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   Table of Contents - Current issue
Coverpage
March-April 2022
Volume 54 | Issue 2
Page Nos. 73-153

Online since Tuesday, May 10, 2022

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EDITORIAL  

New undergraduate medical education curriculum Highly accessed article p. 73
Niti Mittal, Bikash Medhi
DOI:10.4103/ijp.ijp_176_22  
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CLINICAL RESEARCH ARTICLES Top

Efficacy of Melaleuca alternifolia and chlorhexidine mouth rinses in reducing oral malodor and Solobacterium moorei levels. A 1 week, randomized, double-blind, parallel study Highly accessed article p. 77
K Prabhu Srikumar, BN Bhagyashree, Sridharan Srirangarajan, Rao J Ravi, Rudresh Vinaya
DOI:10.4103/ijp.ijp_772_20  
OBJECTIVES: The objective is to evaluate the association of Solobacterium moorei (S. moorei) to halitosis and to also check for the effects of two different mouth rinses on levels of S. moorei in saliva and tongue coating and its impact on oral halitosis. MATERIALS AND METHODS: This was a placebo-controlled parallel study of 160 individuals who were randomized and the study was performed using double-blinded protocol. Enrolled individuals filled a structured questionnaire regarding demographic data, oral hygiene habits, and dietary habits. Full mouth organoleptic odor scores (OLR), volatile sulfur compounds levels, Miyazaki's tongue coating index, and Plaque scores were recorded before intervention (baseline) and after 1-week post treatment. Microbiological samples obtained from the tongue and saliva was investigated for S. moorei levels using real time polymerase chain reaction. Participants were randomly assigned for two test mouth rinses (Melaleuca alternifolia and Chlorhexidine) and placebo groups. RESULTS: All salivary and tongue coating samples were tested positive for S. moorei in the halitosis group. One week post-treatment S. moorei counts in saliva and tongue coating samples of test group showed a significant reduction at P < 0.001. Paired t-test results showed that Melaleuca alternifolia was comparable with chlorhexidine in reduction of OLR, and VSC scores (P < 0.001). Salivary levels of S. moorei in Melaleuca alternifolia group showed a higher reduction (5.67 log10 copies/mL) than chlorhexidine group (5.1log10 copies/mL). CONCLUSION: S. moorei showed a positive correlation with oral halitosis scores. Both Melaleuca alternifolia and chlorhexidine were equally effective in reducing S. moorei levels and halitosis score.
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Comparative efficacy of topical coconut cream and clobetasol propionate ointment for the management of oral lichen planus: A double-blinded randomized control trial Highly accessed article p. 84
Roshani Mamadapur, Zameera Naik, S Lokesh Kumar, Anjana Bagewadi
DOI:10.4103/ijp.ijp_984_20  
CONTEXT: Oral lichen planus (OLP) is a quite common chronic inflammatory mucocutaneous disorder affecting the oral cavity and skin. The current treatment relies on systemic or topical corticosteroids but is known to cause side effects thereby demanding a search for an alternative. AIM: This study aims to assess and to compare the efficacy of topical Coconut (Cocos nucifera) 50% cream and Clobetasol propionate 0.05% ointment for the management of OLP. SETTINGS AND DESIGN: An institution-based double-blinded randomized control trial. MATERIALS AND METHODS: Sixty clinically diagnosed OLP patients were allotted to two groups (30 in each): Group I (Coconut cream-50%) and Group II (Clobetasol Propionate ointment-0.05%). Patients were examined every 15 days until two months for a change in the lesion size and reduction in the burning sensation. The measurement of lesion size and burning sensation was done using Adobe Photoshop software (version CS3) and Numeric Pain Rating scale (NPS), respectively. STATISTICAL ANALYSIS USED: The recordings were subjected to the statistical analysis using Wilcoxon matched-pairs and Mann–Whitney U tests for intra-group and inter-group comparisons, respectively. RESULTS: There was an 85% regression in the size of the lesion in Group I whereas Group II had it to be 95%, and a 100% reduction in the NPS score in Group I whereas Group II had it to be 95%. CONCLUSION: The Coconut cream showed a significant decrease in the size of the lesion and the burning sensation with no side effects neither any signs of toxicity reported during the treatment or follow-up, thereby proving to be a safe and promising medication for OLP.
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Sinonasal mucormycosis and liposomal amphotericin B: A quest for dose optimization p. 90
Smile Kajal, Syed Shariq Naeem, Pooja Gupta, Arvind Kumar Kairo, Anam Ahmed, Prankur Verma, Ashish Saini
DOI:10.4103/ijp.ijp_644_21  
OBJECTIVES: Sinonasal mucormycosis is a serious fungal infection. Early diagnosis and prompt antifungal therapy along with surgical intervention is the key to its management. Liposomal amphotericin B (LAmB) given intravenously is the antifungal agent of choice. However, the current literature is not clear on its optimum dosage. We did a retrospective study to find the optimum dose of LAmB in cases with sinonasal mucormycosis. MATERIALS AND METHODS: Thirty patients diagnosed with mucormycosis involving sinonasal, rhino-orbital, or rhino-orbito-cerebral regions and receiving only LAmB as pharmacotherapy were included in our retrospective study from 2017 to 2020. A multiple logistic regression model was developed to correlate the total dose of LAmB and other parameters with the final outcome which was defined clinico-radiologically as improved, worsened, or death. The dose of LAmB which led to the first significant change in urea, creatinine, and potassium levels was also determined. RESULTS: The model showed a good fit in goodness-to-fit analysis (Pearson = 0.999, deviance = 0.995), while the likelihood ratio was statistically significant (0.001). The overall model prediction was 83.3%. However, the correlation of outcome with any of the variables, including mean LAmB dose per kilogram (82.2 ± 13.02 mg/kg), was statistically not significant. CONCLUSION: Many patient-related factors (such as age, comorbidities, extent of the disease, and side effects from LAmB therapy), which vary on a case-to-case basis, contribute to the outcome in a mucormycosis patient. The optimum dose of LAmB for improved outcome still requires individualization guided by experience, till well-designed studies address the question.
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Evaluation of genetic polymorphism of CYP3A5 in normal healthy participants from western India - A cross-sectional study p. 97
Miteshkumar Rajaram Maurya, Sunanda Gautam, Jeffrey Pradeep Raj, Shruti Saha, Sanchita Ambre, Aishwarya Thakurdesai, Aditya Shah, Urmila Mukund Thatte
DOI:10.4103/ijp.ijp_279_21  
BACKGROUND: CYP3A5 enzymes belong to the phase I Group of drug-metabolizing enzymes, which are involved in the metabolism of 50% of the drugs. Participants with CYP3A5 genotype: CYP3A5 *1/*1 are fast metabolizers of drugs and hence will require higher dosing. Whereas those with CYP3A5 * 3/*3 are poor metabolizers of drugs and will require a lower dose to achieve target drug concentration in the blood and those with CYP3A5 * 1/*3 have intermediate drug metabolizing activity. Pharmacogenetic evaluation may improve disease outcomes by maximizing the efficacy and minimizing the toxicity of drugs in patients. MATERIALS AND METHODS: This is a single-center cross-sectional study conducted in the year 2018–2019 to study the population prevalence of genetic polymorphisms of CYP3A5 in healthy participants from western India. Eligible participants willing to give written, informed consent were enrolled in the study. Subsequently, 2 ml venous blood was collected the deoxyribonucleic acid was extracted and then stored at ‒20°C. Genotyping was done by a polymerase chain reaction and restriction fragment length polymorphism. RESULTS: A total of 400 participants with a median age of 22 years (range: 18–58 years) were included. Among them, the genotype prevalence for CYP3A5 * 1/*1 was 17% (n = 67/400); CYP3A5 * 1/*3 was 37% (n = 149/400) and that of CYP3A5 * 3/*3 was 46% (184/400). Out of the total 400 healthy participants analyzed, the allele frequency for CYP3A5 * 1 was 35% (142/400) and that of CYP3A5*3 was 65% (259/400). CONCLUSION: The genotype prevalence for CYP3A5 * 3*3 (46%) and the allele frequency for CYP3A5 * 3 (65%) respectively were the highest among the western Indian population.
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EXPERIMENTAL RESEARCH ARTICLES Top

