hand-foot syndrome due to paclitaxel: A rare case report p. 284 Pritam S Kataria, Pradip P Kendre, Apurva A Patel, Nahush Tahiliani, Vijay Bhargav, Honey Parekh DOI:10.4103/ijp.IJP_547_17 Hand-foot syndrome (HFS) is a relatively frequent adverse reaction to certain anticancer drugs. HFS is a type of dermatitis which has been most commonly described with 5-fluorouracil and capecitabine. However, HFS with paclitaxel is rare and has been reported sparingly in the literature. A 52-year-old male patient with recurrent carcinoma of the buccal mucosa was started on palliative chemotherapy regimen, injection paclitaxel (175 mg/m2) in combination with injection carboplatin. On post-chemotherapy day 13, the patient started developing pain, dysesthesia followed by bullae formation, and desquamation over palms and soles. Clinically, the patient had Grade 3 HFS characterized by symmetrical, tender skin lesions over the dorsal aspect of palms, and soles with desquamation necessitating interrupti

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Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored Highly accessed article p. 73 Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18 There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.

Sunscreens

Sunscreens: Time to think beyond UV rays

p. 78

Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18   It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.

Idiopathic guttate hypomelanosis: An overview p. 83 Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18 Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this

Melasma p. 91 Rupali Dharni, Bhushan Madke, Adarsh L Singh, DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17 Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood’s lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood’s lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood’s lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.

PUVASOL and NBUVB in patients with vitiligo p. 96 Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17 Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achiev

Actinic keratosis in vitiligo after oral PUVAsol therapy with review p. 103 Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18 Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.

Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl p. 107 Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18 Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.

Erythema dyschromicum perstans in pregnancy p. 110 Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18 Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.

Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus p. 114 Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18 Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration “steroid-induced perilymphatic hypopigmentation and atrophy” has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.

