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   Table of Contents - Current issue
Coverpage
January-February 2020
Volume 52 | Issue 1
Page Nos. 1-65

Online since Wednesday, March 11, 2020

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EDITORIAL  

Therapeutic options for the treatment of 2019-novel coronavirus: An evidence-based approach Highly accessed article p. 1
Phulen Sarma, Manisha Prajapat, Pramod Avti, Hardeep Kaur, Subodh Kumar, Bikash Medhi
DOI:10.4103/ijp.IJP_119_20  
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RESEARCH ARTICLES Top

A comparative study of alpha-1a blockers (tamsulosin) versus estrogens in the treatment of lower urinary tract symptoms in perimenopausal females p. 6
Krishnendu Maiti, Alankar Jaiswal, Dilip Kumar Pal
DOI:10.4103/ijp.IJP_545_18  
OBJECTIVE: Lower urinary tract symptoms (LUTS) in perimenopausal females are very common. It can be treated with alpha-blockers or application of topical oestrogen. The purpose of this study is to compare the efficacy of alpha-blockers versus topical estrogen in the treatment of LUTS in perimenopausal females. MATERIALS AND METHODS: All perimenopausal females between the age group of 45 and 60 years who present with the symptom of voiding LUTS were divided into two groups. Acute urinary retention patients were excluded from the study. The first group was given alpha-blocker (tamsulosin) and other group was given topical estrogen application (0.5%–1%) in the periurethral region. Patients were followed up clinically by voiding components of the International Prostate Symptom Score and objectively by uroflowmetry and postvoid residual (PVR) urine estimation (ultrasonography). RESULTS: Alpha-blocker group had 40 females and topical estrogen group had 40 females. During the 6-week period, 8 patients of the first group and 6 patients of the estrogen group discontinued the treatment. In the first group, pretreatment mean Qmax (maximum flow rate) of patients was 7.2 ml/s and posttreatment Qmax was 18.4. In the second group, the values were 7.4 ml/s and 10.2, respectively. This difference was statistically significant (P < 0.0001). In the first group, pretreatment PVR urine was significant, which became insignificant after the treatment, whereas in the second group, PVR was significant posttreatment also. CONCLUSION: Alpha-1a blockers should be used as the first-line medical management in perimenopausal females with symptoms of LUTS, as they have a clear advantage over topical estrogens.
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A 12-week prospective randomized controlled comparative trial of vilazodone and sertraline in Indian patients with depression p. 10
Manish Bathla, Shazia Anjum
DOI:10.4103/ijp.IJP_618_18  
BACKGROUND: Depressive disorders are considered to be one of the leading causes of morbidity and mortality accounting for 4.3% of total disability-adjusted life years. Selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors have greater efficacy and lesser side effects; at the same time, these drugs cause sexual dysfunction and weight gain. Vilazodone was supposed to have better efficacy and less sexual dysfunction and weight gain. AIM OF THE STUDY: The aim is to compare efficacy (in terms of Hamilton Depression Rating Scale [HDRS]), sexual dysfunction (in terms of Arizona Sexual Experience Scale [ASEX]), and weight gain caused due to vilazodone and sertraline. MATERIALS AND METHODS: This is a randomized controlled study; 60 patients diagnosed with depressive episode were divided into two groups of 30 each; using block randomization technique, one group was prescribed vilazodone and another sertraline. The groups were compared on the basis of efficacy, weight gain, and sexual dysfunction using HDRS and ASEX at baseline, 4-week, and 12-week intervals. Statistical analysis was done by applying Chi-square test, Fisher's exact test, t- test, and repeated measures ANOVA using Wilks' lambda test. RESULTS: On comparing both vilazodone and sertraline, it was observed that both molecules have equal efficacy in terms of HDRS, but vilazodone does not cause weight gain and sexual dysfunction in terms of ASEX, and these findings are statistically very highly significant. CONCLUSIONS: Our study shows that vilazodone has similar efficacy but can be a better antidepressant due to lesser weight gain and sexual dysfunction compared to sertraline.
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The evaluation of efficacy and safety of methotrexate and pioglitazone in psoriasis patients: A randomized, open-labeled, active-controlled clinical trial p. 16
Afroz Abidi, Dilshad Ali Rizvi, Kshitij Saxena, Savita Chaudhary, Ali Ahmad
DOI:10.4103/ijp.IJP_88_19  
