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   2014| January-February  | Volume 46 | Issue 1  
    Online since January 16, 2014

 
 
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DRUG WATCH
Necrotizing fasciitis secondary to bevacizumab treatment for metastatic rectal adenocarcinoma
Mehmet A. N. Sendur, Sercan Aksoy, Nuriye Yildirim Özdemir, Nurullah Zengin
January-February 2014, 46(1):125-126
DOI:10.4103/0253-7613.125195  PMID:24550600
Bevacizumab is a recombinant humanized monoclonal antibody that selectively blocks the activity of vascular endothelial growth factor (VEGF) receptor and it is used in metastatic colorectal patients. We present here a case of fatal necrotizing fasciitis in a patient during bevacizumab treatment for colorectal cancer. In our review of the literature, necrotizing fasciitis was not reported before or during bevacizumab treatment.
  2 2,425 97
EDUCATIONAL FORUM
Hedgehog signaling pathway: A novel target for cancer therapy: Vismodegib, a promising therapeutic option in treatment of basal cell carcinomas
Afroz Abidi
January-February 2014, 46(1):3-12
DOI:10.4103/0253-7613.124884  PMID:24550577
The Hedgehog signaling pathway is one of the major regulators of cell growth and differentiation during embryogenesis and early development. It is mostly quiescent in adults but inappropriate mutation or deregulation of the pathway is involved in the development of cancers. Therefore; recently it has been recognized as a novel therapeutic target in cancers. Basal cell carcinomas (BCC) and medulloblastomas are the two most common cancers identified with mutations in components of the hedgehog pathway. The discovery of targeted Hedgehog pathway inhibitors has shown promising results in clinical trials, several of which are still undergoing clinical evaluation. Vismodegib (GDC-0449), an oral hedgehog signaling pathway inhibitor has reached the farthest in clinical development. Initial clinical trials in basal cell carcinoma and medulloblastoma have shown good efficacy and safety and hence were approved by U.S. FDA for use in advanced basal cell carcinomas. This review highlights the molecular basis and the current knowledge of hedgehog pathway activation in different types of human cancers as well as the present and future prospects of the novel drug vismodegib.
  2 6,026 622
RESEARCH ARTICLES
Study of levosimendan during off-pump coronary artery bypass grafting in patients with LV dysfunction: A double-blind randomized study
B Shah, P Sharma, A Brahmbhatt, R Shah, B Rathod, Naman Shastri, J Patel, A Malhotra
January-February 2014, 46(1):29-34
DOI:10.4103/0253-7613.125161  PMID:24550581
Objectives: Levosimendan is a calcium sensitizer drug which has been used in cardiac surgery for the prevention of postoperative low cardiac output syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass (CPB). This study aims to evaluate perioperative hemodynamic effects of levosimendan pretreatment in patients for off-pump coronary artery bypass graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF < 30%). Materials and Methods: Fifty patients undergoing OPCABG surgery with low LVEF (<30%) were enrolled in the study. Patients were randomly divided in two groups: Levosimendan pretreatment (Group L) and placebo pretreatment (Group C) of 25 each. Group L, patients received levosimendan infusion 200 μg/kg over 24 h and in Group C Patients received placebo. The clinical parameters measured before and after the drug administration up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit (ICU) stay, and hospital stay were also measured. Results: The patients in group L exhibited higher CI and PCWP during operative in early postoperative period as compared to control group C. Group L also had a less requirement for inotropes, CPB support and IABP with shorter ICU stay as well as hospital stay. Conclusion: Levosimendan pretreatment (24 h infusion) in patient for OPCABG with poor LVEF shows better outcomes and hemodynamics in terms of inotropes, CPB and IABP requirements. It also reduces ICU stay.
  2 3,514 253
Lettuce glycoside B ameliorates cerebral ischemia reperfusion injury by increasing nerve growth factor and neurotrophin-3 expression of cerebral cortex in rats
Heqin Zhan, Shengying Li, Juan Sun, Ruili Liu, Fulin Yan, Bingxuan Niu, Haifang Zhang, Xinyao Wang
January-February 2014, 46(1):63-68
DOI:10.4103/0253-7613.125171  PMID:24550587
Aims: The aim of the study was to investigate the effects of LGB on cerebral ischemia-reperfusion (I/R) injury in rats and the mechanisms of action of LGB. Materials and Methods: The study involved extracting LGB from P. laciniata, exploring affects of LGB on brain ischemia and action mechanism at the molecular level. The cerebral ischemia reperfusion injury of middle cerebral artery occlusion was established. We measured brain histopathology and brain infarct rate to evaluate the effects of LGB on brain ischemia injury. The expressions of nerve growth factor (NGF) and neurotrophin-3 (NT-3) were also measured to investigate the mechanisms of action by the real-time polymerase chain reaction and immunohistochemistry. Statistical analysis: All results were mentioned as mean ± standard deviation. One-way analysis of variance was used to determine statistically significant differences among the groups. Values of P < 0.05 were considered to be statistically significant. Results: Intraperitoneal injection of LGB at the dose of 12, 24, and 48 mg/kg after brain ischemia injury remarkably ameliorated the morphology of neurons and brain infarct rate (P < 0.05 , P < 0.01). LGB significantly increased NGF and NT-3 mRNA (messenger RNA) and both protein expression in cerebral cortex at the 24 and 72 h after drug administration (P < 0.05, P < 0.01). Conclusions: LGB has a neuroprotective effect in cerebral I/R injury and this effect might be attributed to its upregulation of NGF and NT-3 expression ability in the brain cortex during the latter phase of brain ischemia.
