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   Table of Contents - Current issue
Coverpage
March-April 2015
Volume 47 | Issue 2
Page Nos. 135-236

Online since Tuesday, March 17, 2015

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EDITORIAL  

Patient safety in medical education: Medication safety perspectives p. 135
Reginald P Sequeira
DOI:10.4103/0253-7613.153417  
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RESEARCH ARTICLES Top

Perception, attitude and usage of complementary and alternative medicine among doctors and patients in a tertiary care hospital in India p. 137
Vandana Roy, Monica Gupta, Raktim Kumar Ghosh
DOI:10.4103/0253-7613.153418  
Aim: Complementary and alternative medicine (CAM) has been practiced in India for thousands of years. The aim of this study was to determine the extent of use, perception and attitude of doctors and patients utilizing the same healthcare facility. Methods: This study was conducted among 200 doctors working at a tertiary care teaching Hospital, India and 403 patients attending the same, to determine the extent of usage, attitude and perception toward CAM. Results: The use of CAM was more among doctors (58%) when compared with the patients (28%). Among doctors, those who had utilized CAM themselves, recommended CAM as a therapy to their patients (52%) and enquired about its use from patients (37%) to a greater extent. CAM was used concomitantly with allopathic medicine by 60% patients. Very few patients (7%) were asked by their doctors about CAM use, and only 19% patients voluntarily informed their doctors about the CAM they were using. Most patients who used CAM felt it to be more effective, safer, less costly and easily available in comparison to allopathic medicines. Conclusion: CAM is used commonly by both doctors and patients. There is a lack of communication between doctors and patients regarding CAM, which may be improved by sensitization of doctors and inclusion of CAM in the medical curriculum
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Single dose intravenous methyl prednisolone versus oral prednisolone in Bell's palsy: A randomized controlled trial p. 143
Prithvi Giri, Ravindra Kumar Garg, Maneesh Kumar Singh, Rajesh Verma, Hardeep Singh Malhotra, Praveen Kumar Sharma
DOI:10.4103/0253-7613.153419  
Objectives: Corticosteroids have been used in the treatment of Bell's palsy and several other postinfectious neurological conditions. We hypothesized that administration of a single dose of intravenous (IV) methylprednisolone might be an effective alternative to oral prednisolone. Materials and Methods: In this open label, randomized trial, patients with acute Bell's palsy were randomized into two groups. One group received single dose (500 mg) of IV methylprednisolone while the other group received 10 days of oral prednisone. Outcome was assessed at 1 and 3 months with House-Brackmann scale. Results: At 3 months, 93 (79.48%) patients had completely recovered. IV methylprednisolone and oral prednisolone groups had similar recovery rates (80% vs. 78.33%, P > 0.05). Patients with Grade 2 and 3 recovered completely. In patients with Grade 6, the recovery rate was 20%. A better outcome was observed if corticosteroids were administered within 3 days of onset of palsy. Conclusion: Intravenous methylprednisolone and oral prednisolone showed equivalent benefit in patients with acute Bell's palsy.
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A retrospective study of the effects of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in diabetic nephropathy p. 148
Jahnavi V Pathak, Ervilla E Dass
DOI:10.4103/0253-7613.153420  
Objective: Till date, several studies have compared angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in terms of delaying the progression of diabetic nephropathy. But the superiority of one drug class over the other remains unsettled. This study has retrospectively compared the effects of ACE inhibitors and ARBs in diabetic nephropathy. The study aims to compare ACE inhibitors and ARBs in terms of delaying or preventing the progression of diabetic nephropathy, association between blood pressure (B.P) and urinary albumin and also B.P and serum creatinine with ACE inhibitor and ARB, know the percentage of hyperkalemia in patients of diabetic nephropathy receiving ACE inhibitor or ARB. Settings and Design: A total of 134 patients diagnosed with diabetic nephropathy during the years 2001-2010 and having a complete follow-up were studied, out of which 99 were on ARB (63 patients of Losartan and 36 of Telmisartan) and 35 on ACE inhibitor (Ramipril). Subjects and Methods: There was at least 1-month of interval between each observation made and also between the date of treatment started and the first reading that is, the observation of the 1 st month. In total, three readings were taken that is, of the 1 st , 2 nd and 3 rd month after the treatment started. Comparison of the 1 st and 3 rd month after the treatment started was done. Mean ± standard deviation, Paired t-test, and Chi-square were used for the analysis of the data. Results: The results reflect that ARBs (Losartan and Telmisartan) when compared to ACE inhibitor (Ramipril) are more effective in terms of delaying the progression of diabetic nephropathy and also in providing renoprotection. Also, ARBs have the property of simultaneously decreasing the systolic B.P and albuminuria when compared to ACE inhibitor (Ramipril). Conclusions: Angiotensin receptor blockers are more renoprotective than ACE inhibitors and also provide better cardioprotection.
