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Year : 2010  |  Volume : 42  |  Issue : 6  |  Page : 423--424

The Journal Club

RK Dikshit 
 Department of Pharmacology, B. J. Medical College, Ahmedabad, India

Correspondence Address:
R K Dikshit
Department of Pharmacology, B. J. Medical College, Ahmedabad

How to cite this article:
Dikshit R K. The Journal Club.Indian J Pharmacol 2010;42:423-424

How to cite this URL:
Dikshit R K. The Journal Club. Indian J Pharmacol [serial online] 2010 [cited 2020 Aug 3 ];42:423-424
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Patients who believe they are allergic to multiple, pharmacologically unrelated drugs are usually mistaken. This is the message of a retrospective review carried out for 5 years over 23 such "believers" (Ramam M, Bhat R, Jindal S, Kumar U, Sharma VK, Sagar R, Chadda RK. Patient-reported multiple drug reactions: Clinical profile and results of challenge testing. Indian J Dermatol Venereol Leprol 2010;76:382-6). These patients gave a history of 2-40 drug reactions over 1-30 years. Antibiotics and NSAIDs were most commonly accused and urticaria or angioedema was the most commonly reported manifestations. The study was conducted after hospitalization, and it used an oral challenge test (placebo on day 1 and other drugs as single therapeutic dose consecutively thereafter every 12 or 24 h). It was observed that 7 had no reactions, 13 developed false reactions, and only 3 had positive challenge reactions with various NSAIDs. None of the patients could be labeled to have a true multiple drug hypersensitivity. It is opined that true multiple drug reactions are extremely rare, and such a mistaken belief can result into prescription of less effective and/or more expensive alternatives. Oral challenge test may serve as a reliable method to evaluate drug allergy and to help patients have a list of safe drugs.

Clinical profile of Asians suffering from multiple sclerosis is believed to be slightly different from their Western counterparts. For example, Asians (including Indians) may have greater visual impairment initially along with the involvement of optic nerve and spinal cord. Since 1993, β-interferons have assumed that it has an important role in the management of this disease and have been approved for use in relapsing-remitting and secondary progressive multiple sclerosis. The interferon products may help due to their anti-inflammatory effects and by preserving the integrity of blood-brain barrier. In a prospective, follow-up study, the response of 16 Indian patients to interferon-β1a and b has been investigated for a period of 1-3 years (Gupta S, Varadarajulu R, and Ganjoo RK. Beta-interferons in multiple sclerosis: A single center experience in India. Ann Indian Acad Neurol 2010;13:132-5). Before treatment, the average relapses were 3.4 (range, 2-6) and the yearly relapse rate was 1.3 (range, 0.3-3). After treatment, only two had relapses in the first year and no further relapses were seen thereafter. Among side effects, fever developed after first dose in all patients but after 3 months only half the patients had it. Headache, myalgia, and bodyache were also reported. The drug was discontinued in two patients for psychiatric reasons. The authors conclude that the Indian patients suffering from multiple sclerosis respond well to β-interferons. These drugs may, however, be avoided in patients with a history of major psychiatric symptoms.

Popularity of herbal medicine (or indigenous drugs) appears to be increasing day by day. Everyone looks like running for them for a "positive health" or for the treatment of diseases. Perhaps, this is evident more in the case of chronic ailments (and those with lots of remissions and exacerbations) that seem to provide a greater scope for alternative therapy. Type-2 diabetes mellitus (DM) is one such multifactorial, clinical syndrome characterized by inappropriate hyperglycemia. Through my experience at IJP as well as a review of several other publications globally, I feel at times as if every botanical entity is being tried in the treatment of diabetes. The issue has been dealt with a greater objectivity in a recent review (Jayakumar RV. Herbal medicines for type-2 diabetes . Int J Diab Dev Ctries 2010;30:111-2). The author feels that medicinal plant products are being used with varying success by a large number of diabetic patients. A reference has been made to the classification of antidiabetic herbal drugs into four categories according to their mode of action. First group acts like insulin (Momordica charatia or bitter gourd), second group increases the insulin production from β-cells (Allium cepa or onion and Pterocarpus marsupium from the bark of tree and Aloes), third group herbs enhance the glucose utilization (Gingiber officinale or ginger, Cyamospsis tetragonalobus or Gower plant, and Grewia asiatica or phalsa plant), and the last group may alter the fiber content and alter the rate of absorption of glucose from gut (Euphorbia prostrata, Fumaria parvia, Panax ginseng, and Phyllanthus embelica). It is hypothesized that acting as antioxidants the plant products may help contain the damage and may even restore the pancreatic function. It is concluded that medicinal plants need to be explored with greater scientific enthusiasm, different combinations may do a better job, and eventually the herbal medicines may be incorporated in the antidiabetic armamentarium of modern medicine.

