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   Table of Contents - Current issue
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January-February 2017
Volume 49 | Issue 1
Page Nos. 1-135

Online since Monday, February 27, 2017

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EDITORIAL  

Bidding Adieu… Highly accessed article p. 1
Chetna Desai
DOI:10.4103/ijp.IJP_47_17  
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EDUCATIONAL FORUM Top

Veterinary pharmacovigilance in India: A need of hour p. 2
Rishi Kumar, Vivekanandan Kalaiselvan, Ravendra Verma, Ismeet Kaur, Pranay Kumar, GN Singh
DOI:10.4103/0253-7613.201035  
Veterinary pharmacovigilance (PV) is important for the Medicine which are used for treating disease in animals. It becomes more important when these animals are further used for producing food. Adverse drug reactions (ADRs) have a direct impact on animals and indirect impact on human beings, for example, through milk products, other animal producing food products. Currently, PV program of India is playing a vital role in assessing the safety of medicines in Indian Population. The safety of medicine in animals can be assessed by veterinary PV. The research institutes involved in animal research and veterinary hospitals can be considered as ADR monitoring centers to assess the safety of medicines on animals.
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RESEARCH ARTICLES Top

Is aura around citicoline fading? A systemic review p. 4
Saurabh Agarwal, Bhoomika M Patel
DOI:10.4103/0253-7613.201037  
Stroke and traumatic brain injury (TBI) are the critical public health and socioeconomic problems throughout the world. At present, citicoline is used as a coadjuvant for the management of acute ischemic stroke (AIS) and TBI in various countries. This systemic review analyzes the beneficial role of citicoline in AIS and TBI. This systemic review is based on “PubMed” and “Science Direct” search results for citicoline role in stroke and TBI. In this systemic review, we included 12 human trials. A meta-analysis was performed on the basis of neurological evaluation, functional evaluation and Glasgow outcome scale, domestic adaptation evaluation outcomes, and cognitive outcome individually. In neurological evaluation, domestic adaptation evaluation, and cognitive outcomes, there was no significant difference in both the citicoline and placebo groups (odds ratio [OR] = 1.04 [0.9–1.2, P = 0.583]; OR = 1.1 [0.94–1.27, P = 0.209]; OR = 0.953 [0.75–1.2, P = 0.691]). In evaluation of functional outcomes, there was significant difference in both groups and OR was 1.18 (1.04–1.34, P = 0.01). Functional outcomes were significantly improved by citicoline, but the positive role of this drug in neurological recovery, domestic adaptation, and cognitive outcomes is still a topic of discussion for future.
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A study of antimicrobial use in children admitted to pediatric medicine ward of a tertiary care hospital p. 10
Sandip Baidya, Avijit Hazra, Supratim Datta, Amal Kanti Das
DOI:10.4103/0253-7613.201034  
Objectives: Antimicrobials are frequently used in tertiary care hospitals. We conducted an observational study on children admitted to a teaching hospital in Eastern India, to generate a profile of antimicrobial use and suspected adverse drug reactions (ADRs) attributable to them. Materials and Methods: Hospitalized children of either sex, aged between 1 month and 12 years, were studied. Baseline demographic and clinical features, duration of hospital stay, antimicrobials received in hospital along with dosing and indications and details of suspected ADRs attributable to their use were recorded. Every patient was followed up till discharge, admission to the Pediatric Intensive Care Unit, or death. Results: Over the 1 year study period, 332 admissions were screened. The prevalence of antimicrobial use was 79.82%. The majority of the 265 children who received antimicrobials were males (61.10%) and hailed from rural and low socioeconomic background. Median age was 36 months. Six children died, 43 were transferred out, and the rest discharged. In most instances, either 2 (40%) or a single antibiotic (39.6%) was used. Ceftriaxone, co-amoxiclav, amikacin, vancomycin, and ampicillin were predominantly used. Antivirals, antimalarials, and antiprotozoals were used occasionally. Average number of antimicrobials per patient was 2.0 ± 1.27; the majority (84.1%) were by parenteral route and initial choice was usually empirical. Prescriptions were usually in generic name. The antimicrobial treatment ranged between 1 and 34 days, with a median of 7 days. Six ADRs were noted of which half were skin rash and the rest loose stools. Conclusions: The profile of antimicrobial use is broadly similar to earlier Indian studies. Apparent overuse of multiple antimicrobials per prescription and the parenteral route requires exploration. Antimicrobials are being used empirically in the absence of policy. ADRs to antimicrobials are occasional and usually mild. The baseline data can serve in situation analysis for antibiotic prescribing guidelines.
