfied the inclusion and exclusion criteria were included in the study. A standardized data collection form was prepared, and necessary data were collected from patient’s medical records. Results: The maximum number of patients was in the age group of 60-69. 61% patients were residing in the urban area. 32.5% of patients were found to have a history of smoking. 61% patients were diagnosed with the chronic obstructive pulmonary disease (COPD). 74.5% sample collected were sputum. Culture test alone was carried out for 48.5%. 88% were prescribed with cephalosporin. Among the cephalosporin class cefpodoxime was the most commonly prescribed (63%). 42 patients had two drug therapy. Conclusion: A periodic study on the usage of antibiotics and sensitivity pattern in the hospital will enable the health care professionals to select the appropriate one to promote the rational use of antibiotics. © 2016, Asian Journal of Pharmaceutical and Clinical Research.

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2016

Journal Article

J. KC, G, A., Nair, L. P., and Lakshmi R., “A study on pattern of prescribing medications used in secondary prevention of stroke.”, Asian journal of pharmaceutical and clinical research, vol. 9, no. 3, pp. 328-330, 2016.[Abstract]


Objectives: The main objectives of this study were to estimate the demographic details of patients with the first incidence of stroke and to study the
various risk factors for ischemic stroke.
Methods: It was a retrospective, observational study carried out for 1 year at the Department of Stroke Medicine of a tertiary care teaching hospital
in Kerala, India. A total of 636 patients were admitted under stroke medicine during the period from July 1, 2014, to July 1, 2015, and who satisfied
the inclusion and exclusion criteria were included in the study. A standardized data collection form was prepared and necessary data were collected
from patient’s medical records.
Results: The maximum number of patients was in the age group of 60-69 years. 65.1% patients were residing in the rural area. 60.7% patients were
male. Most of them had hypertension as common comorbidity (21.35%) and the highest number of patients had diabetes mellitus and hypertension
(21.7%). Majority of the patients were prescribed with antiplatelets (94.91%), followed by statins (93.8%).
Conclusion: A strict control on the comorbid conditions and sticking on to the medications can prevent the occurrence of future stroke.
Keywords: Stroke, Secondary prevention, Drugs, Prescribing pattern.

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2016

Journal Article

S. Sreeni and Lakshmi R., “Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report”, Research Journal of Pharmacy and Technology, vol. 9, no. 12, pp. 1451-1454, 2016.[Abstract]


Chronic inflammatory demyelinating polyneuropathy (CIDP) is a treatable autoimmune neuropathic condition, which characterize progressive and relapsing stages. Major clinical presentations are gradatory increasing sensory loss and weakness interrelated with loss of reflexes. Relapse can occur at any time for CIDP patients. Diagnosis is based on cerebrospinal fluid protein, electromyography, nerve conduction velocity (NCV) test, peripheral nerve biopsy and electron micrograph of peripheral nerve. Standard treatments for CIDP are corticosteroids, Intravenous Immune Globulin (IVIG), plasma exchange or plasmapheresis. Second line drugs commonly used are immunosuppressant and immune modulatory agents, there are usually chemotherapy drugs which should be only given in special circumstances by specialist in their use. A 55 year old female encountered in the department of neurology, old case of Guillain-Barre Syndrome (GBS) was treated with steroids, later developed CIDP and was on reduced dose of prednisolone. Now presented with complaints of numbness and difficulty in walking, diagnosed to have CIDP relapse. Started treatment with corticosteroid [Tab. Wysolone (prednisolone) 50mg 1-0-0] and immunosuppressant [Tab. Cellcept (mycophenolate mofetil) 500mg 1-0-1]. Patient had significant improvement in symptoms. This case of CIDP relapse is effectively treated with corticosteroid and immunosuppressant with tapering of steroid dose.

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2015

Journal Article

N. V. and Lakshmi R., “Valproic acid induced transaminitis”, International Journal of Pharmacy and Pharmaceutical Sciences, vol. 7, pp. 304-305, 2015.[Abstract]


Valproic acid (VPA) is a broad spectrum antiepileptic agent used in the treatment of absence, myoclonic, partial and tonic clonic seizure and also used in the treatment of bipolar disorder. Although VPA, a proven anticonvulsant agent thought to have relatively few side-effects, has been referred as the third most common xenobiotic suspected of causing death due to liver injury. VPA-induced hepatotoxicity can be identified through an abnormal liver function test mainly an abnormal elevation in hepatic enzymes which is called transaminitis. Here we report a case of 21 y old female presented with transaminitis which occurred after 3 y of taking VPA that was started in view of here seizure disorder. The hepatic enzyme levels came down once VPA was stopped and appropriate treatment measures using hepatoprotectives were initiated. Causality assessment using Naranjo probability scale indicated a probable relationship (score-7) between the patient’s condition and the use of VPA. Clinicians prescribing VPA should go for careful liver function monitoring not only initially but throughout the time the drug is given. © 2015, International Journal of Pharmacy and Pharmaceutical Science. All rights reserved.

