Σάββατο, 19 Νοεμβρίου 2016

Rectal tumor recurrence: What more may we learn?

2016-11-19T14-52-56Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Antonio Manenti, Massimiliano Salati, Alberto Farinetti, Maurizio Zizzo, Emilio Simonini.
Background: Notwithstanding real progress in the treatment of rectal cancers, local recurrence remains a challenging problem. We performed a retrospective observational study focusing on anatomo-surgical data. Methods: In our retrospective study, we adopted new morphological classifications of primary tumor downstaging, after neoadjuvant treatment, and of local recurrence of rectal cancers, mainly based on CT and MRI images. Results: Different risk factors of rectal cancer recurrence were identified: its initial advanced stage, its high histological grading, and its non-responsiveness to neoadjuvant treatment. In addition, particular anatomo-surgical points have been underlined, mainly focused on the total mesorectal excision. Conclusions: We reaffirmed the value of a correct surgical technique, although other aspects of this disease demand further research.


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In-hospital and mid-term outcomes of patients operated on for type A acute aortic dissection complicated by postoperative malperfusion

2016-11-19T14-52-56Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Paolo Nardi, Dionisio F. Colella, Marco Russo, Guglielmo Saitto, Antonio Scafuri, Carlo Bassano, Antonio Pellegrino, Giovanni Ruvolo.
Aims: To evaluate the effect of postoperative malperfusion (PM) on operative mortality and on late survival in patients who underwent surgery for acute type A aortic dissection in a referred center for aortic emergency surgery. Patients and Methods: From January 2005 to September 2015, 237 patients were referred for aortic emergency surgery at our center. We examined complete data available on 214 patients (mean age 62.5±12.6 years, 156 males). At presentation, various types of preoperative malperfusion (cerebral, renal, mesenteric) were observed in 119 patients (55.6%). Arterial access for cardiopulmonary bypass was via femoral artery (n = 99), via axillary artery (n = 99), or into the ascending aorta (n = 22). Aortic repair was performed using an open technique in 124 patients (58%). Results: Fifty-five patients (25.7%) presented PM; operative mortality was 29% (62/214): 47.3% in PM patients vs. 22.6% in non-PM patients (P 75 years at the time of operation (OR: 1.1, P = 0.0004) and renal PM (OR: 53.5, P = 0.0027). Five-year survival was 79±7% in PM vs. 94±3% in non-PM patients (P = 0.002). Independent predictors for reduced survival were age >75 years (OR: 375, P = 0.05) and renal PM (OR: 28.6, P = 0.01). All types of PM and the location of intimal tear distal to the ascending aorta were found as risk factors for survival in the univariate analysis only (P

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Use of soluble complement receptor type 1 to prevent local and distant organ injury in a rat intestinal ischemia reperfusion model

2016-11-19T14-52-56Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Mahir Kirnap, Mahmut Can Yagmurdur, Nilufer Bayraktar, Cem Comuoglu, Gokhan Moray.
Introduction: In this experimental study we aimed to examine the in vivo effect of soluble complement receptor type 1 (sCR1) in preventing local and distant organ injury in an ischemia reperfusion model via the superior mesenteric artery (SMA). Using these data, it may be possible to determine the clinical usage of sCR1. Material and Methods: 24 male rats, weighing between 200 and 250 g, were classified into four groups. In group 1, the SMA was clamped for 60 minutes. In group 2, intravenous (IV) sCR1 was given after laparotomy. In group 3, the SMA was clamped for 60 min, at the 60th minute IV sCR1 was administered, and then 1 min later reperfusion was carried out. Group 4 was the laparotomy group. To investigate organ injury, liver function tests (serum AST and ALT levels) and kidney function tests (serum BUN and creatinine levels) were carried out. To evaluate the systemic and local effects of inflammation, total serum levels of protein, albumin, tumour necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were tested. In tissue samples, glutathione (GSH), malondialdehyde (MDA), and myeloperoxidase (MPO) positive neutrophil counts were identified. Results: According to the statistical analysis, sCR1 was shown to reduce the ischemia-reperfusion injury and have antiinflammatory effects. In addition, distant organ injury due to reperfusion was prevented by sCR1. Conclusion: sCR1 was verified to decrease both mortality and morbidity.


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A Mini Review on the Antimicrobial Treatment, Mechanisms and Patterns of Resistance among Clinical, Veterinary and Environmental isolates of Burkholderia pseudomallei

2016-11-19T09-42-10Z
Source: International Journal of Livestock Research
Muhammad Abubakar Sadiq, Latiffah Hassan, Saleha Abdul Aziz, Zunita Zakaria.
The causative agent of human and animal melioidosis, Burkholderia pseudomallei is a saprophytic organism that is widely distributed in various environmental niches such as soil and water in endemic regions. Infection results from exposure to environments containing B. pseudomallei through direct skin inoculation or contamination of wounds, and inhalation of aerosolised bacteria. The infection is usually treatable with antibiotics but the treatments are becoming difficult, because these bacteria demonstrate a high level of intrinsic resistance against most common clinically relevant antibiotics. There are various mechanisms involved in B. pseudomallei antimicrobial resistance, four among which have been established; expression of multiple drug efflux pumps of the resistance-nodulation-cell division (RND) superfamily, production of hydrolytic enzymes, β-lactamases, deletion of antibiotic target and reduced drug uptake due to outer membrane protein (Omp), BpsOmp38. Most of these mechanisms were established among clinical strains of B. pseudomallei such information among the veterinary and environmental isolates is limited. However there appears to be no distinction between antimicrobial susceptibility and resistance pattern amongst the strains isolated from human and those isolated from animal or environmental sources. The emergence of resistance particularly to ceftazidime, carbapenems, Trimethoprim/sulfamethoxazole and amoxicillin/clavulanic acid, has serious clinical implications, for therapeutic efficacy of both initial and eradication phase drugs are compromised. There is need for more investigation into clinical, veterinary and environmental isolates of B. pseudomallei to determine the antibiotic susceptibility and resistance pattern and characterization of the various antimicrobial resistance genes recognized in the B. pseudomallei genome to elucidate their role in conferring resistance to antimicrobial agents. The information about the resistance mechanisms is imperative in future efforts in design of antimicrobial agents targeting these mechanisms.


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INFLUENCE OF MICROBIAL PHYTASE ON WEIGHT GAIN, FEED CONSUMPTION, FCR, CALCIUM, PHOSPHORUS RETENTION AND ECONOMICS OF BROILER WITH OR WITHOUT FEED MATRIX

2016-11-19T09-42-10Z
Source: International Journal of Livestock Research
MANIK DHUMAL, Mahalsakant Nikam, Rajeev Marewad, shrikant Deshmukh.
An experiment was conducted to evaluate the performance of broiler by supplementation of Phytase with or without using feed matrix. 375 day old Vencobb400 straight run chicks were weighed and distributed randomly into five treatment groups viz, A, B, C, D and E with three replicates of 25 chicks each. The recommended nutritional matrix for 500 FTU and 1000 FTU was used as per manufacturer guidelines. Treatment group A was basal diet without phytase enzyme. The body weights, weight gain, feed consumption and FCR up to 6th week of age were non-significant. The performance of Phytase supplemented groups was at par to that of control even by reducing the nutrients as per matrix and best performance was observed for Treatment groups E . The serum calcium values at 42 days did not differ significantly, however serum phosphorus values showed significant (P


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An in vitro analysis to ascertain whether smokeless tobacco has any detrimental effect on the diagnostic efficacy of salivary lactate dehydrogenase

2016-11-19T08-05-21Z
Source: International Journal of Medical Science and Public Health
Tajindra Singh Saluja, Anita Spadigam, Anita Dhupar, Shaheen Syed.
Background: Salivary diagnostics promise an easily accessible, non-invasive approach for analyzing and monitoring various oral diseases including cancer. Objectives: This study was undertaken to establish the baseline salivary lactate dehydrogenase (LDH) levels in healthy controls and to discern the effect of smokeless tobacco (SLT) on the diagnostic efficacy of salivary LDH. Materials and Methods: Thirty-seven systemically and periodontally healthy individuals in the age group of 19-27 years without any deleterious habit and oral lesion participated in this study. After explaining the procedure to the participants, unstimulated whole saliva was collected by spit method under sterile conditions. Baseline LDH activity was measured spectrophotometrically. After evaluating baseline activity, 1 ml of saliva was mixed with 1 g of SLT and incubated at 37°C. LDH activity was measured at different time intervals. Results: The median value of baseline LDH levels at rest was 338 IU/L. The gender-based variation in LDH activity was found to be non-significant. Exposure of whole saliva to SLT resulted in an initial increase followed by reduction in the LDH activity. Conclusion: This study provides additional rationale for the use of salivary LDH as a biomarker to investigate the aggressiveness and biological nature of oral pathological conditions. Interpretation of changes in salivary LDH activity should be done with caution in individuals habituated to tobacco use.