OBJECTIVES: Psoriasis is a chronic inflammatory disease showing co-existence with metabolic syndrome (MS), as has been confirmed by numerous epidemiologic studies in recent times. In this study, the aim was to ascertain the beneficial effects of pioglitazone in psoriasis, simultaneously targeting the improvement of MS parameters. MATERIALS AND METHODS: We conducted a prospective randomized open-labeled parallel-group interventional study in patients of moderate-to-severe chronic plaque psoriasis. A total of 90 patients were inducted in study and divided into three groups of standard treatment (methotrexate 7.5 mg/week for 12 weeks), active treatment (pioglitazone 15 mg tablets once daily for 12 weeks), and their combination. Primary outcome was taken as percentage Psoriasis Area and Severity Index (PASI) improvement from baseline; secondary outcomes were PASI-75, safety profile, and MS parameters. RESULTS: Intergroup evaluation of PASI score showed that standard treatment methotrexate and active treatment pioglitazone were comparable. Combination of methotrexate and pioglitazone proved superior in efficacy from both standard and active treatment in 8 and 12 weeks. Adverse drug reactions were mild and treated symptomatically. Pioglitazone and combination group also demonstrated beneficial efficacy in parameter of MS hence establishing it as a potential therapy in psoriasis with MS. CONCLUSIONS: Pioglitazone alone or in combination with standard treatment may be a safe alternative drug for psoriasis coexisting with MS proving beneficial for both.
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Comparison of midazolam and low-dose dexmedetomidine in flexible bronchoscopy: A prospective, randomized, double-blinded study p. 23
Rahul Magazine, Shivaraj Kumar Venkatachala, Umesh Goneppanavar, Vyshak Uddur Surendra, Vasudeva Guddattu, Bharti Chogtu
DOI:10.4103/ijp.IJP_287_19  
BACKGROUND: Dexmedetomidine is a clinically useful drug for providing sedation, but concern regarding its cardiovascular side effect profile can limit its widespread use during routine diagnostic flexible bronchoscopy (FB). MATERIALS AND METHODS: Patients between 18 and 65 years of age, who required diagnostic FB, were screened. Eligible patients were randomized to either receive 0.5 μg/kg intravenous dexmedetomidine over 10 min or intravenous midazolam 0.035 mg/kg over 1 min. If required, rescue medication (intravenous midazolam 0.5 mg bolus) was administered. The primary outcome measure was the composite score. Other parameters observed were numerical rating scale, hemodynamic variables, oxygen saturation, number of doses of rescue medication, visual analog scale score for cough, ease of bronchoscopy, Ramsay Sedation Score, and postprocedure patient response after 24 h of bronchoscopy. RESULTS: A total of 54 patients were enrolled, 27 in each group. Total composite score (mean ± standard deviation) in dexmedetomidine and midazolam group at nasopharynx was 7.04 ± 2.19 and 6.59 ± 1.55 (P = 0.387), respectively. The corresponding values at the level of trachea were 9.22 ± 3.69 and 8.63 ± 2.13 (P = 0.475). In the dexmedetomidine group, patient response after 24 h of bronchoscopy showed the quality of sedation to be excellent in three patients, good in 10, fair in 11, and poor in 3 and discomfort to be nil in 14, mild 7, moderate in 3, and severe in 3. The corresponding values in the midazolam group for the quality of sedation were 0, 9, 18, 0 and for discomfort 10, 16, 1, 0. Other parameters did not reveal any statistically significant difference. CONCLUSION: Dexmedetomidine at a dose of 0.5 μg/kg may provide clinically useful conscious sedation, comparable to midazolam.
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Effect of chromium citrate on the mechanism of glucose transport and insulin resistance in Buffalo rat liver cells p. 31
Weijie Zhang, Hui Chen, Yangyang Ding, Qingfang Xiang, Jie Zhao, Weiwei Feng, Liuqing Yang
DOI:10.4103/ijp.IJP_608_18  
OBJECTIVE: Our published literature indicated that chromium citrate could regulate the glycemic index in alloxaninduced diabetic mice. The present study investigated the mechanism of chromium citrate in insulin resistance (IR) buffalo rat liver (BRL) cells. MATERIALS And METHODS: Chromium citrate was synthesized in our laboratory. BRL cells were purchased from the Chinese Academy of Sciences Cell Bank. The glucose transport and IR affected by chromium citrate in BRL cells were examined. The Thiazolyl Blue Tetrazolium Bromide (MTT) and glucose assay experiments were measured by microplate ELISA reader. The protein kinase B (Akt), glucose transporter-4 (Glut4), and phosphor-AMP-activated protein kinase β1 levels were tested by Western blot, and the mRNA expression of glucose transport proteins (Akt2, Glut4, and AMPactivated protein kinase α2 (AMPKα2)) and insulin sensitivity proteins (insulin receptor substrate1 (IRS-1), phosphatidylinositol 3 kinase (PI3K), and peroxisome proliferator-activated receptor γ (PPARγ)) was measured by reverse transcription–polymerase chain reaction. RESULTS: The results indicated that the glucose absorption level of chromium citrate groups was higher than model group significantly. It demonstrated that chromium citrate could significantly improve glucose absorption in IR BRL cells. The Akt, Glut4, and phosphor-AMPKβ1 levels in chromium citrate groups (at doses of 0.4, 0.2, and 0.1 μg Cr/mL) were markedly improved when compared with the other experiment groups, and chromium citrate could more effectively increase the Akt level than chromium trichloride. In addition, the mRNA expression of Akt2, Glut4, and AMPKα2 in chromium citrate groups was significantly improved when contrasted with model group. CONCLUSION: The consequences illustrated that chromium citrate can affect the IR BRL cells' ameliorating glucose transport and IR.
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EDUCATIONAL FORUM Top