Pigment International (Pigment Int) 2018 | July-December | Volume 5 | Issue 2

EDITORIAL
	Lichen planus pigmentosus and frontal fibrosing alopecia: The link explored	p. 73
	Ashraf Raihan, Muthu Sendhil Kumaran DOI:10.4103/Pigmentinternational.Pigmentinternational_19_18   There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
REVIEW ARTICLES
	Sunscreens: Time to think beyond UV rays	p. 78
	Chitralekha Keisham, Nelson Elangbam, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_15_18   It has been known to us that solar radiation contributes to photoaging. Until recently, it was thought to be due to ultraviolet rays alone. However, a growing number of evidence confirms that visible and infrared (IR) rays also contribute to extrinsic aging. Visible and IR rays account for 50% and 45% of the solar radiation reaching the earth. Ultraviolet A induces retrograde mitochondrial signal, thus leading to induction of matrix metalloproteinase. Ultraviolet B and IRC cause heat-related generation of free radicals and destruction of collagen and elastin. Exposure to visible light induces cytokines, free-radical formation, and pigmentary changes in human skin. The end result of solar radiation is generation of free radicals and ultimately oxidative damage, photoaging, and photocarcinogenesis. The present broad spectrum sunscreen does not provide complete protection of the human skin from oxidative insult. So, a combination of a sun protection factor active component along with an antioxidant is the ideal way of photoprotection. Till date, a number of antioxidants have been tried in human and animals which have shown to be an effective photoprotective agent, though few studies have failed to prove the same. Even with conflicting reports, effect of antioxidants on human skin needs to be explored more. A good study design with a large sample size in humans must be conducted as visible light and IR rays contribute significantly to photodamage.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Idiopathic guttate hypomelanosis: An overview	p. 83
	Indrashis Podder, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_17_18   Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity.
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ORIGINAL ARTICLES
	Correlation of clinicodermatoscopic and Wood's lamp findings in patients having melasma	p. 91
	Rupali Dharni, Bhushan Madke, Adarsh L Singh,  DOI:10.4103/Pigmentinternational.Pigmentinternational_33_17   Introduction: Melasma is a commonly acquired pigmentary disorder that manifests as symmetric hyperpigmented macules and patches on the face. Aim: To correlate Wood's lamp and dermatoscopic findings in patients having melasma. Materials and Methods: A total of 80 patients who were clinically diagnosed with melasma were examined under a Wood's lamp and dermatoscope, and all the findings were recorded and analyzed. Result: The degree of agreement between the Wood's lamp findings and dermatoscopic findings was found to be substantial as analyzed by kappa statistics with K = 0.813 and P = 0.0001 (significant). Conclusion: Dermatoscopy is advocated globally as a screening and diagnostic procedure for melasma and other pigmentary disorders, especially for earlier therapeutic intervention targeting different stages and mechanisms involved in pathogenesis.
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	A study of comparison of PUVASOL and NBUVB in patients with vitiligo	p. 96
	Vaaruni Ravishankar, Santoshdev P Rathod, Siddhartha Saikia, Raju G Chaudhary, Rekha B Solanki DOI:10.4103/Pigmentinternational.Pigmentinternational_39_17   Introduction: Vitiligo is an acquired, hypomelanotic disease, characterized by circumscribed depigmented macules. Phototherapy, which is the use of ultraviolet irradiation with or without exogenous photosensitizer is a well established treatment option. Psoralens with sunlight as the source of ultraviolet A-rays is known as PUVASOL. Narrow band Ultraviolet B phototherapy (NBUVB; 311–313 nm) has been introduced over the past decade. Aims: To study the clinical effectiveness and assess the safety of NBUVB and PUVASOL therapy in Vitiligo patients. Methods: The patients were randomly allocated in to two groups containing 25 patients each. Group A patients received NBUVB with an initial dose of 250 mJ/cm2, incremented by 20% with each subsequent visit till optimum dose was achieved, twice a week on non-consecutive days. Group B patients received PUVASOL-oral Trimethylpsoralen or topical 0.2% w/w Trioxsalen followed by exposure to sunlight, twice a week on non-consecutive days. The extent of repigmentation was documented at regular intervals upto 6 months. Results: Amongst patients receiving NBUVB and PUVASOL, 56% and 48% had ≥50% repigmentation respectively. Disease was unstable in 48% and 36% of patients prior to commencement of therapy which reduced to 12% and 16% after therapy, respectively. 16% and 36% of the patients experienced side effects and 76% and 48% showed excellent colour match of the repigmented patches respectively. Conclusion: While both PUVASOL and NBUVB are both good therapeutic options; NBUVB therapy is found to be more effective and more cosmetically acceptable, with better colour matching of lesions and minimal adverse effects.