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Effectiveness and comparison of reteplase versus streptokinase thrombolytic agents in the patients of acute myocardial infarction

2016-11-19T08-05-21Z
Source: International Journal of Medical Science and Public Health
Sunil Kumar Goel, Ishita Goel, Sandeep Agarwal.
Background: Streptokinase and reteplase are commonly used for thrombolytic therapy in the patients with acute myocardial infarction (AMI). A comparative study was designed to evaluate the effectiveness of both thrombolytic agents. Objective: The objective of this study was to compare the effectiveness, reperfusion rates, mortality, and safety profile of two thrombolytics (reteplase and streptokinase) in the patients of AMI. Materials and Methods: The effectiveness of both thrombolytics (reteplase and streptokinase) was compared on AMI patients during hospital stay, at 1-month and 1-year follow-up. The difference of both groups was assessed by Chi-square and Students t-test wherever required. Results: A total of 414 patients of AMI were included in the study. No significant difference was apparent between the effectiveness of both thrombolytics agents at 1-month follow-up of AMI patients. Patients thrombolysed with reteplase showed a significantly low mortality (χ2 = 3.96, d.f. = 1, P = 0.0466) at 1-year post-AMI follow-up. The mean age of patients of reteplase group was 56.7 ± 4.95 years and for patients of streptokinase was 53.2 ± 9.19 years (P

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Evaluation of analgesics use in orthopedic department at tertiary care hospital in Bareilly, Uttar Pradesh, India

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Pooja Agrawal, Vijender Kumar Agrawal.
Background: Analgesics including nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed group of drugs in clinical practice for the management of pain and inflammation. This study was carried out to evaluate the prescribing pattern of analgesics in orthopedic in-patient department of tertiary care teaching hospital at Bareilly (Uttar Pradesh). Methods: This hospital based cross-sectional study was carried out for 3 months from March to May 2015. Collected data included age, sex, diagnosis and line of management during the study. The generic name and the average cost of treatment per patient were evaluated using Indian Drug Review, 2014. The prescribed drugs were assessed with respective National Model List of Essential Medicines (NLEM), 2011 and the rationality of prescriptions was determined using the World Health Organization indicators of drug utilization. The patients' details were recorded in a data collection form and results were analysed by descriptive statistics. Results: Out of 400 patients, 246 were male and 154 were female. The average number of analgesic per prescription was 1.48. In this study, 52.5% of patients had received single analgesic. Diclofenac was the most commonly prescribed analgesic (45.39%). During hospitalization, majority of the patients have received parenteral preparation. Gastro protective agents and antimicrobials were frequently prescribed along with analgesics. Out of 584 analgesics prescribed, 356 (60.96%) were from the NLEM, India. Furthermore, 276 (47.26%) analgesics were prescribed by generic name. The average cost of treatment per patient was 2050.70 INR. Utilization of analgesic in terms of defined daily dose/100 bed-days was 102.06. Conclusions: The percentages of analgesics prescribing from NLEM and the use of analgesic by generic name were found satisfactory.


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Use and satisfaction of complementary and alternative medicine among diabetic patients in a tertiary care hospital

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Monica N., Jayanthi CR, Praveen Panchaksharimath.
Background: Diabetes is a chronic disorder which requires long-term treatment. Non- adherence to treatment is a major factor responsible for morbidities and mortalities associated with diabetes. Complementary and alternative medicine (CAM) use has been one of the reasons for discontinuation of treatment. This study was conducted to assess the extent to which CAM and non-CAM users adhere to medical treatment. Methods: 200 patients attending the diabetic clinic over a period of 2 months participated in the study. After obtaining written informed consent, they were administered a CAM use and satisfaction questionnaire (TSQM) based on effectiveness, no side-effects, convenience and global satisfaction. Results: Out of 200 participants, 29% (58) used CAM. Naturopathy was the most commonly followed type of CAM (60 %; 35). Residing in the rural areas (OR-3.7), Socio- economic status above poverty line (OR- 9), diabetics with co- morbidities (OR- 6) and microvascular complications (OR-6) and using insulin (OR-3) was found to be the predictors of CAM use. However, the incidence of hypoglycemic episodes was 52 times higher among CAM users. (91%; 52) of the CAM users did not reveal the use to their physicians, out of which (70%; 40) did not disclose due to the fear of discouragement by the doctor. CAM was found to be better in all aspects of patient satisfaction like effectiveness, no- side-effects and global satisfaction than conventional medicine while conventional medicine users scored it to be more convenient to use than CAM. Conclusions: Doctors should enquire diabetics regarding CAM use since the voluntary disclosure is very less. Keeping lines of communication open for any discussions regarding pros and cons of CAM. Increasing patient awareness about potential drug interactions, when CAM is practised along with conventional medicine.


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Pharmacoeconomics of desflurane based minimal flow anesthesia for different durations of surgery

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Habib M. R. Karim, Mohd Yunus, Laltanpuii Sailo, Stevie J. N. Sangma, Newstar Syiemiong.
Background: Desflurane is relatively newer volatile anesthetic in clinical practice with many advantages. Unfortunately, it is comparatively costlier. The present observational study is aimed to evaluate the consumption pattern and cost of Desflurane based minimal flow anesthesia with regards to different durations of anesthesia. Methods: Twenty adults of American Society of Anesthesiologists class I and II of either sex were enrolled for the study with informed consent during November 2015 to January 2016. Anesthesia was performed using Intermed Penlon sigma Alfa Desflurane vaporizer and Penlon Prima SP2 workstation. Age and opioid compensated minimum alveolar concentration was fixed for each patient and was monitored using Penlon SP M8 monitor and its attached anesthesia gas monitoring system. Bispectral index was used in affordable patients to monitor depth of anesthesia. Data of Desflurane consumption was collected from the digital numerical display on the vaporizer screen. Statistical analysis was done using INSTAT software and cost was calculated from maximum retail price. Results: Data from 20 patients consisting 60% male (mean + standard deviation age of 39.8 + 16.9 years and weight of 59.7 + 12.52 kilograms) were analyzed. Gender had no effect on consumption of Desflurane. Older patients (>60 years) consumed less than the younger (p


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Propantheline induced pharmacokinetic variability in lithium bioavailability in human volunteers after co-administration with lithium and imipramine

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Preet Sood, Vikram Bhandari, Narinder Singh, Jaswinder Singh.
Background: Lithium is used commonly in bipolar illness. It is co administered with many other drugs like imipramine, fluoxetine to improve the clinical efficacy of the therapy. Co administrations of other drugs like NSAIDS and GIT drugs for various ailments are also common. As this drug possesses a narrow therapeutic range, effect of other drugs on its pharmacokinetic parameters is important to achieve its therapeutic goal as well as to avoid serious adverse effect. Methods: Total n= 30 human volunteers were enrolled in the study. After randomization subjects were divided into three study groups. Group 1 was given lithium (900mg) alone while group 2 and 3 were given lithium (900mg) and imipramine (25mg) at 0h. Group 3 patients were administered propantheline (15mg) 1 hr prior to lithium and imipramine. Results: In group 2 (Li+Imp) treatment with imipramine produced a significant decrease in C max (p