Evaluation of anti-amnesic effect of Conyza bonariensis in rats p. 102
Beenita Saikia, Lipika Buragohain, Chandana Choudhury Barua, Jadav Sarma, Sarojini Mahanta Tamuli, Dhruba Jyoti Kalita, Acheenta Gohain Barua, Iswar Chandra Barua, Ramakrishna Elancheran
DOI:10.4103/ijp.ijp_201_19  
OBJECTIVE: Conyza bonariensis is an ornamental medicinal weed. This experiment was planned to explore the outcome of petroleum ether extract of C. bonariensis (PECB) leaves on scopolamine-induced amnesia in rats. MATERIALS AND METHODS: For impairing memory, 0.4 mg/kg (i. p.) of scopolamine was given. Fifty to 200 mg/kg of PECB was fed orally to rats and 3 mg/kg (i. p.) of tacrine was given as a standard drug. Anti-amnesic property was evaluated in Barnes maze using ANY-maze software. Following a behavioral study, acetylcholinesterase (AChE), β-amyloid1-41, antioxidant enzymes, and cytokine levels were measured. Furthermore, reverse transcription–polymerase chain reaction was done for expression of the marker genes such as AChE, Nrf2, NF-κB, PP2A, and HO-1, whereas BDNF, TrkB, caspase-3, and Bax were measured by Western blotting. RESULTS: PECB and tacrine significantly improved memory dysfunction by decreasing escape latency in Barnes maze. At the highest dose, treatment with PECB altered the scopolamine-induced hyperactivation of AChE and β-amyloid1-41 activity. PECB elevated the levels of superoxide dismutase, glutathione, and catalase and decreased lipid peroxidation and nitric oxide dose dependently. PECB attenuated scopolamine-induced increase of tumor necrosis factor-α and interleukin (IL)-1β concentrations in the hippocampus with reversed diminished IL-10 level toward normal in the brain. Nrf2, HO-1, PP2A, BDNF, and TrkB were significantly upregulated with downregulation of AChE, NF-κB, Tau, Bax, and caspase-3. Different components such as beta-amyrin and alpha-amyrin were isolated from leaves of the plant. CONCLUSION: The results indicated that PECB might be a potential curative drug for the treatment of cognitive impairment.
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Evaluation of the mechanism of Rujiling capsules in the treatment of hyperplasia of mammary glands based on network pharmacology and molecular docking p. 110
Mili Shi, Yue Ma, Pin Xu
DOI:10.4103/ijp.ijp_374_21  
OBJECTIVE: The present study aimed to elucidate the molecular network mechanism of the Rujiling capsule in the treatment of hyperplasia of mammary glands through network pharmacology and molecular docking. MATERIALS AND METHODS: TCMSP and TCMID databases were screened for the active components and their action targets of the Rujiling capsule, whereas the disease targets of hyperplasia of mammary glands were searched in GeneCard and DisGeNET databases. Venny software was employed to identify the common targets of drugs and diseases. Cytoscape software was used to construct the network pharmacological diagram of “drug-active components-target” and the intersection targets were subjected to protein–protein interaction analysis by STRING platform and Cytoscape software. The DAVID database was exploited for gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis of the intersection target. After that, the key target genes with a degree value greater than the median were verified with the active components in molecular docking. RESULTS: A total of 691 drug targets, 251 disease targets, and 108 intersection targets were obtained after retrieval and screening. Among the 686 items enriched by GO included 522 biological processes, 110 molecular functions, and 54 cellular components. At the same time, 114 signal pathways were enriched by KEGG. The results of molecular docking revealed that the docking energies of main active components and some core targets were all <–5 kcal/mol. CONCLUSION: Henceforth, highlighted the role of the Rujiling capsule in the treatment of hyperplasia of mammary glands through multiple components, multiple targets, and multiple signal pathways.
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Tert-Butylhydroquinone alleviates insulin resistance and liver steatosis in diabetes p. 118
Tian-tian Zhu, Chao-Nan Zhu, Ning Huang, Xin Yu, Guang-rui Wan, Shuang-xi Wang, Ping Song, Jian Xu, Peng Li, Ya-ling Yin
DOI:10.4103/ijp.ijp_440_21  
OBJECTIVES: This work aimed to determine tert-Butylhydroquinone (TBHQ)'s effects on insulin resistance (IR) and liver steatosis in diabetic animals and to explore the underpinning mechanisms. MATERIALS AND METHODS: Male ApoE-/-mice underwent streptozocin (STZ) administration while receiving a sucrose/fat-rich diet for type 2 diabetes mellitus (T2DM) establishment. This was followed by a 6-week TBHQ administration. Body weight, fasting (FBG) and postprandial (PBG) blood glucose amounts, and insulin concentrations were measured, and the oral glucose tolerance test (OGTT) was carried out. Hematoxylin and eosin (H and E) staining and immunoblot were carried out for assessing histology and protein amounts in the liver tissue samples. In addition, cultured HepG2 cells were administered HClO and insulin for IR induction, and immunoblot was carried out for protein evaluation. Finally, the cells were stained with the Hoechst dye for apoptosis evaluation. RESULTS: The model animals showed T2DM signs, and TBHQ decreased FBG, ameliorated glucose tolerance and reduced liver steatosis in these animals. In addition, TBHQ markedly upregulated AMPKα2, GLUT4 and GSK3 β, as well as phosphorylated PI3K and AKT in the liver of mice with T2DM. In agreement, TBHQ decreased HClO-and insulin-related IR in cells and suppressed apoptosis through AMPKα2/PI3K/AKT signaling. CONCLUSIONS: TBHQ alleviates IR and liver steatosis in a mouse model of T2DM likely through AMPKα2/PI3K/AKT signaling.
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SHORT COMMUNICATIONS Top