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Differential effects of dexamethasone and rosiglitazone in a sephadex-induced model of lung inflammation in rats: Possible role of tissue inhibitor of metalloproteinase-3 p. 153
Jignesh K Nagar, Praful P Patel, Jogeswar N Mohapatra, Manoranjan M Sharma, Gaurav M Pandya, Malik M Umar, Abhijit A Chatterjee, Shrikalp S Deshpande, Mukul R Jain, Hitesh M Soni
DOI:10.4103/0253-7613.153421  
Objectives: To study the effects of two different classes of drugs in sephadex-induced lung inflammation using rats and explore the potential mechanism (s). Materials and Methods: Effects of dexamethasone (0.3 mg/kg, p.o.) and rosiglitazone (10 mg/kg, p.o.) treatments were evaluated up to 3 days in sephadex challenged rats. 72 h postsephadex administration, broncho-alveolar lavage fluid (BALF) was collected for cell count and cytokine estimation. Lung tissues were harvested for gene expression and histopathology. Results: Dexamethasone treatment resulted in significant inhibition of lymphocytes, monocytes, eosinophils and neutrophils, whereas rosiglitazone inhibited eosinophils and neutrophils only. Further, dexamethasone reduced the elevated levels of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) after sephadex challenge while rosiglitazone significantly reduced the PGE2 levels without altering LTB4 in the BALF. Hydroxyproline content in rat lung homogenate was significantly reduced with dexamethasone treatment but not with rosiglitazone. Both the drugs were found to suppress matrix metallo proteinase 9, whereas only dexamethasone showed inhibition of tumor necrosis factor-alpha and up-regulation of tissue inhibitor of metalloproteinase 3 (TIMP-3) expression and preserved the broncho-alveolar microstructure. Conclusions: Our results revealed that up-regulation of TIMP-3 corroborated well with dexamethasone mediated inhibition of collagen degradation and restoration of alveolar micro-architecture.
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Exploring the role of curcumin containing ethanolic extract obtained from Curcuma longa (rhizomes) against retardation of wound healing process by aspirin p. 160
Rajesh Singh Pawar, Fedelic Ashish Toppo, Avinash Singh Mandloi, Shabnam Shaikh
DOI:10.4103/0253-7613.153422  
Aim: The aim of the study was to assess the curcumin containing ethanolic extract (EtOH) obtained from Curcuma longa (Cl) against retardation of wound healing by aspirin. Materials and Methods: Wound healing process was retarded by administering the dose of 150 mg/kg body weight of aspirin orally for 9 days to observe the effect of EtOH obtained from Cl using excision and incision wound model in rats. The various parameters such as % wound contraction, epithelialization period, hydroxyproline, tensile strength were observed at variant time intervals and histopathological study was also performed. Results: Curcumin containing 5% and 10% ethanolic extract ointment have shown significant (P < 0.01) wound healing activity against an aspirin (administered 150 mg/kg body weight orally for 9 days) retarded wound healing process. Topical application of ointment showed significant (P < 0.01) difference as compared to the control group. Histopathological studies also showed healing of the epidermis, increased collagen, fibroblasts and blood vessels. Conclusion: Ethanolic extract of Cl ointment (EtOHCl) containing 10% curcumin displayed remarkable healing process against wound retardation by aspirin.