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Comparison between didactic lectures and small group discussions among second year medical undergraduates in pharmacology

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Madhav Kashinath Savkar, Vinaya Mariswamy, Manu Gangadhar.
Background: The drawbacks associated with didactic lectures can be overcome by small group discussions (SGDs) which involve a limited number of participants, produce interaction, allow better understanding of concepts, and critical thinking. The objectives of our study were to assess the preferences of 2nd year medical undergraduates between the didactic lectures and the SGDs and the enhancement of knowledge by SGDs in Pharmacology. Methods: This is a mixed (qualitative and quantitative), interventional study, conducted in 2nd MBBS students (n=130). After obtaining the informed consent and Institutional Ethics Committee clearance, the pre and post-tests (20 MCQs) before and after the didactic lectures were conducted. Second set of pre and post-tests with different and validated MCQs of the same topic were conducted before and after 3 SGDs. The preferences of the students between these 2 methods were also assessed using 10 parameters. The results were analysed by paired and unpairedt test and percentages. Results: The means (Standard Deviation [SD]) of the scores obtained by the students before and after didactic lectures were 7.53 (2.27) and 9.02 (2.92), respectively and before and after SGDs were 8.2 (1.95) and 11.42 (2.74), respectively. When the means of post-tests of lectures and SGDs were compared using unpairedt-test' the difference was extremely significant with the P value of


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Efficacy and safety of ivabradine as an add-on to atenolol in patients with chronic stable ischemic heart disease

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Elavarasi Pichai, Ezhil Ramya J., Vasanth Sandanapitchai.
Background: Heart rate is the important key factor for determining the cardiac output, myocardial oxygen demand and coronary blood flow. Reduction in heart rate is the main stay of treatment for preventing and treating IHD. Due to the interactions with other drugs and adverse effects of the conventional drugs, the management of IHD focused on novel targets. Ivabradine is a novel specific and selective if current inhibitor of SA node. The objective of the study was to efficacy and safety of ivabradine as an add-on to atenolol in patients with chronic stable ischemic heart disease. Methods: Interventional, open label, prospective clinical study was done over a period of 1 year. Single centered study conducted in 50 patients in the Outpatient Department of cardiology, Tirunelveli Medical College Hospital, Tirunelveli. Endpoints noted were reduction in resting heart rate using 12 lead ECG and improvement in Canadian cardiovascular society (CCS) class of angina grading. Results: Ivabradine in reducing the heart rate at the end of 1 month (86.60±9.16) and at the end of 3 months (81.82±8.37) compared with baseline (93.08±11.67). CCS class of grade of angina also improved at the end of one month and 3 months compared with baseline. Grade IV (3 - 0 - 0), grade III (7 - 3 - 1) and grade II (40 - 8 - 9). Conclusions: Ivabradine is safe and effective in preventing and treating further anginal attacks in patients with chronic stable ischemic heart disease already on atenolol therapy.


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Prospective study to evaluate the efficacy of fluoxetine in comparison with amitriptyline in patients with depression

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Vasanth Sandanapitchai, Sarojini Ramasamy, Elavarasi Pichai.
Background: Mental disorders are common in medical practice and may present either as a primary disorder or as a comorbid condition. They are a group of disorders characterized by altered regulation of mood, behavior and affect. Depressive disorder ranks top among the mental disorders. Depression is a disorder of public health importance, in terms of its prevalence, morbidity, mortality and economic burden. Methods: Study was carried out in the outpatient department of psychiatry, Government Rajaji Hospital, Madurai, after obtaining clearance from Institutional ethical committee, written informed consent was obtained from all the patients. Eighty newly diagnosed patients suffering from depression, attending psychiatric outpatient department were selected after satisfying inclusion and exclusion criteria. They were divided into two groups with 40 patients in each group. Group I received amitriptyline (25- 150 mg /day) and group II received fluoxetine (20- 40 mg /day). Efficacy was assessed by measuring the reductions in the total HAM D-Scores (Hamilton depression rating scale) at the end of the study from baseline scores. Results: The efficacy of two antidepressants was compared and it was found that the incidence of depression was higher among the 20 40 years age groups in both the study groups. Females were more in number as compared to males in both the study groups. The efficacy of fluoxetine is comparable to that of Amitriptyline both were equally efficacious in the treatment of depression. Conclusions: Depression is a disorder of major public health importance, in terms of its prevalence, morbidity, mortality and economic burden. The prevalence of depression is more in women than men. Fluoxetine and amitriptyline were equally efficacious in the treatment of depression.


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Self-medication in ophthalmology - a northern Indian tertiary hospital experience

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Rohini Gupta, Pavan Malhotra.
Background: The objective of the study was to identify practice and pattern of self-medication use among new patients attending ophthalmology OPD in a tertiary care hospital of north India. Self-medication practice is a common phenomenon all over the world but it has been reported to be very common in the developing countries especially in India. When consumers self-medicate without consulting the eye care giver, the issues of safety and irrational use of drugs arise. Methods: A cross-sectional questionnaire based, observational study was planned among the patients reporting for the first time to Ophthalmology OPD in ASCOMS, Jammu. The patients enrolled in the study were randomly selected in the age group ≥18 years. Detailed history regarding self-medication prior to reporting to OPD was obtained. A questionnaire elucidating details of self-medication regarding history of ocular self-medication, type of ocular medication used, their reasons for resorting to ocular self-medication etc. was provided to them. All participants were informed about the scope and purpose of the study. An informed consent was obtained in every case prior to being given the questionnaire. Results: A total of 296 responders were interviewed. Among these 122 (41.2%) admitted to have used eye medicines before coming to hospital. Redness in 38 (31.1%) cases was the most common complaint for which the patients opted self-medication. 49 (40.2%) patients did not know what drug they had used. Among the various drugs used, the commonest was the antibiotic eye medication in 33 (27%) patients followed by steroids 13 (10.7%). Among the responders 9 (7.3%) experienced side-effects after self-medication. Main factors influencing self-medication were advice from friends/relatives, living far from hospital and high cost of treatment at the hospital. Conclusions: Self-medication with eye medicines is common among the population interviewed. Educating the public about the dangers of self-diagnosis and treatment, possibly leading to delay in detection of more serious underlying ailments is essential.


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Diuretic effect of chloroform seed extract of Moringa oleifera (Linn.) in Wistar rats

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Hema Senthil Kumar, Lourdu Jafrin A..
Background: Diuretics are widely prescribed group of drugs for mobilizing oedema in a variety of clinical situations, including hypertension, heart failure, renal failure, nephrotic syndrome and cirrhosis. Problems like drug resistance, adverse drug reactions and emerging newer diseases, have necessitated research on the vast untapped potential of herbals as potent drugs. Hence in this study an attempt has been made to evaluate the diuretic property of Moringa oleifera. Methods: Twenty-four adult wistar rats of either sex were divided into four group of six each and they were fasted for 18 hours. Group I received normal feed and water ad libitum. Group IIa received frusemide 1mg/kg, Group IIb received thiazide 2.5 mg / kg and Group III received chloroform extract of Moringa oleifera seed (1000 mg/kg) orally. The diuretic response was assessed by the increase in urine volume and urinary electrolytes. Results: The analysis showed an increase in urine volume in the groups IIa, IIb and III. Conclusions: The observations of the present study showed, the total volume of urine, natriuretic, kaliuretic effect exerted by the plant extract was similar to that of hydrochlorothiazide (moderate efficacy diuretic).