  2 2,905 119
Effect of aged garlic extract and s-allyl cysteine and their interaction with atenolol during isoproterenol induced myocardial toxicity in rats
Pulla Reddy Avula, Syed Mohammed Asdaq, Mohammed Asad
January-February 2014, 46(1):94-99
DOI:10.4103/0253-7613.125185  PMID:24550592
Objectives: The study evaluates the cardioprotective effect of aged garlic extract (AGE) and its constituent; S-allylcysteine (SAC) and their interaction with atenolol during isoproterenol induced cardiac toxicity in rats. Materials and Methods: Rats were administered AGE at two different doses of 2 ml/kg or 5 ml/kg orally whereas SAC was administered either at a dose 13.1 mg/kg or 32.76 mg/kg. The AGE or SAC was given alone or in combination with atenolol (6 mg/kg, p.o), every alternate day for three weeks. At the end of treatment, two doses of isoproterenol (150 mg/kg, s.c) were administered to rats. The electrocardiogram (ECG) was recorded followed by withdrawal of blood to estimate serum lactate dehydrogenase (LDH) and creatinine kinase-MB (CK-MB) activities. The activities of LDH, CK-MB as well as superoxide dismutase (SOD), catalase and thiobarbituric acid reactive substances (TBARS) were also determined in the heart tissue homogenate (HTH). Results: The isoproterenol induced ECG changes were restored to normal in all treated groups. The AGE and SAC administration caused a decrease in serum LDH and CK-MB activities and an elevation of LDH and CK-MB activities in HTH. Atenolol alone or in combination with AGE and S-allylcsyteine demonstrated similar changes in biomarker activities. Conclusion: AGE showed dose-dependent cardioprotection. However, concurrent administration of SAC with atenolol (6 mg/kg, p.o) combated more effectively the myocardial dysfunction during isoproterenol induced cardiotoxicity in rats.
  2 3,062 168
DRUG WATCH
Stevens-Johnson syndrome following use of metronidazole in a dental patient
Goutameswar Mazumdar, Koushik Shome
January-February 2014, 46(1):121-122
DOI:10.4103/0253-7613.125193  PMID:24550598
Metronidazole alone rarely causes Stevens-Johnson syndrome (SJS). We present a case of an elderly male patient who, following metronidazole use, developed neurological symptoms followed by pain and blisters on both soles, erythema of face and neck, scrotal itching and erosion, and hemorrhagic encrustation around the lips and oral mucous membrane. Initial neurological symptoms followed by mucocutaneous manifestation of SJS following metronidazole use is probably a new presentation of this case.
  1 2,981 197
Clopidogrel: A possible exacerbating factor for psoriasis
Vikram K Mahajan, Gayatri Khatri, Neel Prabha, C Abhinav, Vikas Sharma
January-February 2014, 46(1):123-124
DOI:10.4103/0253-7613.125194  PMID:24550599
A 64-year-old man developed palmoplantar pustulosis eventuating into palmoplantar pustular psoriasis following treatment with diltiazem, atenolol, aspirin and atorvastatin for suspected coronary artery disease (CAD). Treatment for psoriasis, stopping atenolol and substituting aspirin with clopidogrel did not benefit. Subsequently, he stopped all his drugs and did not develop psoriasis or symptoms/signs of CAD. Re-challenge with oral clopidogrel precipitated his skin lesions. This case has implications for patients having psoriasis and cardiovascular comorbidity where clopidogrel/ticlopidine or aspirin may not be a useful alternative.
