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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 9 | Issue 4
Page Nos. 167-200

Online since Friday, February 1, 2019

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RESEARCH PAPERS  

Impact of concomitant use of beta blocker, statin, aspirin, and metformin on central hemodynamics and arterial stiffness in hypertension Highly accessed article p. 167
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_62_18  
Objective: To assess the impact of concomitant use of aspirin, BB (metoprolol), statin (atorvastatin), and metformin on central haemodynamics and arterial stiffness parameters in treated hypertensive patients. Materials and Methods: We did a cross-sectional study on 476 treated hypertensives. Oscillometric PWA was accomplished by Mobil-o-Graph (IEM, Germany) and groups were stratified using low-dose aspirin, statin, BB, or metformin. Parameters studied were brachial hemodynamics (BP, heart rate, and rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification), and central hemodynamics (central BP, cardiac output, and stroke work). Results: All pairs were matched by or comparable for major confounding factors except concomitant use of drugs. The use of BB, aspirin, and statin had favorable effect on brachial and central hemodynamics. Metformin use had effect more on central than brachial hemodynamics. BB and metformin had negative, statin had indifferent, and aspirin had positive effect on arterial stiffness. Only few of these differences had statistical significance. Frequency of central pulse pressure ≥40 was insignificantly affected by drugs studied. Conclusions: Concomitant aspirin, BB, and metformin in hypertensives have favorable effects on hemodynamics, brachial more than central. Arterial stiffness has positive impact of metformin and negative impact of BB use. These effects must be considered in studies focusing hypertensive therapies. It remains inconclusive whether these results are due to drugs or their indication.
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A randomized open-label study to evaluate the effects of escitalopram and mirtazapine on psychomotor functions and memory in patients with depression p. 174
Anal Modi, Mira Desai, Samidh Shah, Minaxi Parikh
DOI:10.4103/jpp.JPP_66_18  
Objective: To compare the effects of escitalopram and mirtazapine on psychomotor functions and memory and also to correlate the antidepressant efficacy of these drugs with psychomotor functions. Materials and Methods: This study was carried out at a tertiary care teaching hospital on 104 newly diagnosed literate patients with endogenous depression as per the inclusion and exclusion criteria. Patients were prescribed either escitalopram (20 mg OD) or mirtazapine (15 mg OD) or amitriptyline (75 mg BD). Psychomotor functions were assessed by digit-letter substitution, six-letter cancellation, choice reaction time, hand steadiness, and flicker fusion tests, and memory was assessed by PGI memory scale at the baseline and at the end of the 1st week, 1st month, and 4th month. Efficacy of drugs was measured by the Hamilton Depression Rating Scale (HDRS) at the baseline and each follow-up. The antidepressant efficacy of these drugs with various psychomotor function tests was correlated using Pearson's correlation test. P < 0.05 was considered statistically significant. Results: A total 95 patients, 32 in escitalopram, 32 in mirtazapine, and 31 in amitriptyline group, completed the study. Escitalopram and mirtazapine improved all psychomotor functions while amitriptyline significantly deteriorated (P < 0.001). All three drugs were equally efficacious (P > 0.05). A strong correlation was observed between psychomotor functions and HDRS score in patients treated with escitalopram (positive correlation), mirtazapine (positive correlation), and amitriptyline (negative correlation). Conclusion: Escitalopram and mirtazapine improve psychomotor function in patients with endogenous depression while amitriptyline deteriorates it. Thus, escitalopram and mirtazapine may be preferred to amitriptyline in clinical practice.
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A novel potential role of Vitamin K2-7 in relieving peripheral neuropathy p. 180
Dilip S Mehta, Yogesh A Dound, Shashank S Jadhav, Abhay A Bhave, Milind Devale, Ashok D B Vaidya
DOI:10.4103/jpp.JPP_72_18  
Objective: To assess the efficacy, tolerability and safety of vitamin K2-7 in patients with peripheral neuropathy (PN). Materials and Methods: This study was conducted in 100 patients with PN suffering from VBD or T2DM. Vitamin K2-7 capsules (200 mcg) were given orally for 8 weeks followed up to the 12th week. Symptoms included tingling and numbness along with weakness, fatigue, and cramps. The intensity of the symptoms of PN was assessed on a Visual Analog Scale (VAS). Results: At baseline, the VAS score was 6–9 for VBD group and 8–10 for T2DM group. After treatment with Vitamin K2-7 by the 12th week, VAS score had reduced to 1–2 in both groups. The decrease was statistically significant (P < 0.0001). Conclusion: For the first time, in larger sample size, it has been shown that Vitamin K2-7, 200 mcg for 8 weeks, has a therapeutic activity for the symptoms of PN in VBD and T2DM. The reduction in symptoms was persistent in spite of de-challenge of Vitamin K2-7. Vitamin K2-7 was also well tolerated by all the patients. Thus, it can be concluded that Vitamin K2-7 has potential therapeutic effects for PN due to VBD or T2DM.
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In vitro effects of a novel silver-based complex on influenza virus p. 186
Vladimir Silnikov, Evgenii Plotnikov
DOI:10.4103/jpp.JPP_50_18  
Objective: To study the mechanism of antiviral activity of a new silver-based compound of general formula C6H19Ag2N4 LiO6S2 on influenza virus. Materials and Methods: Antiviral properties were investigated on test culture of Madin–Darby canine kidney (MDCK) cells with serial tenfold dilutions of the influenza virus. The completeness of viral inactivation was confirmed by determining the virus titer after a double passage of virus-containing suspension in MDCK cell culture. Reverse transcription polymerase chain reaction analysis of viral RNA, enzyme immunoassay, and transmission electron microscopy for morphological analysis of influenza virus particles were applied for analysis of viral RNA and effect of substance influence. Results: The results indicate a significant change in the antigenic structure of viral proteins of influenza virus by the silver-containing complex. The main inactivation mechanism of influenza virus by the action of the silver-containing complex is associated primarily with the effect on virion protein structure rather than cleavage of the viral RNA. It was revealed that the mechanism for the inactivation of influenza virus is not associated with cleavage of viral RNA corresponding genes M, NS, or nucleoprotein but more probable with changes of the antigen determinants of virion. It was found a significant damaging effect on influenza virus under action of tested substance at concentration higher than 0.4 mM. Conclusion: The novel silver-based complex possesses antiviral properties and could be considered as a prospective antiviral drug.
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CASE REPORTS Top