Lithium is useful in the treatment of manic-depressive (bipolar) disease, a mood disorder in which a person alternates between depression and mania. However, those on lithium often report of the cognitive impairments (memory, learning, attention, etc.) that can be verified on psychometric testing. In an experimental study, the authors have tried to evaluate the impact of lithium ingestion on cognition and some subsets of sensory skill in rats (Shallie PD, Akpan HB, Adefule AK, Fakoya D, and Fagbohun TR. Assessment of lithium ingestion on cognition and some subset of motor skill. J Pharm Bioall Sci 2010;2:113-7). Lithium was given with or without saline for 4 weeks. Cognitive functions were tested using the Barnes maze, negative geotaxis, and cliff avoidance. Those treated with lithium showed a significant decline in learning and memory as compared to control. Surprisingly, those treated with lithium and saline showed an enhanced cognitive ability. The authors hypothesize that lithium competes with sodium, potassium, magnesium, and calcium and thus may change the impulse conduction. A co-administration of saline would enhance the sodium exchange across the membrane leading to stable Na/K ion channels, which may delay or prevent the neuronal injury by lithium. The authors conclude that one must be careful when using lithium and it should preferably be co-administered with saline.

Another etiology for type 2 diabetes mellitus (DM), this one is situated in central nervous system and can be treated neurosurgically! In an interesting publication (Jannetta PJ, Fletcher LH, Grondziowski PM, Casey KF, and Sekula RF. Type 2 diabetes mellitus: A central nervous system etiology. Surg Neurol Int 2010;1:31), the authors describe a series of 10 patients with steadily progressive type 2 DM that were subjected to right retromastoid craniectomy and microvascular decompression of the medulla using a technique that was developed earlier. The authors refer to the older belief that linked the etiology of essential hypertension with a vascular compression syndrome of the left anterolateral medulla. The authors had observed earlier that 15 consecutively operated patients for right-sided cranial nerve vascular compression syndrome were all suffering from type 2 DM and had arterial compression of the right anterolateral medulla oblongata. On this basis, it was derived that there should be a right lateral medullary syndrome wherein the pancreas can be affected as it is partly innervated by the right vagus nerve by means of hepatic and celiac branches. All 10 operated patients (nine males, one female, mean age 53 years, and mean duration of DM 7 years) had visible right lateral medullary compression by arterial loops on MRI that was surgically corrected. Patients were followed-up for a year post-operatively and seven of them showed a significant improvement in their glucose control with no change in diet/drugs, etc. Three nonresponders had a higher body mass index (mean, 34) than others (mean, 28). It is opined that a number of problems of aging are due to arterial compression of the brain stem particularly the medulla oblongata and that the microvascular decompression may be an effective treatment for nonobese type 2 diabetes patients. An interesting message by the authors is "one does not inherit diabetes but one inherits the blood vessels."

….and now the pharmacology of hair care, shampoos, and conditioners! In a review, that many (or most!) of us would be eager to read, the author has provided a deep insight into these items of common, daily use (Draelos ZD. Essentials of hair care often neglected: Hair cleansing. Int J Trichol 2010;2:24-9). A number of scientific facts are described in a simple manner and many not-so-well-known facts are brought to our notice. The author says that the basic function of a shampoo is to clean the scalp of sebum and other items (such as sweat, dead layers of skin, and dirt). Bar soaps should not be used for this purpose as they leave behind a soap-scum which is hard to clean and may cause seborrheic dermatitis. Shampoos clean with the help of detergents (mostly anionic surfactants such as laureth sulfates, sulfosuccinates, etc). They contain several other ingredients, e.g. foaming agents (to spread the detergent), thickeners, and opacifiers (just to give an acceptable appearance), sequestering agents (to prevent the formation of "scums" or remnants), pH adjusters (to prevent detergent-induced damage), and special additives (to improve the saleability!). Several factors will have to be considered while selecting a shampoo. The author reveals that too much cleaning is undesirable, botanicals and vitamins are largely added for marketing purposes, it is not necessary to clean the hair daily and some ingredients (formalin, parabens, hexachlorophene, and miranols) may rarely cause an allergic contact dermatitis. Once shampoos have done their job, the conditioners come into play. They give manageability, gloss, and antistatic properties to the hair. They may be added to the shampoos, and fatty alcohols, fatty esters, vegetable/mineral oils and humectants are commonly used as conditioners.