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CASE REPORTS
	Actinic keratosis in vitiligo after oral PUVAsol therapy with review	p. 103
	Saumya Sankhwar, Sunil K Gupta DOI:10.4103/Pigmentinternational.Pigmentinternational_2_18   Abstract Vitiligo is an acquired disorder characterised by depigmentation. The etiopathogenesis is still unclear and many theories have been proposed for the same. It is believed that due to lack of protective melanin, a vitiliginous patch is more prone to photodamage by UV radiation and development of skin cancers especially following PUVASOL therapy. But, few cutaneous malignancies have been reported and even fewer cases of actinic keratoses have been reported over a vitiliginous skin. Here, we report a case of elderly female who developed actinic keratoses over longstanding sun exposed vitiliginous skin post PUVA therapy.
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	Xeroderma pigmentosum complicated by keratoacanthoma in a Kashmiri girl	p. 107
	Yasmeen J Bhat, Peerzada Sajad, Najmu Saqib, Iffat Hassan, Roohi Wani DOI:10.4103/Pigmentinternational.Pigmentinternational_5_18   Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. It manifests clinically as intense cutaneous photosensitivity, acute burning under minimal sun exposure, erythema, xerosis, poikiloderma, actinic keratosis, lentigines, and development of malignant lesions like basal cell carcinoma, squamous cell carcinoma, and melanoma in sun-exposed areas. We hereby report a case of xeroderma pigmentosum complicated by keratoacanthoma in a 9-year-old ethnic Kashmiri girl who had history of photosensitivity, dry skin, and pigmentary changes from the age of 2 years.
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	Erythema dyschromicum perstans in pregnancy	p. 110
	Shagufta Rather, Atiya Yaseen, Sameena Batool, Iffat Hassan DOI:10.4103/Pigmentinternational.Pigmentinternational_8_18   Erythema dyschromicum perstans is a slowly progressive acquired dermatoses characterized by macular hyperpigmentation. There is no racial, genetic, or sex predilection. It occurs in adults, with some isolated cases and small series occurring in prepubertal children. The pigmentary disorder has never been reported in patients during pregnancy. We report a singular case of the disorder in a pregnant woman.
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	Steroid-induced perilymphatic hypopigmentation: Response to tacrolimus	p. 114
	Sneha Ghunawat, Rashmi Sarkar DOI:10.4103/Pigmentinternational.Pigmentinternational_11_18   Intralesional steroids are commonly used in dermatological practice. This route of administration has the advantage of minimal side effects. However, other adverse reactions namely local atrophy, ulceration, infections, etc. have been noted. One peculiar side effect following this route of administration "steroid-induced perilymphatic hypopigmentation and atrophy" has been described below. Although this condition repigments spontaneously, the use of tacrolimus to fasten the response has been highlighted in the case report.
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LETTER TO EDITOR
	Dermoscopy − Master by analysis and patience, not haste and nonchalance	p. 117
	Sidharth Sonthalia, Abhijeet K Jha, Manal Bosseila, Enzo Errichetti DOI:10.4103/Pigmentinternational.Pigmentinternational_38_17
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THE CLINICAL PICTURE
	Bilateral nevus of Ota	p. 120
	M. M. Aarif Syed, Bibush Amatya, Shazia Alam DOI:10.4103/Pigmentinternational.Pigmentinternational_1_18
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THROUGH THE DERMOSCOPE
	Dermoscopy of pigmented basal cell carcinoma	p. 123
	Kinjal D Rambhia, Vrutika H Shah, Rajesh P Singh DOI:10.4103/Pigmentinternational.Pigmentinternational_13_18
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CURRENT BEST EVIDENCE
	Current Best Evidence in Pigmentary Dermatology	p. 125
	Divya Kamat, Vinay Keshavamurthy DOI:10.4103/Pigmentinternational.Pigmentinternational_22_18
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CROSSWORD
	PIGMENTCROSS 4	p. 130
	Ashish Amrani, Anupam Das DOI:10.4103/Pigmentinternational.Pigmentinternational_24_18
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Indian Journal of Pharmacology (Indian J Pharmacol) 2018 | September-October | Volume 50 | Issue 5