Cost-effective innovation of locally assembled mannequins for undergraduate skill development in parenteral drug administration p. 39
Susan Mani, M Nisha, Jolly Varghese, Serah Johny, Anna Mathew
DOI:10.4103/ijp.IJP_279_19  
INTRODUCTION: The new competencybased curriculum for undergraduate medical education by the Medical Council of India mandates simulation using mannequins for teaching parenteral drug administration. Traditional education tends to focus on textbook learning, whereas competencybased education concentrates on the outcomes that directly guide the assessment of learners. OBJECTIVE: To introduce a module for the development of the core competency of parenteral drug administration using costeffective locally assembled mannequins for handson skill development in administering injections to be assessed using objective structured practical examination (OSPE). MATERIALS AND METHODS: Costeffective and durable fiberglass arms from mannequins used for fashion display were prepared for parenteral drug administration. The padding is easily done with wadding and gauze/crepe bandages, and the assembling requires only 15 minutes per arm. The training can be conducted in the department, giving students adequate opportunity for handson learning on individual arms during the practical sessions. As initial investment and recurring costs are low, it is possible for the department to obtain enough number of mannequins for each student to practice individually on an injection arm. RESULTS: Students practice injection technique freely, without fear of damaging the mannequin or having to do it on a patient. This helps them to assimilate the steps and sub-steps of doing the task in a much more realistic way and builds their confidence. Assessment of the performance of injection technique, infection control practices, and drug delivery are possible. CONCLUSION: We have observed a greater trend toward selflearning and selfefficacy and better adherence to the protocol of injection technique because of the handson training the students receive.
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SHORT COMMUNICATIONS Top