Pharmacological evaluation of embelin - chitosan nanoparticles as an antidiabetic agent p. 126
Saba Maanvizhi, Narayanaswamy Radhakrishnan, Chitra Krishnan, Arumugam Gnanamani
DOI:10.4103/ijp.ijp_47_20  
Embelin has been reported to possess variety of pharmacological activities such as androgenic antagonists, antiangiogenic, antibacterial, anticancer, anticonvulsant, antidiabetic, antidepressant, antihelmintic, antifertility, antihyperlipidemic, anti-inflammatory, antimalarial, antimitotic, antiobesity and antioxidant properties. The current research work aimed to study the hypoglycemic effect of embelin-chitosan nanoparticles (ECNPs) diabetic rats provoked by streptozotocin (STZ). Embelin nanoparticles (ENPs) were created by combining chitosan, a natural biopolymer, and glutaric acid, a new cross-linker. STZ 50 mg/kg was given intravenously into Sprague-Dawley rats weighing 250–300 g (75–90 days) to induce experimental diabetes. The antidiabetic efficacy of orally administered ECNPs in diabetic rats developed by STZ was investigated, as well as histological examination. When compared to diabetic control rats, ECNPs (25 mg/kg body weight and 50 mg kg body weight) and standard glibenclamide (10 mg/kg body weight) treated rodents exhibited a remarkable drop in glucose contents. Furthermore, histological research showed that ECNPs-treated rats were harmless up to amount of 25 mg/kg bwt. Thus current investigation reveals that ECNPs have antidiabetic potential and may be beneficial in treating hyperglycemia in people.
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A preliminary study to evaluate the behavior of Indian population toward E-pharmacy p. 131
Seema Bansal, Hardeep Kaur, Saniya Mahendiratta, Phulen Sarma, Subodh Kumar, Amit Raj Sharma, Rupa Joshi, Anusuya Bhattacharyya, Manisha Prajapat, Ajay Prakash, Bikash Medhi
DOI:10.4103/ijp.ijp_836_21  
The use of the Internet has increased exponentially for buying as well as selling of goods. Even the purchase of medications online is no exception. Owing to its benefits, there are certain risk factors in purchase of online medicines. Currently, the data on the use of Internet pharmacies are limited. Thus, the main objective of our study is to assess the knowledge, attitude, and practices (KAP) of Indian population toward E-pharmacy in India carried out in the Department of Pharmacology, PGIMER, Chandigarh. A KAP questionnaire was prepared which was distributed to the participants through Google Forms and a URL sent to them. This questionnaire was divided into four sections including demographics, occupation, income, and use of the Internet to measure the alertness toward the online purchase of medicines. A total of 322 responses were collected, out of which only 268 (83.2%) participants were aware of online pharmacy. The awareness was more in males and that too in urban population. Among the respondents, majority of the users prefer to buy medicines offline (81%, n = 217) which can be due to poor quality of medicines and lack of trustworthy websites. The utmost reason for buying the medicine online was deficiency of availability in the market and differences in the prices. The most preferred drugs respondents were willing to buy online were prescription drugs followed by cosmetics and dietary supplements. In conclusion, of our results, most of the people use the Internet to search for the medications online who prefer to consult the physicians before buying. Therefore, the future of online pharmacy can be improved if there will be some set guidelines, awareness, and knowledge among the users.
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REVIEW ARTICLE Top