Complete response to afatinib in lung adenocarcinoma of epidermal growth factor receptor exon-19 deletion mutation and disease recurrence on drug discontinuation p. 191
Rashmi Kumari, Emmanuel James, K Pavithran
DOI:10.4103/jpp.JPP_111_18  
Lung adenocarcinoma, the most widespread cause of neoplasm associated mortality in both men and women worldwide, is a subtype of non-small cell lung cancer (NSCLC). We address here the case of a 62-year-old female presented with symptoms of cough and breathlessness of 2-months duration. Histopathological examination of lung biopsy and immunohistochemical tests revealed lung adenocarcinoma. Integrated positron emission tomography-computed tomography (PET-CT) scan suggested right lung lesion with stage 4 (T3N3M1b) disease. Epidermal growth factor receptor (EGFR) mutation analysis was positive for exon-19 deletion mutation, and she was started on afatinib 40 mg once daily. PET-CT scan, at 6-months follow-up, was suggestive of complete response to therapy. Due to drug-induced persistent diarrhea, afatinib was discontinued by the patient, but a repeat PET-CT scan 6 months after discontinuation of treatment suggested disease recurrence. However, T790M-resistant mutation analysis was found to be negative, and she was restarted on afatinib at 30 mg once daily to minimize the drug-related diarrhea. After 15 months of afatinib therapy at reduced dosage, reevaluation by PET-CT suggested disease progression. Although afatinib monotherapy is effective in EGFR exon-19 deletion mutation NSCLC, this report suggests that discontinuation of the drug can lead to disease recurrence, and reducing the drug dose is not beneficial once disease recurrence occurs. To the best of our knowledge, this is the first reported case from India of advanced lung adenocarcinoma of EGFR exon-19 deletion showing a complete response to afatinib and recurrence of the disease after discontinuation of drug.
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Crizotinib-induced photoallergic dermatitis: A case report of an unconventional adverse effect of a novel molecule p. 195
Rajeshwari Dabas, Manasa Shettisara Janney, Sandeep Arora, Radhakrishnan Subramaniyan
DOI:10.4103/jpp.JPP_106_18  
Crizotinib is a novel tyrosine kinase inhibitor approved globally for the treatment of patients with locally advanced or metastatic non-small cell lung carcinoma (NSCLC) which is anaplastic lymphoma kinase (ALK) positive. It is an ATP-competitive small-molecule inhibitor of the receptor tyrosine kinases, namely, c-Met, ALK, and ROS 1. Cutaneous toxicity is encountered in >50% of patients on tyrosine kinase inhibitors and they include acne-like (acneiform) rash, discoloration, dryness, and hyperkeratosis of the skin, perifollicular inflammation, acral erythema, panniculitis, paronychia, periungual splinter hemorrhages, alopecia, facial hypertrichosis, and changes in the structure of the eyelashes, hair, and nails. Crizotinib frequently results in gastrointestinal disturbances, visual impairment, peripheral edema, QT-prolongation, and liver enzyme elevation. Photoallergic dermatitis with crizotinib is rare. We hereby report a case of a 50-year-old male with ROS 1 positive metastatic adenocarcinoma of the lung on crizotinib who presented with multiple well- to ill-defined erythematous plaques over both photo exposed and covered sites involving the face, neck, chest, shoulder, forearms, and dorsum of both hands. Based on the history, temporal association with the intake of the drug and histopathological evidence, a diagnosis of photo-allergic dermatitis was made. Lesions regressed in 4 weeks with the use of oral and topical steroids, emollients, and strict photoprotection. Regular, prophylactic, photoprotective measures in patients on photosensitizing drugs like crizotinib reduces the overall morbidity and improves their quality of life.
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CORRESPONDENCE Top

Coagulopathy: A possible mechanism of terlipressin-induced peripheral ischemic complications – Evidence from published case reports p. 198
Phulen Sarma, Vidya Mahalmani, Shammy Chandel, Subodh Kumar, Hardeep Kaur, Ajay Prakash, Deba Prasad Dhibar, Bikash Medhi
DOI:10.4103/jpp.JPP_127_18  
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ERRATUM Top

Erratum: Efficacy and safety of oral diclofenac sustained release versus transdermal diclofenac patch in chronic musculoskeletal pain: A randomized, open label trial p. 200

DOI:10.4103/0976-500X.251391  
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