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2015

Journal Article

Lakshmi R., Liniya, S., and Vijayalakshmi, S., “Dapsone induced hypersensitivity syndrome – A case report”, International Journal of Pharmacy and Pharmaceutical Sciences, vol. 7, pp. 585-587, 2015.[Abstract]


4,4’-Diaminodiphenylsulphone (Dapsone) is widely used for a variety of infectious, immune and hypersensitivity disorders, with indications ranging from Hansen's disease, inflammatory disease and insect bites. However, the use of dapsone may be associated with a plethora of adverse effects, some of which may involve the pulmonary parenchyma, methemoglobinemia with resultant cyanosis, bone marrow aplasia and/or hemolytic anemia, peripheral neuropathy and the potentially fatal dapsone hypersensitivity syndrome (DHS). DHS typically presents with a triad of fever, skin eruption and an internal organ (lung, liver, brain and other systems) involvement, occurring several weeks to as late as 6 months after the initial administration of the drug. In this sense, it may resemble a DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms). DHS must be promptly identified as untreated and the disorder could be fatal. Moreover, the pulmonary/systemic manifestations may be mistaken for other disorders. Eosinophilic infiltrates, pneumonitis, pleural effusions and interstitial lung disease may be seen. This syndrome is best approached with the immediate discontinuation of the offending drug and prompt administration of oral or intravenous glucocorticoids. An immunological-inflammatory basis of the syndrome can be envisaged based on the pathological picture and excellent response to anti-inflammatory therapy. Since dapsone is used for various indications, physicians from all specialties may encounter DHS and need to familiarize themselves with the salient features of the syndrome and its management. © 2015, International Journal of Pharmacy and Pharmaceutical Sciences. All rights reserved.

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2015

Journal Article

Lakshmi R., Ajai, A. V., and K, A., “Neurocysticercosis: revealing the facts of a rare disease”, International Research Journal of Pharmacy, vol. 6, no. 1, pp. 1-4, 2015.[Abstract]


Neurocysticercosis, a Central Nervous System disorder caused due to the infestation of the pork tapeworm Taenia solium, is charaterised by seizures and headache most commonly, followed by certain other neurological systems.

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2015

Journal Article

Lakshmi R. and Karakkattu, J., “Wegener’s granulomatosis with Polyangitis”, The antiseptic, vol. 112, no. 1, pp. 6-7, 2015.

2015

Journal Article

Lakshmi R. and Vinod, K., “Eisenmenger Syndrome- A case report”, The antiseptic, vol. 112, no. 12, pp. 14-17, 2015.

2014

Journal Article

Lakshmi R., Nusrin, K. S., Georogy, S. A., and Sreelakshmi, K. S., “Role of beta lactamases in antibiotic resistance: A review”, International Research Journal of Pharmacy, vol. 5, no. 2, pp. 37–40, 2014.[Abstract]


Penicillin, the first β - lactam antibiotic was introduced into clinical practice in 1940s. Since then a large number of different β - l actam antibiotics including penicillins, cephalosporins, monobactam and carbapenems have been de veloped. All of them are structurally related through the presence of a core β - lac tam ring. β - lacta m antibiotics interfere with the synthesis of bacterial cell wall , they also inhibit the transpeptidases so t hat cross linking does not take place. The wide use of β - lactam antibiotics has created major resistance problems leading to increased morbidity, mortality and heath care costs. Resi stance is most often mediated by lactamases which is produced from both gram negative and positive bacteria. β - lactamases are enzymes responsible for many failures of antimicrobial therapy because of the hydrolysis of β - lactam antibiotics to inert and ineffective agents. β - lactamases are one of the reason behind the bacterial resistance to β - lactam antibiotics . In recent yea rs new varieties of beta lactamases has b een detected in increasing rate . Combination of β - lactam antibiotics with β - lactamases inhibitors has been successfully used to control resistance during last two decades. These inhibitors greatly en hance the effica cy of their partner β - lactam antibiotics (amoxillin, ampicillin, piperacillin, and ticarcillin) in the treatment of serious Entero bacteriaceae and penicillin resistant Staphylococcal infections. The prevalence of clinically relevant β - lactamases from othe r classes that are resistant to inhibition is rapidly increasing. Lack of effectiveness of currently available β - lactamase inhibitors is a main problem with the combination therapy. This review describes the various β - lactum antibiotics and effect of diffe rent β – lactamases that produced by the sever al bacteria ’ s against the β - lacta m antibiotics, their resistance pattern and its effective management with combination therapy .