  1 2,875 192
RESEARCH ARTICLES
Anti-anxiety effect of a novel 5-HT 3 receptor antagonist N-(benzo[d]thiazol-2-yl)-3-ethoxyquinoxalin-2-carboxamide (6k) using battery tests for anxiety in mice
Yeshwant Vijay Kurhe, Mahesh Radhakrishnan, Devadoss Thangaraj, Deepali Gupta
January-February 2014, 46(1):100-104
DOI:10.4103/0253-7613.125186  PMID:24550593
Objective: To investigate the anti-anxiety activity of "6k", a novel 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonist in in mice. Materials and Methods: Anti-anxiety activity of "6k" (1, 2, and 4 mg/kg, intraperitoneally (i.p.)) was evaluated in mice by behavioral tests such as elevated plus maze (EPM), open field test (OFT), light-dark box (L&D), and hole board test (HBT). Diazepam (2 mg/kg, i.p.) served as reference standard. Results: "6k" significantly (P < 0.05) increased the time and entries in open arm in EPM as compared to vehicle control group. Further, "6k" significantly (P < 0.05) increased the central and peripheral ambulation along with rearings and time in central area; whereas, reduced the fecal pellets in OFT as compared to vehicle control group. There was significant (P < 0.05) reduction in the latency to enter dark chamber; whereas, increased number of crossings and time in light chamber in L&D aversion test by treatment with "6k" as compared to vehicle control group. In HBT, "6k" significantly (P < 0.05) increased the number of head dipping and squares crossed; whereas, reduced the latency for first head dip and number of fecal pellets as compared to vehicle control group. Conclusion: A novel 5-HT 3 receptor antagonist has anti-anxiety action.
  1 2,799 220
Efficacy and safety of add on therapy of bromocriptine with metformin in Indian patients with type 2 diabetes mellitus: A randomized open labeled phase IV clinical trial
Arijit Ghosh, Nilanjan Sengupta, Pranab Sahana, Debasis Giri, Parama Sengupta, Nina Das
January-February 2014, 46(1):24-28
DOI:10.4103/0253-7613.125160  PMID:24550580
Objective: To compare the effectiveness and safety of add on therapy of bromocriptine with metformin in type 2 diabetes mellitus (DM) patients. Material and Methods: Adult type 2 DM patients fulfilling the inclusion criteria were randomized in three groups. Group A received metformin (1000 mg/ day), while group B patients were treated with metformin (1000 mg/day) plus bromocriptine (0.8 mg/day) and group C received metformin (1000 mg/day) plus bromocriptine (1.6 mg/day) for 12 weeks. Fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), and body weight were measured at week 4, 8, and 12 visits and glycosylated hemoglobin (HbA 1C ) at week 12 visit. Results: Metformin alone and in combination with bromocriptine in escalating dose (0.8 mg/day and 1.6 mg/day) significantly (P < 0.05) decreased FPG and PPPG levels at weeks 4, 8, and 12 compared with pretreatment values. HbA 1C level in all three treatment groups significantly (P < 0.05) decreased at week 12 as compared with pretreatment baseline value. HbA 1C level in groups B and C significantly (P < 0.05) decreased as compared with group A at week 12 . Addition of bromocriptine to metformin also significantly (P < 0.05) decreased FPG and PPPG levels in a dose-dependent manner as compared with metformin alone. Intergroup analysis did not show any statistically significant change in weight of study subjects at different intervals. Conclusion: The combination of bromocriptine with metformin significantly decreased FPG, PPPG, and HbA 1C compared with metformin alone in type 2 DM patients in a dose-dependent manner.
  1 3,827 659
Neuroprotective effect of a triterpenoid saponin isolated from Momordica cymbalaria Fenzl in diabetic peripheral neuropathy
Raju B Koneri, Suman Samaddar, SM Simi, Srinivas T Rao
January-February 2014, 46(1):76-81
DOI:10.4103/0253-7613.125179  PMID:24550589
Objectives: To investigate the neuroprotective potential of a saponin isolated from the roots of Momordica cymbalaria against peripheral neuropathy in streptozotocin-induced diabetic rats. Materials and Methods: A steroidal saponin (SMC) was isolated from M. cymbalaria Fenzl and purified by preparative high-performance liquid chromatography. Diabetes was induced in male Wister rats by injecting streptozotocin 45 mg/kg. Diabetic rats were divided into six groups for neuroprotective effect-three each for preventive and curative groups. Neuropathic analgesia was assessed by tail-flick and hot-plate methods. Dorsal root ganglion (DRG) neurons and sciatic nerves were isolated, and histopathological analysis was performed. Antioxidant activity (superoxide dismutase, catalase, and inhibition of lipid peroxidation) of the saponin was also carried out on the isolated DRG neurons and sciatic nerves to assess total oxidative stress. Results: In both preventive and curative protocols, rats administered with SMC showed significant decrease in tail immersion latency time and increase in pain sensitivity when compared to diabetic control group. There was improvement in the myelination and degenerative changes of the nerve fiber in both the groups, and an obvious delay in the progression of neuropathy was evident. SMC treatment showed significant decrease in superoxide dismutase, catalase activity, and lipid peroxidation in the nerves. Conclusions: The steroidal saponin of M. cymbalaria (SMC) possesses potential neuroprotective effect in diabetic peripheral neuropathy with respect to neuropathic analgesia, improvement in neuronal degenerative changes, and significant antioxidant activity.