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Acute and sub-chronic oral toxicity study of black tea in rodents p. 167
Tapas Kumar Sur, Suparna Chatterjee, Alok Kumar Hazra, Richeek Pradhan, Supriyo Chowdhury
DOI:10.4103/0253-7613.153423  
Objectives: Systematic oral toxicity study for black tea (Camellia sinensis), the most commonly consumed variety of tea, is lacking. The present study was undertaken to assess the iron load on black tea (Camellia sinensis) and its safety aspects in animals. Materials and Methods: The analysis of iron was done in six tea samples as per American Public Health Association method using flame atomic absorption spectrophotometer. Maximum physical iron-loaded tea sample was identified on black tea sample 2 (BTS-2), and this was further studied for acute and 90-day sub-chronic toxicity following Organisation for Economic Co-operation and Development guidelines. Results: Black tea sample 2 did not show any signs of toxicity or mortality at up to 2 g/kg per oral dose in Swiss albino mice. 90-day toxicity studies in Wistar rats did not reveal any evidence of toxicity at up to 250 mg/kg/day (2.5% infusion of BTS-2) oral dose as exhibited by regular observations, body weight, food consumption, hematology, serum chemistry, organ weights, and histopathology. Further, serum iron, total iron binding capacity, unsaturated iron binding capacity, and ferritin were not altered after 90 days of treatment. Masson trichrome staining and Perls' staining did not reveal any abnormalities in hepatic tissue following 90-day treatment of high iron-loaded BTS-2. Conclusions: This safety study provides evidence that BTSs, in spite of relatively high iron content, show no significant iron-related toxicity on acute or sub-chronic oral administration in animals.
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Effect of a combination of duloxetine with hydroxyzine on experimental models of anxiety in mice p. 173
Sonam Patel, Pravin Popatrao Kale, Veeranjaneyulu Addepalli, Amrita Sarkar, Jay Savai
DOI:10.4103/0253-7613.153424  
Objective: There is a strong association between depression and anxiety. Duloxetine, an antidepressant agent, is also used in the treatment of anxiety. Hydroxyzine is preferred over benzodiazepines in the treatment of anxiety. Present study was designed to study the impact of a combination of duloxetine with hydroxyzine in treatment of anxiety. Materials and Methods: Mice received intraperitoneal injection of normal saline (10 ml/kg), duloxetine alone (10 mg/kg), hydroxyzine alone (10 mg/kg), and hydroxyzine plus duloxetine (5 mg/kg, each). Results: The in vivo results (elevated plus maze and light/dark transition tests) showed significant anxiolytic activity with the hydroxyzine treatment than the control group. The brain monoamines were significantly increased in hippocampi, cerebral cortices, and whole brain in drug-treated groups than in the control group. The group receiving the combination showed similar results in the in vivo models and in vitro tests (brain monoamine estimations) than respective monotherapies, with the exception of a greater increase of norepinephrine levels in cerebral cortices in duloxetine-treated group. Conclusion: Combination of duloxetine with hydroxyzine is not beneficial in anxiolytic treatment than the respective monotherapies. There is a need to study the pharmacokinetic drug-drug interactions to understand the present study outcomes.
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Effect of ethanolic extracts of Justicia neesii Ramam. against experimental models of pain and pyrexia p. 177
Nimmakayala Sridhar, Duggirala Suguna Lakshmi, Puchchakayala Goverdhan
DOI:10.4103/0253-7613.153425  
Objective: The main objective of this study is to evaluate the analgesic and anti-pyretic activities of ethanolic extracts of Justicia neesii Ramam. by different experimental models. Materials and Methods: The analgesic activity of plant extract was evaluated against thermal and chemical stimulus induced by Eddy's hot plate and acetic acid respectively in mice. Brewer's yeast induced pyrexia was used to evaluate the antipyretic activity in rats and TAB vaccine induced pyrexia was used to evaluate the antipyretic activity in rabbits. Results: In the hot plate model 400 mg/kg p.o. dose of J. neesii has shown its maximal effect at 3 h. The results are significant (P < 0.05) and comparable to the values of standard drug pentazocine (30 mg/kg i.p.). In acetic acid induced writhing model 400 mg/kg p.o. of plant extracts have shown highly significant activity (P < 0.001) and better than standard drug indomethacin (10 mg/kg p.o.). The 400 mg/kg p.o. dose of plant extract has given significant results against both yeast induced pyrexia and TAB vaccine induced pyrexia (P< 0.01 and 0.05 respectively). These values are comparable to that of paracetamol 100 mg/kg p.o. standard dose. Conclusion: This study shows that the ethanol extract of J. neesii has significant analgesic and antipyretic activity.