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Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital p. 16
KB Rakesh, Mukta N Chowta, Ashok K Shenoy, Rajeshwari Shastry, Sunil B Pai
DOI:10.4103/0253-7613.201036  
Objectives: To assess the polypharmacy and appropriateness of prescriptions in geriatric patients in a tertiary care hospital. Methods: An observational study was done in geriatric patients (>60 years) of either gender. The data collected from patients included: Socio-demographic data such as age, gender, marital status, educational status, socioeconomic status, occupation, nutritional status, history of alcohol/smoking, exercise history, details of comorbid diseases, medication history, findings of clinical examination etc. In this study, polypharmacy was considered as having 5 or more medications per prescription. Medication appropriateness for each patient was analysed separately based on their medical history and clinical findings by applying medication appropriateness index, screening tool to alert to right treatment (START) and Beers criteria and STOPP criteria. Results: A total of 426 patients, 216 (50.7%) were males and 210 (49.3%) were females. Polypharmacy was present in 282 prescriptions (66.2%). Highest prevalence of polypharmacy was seen in 70-79 years age group compared to the other two groups and it was statistically significant. Out of 426 patients, 36 patients were receiving drugs which were to be avoided as per Beers criteria. Among the total patients, 39 patients were overprescribed as per MAI, 56 patients were under prescribed as per START criteria and 85 out of 426 prescriptions were inappropriate in accordance with beers criteria, stop criteria, start criteria and MAI index. Conclusion: Around 66.19% patients were receiving polypharmacy. Significant number of patients were receiving drugs which are to be avoided as well as overprescribed and under prescribed. Inappropriate prescription was seen in a good number of patients.
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Central dopaminergic system plays a role in the analgesic action of paracetamol: Preclinical evidence p. 21
A Bhagyashree, Shyamjith Manikkoth, Melinda Sequeira, Roopa Nayak, SN Rao
DOI:10.4103/0253-7613.201029  
Objective: Even after 100 years of discovery, the exact mechanisms for the analgesic action of paracetamol are under scanner. It was recently proposed that paracetamol may act through different mechanisms, especially altering the serotoninergic system. The main objective of this preclinical study was to verify the role of drugs modulating dopaminergic system (l-dopa, bromocriptine, olanzapine) on the analgesic effect of paracetamol. Materials and Methods: Thirty adult male albino mice were divided into five groups: distilled water (0.5 ml/25 g), paracetamol (200 mg/kg), levodopa (10 mg/kg) + paracetamol, bromocriptine (5 mg/kg) + paracetamol (200 mg/kg), and olanzapine (2 mg/kg) + paracetamol (200 mg/kg). All drugs were administered orally for 14 days. Eddy's hot plate and tail immersion tests were used to determine analgesic activity. Tests were conducted 1 h after the drug administration on the 14th day. After that, animals were sacrificed and brains were dissected out, to measure the levels of dopamine. Statistical comparisons among the groups were performed by one-way analysis of variance followed by Tukey-Kramer test. Results: Coadministration of l-dopa and bromocriptine with paracetamol increased the antinociceptive activity of paracetamol significantly, whereas coadministration of olanzapine with paracetamol decreased the analgesic activity of paracetamol in the Eddy's hot plate and tail immersion tests considerably. There was a significant increase (P < 0.001) in the levels of dopamine in the brains of mice, which received levodopa, bromocriptine, and paracetamol. However, it was opposite in the brains of animals which received olanzapine. Conclusion: The results suggest that analgesic action of paracetamol is influenced by dopaminergic system.
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Palliative effects of lutein intervention in gamma-radiation-induced cellular damages in Swiss albino mice p. 26
Vidya Vasudeva, Yogish Somayaji Tenkanidiyoor, Vishakh Radhakrishna, Pooja Shivappa, Srikanth Patil Lakshman, Ronald Fernandes, Krishna Ananthapura Patali
DOI:10.4103/0253-7613.201013  
Objectives: Radiation-induced hematological, biochemical, and cytogenetic damages to the normal cells are major concerns in the field of radiotherapy. The carotenoids and their derivatives have been the source of antioxidants with wide range of medicinal applications. The objective is to evaluate the protective effects of lutein, a carotenoid, against radiation-induced cellular and tissue damages. Methods: Swiss albino mice were grouped into 5, 50, 250, and 500 mg/kg b.wt. of lutein treatment groups, a sham and vehicle control group. The groups were irradiated with a lethal dose of 10 Gy y'-radiation. The mortality was recorded for 30 days to optimize the protective dose against radiation. The mice were administered with the compound orally for 15 consecutive days and irradiated with a sublethal dose of 6Gy. The hematological changes in blood and antioxidant parameters were determined in liver, kidney homogenates, and hemolysate/serum. The hematological parameters were recorded using an automated cell counter. The antioxidants such as malondialdehyde (MDA), glutathione (GSH), superoxide dismutase, catalase, glutathione peroxidase and glutathione-S-transferase were spectrophotometrically determined. Results: The red blood cell, white blood cell count, lymphocyte count, hemoglobin, platelet levels, and hematocrit value were found to be decreased in the irradiated groups. Lutein pretreatment maintains near-normal levels of these parameters indicating resistance/recovery from the radiation-induced damages. The antioxidant levels were found to be reduced in all the irradiated groups. However, lutein pretreatment (50 mg/kg b.wt.) has increased the catalase activity of hemolysate. Lutein pretreatment has reduced the MDA levels in hemolysate, when administered at doses of 5, 250, and 500 mg/kg b.wt. in comparison to its control. Conclusion: The study demonstrates the radioprotective potential of lutein by maintaining the hematological and antioxidant homeostasis.