EDITORIAL
	Developing and sustaining India's capacity for preclinical drug discovery	p. 225
	David I Lewis, Bhagirath K Patel, B Dinesh Kumar, Bikash Medhi DOI:10.4103/ijp.IJP_641_18
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RESEARCH ARTICLES
	Effect of Vaccinium macrocarpon on MK-801-induced psychosis in mice	p. 227
	Disha Shukla, Rajesh A Maheshwari, Kirti Patel, R Balaraman, Ashim Kumar Sen DOI:10.4103/ijp.IJP_74_17   OBJECTIVES: This study was aimed to investigate the effect of aqueous cranberry extract (ACE) on MK-801-induced psychosis in mice.MATERIALS AND METHODS: MK-801-treated mice were administered ACE (1 and 2 g/kg, p.o.) for 14 days. Various behavioral parameters and neurochemical estimations such as dopamine (DA), 5-hydroxytryptamine (5-HT), norepinephrine (NE), gamma-aminobutyric acid (GABA), glutamate, and glycine as well as markers of oxidative stress such as nitrite levels were measured.RESULTS: Psychosis-induced mice showed a significant elevation of immobility time in forced swim test, locomotor activity, and reduction in time of permanency in rota-rod test, escape latency time in Cook's pole test while treatment with ACE showed a significant alteration in above-mentioned behavioral parameters in MK-801-induced psychosis. Moreover, MK-801-induced psychosis in the mice showed a significant increase in DA, 5-HT, and NA levels and decrease in GABA, glutamate, and glycine levels in the brain. In contrast, treatment with ACE at both doses remarkably altered the neurochemical parameters. In addition, ACE-treated mice showed a substantial reduction in acetylcholinesterase, D-amino acid oxidase enzyme activity, and nitrite levels which were elevated by the administration of MK-801. CONCLUSIONS: Treatment with ACE once for 14 days (1 and 2 g/kg) significantly ameliorated the behavioral symptoms in experimentally induced psychosis by virtue of neuromodulation and decreased oxidative stress.
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	Efficacy of melatonin on sleep quality after laparoscopic cholecystectomy	p. 236
	Vaibhav Vij, Divya Dahiya, Lileswar Kaman, Arunanshu Behera DOI:10.4103/ijp.IJP_250_18   CONTEXT: Postoperative sleep and circadian rhythm disturbances were associated with prolonged postoperative convalescence, respiratory, and cardiovascular morbidity. Sleep disturbances have been shown to be due to decreased levels of circulating melatonin after surgery. If this sleep pattern and circadian rhythm are recycled, outcome after surgery could be improved. AIMS: The aim of this study was to observe the effect of melatonin on the quality of sleep in patients undergoing laparoscopic cholecystectomy (LC).SUBJECTS AND METHODS: Hundred patients of LC participated in this randomized, placebo-controlled, double-blind, clinical trial. Patients were randomized equally into Group A who received 6 mg melatonin tablets 45 min before sleep for 3 days after surgery and Group B who received placebo. RESULTS: Melatonin usage results in decrease in sleep latency (SL) as compared to placebo (13.6 ± 14.95 vs. 20.10 ± 16.18 min, P = 0.04). There was also increased total sleep duration (TSD) on postoperative day (POD) 1 (P = 0.004) and POD 2 (P = 0.001) in Group A. There was a decrease in daytime naps and night awakenings after surgery in Group A though it was not significant statistically. Subjective assessment of sleep on visual analog scale showed reduced sleep scores (P = 0.001 on POD 1 and 2) and decreased pain (P = 0.02 on POD 1) in Group A. Statistically significant difference was not observed in fatigue or general well-being among groups. CONCLUSIONS: Results in this study could demonstrate that melatonin as a single agent could improve the quality of sleep after LC by decreasing SL and increasing TSD.
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	In silico approach to study the metabolism and biological activities of oligomeric proanthocyanidin complexes	p. 242
	Sankar Jamuna, Ashokkumar Rathinavel, Sakeena Sadullah Mohammed Sadullah, Sivasitambaram Niranjali Devaraj DOI:10.4103/ijp.IJP_36_17   OBJECTIVES: Over the past three decades, numerous studies have focused on the biological activities of oligomeric proanthocyanidins (OPCs) in the prevention of many diseases such as neurodegeneration, atherosclerosis, tumorigenesis, and microbial infections. OPC has redox-active metabolites which could modulate the intracellular redox equilibrium to maintain the antioxidant homeostasis. This redox-modulating efficiency of OPC could provide new insights into therapeutic approaches that could reduce the burden of cardiovascular diseases. The main objective of this study was to explore the biological and metabolic activities of OPC using in silicoapproaches. METHODS: To validate the above objective, chemoinformatic tools were used to predict the metabolism of OPC after ingestion, based on both the ligand and structure of the constituent compounds. RESULTS: OPC showed possible sites for Phase I metabolism by cytochrome P450, and the metabolites obtained thereafter may be responsible for its biological activities. Absorption, distribution, metabolism, elimination, and toxicity properties showed efficient absorption, distribution, and metabolism of OPC, without toxicity. CONCLUSION: Thus, from the results obtained, OPC could be strongly recommended as a cardioprotective drug.