Animal models - Mimicking the pain of trigeminal neuralgia p. 138
Sonu Gupta, Ravinder Nath Bansal, Surender Pal Singh Sodhi, Gursimrat Kaur Brar
DOI:10.4103/ijp.ijp_296_19  
Trigeminal neuralgia (TN) is an episodic facial pain which feels like an electric shock of unilateral origin. This neuropathic disorder is an intensely stressful to bear for patient and impacts the quality of life. Most of the cases of TN arise when the root of fifth cranial nerve, i.e., trigeminal nerve is compressed after a few millimeters of its entry into the pons. This article describes various animal models and the role of biomarkers to study the underlying mechanisms of neuropathic pain in animal models as well as different modes of management of TN.
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LETTERS TO THE EDITOR Top

Diffuse subendocardial ischemia secondary to disulfiram-alcohol ingestion p. 146
Rakesh Agarwal
DOI:10.4103/ijp.ijp_930_21  
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An unusual case of dependence of megadose of veterinary intravenous pheniramine with opioid use disorder p. 148
Priya Tyagi, Shobit Garg, Veena Tejan, Mantaz Kaur Dhillon
DOI:10.4103/ijp.ijp_868_21  
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Desensitization to liposomal amphotericin B after anaphylaxis in a patient with COVID-19-associated mucormycosis – A case with review of literature p. 150
Satish Swain, Animesh Ray, Naveet Wig, Anjan Trikha
DOI:10.4103/ijp.ijp_883_21  
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Role of Vitamin D in COVID-19: Correspondence p. 153
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/ijp.ijp_897_21  
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