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Neuroprotective effect of Clerodendrum serratum Linn. leaves extract against acute restraint stress-induced depressive-like behavioral symptoms in adult mice p. 34
Babitha K Vazhayil, Shanmuga Sundaram Rajagopal, Thiyagarajan Thangavelu, Gomathi Swaminathan, Elavarasi Rajagounder
DOI:10.4103/0253-7613.201028  
Objective: The objective of this study was to study the effect of ethanol extract of Clerodendrum serratum (EECS) Linn. on acute restraint stress (ARS)-induced depressive-like behavior and biochemical alterations in mice. Materials and Methods: Ethyl acetate and n-butanol fractions of EECS were analytically characterized for the flavonoid components, apigenin (API) and luteolin (LUT) by reverse-phase high-performance liquid chromatography. Behavioral tests, namely, forced-swim test and tail-suspension test were performed for assessing antidepressant-like effect and anxiolytic activity in mice. Oxidative stress parameters and biochemical alterations in mice brain tissue were also performed. Statistical Analysis: Expression of data was done as mean ± standard error of mean. The normally distributed data were subjected to two-way ANOVA followed by Dunnett's test. P < 0.05 was considered statistically significant. Results: The study showed that flavonoids, API and LUT were present in ethyl acetate and n-butanol fractions of EECS, which significantly reversed ARS-induced depressive-like behavior without affecting locomotion. EECS also attenuated oxidative damage caused by ARS. The level of norepinephrine and 5-hydroxytryptamine was also significantly restored by pretreatment with EECS for 7 days. Conclusion: EECS significantly alleviated ARS-induced depressive-like behavior without affecting locomotion.
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Anticholinergic, antihistaminic, and antiserotonergic activity of n-hexane extract of Zanthoxylum alatum seeds on isolated tissue preparations: An ex vivo study p. 42
Beenita Saikia, Chandana Choudhury Barua, Prakash Haloi, Pompy Patowary
DOI:10.4103/0253-7613.201025  
Objectives: The aim of this study was to evaluate anticholinergic, antihistaminic, and antiserotonergic activity of the n-hexane extract of the seeds of Zanthoxylum alatum (ZAHE) on isolated ileum of rat and guinea pig and fundus of rat. Materials and Methods: ZAHE was prepared using soxhlet extraction and cumulative concentration response curves were constructed using various doses on the tissues for acetylcholine (ACh), 5-hydroxytryptamine (5-HT), and histamine with or without n-hexane extract. Atropine, ketanserin, and pheniramine maleate were used as antagonists for ACh, serotonin, and histamine, respectively. Results: ZAHE-induced concentration-dependent inhibition of isolated ileum and fundus in rat and ileum of guinea pig. The half maximal effective concentration (EC50) of ACh in the presence of atropine (10−6 M; P < 0.05) and ZAHE (1000 μg/ml; P < 0.01) was significantly higher than EC50of ACh alone. The EC50of 5-HT in the presence of ketanserin (10−5 M; P < 0.01) and ZAHE (1000 μg/ml; P < 0.05) was higher than EC50of 5-HT alone. Similarly, the EC50of histamine in the presence of pheniramine maleate (10−6 M; P < 0.01) and ZAHE (300 μg/ml; P < 0.01 and 1000 μg/ml; P < 0.05) was also significantly higher than EC50of histamine alone. Conclusion: From the study, it was observed that ZAHE shows significant anticholinergic, antiserotonergic, and antihistaminic activity. The study provides sufficient evidence that the seeds can be used in gastric disorders, cough, chest infection, etc., as per folklore claims.
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Effect of daidzein on cisplatin-induced hematotoxicity and hepatotoxicity in experimental rats p. 49
Sanjiv Karale, Jagadish Vasudev Kamath
DOI:10.4103/0253-7613.201022  
Objective: The objective of the study was to investigate the effect of daidzein flavonoid on cisplatin (CP)-induced hematotoxicity and hepatotoxicity in experimental rats. Materials and Methods: The Wistar rats were randomly divided into four equal groups: Normal (saline 1 ml p.o.), CP (7.5 mg/kg once intraperioteneally on 16th day), test group of low dose (combination of CP and daidzein 20 mg/kg p.o. for 21 days), and test group of high dose (combination of CP and daidzein 40 mg/kg p.o. for 21 days). Blood samples were collected on 22nd day from each rat and subjected for evaluation of hematological parameters such as red blood corpuscles (RBC), white blood corpuscles, hemoglobin (Hb) and platelets, and serum biomarkers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Liver of each rat was excised and subjected for antioxidants evaluation such as malonyl dialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), catalase, and histopathological study. Results: Daidzein had a significant (P < 0.001) beneficial role in CP-induced hemotoxicity by increasing RBC, Hb, packed cell volume, and platelets. Daidzein also exhibited a significant (P < 0.001) protection against CP-induced hepatotoxicity by decreasing ALT, AST, ALP, and MDA level and by elevating the GSH, SOD, and catalase. Conclusions: Daidzein attenuates CP-induced oxidative stress on blood cells and antioxidants in rats.