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	Antidiabetic potential of active fraction obtained from methanolic extract of Ichnocarpus frutescens: A possible herbal remedy	p. 251
	Mallu Srujana, Ranjana Ramesh, Lakshmi Devi Nanjaiah DOI:10.4103/ijp.IJP_24_18   OBJECTIVES: Ichnocarpus frutescens is a common plant used by tribal people and in Ayurveda for its high medicinal value. The purpose of the study was to investigate whether I. frutescens has any persuasive medicinal property to manage diabetes mellitus.MATERIALS AND METHODS: Initially, male albino Wistar rats were given intraperitoneal injection of streptozotocin-nicotinamide to induce diabetes, followed with the administration of active fraction obtained from the methanolic extract of I. frutescens for the next 28 consecutive days. Glibenclamide (25 mg/kg) was used as positive control. RESULTS: According to the results obtained, active fraction at a dose of 50 mg/kg body weight exhibited significant antihyperglycemic activity, which was evident with reduced blood glucose level up to 58.84%. The active fraction also showed improvement in serum lipid profile as well as regeneration of pancreatic β-cells in diabetic rats. Concurrent histopathological studies reinforce the effect of active fraction in healing pancreas, thus justifying the possible mechanism of its antidiabetic activity. CONCLUSION: The results of the present investigation lead credence to the use of I. frutescens in ameliorating the diabetic condition.
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	A comparative randomized study on effect of vaginally administered glyceryl trinitrate placebo on cervical ripening prior to induction of labor in overdue pregnancies	p. 260
	Özlem Dülger, Bulat Aytek Sik, Yilda Arzu Aba DOI:10.4103/ijp.IJP_182_18   OBJECTIVE: The aim of this study is to examine the effectiveness and adverse effects of local glyceryl trinitrate (GTN) application during labor compared with a placebo group. METHODS: The study consisted of 70 pregnant women with overdue pregnancies who presented to the hospital for labor induction between January 2009 and January 2011 in the Obstetrics Clinic of Istanbul Süleymaniye Gynecology and Obstetrics Education and Training Hospital. Vaginal suppositories-containing GTN (36/70) or placebo (34/70) was administered to the participants in a randomized fashion. The placebo and GTN involving vaginal ovules used in the study were prepared in the Pharmacy Department of Istanbul University Faculty of Pharmacy. Maternal effects during labor, rates of normal vaginal and C/S deliveries, the interval between the initial medication and delivery, and amount of total oxytocin used were compared between the GTN and placebo groups. RESULTS: There were no significant differences between the GTN and placebo groups regarding bishop scores, the interval between medication and delivery, delivery types, indications for cesarean section, and complications including hyperstimulation, tachysystole, uterine rupture, placental abruption, and uterine atony (P > 0.05). CONCLUSION: Our results revealed that there were no differences between GTN and placebo regarding their effect on cervical ripening in overdue pregnant women.
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	Oxaceprol versus tramadol for knee osteoarthritis: A randomized controlled trial	p. 266
	Kaushik Mukhopadhyay, Parasar Ghosh, Partha Ghorai, Avijit Hazra, Amal Kanti Das DOI:10.4103/ijp.IJP_633_16   OBJECTIVES: To assess efficacy and safety of oxaceprol, a hydroxyproline derivative with putative mechanism of action different from traditional nonsteroidal anti-inflammatory drugs, in symptomatic knee osteoarthritis, in comparison to tramadol. MATERIALS AND METHODS: A parallel group, double-blind, randomized controlled trial was conducted with ambulatory patients over 50 years age suffering from knee osteoarthritis causing pain of at least moderate intensity. Patients were randomized to receive either oxaceprol 200 mg thrice daily or tramadol 50 mg thrice daily for 12 weeks. The primary efficacy variable was symptom relief as assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) version 3.1 for pain, stiffness, and physical function. Responder rate (50% pain relief), patient's Clinical Global Impression (CGI), and rescue medication use were other outcomes measured. Vital signs, routine blood counts, tests of hepatorenal function and treatment-emergent adverse events were recorded for safety assessment.RESULTS: From 91 patients recruited, 43 on oxaceprol and 36 on tramadol were evaluable. The WOMAC scores declined significantly from baseline in each arm but remained comparable between groups throughout the 12-week study period. The CGI ratings and 50% responder rates were also comparable at the final visit. Differences in dose up-titration and rescue medication requirements were statistically nonsignificant. So also were the adverse event counts. Compliance was satisfactory in both groups. CONCLUSIONS:Efficacy and tolerability of oxaceprol were comparable to tramadol, and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis.
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	A retrospective analysis of reporting of adverse drug reactions to oncology drugs: An experience from a national center of clinical excellence	p. 273