  1 4,163 324
SHORT COMMUNICATIONS
A study of agreement between the Naranjo algorithm and WHO-UMC criteria for causality assessment of adverse drug reactions
Mahesh N Belhekar, Santosh R Taur, Renuka P Munshi
January-February 2014, 46(1):117-120
DOI:10.4103/0253-7613.125192  PMID:24550597
Objectives: Reliability and usefulness of various adverse drug reaction (ADR) causality assessment scales have not been fully explored. There is no universally accepted method for causality grading of ADRs. In the present study we assessed agreement between the two widely used causality assessment scales, that is, the World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria and the Naranjo algorithm. Materials and Methods: The same observer assessed all ADRs (n = 913) collected between January 2010 and December 2012 using the WHO-UMC criteria and Naranjo algorithm at a tertiary care hospital in India. We found that the most frequently assigned causality category was "possible" with both the scales. Results: A disagreement in the causality assessment was found in 45 (4.9%) cases reflecting ''poor'' agreement between the two scales (Kappa statistic with 95% confidence interval = 0.143 [0.018, 0.268]). The mean time taken to assess causality of the ADR using the WHO-UMC criteria was shorter than that by the Naranjo algorithm. Conclusion: This study showed that there is a poor agreement between the WHO-UMC criteria and Naranjo algorithm with the former being less time-consuming.
  1 6,589 401
EDITORIAL
Being a clinical pharmacist: Expectations and outcomes
Parloop A Bhatt
January-February 2014, 46(1):1-2
DOI:10.4103/0253-7613.124882  PMID:24550576
  - 3,635 401
ERRATUM
Erratum

January-February 2014, 46(1):126-126
  - 1,372 86
RESEARCH ARTICLES
Antisecretory and antimotility activity of Aconitum heterophyllum and its significance in treatment of diarrhea
Satyendra K Prasad, Divya Jain, Dinesh K Patel, Alakh N Sahu, Siva Hemalatha
January-February 2014, 46(1):82-87
DOI:10.4103/0253-7613.125182  PMID:24550590
Aim: The roots of the plant Aconitum heterophyllum (EAH) are traditionally used for curing hysteria, throat infection, dyspepsia, abdominal pain, diabetes, and diarrhea. Therefore, the present study was undertaken to determine the mechanism involved in the anti-diarrheal activity of roots of A. heterophyllum. Materials and Methods: Ant-diarrheal activity of ethanol extract at 50, 100, and 200 mg/kg p.o. was evaluated using fecal excretion and castor oil-induced diarrhea models, while optimized dose, that is, 100 mg/kg p.o. was further subjected to small intestinal transit, intestinal fluids accumulation, PGE 2 -induced enteropooling and gastric emptying test. To elucidate the probable mechanism, various biochemical parameters and Na + , K + concentration in intestinal fluids were also determined. Further, antibacterial activity of extract along with its standardization using aconitine as a marker with the help of HPLC was carried out. Results: The results depicted a significant (P < 0.05) reduction in normal fecal output at 100 and 200 mg/kg p.o. of extract after 5 th and 7 th h of treatment. Castor oil-induced diarrhea model demonstrated a ceiling effect at 100 mg/kg p.o. with a protection of 60.185% from diarrhea. EAH at 100 mg/kg p.o. also showed significant activity in small intestinal transit, fluid accumulation, and PGE 2 -induced enteropooling models, which also restored the altered biochemical parameters and prevented Na + and K + loss. The extract with 0.0833% w/w of aconitine depicted a potential antibacterial activity of extract against microbes implicated in diarrhea. Conclusion: The study concluded antisecretory and antimotility effect of A. heterophyllum, which mediates through nitric oxide path way.
  - 3,739 247
Comparison of efficacy, safety, and cost-effectiveness of various statins in dyslipidemic diabetic patients
Abdulbari Bener, Muzeyyen Dogan, Lolwa Barakat, Abdulla O.A.A. Al-Hamaq
January-February 2014, 46(1):88-93
DOI:10.4103/0253-7613.125184  PMID:24550591
Background and Aim: To determine efficacy safety and the cost effectiveness, of the four most commonly prescribed statins (rosuvastatin, atorvastatin, pravastatin, and simvastatin) in the treatment of dyslipidemia among diabetic patients. Materials and Methods: This is a cohort, observational, population-based study conducted at diabetic clinics of the Hamad Medical Hospital and Primary Health Care Centers (PHCC) over a period from January 2007 to September 2012. The study included 1,542 consecutive diabetes patients above 18 years of age diagnosed with dyslipidemia and prescribed any of the indicated statins. Laboratory investigations were taken from the Electronic Medical Records Database (EMR-viewer). The sociodemographic, height, weight, and physical activities were collected from Patient's Medical Records. Information about statin was extracted from the pharmacy drug database. The effective reductions in total cholesterol using rosuvastatin with atorvastatin, simvastatin, and pravastatin in achieving cholesterol goals and improving plasma lipids in dyslipidemic diabetic patients were measured. Serum lipid levels measured a 1 week before the treatment and at the end 2 nd year. Results: Rosuvastatin (10 mg) was the most effective in reducing low-density lipoprotein cholesterol (LDL-C; 28.59%), followed by simvastatin 20 mg (16.7%), atorvastatin 20 mg (15.9%), and pravastatin 20 mg (11.59.3%). All statins were safe with respect to muscular and hepatic functions. Atorvastatin was the safest statin as it resulted in the least number of patients with microalbuminuria (10.92%) as compared to other statins. Treatment with rosuvastatin 10 mg was more effective in allowing patients to reach European and Adult Treatment Plan (ATP) III LDL-C goals as compared to other statins (P < 0.0001) and produced greater reductions in LDL-C, total cholesterol, and non-HDL-C, produced similar or greater reductions in triglycerides (TGs) and increased in HDL-C. Conclusion: Rosuvastatin 10 mg was the most effective statin in reducing serum lipids and total cholesterol in dyslipidemic diabetic patients.