Fasting insulin levels correlate with the frequency of hypoglycemic events in people with type 2 diabetes on treatment with sulfonylureas: A pilot study p. 44
Konstantinos Kolokas, Theocharis Koufakis, Iakovos Avramidis, Spyridon Gerou, Maria Chatzidimitriou, Kyriakos Kazakos, Kalliopi Kotsa
DOI:10.4103/ijp.IJP_80_19  
AIMS AND OBJECTIVES: We aimed to explore whether fasting insulin levels correlate with the risk of hypoglycemia in people with Type 2 diabetes (T2D) receiving sulfonylureas (SUs). MATERIALS AND METHODS: Our study included 58 individuals with T2D who had been on treatment with SUs, but not insulin, for more than 2 years. Confirmed hypoglycemic episodes during the past year were self-reported by the patients, and a potential relationship of hypoglycemic event frequency with fasting insulin levels was investigated. RESULTS: Fasting insulin concentrations were found to have a low positive and statistically significant correlation with the number of cases of mild hypoglycemia per year (ρ = 0.279/P = 0.034) and a moderately positive and statistically significant correlation with the number of severe hypoglycemic events per month (ρ = 0.349/P = 0.007) and per year (ρ = 0.39/P = 0.002). CONCLUSION: Our results suggest that fasting insulin levels might be a predictor of the risk of hypoglycemia in people with T2D on treatment with SUs.
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Use of rituximab in muscle-specific tyrosine kinase antibody-positive myasthenia gravis: Preliminary observations from a tertiary care center in Northern India p. 49
Julie Sachdeva, Karthik Vinay Mahesh, Ritu Shree, Gaurav Jain, Aastha Takkar Kapila, Tirulapati Padmavathi Shashikala, Manoj Kumar Goyal, Manish Modi, Vivek Lal
DOI:10.4103/ijp.IJP_333_18  
OBJECTIVES: Approximately 10%–15% of patients with myasthenia gravis (MG) are refractory to standard treatment. A sizable chunk of these patients is due to muscle-specific tyrosine kinase (MuSK) antibody-positive MG which often runs a severe course with frequent relapses and poor response to conventional treatment. We report six patients with refractory MuSK-positive MG who responded well to the treatment with rituximab. PATIENTS AND METHODS: In this prospective institute-based observational study, we report six MuSK antibody-positive MG patients, who did not achieve remission with standard treatment and were later started on rituximab infusion. RESULTS: There was a significant clinical improvement in all patients after starting rituximab. CONCLUSION: Rituximab is an effective immunomodulatory therapy in MuSK antibody-positive MG patients who are not responding to the standard treatment.
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DRUG WATCH Top

A rare occurrence of intrauterine death following an allergic reaction to iron sucrose p. 53
Asha Basavareddy
DOI:10.4103/ijp.IJP_169_18  
During pregnancy, iron-deficiency anemia if untreated can affect the mother and child and hence iron is supplemented. Intolerance to oral iron therapy and malabsorption are common indications for parenteral iron therapy. The regularly used intravenous iron preparations are iron sucrose, sodium ferric gluconate, and iron dextran, of which iron sucrose has a satisfactory safety profile. We report a case of iron sucrose causing rare reaction with generalized edema in the mother, which was followed by intrauterine death. The oxidative stress due to immune-mediated mechanisms or adjuvant used in iron sucrose could cause mild rashes to severe anaphylactic reactions. This case report warns us toward the use of parenteral iron preparations in pregnant women, as one of the safe formulations could lead to an unusual fatal outcome in the fetus.
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SYSTEMATIC REVIEW Top

Drug targets for corona virus: A systematic review Highly accessed article p. 56
Manisha Prajapat#, Phulen Sarma#, Nishant Shekhar#, Pramod Avti, Shweta Sinha, Hardeep Kaur, Subodh Kumar, Anusuya Bhattacharyya, Harish Kumar, Seema Bansal, Bikash Medhi
DOI:10.4103/ijp.IJP_115_20  
The 2019-novel coronavirus (nCoV) is a major source of disaster in the 21th century. However, the lack of specific drugs to prevent/treat an attack is a major need at this current point of time. In this regard, we conducted a systematic review to identify major druggable targets in coronavirus (CoV). We searched PubMed and RCSB database with keywords HCoV, NCoV, corona virus, SERS-CoV, MERS-CoV, 2019-nCoV, crystal structure, X-ray crystallography structure, NMR structure, target, and drug target till Feb 3, 2020. The search identified seven major targets (spike protein, envelop protein, membrane protein, protease, nucleocapsid protein, hemagglutinin esterase, and helicase) for which drug design can be considered. There are other 16 nonstructural proteins (NSPs), which can also be considered from the drug design perspective. The major structural proteins and NSPs may serve an important role from drug design perspectives. However, the occurrence of frequent recombination events is a major deterrent factor toward the development of CoV-specific vaccines/drugs.
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