	Pramod Kumar Sharma, Arup Kumar Misra, Ajay Gupta, Surjit Singh, Puneet Dhamija, Puneet Pareek DOI:10.4103/ijp.IJP_544_17   INTRODUCTION: Adverse drug reaction (ADR) is a public health problem which constitutes one of the leading causes of morbidity and mortality worldwide. In India, only a few studies reported cancer chemotherapy-induced ADRs. The objectives of the present study were to assess the organ system involved, frequency, severity, and preventability of the ADRs occurred. MATERIALS AND METHODS: Data on ADRs of retrospective cohorts were extracted from the filled ADR forms received from the department of radiation oncology. Descriptive statistic was used to summarize and analyze the available data, namely patient demography, causality, severity, and preventability of the event. RESULTS: A total of 191 chemotherapy-induced ADR reports were received from 164 patients during the period March 2015 to August 2017. Almost three-fourth of the ADRs occurred in patients who were receiving regimens involving multiple drugs. Taxanes, alkylating agents, and platinum compounds were the common drug groups involved. The skin (n = 90) was the most frequently involved organ with alopecia and hyperpigmentation as most common manifestations. The severity (Hartwig and Siegel) and preventability scales (Modified Schumock and Thornton) indicated that most reactions were mild (54.45%) in nature and the majority of them were preventable. More than two-third (69%) of the reactions were related "possible" to the suspected drug as determined by the World Health Organization causality assessment. CONCLUSION: Chemotherapy-related ADRs among cancer patients are worrisome. It has a negative impact on patient quality of life and in addition increases cost of therapy. It is found that timely reporting of chemotherapy-related ADRs and having an effective ADR monitoring system in place ensure preventability of the ADRs in many cases. Oncologists, Radiotherapists and Onco-surgeons should be actively involved in ADR reporting (Onco-Pharmacovigilance) and exchange constructive information, update and educate each other about appropriate use of anticancer drugs. Onco-pharmacovigilance is the need of the hour and could be of immense value in reducing morbidity and mortality if practiced with utmost importance.
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	Ten units intravenous oxytocin over 2–4 h is as effective as 30 units over 8–12 h in preventing postpartum hemorrhage after cesarean section: A randomized controlled trial	p. 279
	Maria Cecilia, Reeta Vijayaselvi, Ramandeep Bansal, Latha Lakshmi, Ruby Jose DOI:10.4103/ijp.IJP_419_18   OBJECTIVES: Currently, recommended high-dose oxytocin regimen for the prevention of postpartum hemorrhage (PPH) following cesarean delivery (CD) is associated with maternal side effects frequency of which is greater with a higher cumulative dose and rapid administration of oxytocin. Here, we evaluated the efficacy of single-dose intravenous oxytocin over 2–4 h (total = 10 units) with oxytocin maintenance infusion for 8–12 h (total = 30 units) in postoperative CD women for the prevention of PPH. METHODS: The current double-blinded randomized controlled trial was carried out in a tertiary care institute in Southern India. The primary outcome measures included the following: (a) the need for additional uterotonics to control PPH and (b) significant deterioration of vital signs as assessed by pulse rate and blood pressure in the postoperative period. The secondary outcome measures were as follows: (a) significant difference (≥10% between preoperative and postoperative packed cell volume) and (b) need for blood transfusion. RESULTS AND CONCLUSIONS: Two hundred and seventy-one women were randomized into Group A (oxytocin = 10 units; n = 135) and Group B (oxytocin = 30 units; n = 136). Both the groups were comparable with regard to demographic characteristics. There was no difference in any of primary or secondary outcome measures in the two groups. Thus, low-dose oxytocin regimen is as effective as high-dose oxytocin regimen in the prevention of PPH in postoperative CD women.
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DRUG WATCH
	Rare occurrence of hand-foot syndrome due to paclitaxel: A rare case report	p. 284
	Pritam S Kataria, Pradip P Kendre, Apurva A Patel, Nahush Tahiliani, Vijay Bhargav, Honey Parekh DOI:10.4103/ijp.IJP_547_17   Hand-foot syndrome (HFS) is a relatively frequent adverse reaction to certain anticancer drugs. HFS is a type of dermatitis which has been most commonly described with 5-fluorouracil and capecitabine. However, HFS with paclitaxel is rare and has been reported sparingly in the literature. A 52-year-old male patient with recurrent carcinoma of the buccal mucosa was started on palliative chemotherapy regimen, injection paclitaxel (175 mg/m2) in combination with injection carboplatin. On post-chemotherapy day 13, the patient started developing pain, dysesthesia followed by bullae formation, and desquamation over palms and soles. Clinically, the patient had Grade 3 HFS characterized by symmetrical, tender skin lesions over the dorsal aspect of palms, and soles with desquamation necessitating interruption of treatment. Therefore, this case has been presented to be cognizant with this rare form of side effect with one of the most commonly used drug in oncology.
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