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Evaluation of changes in rat fatigability and biochemical parameters after oral and intra-peritoneal administration of adenosine tri phosphate: an experimental study

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Sheshidhar Gajanan Bannale, Sangappa V. Kashinakunti, Manjula Rangappa, Pundarikaksha Hulikallu Purushothama, Yasmeen A. Maniyar, Manjunath Sajjanavar.
Background: Adenosine tri phosphate (ATP) is an important intracellular energy source and has many extracellular functions meadiacating through purine receptors. Currently ATP is available in the market as oral dietary supplement. However there are inconclusive studies regarding its efficacy through oral route. Hence this study was carried out to evaluate efficacy of oral and intraperitoneal administration of ATP in experimental rats by comparing swim exhaust time and associated biochemical changes. Methods: 18 Swiss albino rats of either gender were grouped randomly into three groups, consisting of group -1 control group which receive distilled water (5ml/kg body weight) whereas group 2 and 3 received oral and intraperitoneal ATP (60mg/kg body weight) for 8 days. On 8th day all rats all rats were evaluated for extent of physical fatigue by using exhaustive swimming test time required to attain immobility status is noted. Under aseptic precautions blood samples were drawn from rat tail vein and biochemical parameters like uric acid, triglycerides, total cholesterol, random blood sugar and c-reactive protein levels were measured. Results: There was a significant (p


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Pharmacovigilance study in medicine department in a tertiary care hospital

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Rajat Mishra, Santosh Kumar Jeevangi, Shrenik Vardhamane, Sunil Kumar.
Background: Adverse drug reactions (ADRs) are major worldwide public health problem. Proper reporting of an ADR is very important as it reduces number of deaths due to ADR and extra financial burden on patients. The aim of the study was to assess the pattern of ADR reporting in outpatients and inpatients of medicine department and to assess their causality, severity and preventability. Methods: This was a prospective observational study done from April 2013 to June 2014 or in 100 consecutive study subjects (which ever happen first) with ADRs in department of medicine. The clinical pattern, spectrum of ADRs reported and assessment of ADRs in terms of causality, severity and preventability .The causality, severity and preventability assessment was done on the basis of applying various scales for each of them. Results: A total of 153 suspected ADRs were reported and evaluated from 100 patients. Dermatological system (28%) was most commonly involved. Drug class most commonly associated was Antimicrobials (51%). 68% ADRs were classified as Probable in view of causality, while 68% were found to be Moderate in case of severity. In 65% of the cases the ADRs was Probably Preventable. In majority of the cases the suspected drug was withdrawn and alternate therapy was instituted. Most patients recovered from the ADR.70% of these ADR was Type A. Conclusions: Awareness about ADR reporting is still poor amongst healthcare professionals in India. Conducting regular training programmes can improve the number of ADR reporting.


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Effect of vitamin D on vascular health in hypertensive patients with vitamin D deficiency

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Suresh Kumar Srinivasamurthy, Sadish Kumar Kamalanathan, Vishwanath Vinod Kolar, Rajan Sundaram, Charan Raj Goud, Adithan Chandrasekaran.
Background: Many observational studies have shown association of cardiovascular disease and vitamin D deficiency. However, there is a need for prospective studies to show causal effect of vitamin D and cardiovascular diseases in India. Hence the present study was designed to study the effect of vitamin D on markers of vascular health in hypertensive patients with vitamin D deficiency. The objective of the study was to assess the effect of vitamin D supplementation on markers of vascular health in hypertensive patients with vitamin D deficiency. Methods: Hypertensive patients were screened for vitamin D deficiency defined as 25 OH vitamin D less than 20 ng/mL after written informed consent. Hypertensives deficient with 25 OH vitamin D were recruited for the study to receive cholecalciferol 60000 IU/ week for 8 weeks. The vascular parameters such as blood pressure, pulse wave velocity, arterial stiffness index, malondialdehyde and total antioxidant status were assessed at baseline and after 8 weeks of cholecalciferol. The results were analysed using pairedt test. Results: A total of 119 hypertensive patients were screened for vitamin D status. Among them 57 patients were found to be vitamin D deficient (48.7%). Thirty two patients completed the study. The baseline serum 25 OH vitamin D3 was 12.55 ± 5.7 ng/mL and it increased to 40.06 ± 10.53 ng /mL after 8 weeks. Conclusions: The vascular parameters didnt show any statistically significant difference between baseline and at 8 weeks. However trend for decline was observed for malondialdehyde, right brachial pulse wave velocity.


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Effect of Withania somnifera on physical and cardiovascular performance induced by physical stress in healthy human volunteers

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Tripathi RK, Salve BA, Petare AU, Raut AA, Rege NN.
Background: Withania somnifera (WS) rejuvenates, increases vigour, vitality and immunity. The antistress effects of WS on physical performance and cardiovascular parameters during exercise were evaluated in healthy volunteers. Methods: Prospective, open label, randomized, placebo controlled, comparative, pilot study was designed in healthy adult volunteers. After Ethics committee approval 30 consented participants were randomly assigned into three equal groups to receive single capsule for 28 days containing maize starch (placebo group), WS aqueous extract 330mg (WS 330 gr) and 500mg (WS 500 gr). They were assessed at day 0, day 14, day 28 with physical stressors (six minute exercise test, YMCA Submaximal Test, Fixed workload exercise on cycle ergometer), Jammers' hand held dynamometer test and cold pressor test in each visit. Physical performance was evaluated as maximum distance, speed, oxygen consumption, hand grip strength. Cardiovascular response was assessed by heart rate and blood pressure measurements. Results: On day 28, both WS 330 and WS 500 groups showed significant increase in mean distance travelled and average speed compared to placebo (p


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Analgesic activity of ethanolic extract of leaves of Nyctanthes arbor-tristis linn on experimental animal models

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Pallavi Bordoloi, Tarali Devi, Mangala Lahkar.
Background: The present study has been undertaken to evaluate the pharmacological efficacy of ethanolic extract of leaves of Nyctanthes arbor-tristis (EENA) LINN as an analgesic agent in comparison with standard non-steroidal anti-inflammatory agents. Methods: The extract was prepared by soxhlet method and acute toxicity test was performed as per OECD guidelines. The peripheral analgesic activity was assessed using acetic acid induced writhing method. The central analgesic activity was assessed using tail-flick method. Results: It has been shown that EENA 400mg/kg and aspirin 100mg/kg significantly increased the pain threshold as assessed by increase in the latency period or basal reaction time. EENA (200mg, 400 mg/kg) and aspirin 100 mg/kg also significantly reduced acetic acid induced writhing response showing peripheral analgesic activity. Conclusions: Since prostaglandins are involved in the pain perception and are inhibited by flavonoids, it could be suggested that the analgesic effect of Nyctanthes arbortristis might be due to its inhibitory action on PG biosynthesis.


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A study on determinants of adherence to highly active anti-retroviral therapy in a tertiary care hospital

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Sandeep B., Suraj.B..
Background: Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) is a major global health problem. A major concern with scaling up of antiretroviral treatment in resource limited settings is the emergence of drug resistant viral strains due to sub-optimal adherence and the transmission of these resistant viral strains in the population. Adherence is the second largest predictor of progression to AIDS and death after CD4 count. Hence the aim of the present study was to evaluate adherence to HAART and its determinants among HIV/AIDS patients on first line HAART. Methods: This study was cross-sectional, observational in nature carried out among two hundred and seventy (270) HIV/AIDS patients on HAART during December 2013 to November 2014 at ART centre. Frequencies, Proportions and logistic regression analysis were applied and statistical analysis was done using (SPSS) 17.0 version. Results: Among the study population, 52.6% of the patients were male, 81.5% of them were adherent to HAART in the last 7 days recall. Most common reasons for missing HAART regimen in this study were simply forgetting (70%). On Bivariate analysis, Adherence levels was less among Female (p


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A questionnaire based study of students’ opinion on the teaching and learning methods in pharmacology in a medical school of India

