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   Table of Contents - Current issue
Coverpage
April-June 2017
Volume 8 | Issue 2
Page Nos. 45-79

Online since Monday, June 19, 2017

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METHODS  

Assessment of sperm deoxyribose nucleic acid fragmentation using sperm chromatin dispersion assay p. 45
Harsha Pratap, Suma Yekappa Hottigoudar, Kubera Siddappa Nichanahalli, Parkash Chand
DOI:10.4103/jpp.JPP_187_16  
The integrity of sperm deoxyribose nucleic acid (DNA) is one of the determinants that ensure normal fertilization, implantation, pregnancy, and the generation of a healthy progeny. Assessment of sperm DNA fragmentation has gained importance as a tool to provide significant information regarding sperm quality, and it can independently predict sperm fertilizing potential. The sperm chromatin dispersion (SCD) assay is one of the available techniques to detect sperm DNA damage with results comparable to the gold standard – Sperm Chromatin Structure Assay. We present here a detailed methodology of an alkaline modification of SCD that can be carried out with minimal laboratory equipment. The SCD assay is a modified halo assay that utilizes chemical methods to demonstrate sperm DNA fragmentation. It involves the embedding of sperms in an agarose medium followed by exposure to alkaline denaturation and deproteinization. The results are interpreted under a light microscope. A visual scoring system is utilized to differentiate the sperms with possible DNA fragmentation from those without fragmented DNA and to determine the sperm DNA fragmentation index (SDFI) % for each semen sample. The SDFI % is directly proportional to the quality of sperm. The SCD assay is a simple, cost-effective, and reliable technique that can detect sperm DNA fragmentation, thus providing information regarding sperm functional quality and reproductive capacity. It is of significance in clinical and research areas of andrology and reproductive medicine, toxicology, and pharmacotherapeutics.
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RESEARCH PAPERS Top