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Effect of Angelica glauca essential oil on allergic airway changes induced by histamine and ovalbumin in experimental animals p. 55
Shilpa Sharma, Vijaykumar P Rasal, Paragouda A Patil, Rajesh K Joshi
DOI:10.4103/0253-7613.201019  
Objective: Angelica glauca Edgew (Apiaceae) is used in traditional medicine for treatment of several diseases including bronchial asthma. The present investigation was aimed to evaluate broncho-relaxant activity of A. glauca essential oil in histamine and ovalbumin (OVA)-induced broncho constriction in experimental animals. Materials and Methods: Airway was induced using histamine aerosol in guinea pigs (n = 24) and OVA aerosol in albino mice (n = 24). The number of inflammatory cells, namely, absolute eosinophils count in blood, total immunoglobulin E (IgE) in serum, eosinophils, and neutrophils in bronchoalveolar lavage fluid (BALF) and histopathological examination of lung tissues were investigated in A. glauca oil and dexamethasone-treated groups. A. glauca oil 200 μL/kg was given orally, and dexamethasone 2 mg/kg was given intraperitoneal. Both the treatments were repeated daily for 7 days. Results were analyzed by one-way ANOVA, and P ≤ 0.05 was considered statistically significant. Results: Treatment with A. glauca essential oil significantly (P < 0.001) increased the time of preconvulsive dyspnea in histamine-induced guinea pigs. Oral treatment of A. glauca oil significantly (P < 0.001) decreased absolute blood eosinophil count (from 325 ± 3.69 to 200 ± 3.05 cells/mm3), serum level of IgE (from 6.10 ± 0.05 to 0.70 ± 0.08 IU/L), and the number of eosinophils (from 11.0% ±1.41% to 3.0% ±0.51%), neutrophils (from 13.0% ±1.12% to 5.0% ±1.39%) in BALF. Histopathological changes observed in lungs of untreated group were marked suppressed by treatment with A. glauca oil. Conclusion: The essential oil of A. glauca has bronchorelaxation in both histamine and OVA-induced bronchoconstriction in animals. The traditional use of A. glauca against asthma could be attributed to its bronchodilator property as observed in the present study.
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Evaluation of neuroprotective effect of quercetin with donepezil in scopolamine-induced amnesia in rats p. 60
Laxmi Adiveppa Pattanashetti, Ashok D Taranalli, Vinay Parvatrao, Rohit H Malabade, Dushyant Kumar
DOI:10.4103/0253-7613.201016  
Objective: The objective of this study was to evaluate the neuroprotective effect of quercetin with donepezil in scopolamine-induced amnesia in rats. Materials and Methods: Five groups of adult male Wistar rats (12 months old) weighing 180–200 g (n = 6) were used. The normal control group received normal saline and test group animals were pretreated orally with quercetin (25 mg/kg), donepezil (3 mg/kg), and a combination of quercetin (25 mg/kg) with donepezil (3 mg/kg), respectively, dosed at every 24 h interval for 14 consecutive days, afterward amnesia was induced by scopolamine (3 mg/kg) on the 14th day through intraperitoneal route. Cognitive performance was assessed by the Morris water maze, elevated plus maze, and passive avoidance paradigm. Acetylcholinesterase enzyme (AchE) level, biochemical markers such as lipid peroxidase (LPO), glutathione (GSH), β amyloid1-42level, and histopathological study of rat brain were estimated. Statistical analysis was done by one-way analysis of variance, followed by Dunnett's post hoc test. P ≥ 0.05 was considered statistically significant. Results: Pretreatment with quercetin, donepezil, and their combination showed a significant increase in escape latency, step-through latency, and decreased transfer latency in respective cognitive models of the Morris water maze, passive avoidance test, and elevated plus maze. Further coadministration significantly decreased AchE level, β amyloid1-42level as compared to individual therapy. Biochemical markers such as elevated GSH, decreased LPO were observed, and histopathological studies revealed the reversal of neuronal damage in the treatment group (P < 0.05) as compared to scopolamine-treated control group. Conclusion: Pretreatment with quercetin potentiates the action of donepezil in scopolamine-induced amnesia in rats. The improved cognitive memory could be due to the synergistic effect of the drugs by decreasing AchE level, β amyloid1-42level, and antioxidant action in rat brain.