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Prasad SR, Ravi H. Kudthni, Santhosh R..
Background: Pharmacology as a discipline is undergoing continuous development. It is generally agreed that reviewing the teaching program at regular intervals and modifications in the methodologies of imparting basic knowledge about drugs and drug therapies is a must. Students perceptions and attitude regarding the different teaching-learning and evaluation methods are important for further development and restructuring of medical education in future. The present study was undertaken to gather students perception about pharmacology teaching and learning methods. Methods: A 20 item prevalidated Questionnaire proforma was distributed to two batches of undergraduate medical students. The completed questionnaires were collected and data was analysed. Results: Of the 100 students who answered, 62% students considered the importance of pharmacology above all subjects. Among the various topics central nervous system 60%, chemotherapy 52% and cardiovascular pharmacology 42% were considered the most interesting topics. Of the teaching methodologies, more than half of the students (62%) found interactive lectures most helpful, whilst 39 % rated audio-visual aided lectures. In terms of reforms, 48 % of the students suggested to introduce small group discussion hours, 44 % suggested making use of more audio-visual aids and 21 % wanted more clinical pharmacology. Discussions at the end of class (55 %), encouraging students to ask questions during lectures (38 %) were main ways to enhance active student participation. Conclusions: The results of our study revealed a positive feedback from students which will help in making the teaching programme in pharmacology more interesting and relevant.


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Are we too reluctant about irrational nutraceutical combinations?

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
V. Krishnan, Prakash Murugaiah, Aruna Maria Bachmann.
Background: The objective of the study was to study the rationality of Vitamins and minerals combinations available in India and to provide comprehensive data of irrational combinations having excess and sub sufficient quantity of vitamin and minerals than recommended by National Guidelines of India. Methods: This observational study and analysis was done between June and August 2016. Data was collected from current index of medical specialties and drug India. Rationality assessment was done using National list approved drug combinations by Central drug standard control organization (CDSCO) and essentially was cross checked using World Health Organization essential drug list 2015. Adequacy was analysed using Dietary reference intake (DRI) for Indians by Nutrional council of India draft guidance. Results: In our analysis, we have found 1184 irrational nutraceutical preparations available in India market. Out of 461(38.9%) are based on fat soluble vitamins, 190 (16.4%) based on B-complex vitamins based and 5339 (45.1%) related to essential minerals. Among 461 fat soluble vitamins, 104 contain excessive level, 334 contain substandard levels. Similarly 128 and 62 Vitamin B-Complex based preparations are having excess and less quantity than recommended levels respectively and almost all the mineral combinations except four are not prepared following guidelines. None of these combinations were included in National essential list of medicines. Conclusions: Multivitamins are generally considered safe; these are irrationally prescribed and taken as self-medication by public. Many of the ill effects are often unnoticed and under reported. Government of India should regulate the manufacture and sale these nutraceuticals to promote rational use of drugs and to promote wellbeing and safety of Indian population which is primary objective of Health for all.


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Economic burden of diabetes mellitus in western India: a hospital based study

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Arpit Prajapati, Nitin Kothari, Barna Ganguly.
Background: Descriptive cost of illness study can provide an overall picture of diabetes in monetary terms in developing country, which may serve as a vital source of information for health care organizations and planning bodies to plan and prioritize local health policies and schemes. The aim was to explore cost description of diabetes in a tertiary care hospital in Anand district of Gujarat, India. Methods: This was an observational study with one year follow up. Ethical approval was taken from IEC. Patients were recruited and were divided into three categories according to duration of diabetes; newly diagnosed cases as category I, diabetes since last 5 year as category II and since last 10 years as category III. All these patients were followed up with 4 visits. Cost was calculated into three components; direct medical, direct non-medical and indirect cost. Descriptive and regression analysis was done using SPSS version 17.0. Results: Total 90 patients were analyzed after 12 patients were lost to follow up, 30 in each category. Mean total cost was found to be 12391.84 INR. Contributions from direct medical cost, direct non-medical cost and indirect cost were 74%, 2% and 24% respectively. Maximum cost incurred was due to medicine cost (44.14%) followed by complication cost (43.34%). Conclusions: Heavy economic burden highlights the urgent need for the health care organizations to plan and prioritize policies and accordingly in prevention and management of diabetes and its complications.


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A comparison of computer assisted learning and practical animal experiment for undergraduate medical students in pharmacology curriculum - a questionnaire based study conducted in a medical college of North India

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Diwanshu Sharma, Pavan Malhotra.
Background: The practical sessions in pharmacology training involving animal experiments were perceived to be unnecessary as the learning objectives of these practical sessions primarily focus on observational, analytical and interpretative skills. A number of computer simulation and other models have been recommended for use as alternatives to use of animals for medical education. In this study, we compared Computer Assisted Learning (CAL) with practical animal experiments for medical undergraduates based on questionnaire. The objective of the study was to compare Computer Assisted Learning and practical animal experiments for medical undergraduates in pharmacology curriculum. Methods: This was a questionnaire based observational study involving 300 medical undergraduates and eighteen faculty members. It included two systems i.e. CAL and conventional animal experiments. A separate questionnaire was prepared for the faculty members. Results: Results showed that CAL has nearly replaced the practical laboratory experiments as far as the medical undergraduate training is concerned. All the students and teachers believed that CAL is better and more understandable than animal experiments done practically. Conclusions: It is concluded that CAL is a better source of experimentation at the undergraduate level and provides dependable outcomes.


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A survey on knowledge, attitude and practice of pharmacovigilance and adverse drug reaction reporting among healthcare professionals in a tertiary care hospital of Bihar, India

2016-11-19T05-04-49Z
Source: International Journal of Basic & Clinical Pharmacology
Pramod Kumar Manjhi, Manish Kumar, Harihar Dikshit, Lalit Mohan, Hitesh Mishra.
Background: This study was conducted to assess the knowledge, attitude and practice of pharmacovigilance (PV) and adverse drug reaction (ADR) reporting among healthcare professionals in a tertiary care hospital of Bihar. Methods: It was a questionnaire based cross- sectional study carried out for a period of 3 months by a preformed structured questionnaire consisting of 19 questions (11 questions on knowledge, 5 on attitude and 3 on practices) in various departments of I.G.I.M.S., Patna. 120 filled questionnaires by healthcare professionals were collected from department and analysed for mentioned parameters. Among healthcare professionals there were 46 Interns, 20 junior and senior residents, 2 professors, 2 associate professors, 2 assistant professors, 48 nurses of the hospital. A descriptive analysis of data was done. Results: Out of total 120 distributed questionnaires, 112 were completely filled up and considered for analysis. The response rate was 93.3%. Regarding knowledge, attitude and practice based questions 58.9% and 75% were knew the correct definition and important purpose of PV respectively. Among participants 62.5% have knowledge of post marketing surveillance studies done by Pharmaceutical companies and 79.4 % knew that within how many days serious adverse event (SAE) reported in India. Lack of time (36.6 %) followed by non- remuneration ( 33.3%) were major discouraging factor in ADR reporting. 36.6 % think reporting is a professional obligation for healthcare professionals and 19.6 % opined that ADR monitoring centre should be in every hospital. 89 % agree with necessity of ADR reporting where as 91% think PV should be taught in detail to healthcare professionals. 60.7 % had read an article on prevention of adverse drug reaction, 51.7 % had come across with an ADR and less than half (41.9 %) had been trained on how to report. Conclusions: Findings strongly suggest that there is a great need to create awareness and to promote the reporting of ADR amongst prescribers since knowledge and awareness are the most important parameters that can minimize the under reporting of ADRs.


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Removal Of Penile Nut Bolt

2016-11-19T04-20-08Z
Source: The Southeast Asian Journal of Case Report and Review
Rajesh Kumar, Dipendra Kumar Sinha, Aftab Ahmed, Satish Kumar Ranjan, Anup Kumar Tirky.
Penile constriction devices often present significant challenges to urologic surgeons. Failure to remove such devices can lead to significant ischemia and loss of tissue. Patients often present after several days of ischemia and swelling have developed.Here we report a case of sucessfull use of a infant feeding tube to remove a strangulating penile ring in emergency.A case report of a strangulating metal penile ring in a psychiatric patient who presented at emergency with gangrenous change in penil skin.