  - 7,453 634
Antiproliferative effects of n-butyl-β-D-fructofuranoside from Kangaisan on Bel-7402 cells
Ping Lu, Miao Li, Yiceng Lou, Fengping Su, Hongling Li, Xiang Zhao, Yali Cheng
January-February 2014, 46(1):69-75
DOI:10.4103/0253-7613.125175  PMID:24550588
Aims: Kangaisan is a powdered compound prescription of Traditional Chinese Medicine which has been used in cancers for many years in Hubei province, China. The purpose of this study was to investigate the antitumor effects of Kangaisan and screen bioactive components. Materials and Methods: 3-(4,5-Dimethythiazol-2-yl)-2,5 diphenyl-tetrazolium bromide (MTT) assay, flow cytometry, DNA (Deoxyribonucleic acid) fragmentation assay, Western blot, and real time-polymerase chain reaction were used to investigate the antiproliferation effect of n-butyl-β-D-fructofuranoside on Bel-7402 cells. Statistical Analysis: All experiments were performed in triplicate and the results were expressed as mean ± standard deviation. Statistical analysis was performed with analysis of variance using Origin 8.0 software. Results: It was illustrated that treatment of Bel-7402 cells with various concentrations of n-butyl-β-D-fructofuranoside resulted in growth inhibition in both a dose-dependent and time-dependent manner. The arrest of G0/G1 phase was also induced (P < 0.05). The increasing of sub-G1 cell population indicated the apoplectic characteristic (P < 0.05). Furthermore, the emerging of DNA fragmentation and the increase of Bax/Bcl-2 ratio and p53 expression suggested the possible mitochondrial apoptotic pathway (P < 0.05). Conclusions: The results illustrate that Kangaisan showed anticancer effects and n-butyl-β-D-fructofuranoside extracted from Kangaisan can suppress Bel-7402 cells via interfering cell cycle and by inducing apoptosis.
  - 2,627 112
Comparision of uroprotective activity of reduced glutathione with Mesna in Ifosfamide induced hemorrhagic cystitis in rats
Syed Amir Ali, Sandeep Kumar Danda, Syed Abdul Azeez Basha, Asif Rasheed, Osman Ahmed, M Muqtedar Ahmed
January-February 2014, 46(1):105-108
DOI:10.4103/0253-7613.125188  PMID:24550594
Background: Ifosfamide (IFO) is widely used DNA-alkylating agents in cancer chemotherapy for management of solid tumors and hematological malignancies. However, hemorrhagic cystitis limits the use of IFO. Objectives: To compare the efficiency of reduced glutathione with 2-Mesna in reducing Ifosfamide (IFO) induced hemorrhagic cystitis (HC) in wistar rats. Materials and Methods: Ifosfamide and 2-Mesna were dissolved in sterile water for injection and administered to wistar rats of albino strains. The rats were randomly assigned to one of the four groups of 6 rats each: Group I: Vehicle control; Group II: 120 mg/kg of IFO alone by intraperitoneal injection (i.p); Group III: 40 mg/kg Mesna i.p., at the same time and at 4 and 8 h after IFO administration; Group IV: 500 mg/kg of glutathione i.p., 30 min prior to IFO as above. The animals were observed for 5 days. On 6 th day, rats were sacrificed by dissecting the intrajugular vein. The bladders were macroscopically and histopathologically evaluated. Results: Control animals had normal bladders with assigned scores of '0' for the three parameters of edema, hemorrhage and histopathological changes. All the animals receiving IFO (group II) had evidence of HC as evidenced by alterations of edema and hemorrhages. These alterations were almost abolished (P < 0.001) by the glutathione (group III) or Mesna (group IV) in IFO-treated animals. Conclusion: Glutathione could be as useful as Mesna in the preventive management of IFO-induced HC.