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Cardioprotective effect of curcumin and piperine combination against cyclophosphamide-induced cardiotoxicity p. 65
Manodeep Chakraborty, Ananya Bhattacharjee, Jagadish Vasudev Kamath
DOI:10.4103/0253-7613.201015  
Objective: Curcumin is a well-established cardioprotective phytoconstituent, but the poor bioavailability associated with it is always a matter of therapeutic challenge. The present study was undertaken to increase the therapeutic efficacy of curcumin by combining with bio-enhancer like piperine against cyclophosphamide (CP)-induced cardiotoxicity in rats. Materials and Methods: Rats (n = 8) were treated with curcumin (200 mg/kg, p.o.) alone and different dose combination of curcumin (100, 50, 25 mg/kg, p.o.) and piperine (20 mg/kg, p.o.) for 10 days. All the treated groups were subjected to CP (200 mg/kg, i.p.) toxicity on day 1. Twenty-four hours after the last treatment, the effects were evaluated by changes in electrocardiographic (ECG) parameters, serum biomarkers, lipid profile, tissue antioxidants, and histopathological examination. Serum and tissue homogenate parameters were measured by semi-autoanalyzer and spectrophotometer, respectively. Results obtained were assessed by one-way analysis of variance followed by Tukey–Karmer multiple comparison test. Results: Incorporation of piperine with the doses of 50 and 25 mg/kg with curcumin exhibited significant beneficial effect compared to curcumin alone-treated group. The best effective group was a combination of curcumin 50 mg/kg with piperine 20 mg/kg which showed extremely significant (P < 0.001) decrease and increase in ECG and serum biomarker level, respectively, and moderate significant (P < 0.01) decrease in lipid profile, antioxidant levels, and histopathological score, compared to curcumin alone-treated group. Conclusion: From this study, it can be concluded that a novel dose combination of curcumin (50 mg/kg) with piperine (20 mg/kg) exhibited profound cardioprotection compared to curcumin (200 mg/kg) alone-treated group.
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Antidiabetic, antihyperlipidemic, and antioxidant activities of Musa balbisiana Colla. in Type 1 diabetic rats p. 71
Mukundam Borah, Swarnamoni Das
DOI:10.4103/0253-7613.201030  
Objectives: To evaluate the antidiabetic, antihyperlipidemic, and antioxidant activities of the ethanolic extracts of the flowers and inflorescence stalk of Musa balbisiana Colla. in streptozotocin (STZ)-induced Type 1 diabetic rats. Materials and Methods: Diabetes was induced in male Wistar albino rats (150–200 g) by single intraperitoneal injection of STZ (60 mg/kg b.w. i.p.). Albino rats (n = 25) were divided into five groups, of which five animals each. Group A (normal control) and Group B (diabetic control) received normal saline (10 ml/kg/day p.o.), whereas Group C and Group D received 250 mg/kg/day p.o. of flower and inflorescence stalk ethanolic extracts, respectively, for 2 weeks. Group E (diabetic standard) received 6 U/kg/day s.c of Neutral Protamine Hagedorn insulin. Fasting blood sugar, serum insulin, catalase (CAT), malondialdehyde (MDA), and serum lipid profile were estimated at specific intervals of time. Effect of the extracts on intestinal glucose absorption was also evaluated to know the probable mechanism of action. Results: Diabetic control exhibited significant increase in blood glucose, serum cholesterol, triglycerides, low-density lipoprotein, serum MDA levels and decreased serum CAT, and high-density lipoprotein levels which were significantly reverted by flower and inflorescence stalk ethanolic extracts after 2 weeks. Serum insulin levels were in increased (P < 0.05), and intestinal glucose absorption decreased significantly (P < 0.01) in extract-treated groups. Conclusion: Flower and inflorescence stalk of M. balbisiana Colla. possess significant antidiabetic, antihyperlipidemic, and antioxidant activities in STZ-induced Type 1 diabetic rats.
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Antiurolithiatic and antioxidant efficacy of Musa paradisiaca pseudostem on ethylene glycol-induced nephrolithiasis in rat p. 77
Padma Nibash Panigrahi, Sahadeb Dey, Monalisa Sahoo, Ananya Dan
DOI:10.4103/0253-7613.201026  
Objective: Musa paradisiaca has been used in the treatment of urolithiasis by the rural people in South India. Therefore, we plan to evaluate its efficacy and possible mechanism of antiurolithiatic effect to rationalize its medicinal use. Materials and Methods: Urolithiasis was induced in hyperoxaluric rat model by giving 0.75% ethylene glycol (EG) for 28 days along with 1% ammonium chloride (AC) for the first 14 days. Antiurolithiatic effect of aqueous-ethanol extract of M. paradisiaca pseudostem (MUSA) was evaluated based on urine and serum biochemistry, microscopy of urine, oxidative/nitrosative indices, kidney calcium content, and histopathology. Results: Administration of EG and AC resulted in increased crystalluria and oxaluria, hypercalciuria, polyuria, crystal deposition in urine, raised serum urea, and creatinine as well as nitric oxide concentration and erythrocytic lipid peroxidation in lithiatic group. However, MUSA treatment significantly restored the impairment in above kidney function test as that of standard treatment, cystone in a dose-dependent manner. Conclusions: The present findings demonstrate the efficacy of MUSA in EG-induced urolithiasis, which might be mediated through inhibiting various pathways involved in renal calcium oxalate formation, antioxidant effect, and potential to inhibit biochemical markers of renal impairment.