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Comparison of the efficacy of liraglutide with pioglitazone on dexamethasone induced hepatic steatosis, dyslipidemia and hyperglycaemia in albino rats p. 181
K Vinodraj, IM Nagendra Nayak, J Vikram Rao, Paul Mathai, N Chandralekha, B Nitasha, D Rajesh, TK Chethan
DOI:10.4103/0253-7613.153426  
Objectives: To evaluate the efficacy of liraglutide with pioglitazone for prevention of dexamethasone induced hepatic steatosis, dyslipidemia and hyperglycemia in Albino rats. Materials and Methods: There were four groups of six rats each. First group received dexamethasone alone in a dose of 8 mg/kg intraperitoneally for 6 days to induce metabolic changes and considered as dexamethasone control. Second group received liraglutide 1.8 mg/kg subcutaneously 6 days before dexamethasone and 6 days during dexamethasone administration. Third group received pioglitazone 45 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Fourth group did not receive any medication and was considered as normal control. Fasting blood sugar, lipid profile, blood sugar 2 h after glucose load were measured. Liver weight, liver volume, and histopathological analysis were done. Results: Dexamethasone caused hepatomegaly, dyslipidemia, and hyperglycemia. Both pioglitazone and liraglutide significantly reduced hepatomegaly, dyslipidemia and hyperglycemia (P < 0.01). Reduction of blood sugar levels after glucose load was significant with pioglitazone when compared with liraglutide (P < 0.01). Conclusion: Liraglutide has comparable efficacy to pioglitazone in prevention of dexamethasone induced hepatomegaly, dyslipidemia and fasting hyperglycemia.
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Protective effects of amifostine on ischemia-reperfusion injury of rat kidneys p. 185
Ayse Arducoglu Merter, Burhan Mayir, Okan Erdogan, Taner Colak
DOI:10.4103/0253-7613.153427  
Objectives: Amifostine is a drug which can eliminate free oxygen radicals that appear in the body after radiation or chemotherapeutic agent exposure. It is used to decrease the renal toxicity of cisplatin. The aim of this study was to determine the role of amifostine in warm ischemia kidney model for prevention of ischemia/reperfusion injury and also to find out the mechanism for prevention from ischemia/reperfusion injury if such an effect does exist. Materials and Methods: Adult female rats (n = 40) that used in our study were divided into three groups. Group 1: Control (n = 8), group 2: Ischemia-control (n = 16), group 3: Amifostine treated (n = 16). The effect of amifostine on ischemia/reperfusion injury investigated in rat kidneys. Results: At the 7 th day, blood urea nitrogen level was statistically significantly higher in ischemia-control group than all groups (P = 0.001) and mean serum creatinine levels were found to be the highest in ischemia-control group (P = 0.091). Mean malondialdehyde levels in left kidneys removed on the 7 th day were not significantly different (P = 0.105) at all three groups. Between ischemia-control group and amifostine group, there was a significant difference in reduced glutathione (GSH) levels (P = 0.001). In amifostine group, grade 4 necrosis was not detected neither on 7 th day nor day 0. Conclusion: Amifostine could decrease the degree and severity of necrosis after reperfusion. Amifostine could not prevent membrane lipid peroxidation caused by superoxide anion radicals in kidney but they could protect tissues from the harmful effects of ischemia/reperfusion injury by increasing the level of reduced GSH which is a well-known oxygen radical eliminator.
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An evaluation of adherence to society of pharmacists' standards care in pharmacy information systems in Iran p. 190
Sakineh Saghaeiannejad-Isfahani, Javad Sharifi-Rad, Ahmadreza Raeisi, Asghar Ehteshami, Razieh Mirzaeian
DOI:10.4103/0253-7613.153428  
Introduction: Pharmacy information system (PIS) is a complex computerized system used for collecting, storing, and managing the medication therapy data in the course of patients' care. The purpose of this study was to evaluate the level of adherence to the standards established by the societies of pharmacists in the PISs employed in the hospitals in Isfahan, Iran. Methods: The present study was an applied, descriptive-analytical study conducted on the PISs of 19 teaching, private and social insurance hospitals in Isfahan in 2011. Study population consisted of the PISs available in the hospitals under study. Study sample was the same as the study population. The data collection instrument was a self-developed checklist based on the guidelines of the American Society of Health-System Pharmacists and Pharmaceutical Society of Australia, whose validity was assessed and confirmed by expert professors' views. Having been collected by observation and interview methods, data were analyzed by SPSS 18 software using Mann-Whitney statistical test. Results: The findings of the study revealed that the highest rank in adherence to the standards of societies of pharmacists was obtained by social services hospitals (32.75%), while the private hospitals obtained the lowest rank (23.32%). Conclusions: Based on the findings, in the PISs in the hospitals under study, some standards of the society of pharmacists were ignored. Hence, prior to designing and implementing PIS, a needs analysis is required to increase its users' motivation to identify the system potentialities and to allow the system development in compliance with the world technology advancement.