  - 2,489 154
Ecopharmacovigilance: Current state, challenges, and opportunities in China
Jun Wang, Xiamin Hu
January-February 2014, 46(1):13-17
DOI:10.4103/0253-7613.125158  PMID:24550578
In a context of severe pharmaceutical pollution, "ecopharmacovigilance" (EPV) has been an area of novel interest. It aims to ensure that significant environmental issues associated with pharmaceuticals in the environment are identified in a timely way, and managed appropriately. EPV has become a research hotspot as a comprehensive and boundary science in Europe and North America, and regulatory requirements governing the comprehensive environmental risk assessment (ERA) of pharmaceuticals exist in these regions. A speedy Chinese pharmaceutical industry development and drug consumption, China should shoulder more international responsibility and contribute to the worldwide EPV. Compared to the west, EPV in China is in its infancy. We analyzed the current state of EPV-related practice in China and found that many efforts have been made by the Chinese government and specialists to control the ever-worsening environmental pharmaceutical pollution problems, including consummating related policies and regulations, revealing the occurrence and behavior of pharmaceutical residues in environment and developing new technologies to improve their removal performance. Besides, we posed some recommendations on appropriate EPV implementation that can be taken with China in future. These include, building perfect laws and regulation system on EPV, defining the evaluation index for EPV, continuing the clinical rational medication and the pharmaceutical take-back programs in China, popularizing the concept of EPV in China, and strengthening the policy-guided and scientific researches of EPV in pharmaceutical firms and academia.
  - 5,198 579
Assessment of clinical outcomes and prescribing behavior among inpatients with severe preeclampsia and eclampsia: An Indian experience
Shefalika Kumar, Dipika Bansal, Debasish Hota, Madhu Jain, Pawan Singh, BL Pandey
January-February 2014, 46(1):18-23
DOI:10.4103/0253-7613.125159  PMID:24550579
Objectives: The study aims to evaluate the management, maternal-fetal outcomes, and prescription behavior among inpatients with severe preeclampsia and eclampsia. Materials and Methods: This prospective cohort study in a tertiary referral center was conducted in 164 inpatient pregnant women who fulfilled the inclusion criteria. The study was conducted between November 2005 and February 2007. The patients were followed-up till delivery. Antepartum and intrapartum care and maternal and perinatal outcome were noted. Chief outcome measures were maternal and perinatal mortality and drug use indicators. Results: Median age at delivery of the women was 25 (22-28) years. Majority were suffering from antepartum eclampsia (52.5%), followed by preeclampsia (31%) and postpartum eclampsia (16.5%). Nulliparity (61.6%) was more common in eclampsia, while multiparity in preclamptic group. A total of 48% had preterm delivery. Most presented with headache (50%) and hyperreflexia (29%). Only 15% presented with all three prodromal symptoms and 86% had hypertension. There was increased morbidity, operative intervention, and admission to intensive care unit. Most babies (67%) weighed <2.5 kg and had poor outcome. The maternal mortality was 0.4/1000. Average number of drugs prescribed in patients of preeclampsia, antepartum eclampsia, and postpartum eclampsia were 13.2, 14.9, and 14.2, respectively. Antibiotics (24.6%) were the most common class of the drugs prescribed in all the groups, followed by vitamin and calcium supplements (22.7%) and antihypertensives (13.5%). Most common antihypertensive used were calcium channel blockers and anticonvulsant magnesium sulphate. Conclusions: There was increased maternal and perinatal morbidity. Protocols for the management of eclampsia, including antihypertensive and anticonvulsant therapies, should be available and reviewed regularly to improve the standard of care and reduce the prevalence of this dangerous condition.
  - 3,972 299
Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders
Chaitali S Bajait, Sonali A Pimpalkhute, Smita D Sontakke, Kavita M Jaiswal, Amruta V Dawri
January-February 2014, 46(1):35-39
DOI:10.4103/0253-7613.125163  PMID:24550582
Objectives: Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. Altered mineral metabolism contributes to bone disease and cardiovascular disease. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level. No studies about the utilization pattern of PBs in CKD patients have been reported from India. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs. Materials and Methods: This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Demographic, clinical, and medication details were collected in a specially designed proforma. Results: A total 111 prescriptions were included in the study. Average number of drugs per prescription was 9.47. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list. Out of total prescribed drugs (1052), most commonly prescribed were vitamins and minerals (24.71%), cardiovascular drugs, (22.14%), and hematopoietic agents (20.15%). Considering individual drugs, five most commonly prescribed drugs were multivitamins (14.82%), iron (8.65%), folic acid (8.55%), calcium carbonate (8.17%), and calcitriol (5.60%). A total of 11.02% of prescribed drug were PBs. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB. No patient was prescribed lanthanum carbonate. Conclusion: This study identified a wide variety of drug classes including PBs prescribed in CKD patients. Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier.