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Contralateral Neck Metastasis in Oral Squamous Cell Carcinoma-Report of Two Cases with Review of Literature

2016-11-19T04-20-08Z
Source: The Southeast Asian Journal of Case Report and Review
Kavitha Prasad, Rajanikanth B R, Sejal Munoyath, Parimala Sagar, Vineeth K, Anand D.
Lymph node metastasis in the neck is an important prognostic and survival factor in patients with Oral Squamous Cell Carcinoma (OSCC). Patients with pathologically negative cervical lymph nodes are believed to have a good prognosis. However, outcome of patients with lymph node metastasis, occurring after surgical excision and/or adjuvant therapy of the primary tumor is poor. A review of literature shows that the frequency of contralateral neck node metastasis (CLNM) in oral carcinomas varies from 4% to 16.1%.The CLNM includes the presence of initial CLNM, occult CLNM confirmed by pathological study and contralateral neck relapse. The risk factors for CLNM are still controversial and debatable. Primary site and location of the tumor, its extension, clinical stage, pathologic grade, tumor thickness and perineural invasion are the most common risk factors involved in CLNM. In this paper, we discuss two cases of OSCC with CLNM following surgery with adjuvant chemotherapy and radiotherapy (CTRT). The main objective of these case reports is to review the literature and look at the possible predictive clinicopathologic factors for CLNM in surgically treated primary OSCC.


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Dexamethasone in treatment of community acquired pneumonia in children: a randomised control trial

2016-11-19T03-16-50Z
Source: International Journal of Contemporary Pediatrics
Tauhid Iqbali, Anil Kumar Jaiswal, Amit Kumar.
Background: An inflammatory response is a two edge sword in pneumonia as reasonable inflammatory response is required for microorganism clearance but excessive inflammation can cause on-going local and systemic damage. Because of this, despite appropriate antibiotic therapy, adjuvant therapy that can positively modify the immune response has become a relevant approach to improve pneumonia prognosis. The objectives of this study was to document the beneficial effects of adjunctive dexamethasone therapy in patients admitted with community-acquired pneumonia (in terms of length of hospital stay) and to study what patients admitted with CAP benefit most from dexamethasone therapy, based on predefined subgroup of disease severity (PSI 1-5) and C-reactive protein level at admission as well to evaluate utility of CRP in monitoring resolution of CAP. Methods: In this prospective case-control trial, 100 children aged 1 to 14 years were enrolled randomly with confirmed community-acquired pneumonia, who presented to emergency department of paediatrics PMCH Patna. We randomly allocated patients on a one-to-one basis to adjuvant dexamethasone with antibiotics and antibiotics alone groups by drawing lots. Results: The median length of hospital-stay in both the adjuvant dexamethasone group and antibiotics alone group was 7 days with IQR in adjuvant dexamethasone group of 6.0-8.0 days and antibiotics group of 7.0-9.0 days (95% CI of difference in means 0.3-1.2 days; p = 0.001931 and was significant at p value of ≤ 0.01). There was a positive correlation between length of hospital-stay and CRP at the time of admission in adjuvant dexamethasone and antibiotics alone group with R value = 0.0261 and 0.3541 respectively. There also exist a positive correlation between length of hospital-stay and PSI at admission in adjuvant dexamethasone and antibiotics alone group with R value = 0.3555 and 0.1196 respectively. Median length of hospital-stay in those admitted with high PSI (PSI 4-5) and high CRP were 8.0 days in antibiotics alone group compared to 7.0 days in adjuvant dexamethasone group. The mean CRP on day 1, 3 and 5 was 7.734 (SEM 0.664), 3.974 (SEM 0.412) and 1.440 (SEM 0.133) respectively. Conclusions: There was no significant difference in length of hospital-stay in CAP patient treated with adjuvant dexamethasone with antibiotics and antibiotics alone. However it is clearly evident from this study that using adjuvant dexamethasone reduced the length of hospital-stay in those who admitted with higher PSI as well as higher CRP compared to antibiotics alone group. Moreover there was a definite decremental relationship between CRP and resolution of CAP. So use of adjuvant dexamethasone in those presenting with high PSI and high CRP can be consider. Since the sample size of our study was small, further evaluation is warranted.


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Evaluation of the analgesic efficacy of garlic shoots extract in experimental pain models in mice

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Suresh V. Dange, Jill Mathew, Angana Datta, Abhijeet V. Tilak, Makrand Jadhav.
Background: Garlic shoot and leaves are discarded as a waste material. Garlic has many properties like anti-inflammatory, anti-arthritic, anti-oxidant, dyslipidemic, anti-cancer, anti-infective therefore in the present study Garlic shoot extract (GSE) preparation was evaluated for its analgesic efficacy by making use of different central and peripheral pain models. So this study was performed using experimental central and peripheral pain models in mice. Methods: The analgesic efficacy of GSE was assessed by employing different pain models such as i)Hot plate and tail flick tests for central analgesia ii) 4% sodium chloride induced writhing as peripheral analgesic model . The percentage inhibition of writhes and prolongation of reaction time were the parameters of evaluation. The results obtained were analysed by ANOVA and Students unpaired t- test. Results: GSE treatment (250 mg/kg and 500 mg/kg) reduced writhing episodes significantly in 4%NaCl induced writhing in mice as compared to control indicating its analgesic effect. The highest percentage inhibition of pain was seen with 500mg/kg of GSE. GSE treatment, in Hot plate and Tail flick methods significantly prolonged the reaction time at 90,120 minutes. Conclusions: Garlic shoot extract (GSE) was found to be effective in all three models of experimental pain. However it is less potent than standard analgesic drugs and could be employed safely in higher doses.


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Screening of a novel furan compound for its antidepressant activity in albino mice

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Jayakumar JK, Supriya, Nityakarnam, Kishorekumar.
Background: Depression is a common chronic recurrent syndrome, characterized by apathy, loss of energy, retardation of thinking and activity, as well as profound feelings of gloominess, despair and suicidal ideation. The present study aimed to evaluate the antidepressant activity of synthesized novel furan compound by using forced swimming test (FST) and tail suspension test (TST). Methods: The antidepressant activity was studied in albino mice using FST and TST. Fluoxetine (20 mg/kg) were used as standard drugs and test drug novel furan compound (5, 10, 20 mg/kg) was used as test drug. A total of 60 mice were selected for the study and utilized 30 mice in each model. Animals were divided into five groups consisting of 6 animals in each. Control group received 10% tween 80 orally; standard group received fluoxetine 20 mg/kg orally; test group 1 received 5 mg/kg substituted furan compound orally; test group 2 received 10 mg/kg substituted furan compound orally; test group 3 received 20 mg/kg substituted furan compound orally. Results: In FST the low dose test compound had shown the percentage inhibition of 75.5% which was comparable to percentage inhibition of standard drug fluoxetine -82%. In TST the test group-1 had produced 66.6%, test group-2 83.3% and test group-3 produced 100% protection against passive behavior (immobility). The percentage of protection produced by highest dose was equal to standard drug fluoxetine against passive behavior. Conclusions: It can be concluded that the test drug has produced significant inhibition in duration of immobility by FST and also had significant protection against passive behavior. Hence substituted furan had potential antidepressant activity.