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SHORT COMMUNICATIONS Top

Chemical genetic effects of Sargassum wightii during embryonic development in zebrafish p. 195
Rajaretinam Rajesh Kannan, Appadurai Muthamil Iniyan, Samuel Gnana Prakash Vincent
DOI:10.4103/0253-7613.153429  
Objective: Phenotype based small molecule discovery is a category of chemical genetic study. The aim of this study was to observe the phytochemical based genetic effects of Sargassum wightii during organogenesis in embryonic zebrafish. Materials and Methods: The phytomolecules from S. wightii were extracted using organic solvents and treated with the 24 h old developing zebrafish embryos. The active extract was partially purified by column chromatography, C 18 Sep-Pak column and reversed-phase high-performance liquid chromatography. Results: Initially, cardiac bulging was found in 2 dpf to 3 dpf (days post fertilization), then bradycardia and tubular heart were observed in the next 8 h, which also showed the reduction in the heart beat rates. The phenotypic mutation effects of bre, has, dou yan, heg and you were observed in the 3 dpf and 4 dpf of the extract treated zebrafish embryos. Conclusions: This study demonstrated that the phytomolecules from S. wightii exhibited potential molecular switches on the developmental process, which might have significant role in understanding the development based chemical genetic studies in zebrafish.
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Enhancement of nootropic effect of duloxetine and bupropion by caffeine in mice p. 199
Pravin Popatrao Kale, Veeranjaneyulu Addepalli
DOI:10.4103/0253-7613.153430  
Objective: The existing evidence suggests an association between depression and memory impairment. The objective of present study was to assess the effect of low dose caffeine with duloxetine and bupropion on memory. Materials and Methods: Mice were divided randomly into seven groups. Intra-peritoneal treatment of normal saline (10 ml/kg), caffeine (10 mg/kg), duloxetine (10 mg/kg), bupropion alone (10 mg/kg), caffeine + duloxetine (5 mg/kg, each), caffeine + bupropion (5 mg/kg, each), and bupropion + duloxetine (5 mg/kg, each) were given to groups I-VII, respectively. Elevated plus maze was used to evaluate transfer latency (TL) and Morris water maze was used to estimate the time spent in target quadrant. Results: Caffeine with duloxetine treated group was better than other combination treated groups in terms of a significant decrease in TL and increase in the time spent in target quadrant recorded. Conclusion: Combining lower dose of caffeine with duloxetine may enhance cognitive benefits than respective monotherapies.
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Pharmacological screening of glycine amino acid prodrug of acetaminophen p. 202
Arun Parashar
DOI:10.4103/0253-7613.153431  
Objective: To develop an amino acid prodrug of acetaminophen with comparable therapeutic profile and less hepatotoxicity than acetaminophen. Materials and Methods: Acetaminophen prodrug was synthesized by esterification between the carboxyl group of amino acid glycine and hydroxyl group of acetaminophen. Analgesic, antipyretic, ulcer healing, and hepatotoxic activities were performed on Wistar rats in this study. Results: Prodrug showed a 44% inhibition in writhings as compared to 53.3% of acetaminophen. Acetaminophen also offered highest antipyretic activity. Prodrug showed gastroprotective and hepatoprotective effects as it reduced the gastric lesions by 32.1% (P < 0.01) and significantly prevented the rise in liver enzymes (serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and bilirubin). The most notable effect of prodrug was in preventing the depletion of hepatic glutathione (GSH), which is reduced by acetaminophen. Conclusion: Prodrug showed hepatoprotective and gastroprotective effects, although the therapeutic efficacy was compromised. Prodrug was successful in preventing a decrease in GSH, thereby exhibiting promising results in the field of prodrug designing to avoid the toxic effects of acetaminophen.