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A study of the use of drugs in patients suffering from psoriasis and their impact on quality of life p. 84
VV Karamata, AM Gandhi, PP Patel, A Sutaria, MK Desai
DOI:10.4103/ijp.IJP_166_16  
Objective: To study the use of drugs in patients suffering from psoriasis and their effect on quality of life (QOL). Materials and Methods: This was a prospective, observational study carried out in newly diagnosed patient of psoriasis at Department of Pharmacology and Outpatient Department of Skin and Venereal diseases at tertiary care teaching hospital, and patients were divided into three groups: Group A: topical therapy alone, Group B: methotrexate with topical therapy, and Group C: cyclosporine with topical therapy. The efficacy of drug was measured using Psoriasis Area Severity Index (PASI). QOL was measured using Psoriasis Disability Index. Patients were followed up at 1 month and 6 months of treatment. Statistical analysis was done using analysis of variance (ANOVA) test. Results: A total 126 patients were enrolled, out of which 114 patients completed the study. PASI score was reduced significantly (P < 0.001) in each treatment group and QOL score was significantly (P < 0.001) decrease in Group B and C as compared to baseline at the end of 6 months. A significant (P < 0.001) reduction in PASI score and QOL was observed in patients of Group B and C as compared to Group A. Correlation between efficacy and QOL was not significant in all three treatment groups. Conclusion: Combination therapy (topical + systemic) is more efficacious and associated with significant improvement of QOL as compared to topical therapy alone. Methotrexate and cyclosporine are equally efficacious in treating and improving the QOL in patients suffering from psoriasis.
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SHORT COMMUNICATIONS Top

Pricing and components analysis of some key essential pediatric medicine in Odisha state p. 89
Satyajit Samal, Trupti Rekha Swain
DOI:10.4103/0253-7613.201021  
Objective: Study highlighting prices, i.e., the patients actually pay at ground level is important for interventions such as alternate procurement schemes or to expedite regulatory assessment of essential medicines for children. The present study was undertaken to study pricing and component analysis of few key essential medicines in Odisha state. Methodology: Six child-specific medicines of different formulations were selected based on use in different disease condition and having widest pricing variation. Data were collected, entered, and analyzed in the price components data collection form of the World Health Organization-Health Action International (WHO-HAI) 2007 Workbook version 5 - Part II provided as part of the WHO/HAI methodology. The analysis includes the cumulative percent markup, total cumulative percent markup, and percent contribution of individual components to the final medicine price in both public and private sector of Odisha state. Results: Add-on costs such as taxes, wholesale, and retail markups contribute substantially to the final price of medicines in private sector, particularly for branded-generic products. The largest contributor to add-on costs is at the level of retailer shop. Conclusion: Policy should be framed to achieve a greater transparency and uniformity of the pricing of medicines at different health sectors of Odisha.
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Anesthetic efficacy of ketamine–diazepam, ketamine–xylazine, and ketamine–acepromazine in Caspian Pond turtles (Mauremys caspica) p. 93
Milad Adel, Amin Bigham Sadegh, Vincenzo Arizza, Hossein Abbasi, Luigi Inguglia, Hasan Nasrollahzadeh Saravi
DOI:10.4103/0253-7613.201023  
Objectives: The objective of this study was to assess the efficacy of different anesthetic drug combinations on the Caspian Pond turtles (Mauremys caspica). Subjects and Methods: Three groups of the Caspian Pond turtles (n = 6) were anesthetized with three different drug combinations. Initially, a pilot study was conducted to determine the best drug doses for the anesthetization of the turtles, and according to these results, ketamine–diazepam (120 mg/kg ketamine hydrochloride [5%] and 2 mg/kg diazepam [5%]), ketamine–acepromazine (120 mg/kg ketamine hydrochloride [5%] and 1 mg/kg acepromazine [1%]), and ketamine–xylazine (120 mg/kg ketamine hydrochloride [5%] and 1 mg/kg xylazine [2%]) were injected intramuscularly. The onset times of anesthetization and the recovery time were measured. Statistical analysis of the data was performed using one-way analysis of variance followed by t-tests, and P < 0.05 was considered statistically significant. Results: There were statistically significant differences in the mean of the onset times of anesthesia and recovery time among the three drug combinations depending on the treatment used. The onset of anesthesia of the animals treated with the ketamine–diazepam combination was 60% and 42% shorter, for male and female turtles, respectively, compared to that obtained with the ketamine–acepromazine combination and 64% (male turtles) and 50% (female turtles) shorter than that obtained with the ketamine–xylazine combination. Further, the recovery time, in male turtles, was 17% shorter in animals treated with the first drug combination than those treated with the ketamine–acepromazine combination and 37% shorter than those treated with the ketamine–xylazine combination. The recovery time, in female turtles, did not seem to be significantly different among treatments. Conclusions: The study showed that the ketamine–diazepam drug combination is the anesthetic combination with the fastest onset time and shortest recovery time.