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To compare the efficacy and preserved/preservative free nepafenac eye drops in the post cataract inflammation patients

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Preet Sood, Manmohan Bhanot, Narinder Singh.
Background: Nepafenac is a novel topical NSAID used to treat post operative ocular inflammation and pain. Benzylkonium chloride is used as preservative in the formulation, is notorious in causing ocular surface defect. Now a day, preservative free formulation is available. This study is the comparison of the efficacy and safety of preservative free nepafenac with standard nepafenac eye drop formulation. Methods: This is a prospective investigator masked randomised parallel trial. Total n= 104 patients were enrolled. After randomization, patients were divided into two groups (nepafenac withwithout preservative drug).Patients were examined preoperatively (day-1) and post operatively on days 1, 3, 5, 7, 15 and 30 days. The signs of inflammation and tear film break up time were recorded. Results: preservative free nepafenac was found better at certain points like aqueous cells at day15 (p=0.02), conjunctival hyperemia at day 5 (p=0.009) and pain at day3 (p=0.004) at other points. Effect on tear film breakup time was recorded but it is not statistically significant. Conclusions: preservative free nepafenac is found effective in controlling the ocular post inflammation. For evaluating the effect on dryness of eye we need longer trials. Preservative free nepafenac should be preferred over the nepafenac eye drops.


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Evaluation of inappropriate prescribing to the hospitalized elderly patients in Al Shifa hospital, Gaza, Palestine

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Lina K. Massoud, Hala Z. Al Agha, Mahmoud H. Taleb.
Background: The current study aimed to assess the prevalence of inappropriate prescribing (IP) for hospitalized elderly patients at Al Shifa Hospital, Gaza, Palestine. Methods: This study was a retrospective cross-sectional study. A total of 2385 prescribed drugs for 380 elderly inpatients in internal, cardiology, and respiratory departments were screened for IP. Four criteria were used to detect IP using chart review method; Drug-drug interactions (DDIs), drug contra-indications (CI), duplication of therapy and Beers' criteria 2012. Results: The results showed that 44.2% of patients had at least one IP. Around 33.2% of the patients had DDIs, 19.2% had IP according to Beers' criteria and 1.1% had drug CI. There was no duplication of therapy. A total of 323 IP instances were detected. Of them, 74% for DDIs and 24.8% for Beers' criteria. The prevalence of overall IP was significantly influenced by age (p-value=0.024), polypharmacy (p-value


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Evaluation of pharmacological and toxicological studies of an ayurvedic medicine Rasaraj Ras on biological system of the male Sprague-Dawley rats

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Ferdousi Akter, Md. Mamun Sikder, Shemonty Hasan, Mustari Hossain, Massnoon Ali, Manoth Kumer Biswas, Nilay Saha, M. S. K. Choudhuri.
Background: In this study, the pharmacological and toxicological effects along with possible side effects of the classical ayurvedic formulation Rasaraj Ras (RR) which is used as a traditional medicine in the treatment of hemiplegia in the rural population were evaluated. Methods: During this study, various experiments on body growth rate, organ-body weight ratio and tissue hydration indices were performed to evaluate its efficacy and toxicity. To find out the toxicological characteristic of RR, it was administered chronically to the male Sprague-Dawley rats at a dose of 40 mg/kg. After 28 days chronic administration of the RR preparation the following toxicological changes were noted. Results: All throughout the experimental period the RR treated animals were always maintaining negligible changes in body weight, but all throughout the experimental period no statistically significant increase or decrease was noted. There is a statistically significant decrease in the relative percent weight of the male rat heart. There is a statistically highly significant decrease in the absolute weight of the male rat liver. There is a statistically highly significant decrease in the relative percent weight of the male rat liver. There is a statistically significant decrease in the relative percent weight of the male rat kidney. In the tissue hydration index determination, no significant changes were noted in case of any organ. Conclusions: As RR decreases abnormally weight of several organs in body of treated rats, so it should not be administered chronically at a higher dose.


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Comparison of safety of loteprednol 0.5%/ difluprednate 0.05%/ prednisolone1% eye drops in the post cataract surgery patients

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Preet Sood, Manmohan Bhanot, Narinder Singh.
Background: Post surgical ocular inflammation is a common happening after the cataract surgery. Topical steroids are the main stay of the treatment. Although it is quite effective in controlling it but it produces severe adverse drug reactions i.e. rise in intraocular pressure and dryness in the eyes. In present study we have compared the two newer topical steroids i.e. loteprednol and difluprednate with prednisolone for the safety issue. Methods: Total n=150 patients of cataract were enrolled in the study. Institutional ethics committee approval was taken. After randomization, patients were allocated into three groups of 50 each. Baseline reading of intraocular pressure and tear film breakup time was recorded. Post operatively examination was done on day 7, 15 and 30 day. The results were compared as prednisolone versus loteprednol, prednisolone versus difluprednate. Results: A. On intraocular pressure 1.prednisolone versus difluprednate statistically significant effect at day 7 (p=0.043), day15 (p=0.010) and at day 30(p=0.036) were there. 2. Prednisolone versus loteprednol- The difference was statistically highly significant at day 7 (0.00), day 15 (p=0.009) and at day 30th (p=0.00). B. On tear film breakup time-No significant effect on tear film breakup time is observed. Conclusions: Both the newer drugs are much safer as compared to prednisolone for intraocular pressure. As they are equiefficacious to prednisolone their use in post cataract surgery inflammation is recommended.


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Pentobarbitone-induced sleeping time and sub-acute toxicity studies of Trichilia monadelpha aqueous extract

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
George Owusu, Meshack Antwi-Adjei, Isaac T. Henneh.
Background: Trichilia monadelpha is used either alone or in combination with other plants to treat many diseases in West Africa. Earlier, the anti-inflammatory, analgesic and anti-parasitic effects of the plant have been investigated to confirm its folkloric use. The current study is aimed at investigating the sub-acute toxicity profile as well as hypno-sedative effect of the Trichilia monadelpha aqueous extract (TAE). Methods: For the pentobarbitone-induced sleeping test, rats (150-200 g, n=5) were pre-treated with TAE (100, 300 and 1000 mg/kg, p.o.) or distilled water (control group) 30 minutes before they were challenged with Pentobarbitone Sodium (50 mg/kg body weight, i.p). Sleeping time of each animal was recorded and analysed. In the sub-acute toxicity test, rats were treated daily either TAE (30, 100 and 1000 mg/kg) or water (control group) for two weeks after which the animals were sacrificed. Blood samples were collected for haematological and biochemical analyses. Specific organs were then removed and weighed immediately. Results: The pentobarbitone-induced sleeping test resulted in a significant and dose-dependent increase in the duration of sleep of the rats. There were however no significant changes in the relative weight of vital organs of the control and TAE treated groups. Similarly, there were no significant differences in haematological and biochemical parameters between control and TAE treated groups. Conclusions: TAE significantly and dose-dependently increased the duration of pentobarbitone-induced sleeping time in rats. TAE showed no significant changes in the relative weight of the vital organs, haematological and biochemical parameters.


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Anti-inflammatory activity of fatty extract of Vitalleria paradoxa Kernel (Shea butter) and pattern of its clinical use in arthritis in Enugu, South East Nigeria

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Muoghalu GU., Akah PA, Okoye TC, Ezenyi IC, Ibeneme S., Okoli CO.
Background: The fatty seed extract of Vitellaria paradoxa Kernel (Sapotaceae) commonly called Shea butter, is a popular remedy for arthritis in west Africa. This study investigated the knowledge, prevalence and pattern of use of Shea butter in clinically diagnosed arthritic patients as well as its effects on acute (topical and systemic) and chronic inflammation in rodents. Methods: Knowledge, prevalence and pattern of use were determined using pre-tested questionnaire in clinically diagnosed patients whereas the anti-inflammatory activity was studied using xylene-induced mouse ear edema, carrageenan-induced rat paw edema, formaldehyde-induced arthritis in rats and cotton pellet granuloma test in rats. Results: The results showed that of the 164 respondents, 94.1% know about Shea butter and 59.6% have used it mainly as a massage ointment once or twice daily. However, 73.7% of the users combine this remedy with analgesics to achieve relief. The pharmacological tests showed that topical application of Shea butter inhibited acute edema of the mouse ear. Systemic oral administration caused significant (p