Efficacy of atorvastatin in prevention of contrast-induced nephropathy in high-risk patients undergoing angiography: A double-blind randomized controlled trial p. 50
Maaz Hussain Syed, Prakash Narayan Khandelwal, Vijay R Thawani, SS Katare
DOI:10.4103/jpp.JPP_156_16  
Objective: To evaluate the efficacy and safety of atorvastatin (ATN) 80 mg in the prevention of contrast medium- induced nephropathy (CIN) in high risk patients undergoing angiograph. Materials and Methods: This was a prospective, double-blind, two-arm, parallel group RCT. A total of 216 patients undergoing coronary angiography were screened, and 188 eligible patients were randomized to two treatment arms. Patients in Group A received tablet N-acetylcysteine (NAC) 1200 mg once daily, and patients in Group B received tablet atorvastatin 80 mg + NAC 1200 mg once daily, for 3 days before, and 2 days after angiography. Results: A total of 160 patients completed the trial. Postprocedure, nine and two CIN cases were found in Group A and B, respectively. The mean change in serum creatinine was 0.086 ± 0.168 in Group A and 0.021 ± 0.083 in Group B, which was statistically significant (P = 0.0289). Postprocedure, the estimated glomerular filteration rate was reduced by 19.52 in Group A and 13.55 in Group B (P = 0.003). Conclusion: This trial indicates the positive role of statins in preventive strategy against CIN along with NAC.
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Comparative effect of divided doses of adult solid and liquid oral formulations of antiepileptic drugs in the management of pediatric epilepsy p. 54
Ravi Prasad Nidanapu, Bascarane Tamijarassy, Subramanian Mahadevan, Batmanabane Gitanjali
DOI:10.4103/jpp.JPP_7_17  
Objective: To compare the differences in the efficacy and safety of the commonly prescribed AEDs in the management of epilepsy in children when using divided doses of adult solid oral formulations (DDSF) with the liquid oral formulations (LFs). Materials and Methods: Patients who had one or more seizures per month and prescribed with DDSF were recruited. Initially the patients were continued on DDSF for 4 months following which they were switched over to LF for the subsequent 4 months. Seizure frequencies and adverse drug effects (ADRs) were recorded every month for 8 months and plasma AED levels were estimated at the end of 4th and 8th months. Results: A total of 200 patients completed the study protocol. The median seizure frequencies per month with DDSF and LF were: partial seizures (20.5, 9.0; P< 0.001), generalized tonic-clonic seizures (6.5, 2.0; P< 0.001), myoclonic seizures (58.5, 29.0; P< 0.001). Mean plasma drug levels ± SD (μg/ml) with DDSF and LF were: sodium valproate (48.2 ± 13.7, 69.1 ± 16.3; P < 0.001), phenytoin sodium (5.0 ± 2.4, 12.8 ± 3.8; P < 0.001), carbamazepine (4.5 ± 2.0, 11.5 ± 4.8; P < 0.001) and phenobarbitone (14.1 ± 5.2, 25.4 ± 12.3, P < 0.001). The incidence of treatment emergent ADRs was poor scholastic performance (25.5%), behavioral problems and dizziness/sedation (21.0%), somnolence/sleep disorders (19.5%). Conclusion: Patients treated with LF had better seizure control and optimal therapeutic drug levels and less adverse effects when compared to DDSF.
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Hybrid therapy versus sequential therapy for eradication of Helicobacter pylori: A randomized controlled trial p. 62
Sahoo Ashokkumar, Sonia Agrawal, Jharna Mandal, Sathasivam Sureshkumar, Gubbi Shamanna Sreenath, Vikram Kate
DOI:10.4103/jpp.JPP_24_17  
Objective: To compare the sequential therapy (ST) with the hybrid therapy (HT) for the eradication of Helicobacter pylori. Materials and Methods: Patients with peptic ulcer disease and gastritis found to be H. pylori positive were randomized to HT group who received omeprazole (20 mg bid) and amoxicillin (1 g bid) for 7 days followed by omeprazole (20 mg bid), amoxicillin (1 g bid), clarithromycin (500 mg bid), and metronidazole (400 mg tid) for the next 7 days and ST group who received omeprazole and amoxicillin for 5 days followed by omeprazole, clarithromycin, and metronidazole for the next 5 days. Eradication rate, compliance, and complications were compared. Results: A total of 120 patients were included, sixty in each group. H. pylori eradication rate was significantly higher in HT group on intention-to-treat analysis (88.3% [confidence interval (CI) 78.3%–94.8%] vs. 73.3% [CI 61.1%–83.3%]; P= 0.037). Per-protocol analysis showed higher eradication rate with HT (93% [CI 83.9%–93.7%] vs. 81.5% [CI 69.5%–90.2%]; P= 0.068); however, the difference was insignificant. Compliance and side effects were similar. A complete course of HT costs $10.77, while ST costs only $6.347. Conclusions: HT achieves significantly higher H. pylori eradication rate than ST with comparable patient compliance and side effects but at an higher price. However, it can be used in places where ST is ineffective.
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Influence of West African ethnicity and gender on beta-cell function and insulin sensitivity in essential hypertensives treated with hydrochlorothiazide and hydrochlorothiazide-lisinopril combination p. 68
Micheal Olamoyegun, Babatope Kolawole, Adesuyi A L Ajayi
DOI:10.4103/jpp.JPP_140_16  
Objective: To assess the effects of hydrochlorothiazide (HCT) given alone and in combination with an angiotensin-converting enzyme inhibitor (ACEI) on beta-cell function in a negroid population to further explore possible ethnic differences in the effect of antihypertensive drugs on homeostasis model assessment – insulin resistance (HOMA-IR). Materials and Methods: A total of 80 newly diagnosed Nigerian essential hypertensive patients were assigned to receive either HCT 25 mg daily or both HCT and lisinopril (Lis; 25/10 mg daily) in an open-label study for 12 weeks. The treatment groups were well matched in clinical and demographic baseline features. Changes in HOMA-IR from baseline to end of study (week 12), fasting plasma glucose (FPG), serum potassium, serum insulin, and blood pressure over the same period were also evaluated. Results: After 12 weeks, mean delta HOMA-IR (and %) was higher in the HCT monotherapy group; although, this change did not reach statistical significance in both groups −0.1 ± 7.1, P= 0.538 (HCT) and 0.6 ± 4.2 P= 0.913 (HCT + Lis); an insignificant increase was observed in FPG and serum insulin in both groups, whereas serum potassium decreased in similar fashion. Blood pressure reduction was similar in both groups. Analysis of HOMA-IR change according to gender in response to HCT mono- or combination therapy with Lis showed no significant difference. Conclusions: HCT monotherapy in hypertensive indigenous Nigerians, was not associated with worse metabolic effects when compared with combination therapy using Lis, an ACEI after 12 weeks. Low-dose thiazide diuretic as first-line antihypertensive medication may be safe in the short-term, further larger and long-term studies are needed to corroborate this finding.
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RESEARCH LETTER Top

Levocetirizine-induced psychiatric disorders in a pediatric patient: A case report and a pharmacovigilance database analysis p. 74
Carla Carnovale, Simone Russo, Gigliola Biondelli, Marta Gentili, Marco Pozzi, Stefania Antoniazzi, Sonia Radice, Emilio Clementi
DOI:10.4103/jpp.JPP_14_17  
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CASE REPORT Top

Dalbavancin use for the treatment of methicillin-resistant Staphylococcus aureus pneumonia p. 77
Katie E Barber, Amir Tirmizi, Richard Finley, Kayla R Stover
DOI:10.4103/jpp.JPP_2_17  
Dalbavancin is a lipoglycopeptide with a long half-life that allows infrequent dosing. It is indicated for the treatment of acute bacterial skin and skin structure infections caused by susceptible organisms, including Staphylococcus aureus and methicillin-resistant S. aureus (MRSA). Although this agent has been used off-label clinically, there are minimal data in infections outside the current indications. We report a case of a 28-year-old nonadherent male with HIV presenting with pneumonia due to MRSA that was treated with dalbavancin. The patient was admitted to the hospital with classic pneumonia symptoms, and sputum cultures and bronchoalveolar lavage grew MRSA. Other infections were ruled out. The patient was initially treated with vancomycin, but subtherapeutic concentrations prompted a change to dalbavancin upon discharge. The patient was readmitted 11 days later with the complaints of hemoptysis and shortness of breath, with unchanged imaging. However, no evidence of MRSA was found at this time. Utility of dalbavancin for other disease states has profound implications, particularly in patients with poor medication adherence.
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