  - 3,720 349
Keyhole limpet hemocyanin augmented the killing activity, cytokine production and proliferation of NK cells, and inhibited the proliferation of Meth A sarcoma cells in vitro
Md. Moklesur Rahman Sarker, Ming Zhong
January-February 2014, 46(1):40-45
DOI:10.4103/0253-7613.125164  PMID:24550583
Objective: Keyhole limpet hemocyanin (KLH) is a popular tumor vaccine carrier protein and an immunostimulant. The present study aimed to investigate the immunoregulatory activity of KLH on cytotoxicity, cytokines production, and proliferation of natural killer (NK) cells. Moreover, antiproliferative activity of KLH on Meth A sarcoma cells was studied. Materials and Methods: Cytotoxicity was determined with killing ability of NK cells against yeast artificial chromosome (YAC)-1 cells. Interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) productions by NK cells were measured by enzyme-linked immunosorbent assay (ELISA). Proliferations of NK and Meth A cells were determined by [ 3 H]thymidine incorporated proliferation and 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) methods, respectively. Results: KLH at 6.25, 12.5, and 25 μg/well augmented cytotoxicity of NK cells against YAC-1 cells by 2.5, three, and five-times, respectively. KLH at 25 μg/well enhanced IFN-γ and TNF-α productions by 17- and 23-folds, respectively. The proliferation of NK cells was three times stimulated by KLH. The proliferation of Meth A cells was markedly inhibited by all the doses; the highest (4-folds higher) inhibition was observed at a dose of KLH (25 μg/well). Conclusion: The study demonstrated the anticancer activity of KLH acting through the induction of NK cells and inhibition of cancer cells. KLH, therefore, may be a good candidate for an anticancer agent alone or in combination with other chemotherapeutic agents.
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Combination of vildagliptin and rosiglitazone ameliorates nonalcoholic fatty liver disease in C57BL/6 mice
Jeyamurugan Mookkan, Soumita De, Pranesha Shetty, Nagaraj M Kulkarni, Vijayaraj Devisingh, Mallikarjun S Jaji, Vinitha P Lakshmi, Shilpee Chaudhary, Jayanarayan Kulathingal, Navin B Rajesh, Shridhar Narayanan
January-February 2014, 46(1):46-50
DOI:10.4103/0253-7613.125166  PMID:24550584
Objectives: To evaluate the effect of vildagliptin alone and in combination with metformin or rosiglitazone on murine hepatic steatosis in diet-induced nonalcoholic fatty liver disease (NAFLD). Materials and Methods: Male C57BL/6 mice were fed with high fat diet (60 Kcal %) and fructose (40%) in drinking water for 60 days to induce NAFLD. After the induction period, animals were divided into different groups and treated with vildagliptin (10 mg/kg), metformin (350 mg/kg), rosiglitazone (10 mg/kg), vildagliptin (10 mg/kg) + metformin (350 mg/kg), or vildagliptin (10 mg/kg) + rosiglitazone (10 mg/kg) orally for 28 days. Following parameters were measured: body weight, food intake, plasma glucose, triglyceride (TG), total cholesterol, liver function tests, and liver TG. Liver histopathology was also examined. Results: Oral administration of vildagliptin and rosiglitazone in combination showed a significant reduction in fasting plasma glucose, hepatic steatosis, and liver TGs. While other treatments showed less or no improvement in the measured parameters. Conclusions: These preliminary results demonstrate that administration of vildagliptin in combination with rosiglitazone could be a promising therapeutic strategy for the treatment of NAFLD.
  - 3,961 259
Protective effects of resveratrol against di-n buthyl phthalate induced toxicity in ductus epididymis and ductus deferens in rats
Erhan Sahin, Celal Ilgaz, Deniz Erdogan, Gülnur Take, Güleser Göktas
January-February 2014, 46(1):51-56
DOI:10.4103/0253-7613.125167  PMID:24550585
Objective: This study aimed to observe the possible protective effects of resveratrol (RSV) against damage induced by di-n-butylphthalate (DBP), on the ductus epididymis and deferens in rats. Materials and Methods: Six groups of rats were used in the experiment: Group 1: Control group; Group 2: Solvent (carboxymethylcellulose (CMC), 10ml/kg); Group 3: 500 mg/kg/day DBP; Group 4: 500 mg/kg/day DBP+20 mg/kg/day RSV; Group 5: 1000 mg/kg/day DBP; Group 6: 1000mg/kg/day DBP + 20 mg/kg/day RSV. Groups were treated by gavage for 30 days. Immunohistochemical, electronmicroscopic and histomorphometric examinations were carried out in the epididymis and deferens. Results: In the ductus epididymis and deferens mitochondrial crystolysis, exfoliation of the stereocilia and openings in lateral surface increased with DBP dosage, but these structures were recovered with RSV. DBP reduced the epithelial height of epididymis and vas deferens. Lumen dilatation was observed in both tissues. These disorders may lead to dysfunction of epithelial absorption. In the TUNEL examinations in both tissues, there were no apoptotic cells or apoptotic bodies. Conclusion: In conclusion, DBP administration caused structural degeneration in the epididymis and deferens, parallel to dose evaluation and RSV can reverse these changes with its protective effects.