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2014

Journal Article

Lakshmi R., Karakkattu, J., and Keerthana, S., “Health benefits and medicinal uses. ”, Health- a journal devoted to healthful living, 2014.

2014

Journal Article

Lakshmi R., Karakkattu, J., and Keerthana, S., “Kalpa vriksha- Health benefits and medicinal uses”, Health- a journal devoted to healthful living, vol. 92, no. 7, pp. 4-8, 2014.

2013

Journal Article

Lakshmi R., Vijayalakshmi, S., Raju, A., and Joy, T. M., “Assessment of various risk factors of breast cancer”, International Journal of Pharmacy and Pharmaceutical Sciences, vol. 5, pp. 675-678, 2013.[Abstract]


Objectives: The main objectives of this study were to assess the various modifiable and non modifiable risk factors of breast cancer and to study the various chemotherapeutic regimens prescribed for the treatment of breast cancer. Methods: It was a prospective observational study carried out for 6 months (1st July-31st December 2012) at the department of medical oncology of Amrita Institute of Medical Sciences, Kochi, Kerala India. Total 180 patients who visited the department of medical oncology during the study period and who satisfied the inclusion and exclusion criteria were included in the study. A standardized data collection form was prepared and necessary data were collected from patients and/or caregivers. Results: The maximum numbers of patients were in the age group of 51-60.Most of the patients was postmenopausal and married. 73.88% patients were residing in urban area. 73.33% patients don't have any family history of cancer. Only 30 patients undergone hysterectomy and 150 were not. In this study out of 180 patients only 9(5%) had a history of HRT/OCT use. Majority of patients had hypertension as the co morbidity followed by diabetes mellitus.103 patients were obese. 51 patients had their first menarche at the age of 14 and gave their first child birth at an age of 25 and breast fed for an average of 2 years. Conclusion: Awareness of various risk factors of breast cancer will help in early detection of breast cancer and can save thousands of lives.

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2013

Journal Article

Lakshmi R., Emmanuel James, and Kirthivasan, Rb, “Study on impact of clinical pharmacist's interventions in the optimal use of oral anticoagulants in stroke patients”, Indian Journal of Pharmaceutical Sciences, vol. 75, pp. 53-59, 2013.[Abstract]


Anticoagulants are very useful medications but can also lead to haemorrhagic as well as thromboembolic complications when not used correctly or without proper medical attention. Anticoagulant's complex pharmacology and pharmacokinetics contribute to its narrow margin of safety. Pharmacist's unique knowledge of pharmacology, pharmacokinetics and interactions makes them well-suited to assist patients in maintaining safe and effective anticoagulation. Successful anticoagulation therapy implies fewer incidences of therapeutic failures and bleeding complications. The anticoagulation management service staffed by clinical pharmacists is a service established to monitor and manage oral and parenteral anticoagulants. In this research work, 40 patients each were included in the intervention and the control groups. In the intervention group, patient's knowledge score on anticoagulation increased from an average of 5.6±3.2 to 13.8±0.94 (P=0.000) after clinical pharmacist's counselling, whereas in the control group there was no significant improvement in patient's baseline knowledge over the knowledge score at the end of the study (8.0±1.59 vs. 8.3±2.6) (P=0.218). In the intervention group, 73.45% of the international normalised ratio test results were within the therapeutic range, 8.45% supratherapeutic and 18.5% subtherapeutic during the 6 months data collection period. The corresponding data for the control group were 53.2 (P=0.000), 18.4 (P=0.000) and 28.4% (P=0.002), respectively. Forty four adverse drug reactions (ADRs) related to anticoagulants were identified in the intervention group as compared to 56 in the control group. These results revealed that the clinical pharmacist's involvement in the anticoagulation management improved the therapeutic outcome of patients and demonstrate the benefits of clinical pharmacist guided anticoagulation clinics in India.

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2013

Journal Article

Lakshmi R., Karakkattu, J., and Keerthana, S., “Hibiscus”, Health- a journal devoted to healthful living., vol. 91, no. 3, pp. 9-11, 2013.

2013

Journal Article

Lakshmi R., Raju, A., Joy, T. Mary, and S, V., “Male breast cancer.”, Health - a journal devoted to healthful living. , 2013.

2013

Journal Article

Lakshmi R., Raju, A., Joy, T. Mary, and S., V., “Male breast cancer”, Health - a journal devoted to healthful living, vol. 91, no. 5, pp. 23-27, 2013.