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Pharmacovigilance study of beta adrenergic receptor antagonists in patients visiting department of medicine of a tertiary care hospital, Surendranagar, Gujarat, India

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Madhav Trivedi, Tejas Acharya, Fenilkumar Kotadiya, Ritesh Vekariya, Dimple Mehta.
Background: The objective of this study was to evaluate incidence, patterns, and severity of Beta blockers induced adverse drug reactions (ADR). Methods: A total of 500 patients taking Beta blockers were enrolled in the study by taking an informed consent. Reporting of all Beta blockers-induced ADRs was done by filling CDSCO ADR form. All ADR reports were evaluated according to WHO-UMC causality assessment scale. Results: A total of 64 ADRs (48 males and 18 females) was observed in 500 patients taking beta blockers. Of 64 ADRs, 20 (31.25%) were mild, 34 (53.13%) were moderate, and 10 (15.62%) were classified as severe. 26 (40.62%) ADRs were classified as Probable, followed by 22 (34.38%) ADRs were in Possible category, 8 (12.5%) were in certain category, 4 (6.25%) ADRs were unlikely and 4(6.25%) ADRs were Conditional. Among 64 ADRs, 22 (3.43%) patients developed bronchospasm, 10 (1.56%) bradycardia, 8 (1.25%) fatigue, 8 (1.25%) nausea/GI upset, 4 (0.62%) erectile dysfunction, 4 (0.62%) dry cough, altered lipid profile, insomnia, night mares and diarrhea are other rare ADRs. Conclusions: Incidence of ADRs by beta blockers is 12.80% with bronchospasm as the most common ADR followed by bradycardia. As atenolol is most frequently used beta blocker, ADRs due to atenolol are more common.


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Lixisenatide: a once-daily glucagon-like peptide-1 receptor agonist

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Tushar Balchand Chudiwal, Indrajeet Omprakash Sharma.
Lixisenatide (AVE0010) is a once-daily glucagon-like peptide-1 (GLP-1) receptor agonist used in the treatment of type 2 diabetes. Phase II dose-finding and pharmacodynamic studies identified the 20 µg once-daily dose as having the optimum combination of efficacy, convenience and tolerability. Lixisenatide was prospectively investigated in a series of 11 multinational, randomised, controlled phase III trials (GLP-1 agonist AVE0010 in patients with type 2 diabetes mellitus for Glycemic control and safety evaluation [Getgoal] programme) that included a direct head-to-head study with exenatide. The Getgoal programme established the efficacy and safety profile of lixisenatide 20 µg once daily across the spectrum of patients with type 2 diabetes, including patients not treated with anti-diabetic agents, those failing on oral agents and as an adjunct to basal insulin therapy. The main efficacy endpoints were met in all studies, with the baseline to endpoint reductions in HbA1c consistently ranging from 0.7% to 1.0%. In a head-to-head comparison with exenatide 10 µg twice daily, lixisenatide 20 µg once daily was non-inferior for HbA1c reduction, achieved with threefold fewer patients with symptomatic hypoglycemia events and better gastrointestinal tolerability. Three randomised trials of lixisenatide treatment added to basal insulin showed significantly improved glycemic control over placebo, with pronounced postprandial glucose reductions and good tolerability. Discontinuations for adverse events were consistently low, ranging from 2.5% to 10.4%. As the provision of individualized care moves center stage in diabetes management, lixisenatide with once-daily dosing, a single maintenance dose and fixed-dose pens offers an important treatment option for type 2 diabetes.


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Spurious drugs: do we neglect during our clinical practice? a systematic review

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
E. Manivannan, V. Sivasankari.
Spurious drugs are those manufactured by concealing the identity of the true ones. It forms one of the largest growing markets in India. The aim of this review is to create an awareness of the prescribing doctors that substandard or fraudulent drugs are widely prevalent and it is in our doorstep during the regular practice. The duty of the prescriber is to identify these drugs, share the informations to the fellow colleagues and avoid them from prescribing. It is the role of the physicians to intimate this information to the patients also who consumes these drugs due to lack of awareness as like food products which are consumed as an adulterant one. We the health care professionals carry the duty of identifying these spurious drugs being manufactured and marketed by unlicensed or licensed pharmaceutical companies which are hazardous to our patients health. All the datas about this misbranded drugs are gathered from Journals and related websites from 2000-2016, thereby complied to reveal the present situation of spurious drugs. The Government of India has taken steps to implement Cosmetics Act 1940 and special courts are set up for speedy disposal of these related cases. Also the Government in its part announced the Whistle Blower Scheme to encourage the public to be vigilant and report the widespread infiltration of spurious drugs in the market and to receive the cash reward for this information.


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Self-medications with potential abuse in the Middle East: a systematic literature review

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Malak M. Khalifeh, Nicholas D. Moore, Pascale R. Salameh.
Self-medication (SM) is highly prevalent in the Middle East. However, regulations in the Middle East are not always enforced and therefore many prescription medicines can be purchased as SM, resulting in potential abuse of many medicines. The aim of this article, therefore, was to undertake a comprehensive review to identify the different types of self-medications involved in abuse in the Middle East and to identify harms related to SM abuse. An extensive review of the published literature pertaining to the subject (19902015) was conducted using PubMed, Web of Science, Cochrane and Google Scholar databases for OTC medication abuse in the Middle East. Twenty two papers were identified. Medications involved in SM abuse included: psychoactive prescription-only medicines, codeine-containing products, tramadol, anabolic steroids, sedative antihistamines, decongestants and laxatives. Moreover, studies in the region rarely reported harms related to SM abuse and strategies to limit this abuse. Potential SM abuse involving a range of medicines is a public health problem in the Middle East. Future interventions and regulations should be applied to limit the expansion of SM use and potential abuse.


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Need of fostering academic research for bridging the gap of “science- commerce disconnect” in ‘non-profitable’ therapy areas

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Anant D. Patil, Tushar Balchand Chudiwal, Pratishtha Banga.
Pharmaceutical companies share the goal of patient benefit with healthcare professionals. However, they are commercial organizations and hence, sometimes, commercial interest may take over science, resulting in science-commercial disconnect. This can result in innovation-deficit and financial burden on the patients. Finding new indications for existing drugs and promoting academic research in non-profitable areas are some measures to curtail pharmaceutical innovation-deficit. Greater involvement of academicians and non-government organizations in clinical research with government support/funding will help in providing best treatment options to the patients for better outcomes.


http://ift.tt/2fOwtGF

Global medication waste management practices: challenges and opportunities in developing countries

2016-11-19T02-01-43Z
Source: International Journal of Basic & Clinical Pharmacology
Vipula R. Bataduwaarachchi, Chamari L. Weeraratne.
Medication waste is synonymous with pharmaceutical waste, unused or expired medicines. Improper disposal of medication waste leads to serious personal and environmental health hazards. There were no established medication waste management programmes in most of the developing countries including Asia. Presence of unique socioeconomic problems in these counties makes the establishment of successful medication waste management programme a challenge. We reviewed the literature pertaining to the disposal of medication waste in different countries in order to understand the current status. We found that the medication waste disposal via normal sewage systems was the main method practiced in most of the countries and that the situation was much worse in developing countries. Return of unused medicines to pharmacies, which is considered to be the best method, was successfully practiced in some developed countries with established systems. Lack of proper mechanism to handle medication waste seems to be the main reason behind substandard medication waste management in developing countries. We propose a simple model for the disposal of medication waste taking into consideration the unique challenges and infra-structure issues in developing countries. International level policy and funding support, national level policy and unbiased financial allocations, institutional level comprehensive programmes according to the local requirements and most importantly the public support will make medication waste management programme a success. Furthermore, developing countries should join the on-going international forum on medication waste management. This short communication will be an eye opener for the academic key opinion leaders in developing countries to initiate medical waste management programmes in their countries.


http://ift.tt/2g5GWk2

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