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A pharmacological evidence for the presence of antihistaminic and anticholinergic activities in Equisetum debile Roxb p. 98
Shahrukh Ali, Muhammad Ovais Omer, Mueen Ahmad Chaudhry, Muhammad Ashraf, Allah Bukhsh
DOI:10.4103/0253-7613.201017  
Objective: The study was designed to evaluate possible antihistaminic and anticholinergic activities of Equisetum debile. Materials and Methods: Effects of crude ethanolic (Ed.Eth) and effects of crude aqueous (Ed.Aq) extracts of E. debile were studied using isolated guinea pig ileum, rabbit jejunum, and rabbit trachea. Tissue responses were recorded using isotonic and isometric transducers, connected with PowerLab data acquisition system. Results: A dose-dependent (0.1–0.3 mg/ml) rightward shift was demonstrated in histamine concentration-response curves. Whereas a complete relaxation of carbachol (1 μM)-induced contractions in isolated rabbit jejunum (3 mg/ml) and tracheal (10 mg/ml) preparations was observed, similar to dicyclomine at 1 and 3 μM, respectively. However, no significant difference between the effects of Ed.Eth and Ed.Aq was observed. Conclusion: Study provides pharmacological evidence for the presence of antihistaminic and anticholinergic activities in crude extracts of E. debile and also highlight its medicinal significance in the management of airway and gastrointestinal disorders.
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Rational drug therapy education in clinical phase carried out by task-based learning p. 102
S Sirri Bilge, Bahar Akyüz, Arzu Erdal Ağrı, Mıdık Özlem
DOI:10.4103/0253-7613.201009  
Objectives: Irrational drug use results in drug interactions, treatment noncompliance, and drug resistance. Rational pharmacotherapy education is being implemented in many faculties of medicine. Our aim is to introduce rational pharmacotherapy education by clinicians and to evaluate task-based rational drug therapy education in the clinical context. Methods: The Kirkpatrick's evaluation model was used for the evaluation of the program. The participants evaluated the program in terms of constituents of the program, utilization, and contribution to learning. Voluntary participants responded to the evaluation forms after the educational program. Data are evaluated using both quantitative and qualitative tools. SPSS (version 21) used for quantitative data for determining mean and standard deviation values. Descriptive qualitative analysis approach is used for the analysis of open-ended questions. Results: It was revealed that the program and its components have been favorable. A total 95.9% of the students consider the education to be beneficial. Simulated patients practice and personal drug choice/problem-based learning sessions were appreciated by the students in particular. 93.9% of the students stated that all students of medicine should undergo this educational program. Among the five presentations contained in the program, “The Principles of Prescribing” received the highest points (9 ± 1.00) from participating students in general evaluation of the educational program. Conclusion: This study was carried out to improve task-based rational drug therapy education. According to feedback from the students concerning content, method, resource, assessment, and program design; some important changes, especially in number of facilitators and indications, are made in rational pharmacotherapy education in clinical task-based learning program.
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Evaluation of relationship of inhaler technique with asthma control and quality of life p. 110
Bharti Chogtu, Sadhana Holla, Rahul Magazine, Asha Kamath
DOI:10.4103/0253-7613.201012  
Introduction: There is a need to assess erroneous steps in the use of inhaler devices in people who have asthma. The objectives of this study were to assess the inhaler technique in patients who have asthma, the factors affecting improper technique, and the association of inhaler use with asthma control, hospital visits, and quality of life (QOL) of patients who have asthma. Methods: It was an observational, prospective, cross-sectional study conducted on patients with bronchial asthma. Patients were enrolled in the study; their history was recorded and they were asked to use inhaler in the presence of an investigator and the technique was scored. Asthma control and QOL of patients were assessed using asthma control questionnaire and Mini Asthma QOL questionnaire. Results: A total of 330 patients completed the study. Nearly 36.6% of the patients performed the steps incorrectly. Breathing normally for 30–60 min postinhaler use was the most common step done incorrectly. Patients with poorly controlled asthma (P < 0.001) and those with predicted forced expiratory volume at 1 s <70% performed the steps erroneously (P < 0.001). Conclusion: All patients, particularly those above 40 years, should be given proper instructions regarding inhaler use to obtain therapeutic advantage.
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METHODS Top

Noninvasive recording of electrocardiogram in conscious rat: A new device p. 116
Pradeep Kumar, Pooja Srivastava, Ankit Gupta, Manish Bajpai
DOI:10.4103/0253-7613.201031  
Aim: Electrocardiogram (ECG) is an important tool for the study of cardiac electrophysiology both in human beings and experimental animals. Existing methods of ECG recording in small animals like rat have several limitations and ECG recordings of the anesthetized rat lack validity for heart rate (HR) variability analysis. The aim of the present study was to validate the ECG data from new device with ECG of anesthetized rat. Materials and Methods: The ECG was recorded on student's physiograph (BioDevice, Ambala) and suitable coupler and electrodes in six animals first by the newly developed device in conscious state and second in anesthetized state (stabilized technique). Results: The data obtained were analyzed using unpaired t-test showed no significant difference (P < 0.05) in QTc, QRS, and HR recorded by new device and established device in rats. Conclusion: No previous study describes a similar ECG recording in conscious state of rats. Thus, the present method may be a most physiological and inexpensive alternative to other methods. In this study, the animals were not restrained; they were just secured and represent a potential strength of the study.