2012

Journal Article

Lakshmi R., Anitha, S., N, A. K., and Roshni, P. R., “Warfarin resistance: mechanisms and management”, International Journal of Pharmaceutical Sciences and Research, vol. 3, no. 2, p. 353, 2012.[Abstract]


Anticoagulants are a class of drugs commonly used to prevent the blood from forming dangerous clots that could result in a stroke. Warfarin is an oral anticoagulant. Warfarin differs from most other drugs in that the dosage required to achieve a desired therapeutic effect varies greatly among individuals. Resistance to warfarin has been described as the inability to prolong the prothrombin time or raise the international normalized ratio (INR) into the therapeutic range when the drug is given at normally prescribed doses. However, a higher warfarin requirement does not itself establish the diagnosis of warfarin resistance. Warfarin resistance can be classified as acquired versus hereditary. It can be diagnosed by laboratory studies and can be managed.

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2012

Journal Article

Lakshmi R., Athira, R., Teena, J. M., and Vijayalakshmi, S., “Breast cancer risk factors: preventable and non-preventable”, IJPR, vol. 3, no. 10, pp. 1-5, 2012.[Abstract]


Worldwide, breast cancer comprises 22.9% of all cancers (excluding non-melanoma skin cancers) in women. The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. In 1940, the lifetime risk of a woman developing breast cancer was 5%, or one in 20. The American Cancer Society estimates that risk being 13% in 2012, or more than one in 8. Studies have shown that certain factors, called risk factors, increase the likelihood that a woman will develop breast cancer. Many of these risk factors are not reversible, but some can be modified. A “risk factor” is anything that increases the risk of developing breast cancer. Many of the most important risk factors for breast cancer are beyond control (non-preventable), such as age, family history, and medical history. However, there are some risk factors that are preventable, such as weight, physical activity, and alcohol consumption.

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2012

Journal Article

A. S, Lakshmi R., Cherian, S., and Roshni P. R., “Maternal hypothyroidism – a clinical perspective”, International Journal of Medical and Pharmaceutical Sciences, 2012.[Abstract]


Maternal hypothyroidism, in simple terms, refers to low thyroid hormone levels during pregnancy. The diagnosis is made by a TSH that is greater than normal, and this situation deserves therapy. Many studies have shown that maternal thyroid hormones are very important in pregnancy1-3. Most importantly, emerging data seems to suggest that thyroid hormones are especially important for fetal brain development, especially during early pregnancy4. This article will discuss the importance, diagnosis and management of maternal hypothyroidism, from a clinician’s perspective.

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2011

Journal Article

S. Sekhar. M, N., A. K., Venugopal, S., Ponnechen, M., Paul, M. C., and Lakshmi R., “Patient Counseling for Anticoagulation Patients”, International Journal of Drug Discovery and Technology., vol. 2, no. 1, pp. 55-61, 2011.[Abstract]


The goal of anticoagulation therapy with warfarin is to decrease theclotting ability of your blood so that blood clots are prevented. The most importantaspect of warfarin therapy is to keep your levels within a therapeutic range. If yourlevel goes too low, you are at risk for blood clots, if it goes too high, you are at risk for bleeding. Many factors can affect your level.

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2011

Journal Article

B. K. S, A, S., Lakshmi R., and R, S., “Pharmacoeconomics – Indian Scenario”, Indian Journal of Pharmacy Practice, 2011.[Abstract]


Steady increase in the number of diseases and the number of treatments has increased patient sensitivity towards cost. This has necessitated a method that can effectively compare the cost and the consequence of a treatment method, has led to the introduction of Pharmacoeconomics. Pharmacoeconomics is a description and analysis, of the costs and consequences of pharmaceuticals and pharmaceutical services and their impact on individuals, healthcare systems and society. This should ideally form the basis of the Hospital formulary system, and is often used as a tool by insurance agencies to decide on what to fund and what not to. Globally, Pharmacoeconomics has been making strong inroads in many countries, where healthcare spending is governed by economic considerations. International Society for Pharmacoeconomics and Outcomes Research exists to spread the word and to encourage more countries to embrace the analytical technique, which would reduce their spending on healthcare. Pharmacoeconomics is yet to make an appearance in India where majority of healthcare spending is done by patients out of their own pockets, unlike medical insurance policies in most developed countries. It is important that Pharmacoeconomic researches should be introduced strongly in the India and should be performed from the clinical trial onwards so that the government can ensure that money spends in the right direction and also reduce the financial burden on patients.

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2011

Journal Article

S. Sekhar, N, A. K., Venugopal, S., Ponnechen, M., Paul, M. C., and Lakshmi R., “Patient counselling for anticoagulation patients.”, International Journal of Drug Discovery And Technology. , 2011.

2010

Journal Article

S. Sekhar, Jose, P., Lakshmi R., Sankar, B. K., and P., R. K., “Unraveling the myth: herbs aren't safe.”, International Journal of Drug Targets. , 2010.

Faculty Research Interest: 
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