  - 2,730 162
Nitric oxide in central amygdala potentiates expression of conditioned withdrawal induced by morphine
Manizheh Karami, Mahnaz Rahimpour, Sara Karimi, Hedayat Sahraei
January-February 2014, 46(1):57-62
DOI:10.4103/0253-7613.125169  PMID:24550586
Objective: The aim of this study was to evaluate if nitric oxide (NO) in the central amygdala (CeA) is involved in the expression of withdrawal aspects induced by morphine. Materials and Methods: Male Wistar rats (weighing 200-250 g) were bilaterally cannulated in the CeA and conditioned to morphine using an unbiased paradigm. Morphine (2.5-10 mg/kg) was subcutaneously injected once a day throughout the conditioning phase of the procedure. This phase also included 3-saline paired sessions. Naloxone (0.1-0.4 mg/kg, intraperitoneally [i.p.]), an antagonist of opioid receptors, was administered i.p. 10 min prior to testing of morphine-induced withdrawal features. The NO precursor, L-arginine (0.3-3 μg/rat) was intra-CeA injected prior to testing of naloxone response. To evaluate the involvement of NO system an inhibitor of NO synthase (NOS), N G -nitro-L-arginine methyl ester (L-NAME) (0.3-3 μg/rat), was injected ahead of L-arginine. Control group received saline solely instead of drug. As a complementary study, the activation of NOS was studied by nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d). Results: Morphine induced a significant increase in wet dog shaking and grooming behaviors compared with controls. Injection of naloxone pre-testing of morphine response significantly reversed the response to morphine. However, pre-microinjection of L-arginine intra-CeA recovered the response to morphine. Injection of L-NAME intra-CeA ahead of L-arginine though had no effect behaviorally, but, inhibited the NOS which has been evidenced by NADPH-d. Conclusion: The present study shows that NO in the CeA potentiates the expression of conditioned withdrawal induced by morphine paired with naloxone.
  - 2,290 133
SHORT COMMUNICATIONS
An experimetal evaluation of nephroprotective potential of Butea monosperma extract in albino rats
Nisha Sonkar, Aditya Ganeshpurkar, Priyanka Yadav, Shagun Dubey, Divya Bansal, Nazneen Dubey
January-February 2014, 46(1):109-112
DOI:10.4103/0253-7613.125190  PMID:24550595
Objective: The current work was aimed to evaluate the nephroprotective potential of Butea monosperma. Materials and Methods: Butea monosperma was collected from local forest of Jabalpur and extracted with ethanol. Healthy adult male Wistar albino rats between 5 and 6 months of age and weighing about 150-200 g were used for the study. Acute toxicity studies were performed to determine dose of extract. Nephrotoxicity was induced by gentamicin. Animals were divided in four groups in which first group served as positive control, second group as gentamicin treated toxic control; animals of group three and four were treated with Butea monosperma extract. Extract was administered to animals via oral route. Serum creatinine, serum urea, and blood urea nitrogen were estimated. Body weight was also determined. Histopathological studies were performed to access gross anatomical changes in animals. Results: The extract of Butea monosperma was found to be rich in flavonoids, polyphenolics, and alkaloids. Urine creatinine, serum urea, and blood urea nitrogen were found to be significantly (P < 0.001) increased in rats treated with only gentamicin; whereas, treatment with the ethanolic extract of leaf of Butea monosperma reversed the effect of gentamicin indicating nephroprotective activity. Conclusion: The present study revealed that ethanolic extract of Butea monosperma is a good source of phytochemicals. The phytoconstituents flavonoids, phenolics, and alkaloids present in the extracts may be responsible for antioxidant activity. By the virtue of antioxidant activity, Butea monosperma demonstrated nephroprotective activity.
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Effect of ovarian sex hormones on non-steroidal anti-inflammatory drug-induced gastric lesions in female rats
Tultul K Sangma, Seema Jain, Pramod K Mediratta
January-February 2014, 46(1):113-116
DOI:10.4103/0253-7613.125191  PMID:24550596
Objective: The objective of the following study is to investigate the effect of ovarian sex hormones on gastric ulcer in female rats. Materials and Methods: Female rats were treated daily with estrogen (0.05 and 0.1 mg/kg), progesterone (2.0 and 5.0 mg/kg), combined estrogen (0.05 mg/kg) and progesterone (2.0 mg/kg), ranitidine (30 mg/kg) or vehicle for 7 days. Ulcers were induced with aspirin on 7 th day. Four hours later, animals were sacrificed and stomach were removed for macroscopic and biochemical examination. Results: Estrogen in 0.05 and 0.1 doses showed 32% and 18% of ulcer inhibition, respectively, progesterone 09% and 14% inhibition in 2.0 and 5.0 mg/kg doses, respectively, whereas combined estrogen and progesterone showed 23% and ranitidine showed 60% inhibition. However, the inhibition attained and the stomach malondialdehyde and glutathione levels in sex hormone treated groups were not statistically significant when compared to control group. Conclusion: At the tested doses, these ovarian sex hormones neither worsen nor protect against aspirin-induced gastric lesions in female rats.
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