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DRUG WATCH Top

Ciprofloxacin induced acute generallised exanthematous pustulosis p. 119
Caterina Foti, Paolo Romita, Giovanni Zanframundo, Mario Mastrolonardo, Gianni Angelini, Gianfranco Calogiuri, Eustacchio Nettis, Domenico Bonamonte
DOI:10.4103/0253-7613.201014  
Acute generalized exanthematous pustulosis (AGEP) is an uncommon and self-limiting skin rash commonly caused by drugs and is characterized by the acute onset of fever, pustulosis, and neutrophilia from 4 to 10 days after the drug intake. We describe a case of AGEP in a 61-year-old woman that was hospitalized for the acute onset of fever, erythroderma, and pustulosis. Clinical history revealed that she had been treating a bacterial inguinal intertrigo for 4 days with ciprofloxacin 500 mg tablets twice daily and desloratadine 5 mg tablet once daily. To the best of our knowledge, this is the third reported case of AGEP caused by ciprofloxacin, supporting two other previous reports.
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Response to eperisone in patients of therapy-resistant dissociative convulsions: A report of two cases p. 121
Vijendra Nath Jha, Pramod Kumar Singh
DOI:10.4103/0253-7613.201033  
Dissociative convulsions or pseudoseizures are a difficult to treat common psychiatric condition. In a subset of these patients, the chief complaint is clenching of teeth with apparent nonresponsiveness alone. Neither drugs nor psychotherapeutic interventions have been found to be of much help in its management. Report of two such subsets of cases is presented, in which patients with dissociative convulsions showed sudden, dramatic, and sustained good response to the addition of a muscle relaxant eperisone.
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Levetiracetam-induced leukocytoclastic vasculitis p. 124
Mrinal Gupta
DOI:10.4103/0253-7613.201020  
Drug-induced leukocytoclastic vasculitis is a small-vessel vasculitis that most commonly manifests with palpable purpuric lesions on gravity-dependent areas. Vasculitis occurs within weeks after initial administration of medication and demonstrates clearance upon withdrawal of medication. Levetiracetam, a pyrrolidone derivative, is used as an adjunctive therapy in patients with refractory focal epilepsy, myoclonic epilepsy, and primary generalized tonic–clonic seizures. We present a case of a 14-year-old female, who developed cutaneous small-vessel vasculitis within 8 days of initiation of levetiracetam. Vasculitis was successfully managed by discontinuation of medication and systemic corticosteroids. This adverse reaction, to the best of our knowledge, has not been previously reported in literature.
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Chronic lithium intoxication: Varying electrocardiogram manifestations p. 127
Raja Naga Mahesh Maddala, AJ Ashwal, M Sudhakar Rao, R Padmakumar
DOI:10.4103/ijp.IJP_204_16  
Lithium is a commonly used drug in psychiatric practice. It is used in the treatment of depression and bipolar disorder. It has a narrow therapeutic index with documented adverse effects even near therapeutic levels. It has myriad of manifestations at toxic levels. The cardiovascular effects range from relatively benign ST-T wave changes to fatal arrhythmias. We describe a case of lithium toxicity which presented as a junctional rhythm and later showed a variety of manifestations such as complete heart block, atrial fibrillation, sinus bradycardia, and finally reverted to sinus rhythm at par with serum lithium levels.
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Chronic administration of phenytoin and pleomorphic adenoma: A case report and review of literature p. 130
Vikas Maharshi, Pravesh Nagar
DOI:10.4103/0253-7613.201018  
Adverse drug effects that are uncommon or appear only on chronic administration of a drug may not be detected in clinical trials. This explains the need of strict post-marketing vigilance on drug use. Phenytoin administration has been shown in the literature to be associated with development of neoplasia (benign/malignant). In our knowledge current work represents the first case of pleomorphic-adenoma of sub-mandibular salivary gland developed following chronic phenytoin use. A 40 year old male having a history of head trauma twenty years back, had been on tablet phenytoin 100 mg thrice daily since then. One year back he noticed a small swelling in left sub-mandibular region and gradually increasing in size. FNAC and CECT revealed the diagnosis of pleomorphic-adenoma of sub-mandibular salivary gland. Other causes were ruled out. Surgical excision was performed successfully and continuing follow-up with no recurrence at the end of 6 months. Histo-pathogical examination of the tissue did not show any malignant changes.
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Hydroxychloroquine-induced erythroderma p. 132
Sunil B Pai, Bhuvaneshwari Sudershan, Maria Kuruvilla, Ashwin Kamath, Pooja K Suresh
DOI:10.4103/0253-7613.201027  
Erythroderma is characterized by diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. Drug-induced erythroderma has rarely been reported with hydroxychloroquine. We report a case of a 50-year-old female patient, with systemic lupus erythematosus, who developed itchy lesions all over the body 1 month after starting treatment with hydroxychloroquine. Drug-induced erythroderma was suspected. Hydroxychloroquine was withdrawn and the patient was treated with emollients, mid-potency corticosteroids, and oral antihistamines. A biopsy was done which confirmed the diagnosis of erythroderma. She recovered with treatment and was discharged. A careful history and clinical examination to search for potential causative factors will help prevent disabling sequelae in erythroderma.
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ERRATUM Top

Erratum: Modulation of hippocampal gene expression of microRNA-146a/microRNA-155-nuclear factor-kappa B inflammatory signaling by troxerutin in healthy and diabetic rats p. 135

DOI:10.4103/0253-7613.201055  
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