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Hematobiochemical and pathological alterations due to chronic chlorpyrifos intoxication in indigenous chicken p. 206
Shameem Ara Begum, Tirtha Nath Upadhyaya, Taibur Rahman, Debesh Chandra Pathak, Kavita Sarma, Chandana Choudhury Barua, RS Bora
DOI:10.4103/0253-7613.153432  
Objective: The present study investigates the effect of oral administration of chlorpyrifos (CPF) in indigenous chicken. Materials and Methods: The birds were divided into two groups I and II. Group I served as control and group II was treated with CPF (0.36 mg/kg) orally daily up to 12 weeks. Blood samples were assayed for hemoglobin (Hb), total erythrocyte count (TEC), total leukocyte count (TLC), differential leukocyte count, and biochemical constituents like alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), cholinesterase (CHE), total protein and uric acid. Representative pieces of tissues from liver and kidney were collected weekly for histopathological examination. Results: A significant (P < 0.01) increase of Hb, TEC, TLC, and heterophil percent and decrease of lymphocyte percent was observed. Serum ALP, AST, ALT, and uric acid increased significantly and CHE values decreased significantly in CPF treated birds. The protein level remained similar. Uric acid level was found to be increased significantly in the treated group. The results indicate that chronic CPF intoxication produces hematological, biochemical, and pathological changes in treated birds.
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Teratogenic effects of insulin: An experimental study on developing chick embryo p. 212
Pradeep Bokariya, Ruchi Kothari, Vijay K Gujar, MR Shende
DOI:10.4103/0253-7613.153433  
Objective: The objective was to observe the effect of insulin on chick embryos with reference to their growth and developmental defects. Materials and Methods: An experimental study was performed to assess any abnormal growth pattern caused by insulin. For this, two batches of 100 fertilized eggs were utilized. One batch of 50 was used as a control group and other as an experimental group. Insulin (2 IU) was injected on day 2 of incubation. Chicken eggs were dissected out on day 19 of incubation and were carefully observed for any congenital abnormalities. The embryos thus dissected out were subjected to measurement of crown-rump length (CRL), changes in weight of egg, volume of embryos were compared in two groups. The embryos were also examined for any congenital anomalies. Results: No major malformations were observed. Decrease in weight and CRLs was lower in the experimental group as compared to their control counterparts. Values for volume of the embryo were similar in two groups. Conclusion: No obvious teratogenic effects are observed with insulin in the dose use for the study.
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Gamma activity model for treatment-resistant bipolar psychotic mania p. 215
Shashi Ranjan Kumar, Vinod Kumar Sinha, Sai Krishna Tikka, Nishant Goyal
DOI:10.4103/0253-7613.153434  
Objectives: The objective was to investigate the effect of clozapine on spontaneous gamma activity in treatment-resistant bipolar psychotic mania. Methods: Patients with treatment-resistant (TR) bipolar psychotic mania on clozapine monotherapy and nontreatment-resistant bipolar psychotic mania patients receiving lithium were prospectively studied for 6 weeks on severity of psychopathology and 30-49 Hz gamma spectral power. Results: Spectral power significantly increased in the lithium group and decreased in the clozapine group; no within group significant difference found. Conclusions: We propose a model highlighting the role of gamma spectral power and modulations of GABAergic neurotransmission in TR bipolar psychotic mania.
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DRUG WATCH Top

Acebrophylline-induced angioedema p. 219
Sanitha Kuriachan, Mohan Babu V Amberkar, Manu K Mohan, Hameed Aboobackar Shahul, Meenakumari Kamal Kishore
DOI:10.4103/0253-7613.153435  
A 53-year-old woman visited her physician complaining of acute breathlessness and productive cough. Her medications included budesonide and formoterol for asthma, fixed-dose combination aspirin 150 mg + clopidogrel 75 mg + atorvastatin 20 mg for ischemic heart disease. History revealed that she had allergic rhinitis and was hypersensitive to penicillins. The patient was prescribed acebrophylline (ABP). Six hours after ABP therapy she presented with generalized urticarial lesions, swelling of hands, feet, lips and face, suggestive of angioedema. ABP was stopped immediately, and the patient was treated symptomatically. This case was categorized as probable as per standard causality assessment scale.
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A case report on toxic epidermal necrolysis with etoricoxib p. 221
JS Kameshwari, Raju Devde
DOI:10.4103/0253-7613.153436  
Etoricoxib is a selective cyclo-oxygenase 2 (COX-2) enzyme inhibitor and is exploited for its analgesic activity in various disease conditions like osteoarthritis, gouty arthritis, acute pain including postoperative dental pain and primary dysmenorrhea, etc. Although highly efficacious in pain management the safety profile of this COX-2 inhibitor is yet to be established in a broader sense. Short-term clinical trials and postmarketing surveillance have shown a very rare incidence of very serious skin reactions like Steven Johnson syndrome or toxic epidermal necrolysis (TEN). In this case report, we summarize regarding a patient who developed TEN after treatment with etoricoxib for osteoarthritis that later resolved in 15 days after withdrawal and symptomatic treatment.
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Fixed drug eruptions with modafinil p. 224
Loknath Ghoshal, Mausumi Sinha
DOI:10.4103/0253-7613.153437  
Modafinil is a psychostimulant drug, which has been approved by the US Food and Drug Administration for the treatment of narcolepsy associated excessive daytime sleepiness, sleep disorder related to shift work, and obstructive sleep apnea syndrome. However, presently it is being used as a lifestyle medicine; in India, it has been misused as an "over the counter" drug. Modafinil is known to have several cutaneous side effects. Fixed drug eruption (FDE) is a distinctive drug induced reaction pattern characterized by recurrence of eruption at the same site of the skin or mucous membrane with repeated systemic administration. Only two case reports exist in the literature describing modafinil induced FDE until date. Here, we report two similar cases. The increasing use of this class of drug amongst the medical personnel might be posing a threat to the proper use and encouraging subsequent abuse. There might be a considerable population using these drugs unaware of the possible adverse effects. Authorities should be more alert regarding the sale and distribution of such medicines.
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A case of hypersensitivity to soluble and isophane insulins but not to insulin glargine p. 227
Mahesh N Belhekar, Sarayu Pai, Parimal Tayade, Pradip Dalwadi, Renuka Munshi, Prema Varthakavi
DOI:10.4103/0253-7613.153438  
Insulin is an important agent for the treatment of diabetes mellitus (DM). Allergic reactions to insulin therapy, although rare, have been evident since animal insulin became available for the treatment of DM in 1922. Hypersensitivity to insulin has considerably been reduced with the introduction of human insulin produced by recombinant deoxyribonucleic acid technology. Here, we present a case of Type 2 DM who demonstrated immediate (Type 1) hypersensitivity reaction on the sites of subcutaneous injection of soluble and isophane insulin but insulin glargine was tolerated well and provided good glycemic control.
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Cycloserine induced psychosis with hepatic dysfunction p. 230
Vishal R Tandon, Neelam Rani, Roshi , Rahul Gupta, Manu Arora, Vijay Khajuria, Vivek Mahajan
DOI:10.4103/0253-7613.153439  
With the increase in the cases of multidrug resistance tuberculosis, second line anti-tubercular drugs like the cycloserine are being prescribed frequently. Isoniazid and ethambutol are reported to cause psychosis like state; however, few reports of cycloserine induced psychosis are available. To the best of our knowledge, this is the first case of cycloserine induced psychosis with hepatic dysfunction.
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Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease p. 232
Vijayan Sharmila, Thirunavukkarasu Arun Babu
DOI:10.4103/0253-7613.153440  
Chorea is a neurological adverse effect of oral contraceptive pills (OCPs). The onset of chorea following OCPs usage varies widely from few weeks to several years. We report a rare case of chorea which developed within a week of starting OCPs in an adolescent girl with polycystic ovarian disease.
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Clozapine induced akathisia: A case report and review of the evidence p. 234
Sandeep Grover, Swapnajeet Sahoo
DOI:10.4103/0253-7613.153441  
Clozapine is a second-generation antipsychotic medication, which is mostly used in patients with treatment resistant schizophrenia. It is considered to be associated with lower incidence of extrapyramidal side-effects. Akathisia is considered to be a rare side-effect of clozapine. In this report, we describe a patient who developed akathisia while receiving clozapine and review the literature. Existing literature suggests that except for few initial reports, data suggests that clozapine is in general associated with lower incidence of akathisia compared to first generation antipsychotics. Data comparing clozapine with other atypical antipsychotics is equivocal.
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BOOK REVIEW Top

Fundamentals of experimental pharmacology p. 236
R Balaraman
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