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   2014| January-March  | Volume 5 | Issue 1  
    Online since January 7, 2014

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Drug utilization pattern and pharmacoeconomic analysis in geriatric medical in-patients of a tertiary care hospital of India
Binit N Jhaveri, Tejas K Patel, Manish J Barvaliya, CB Tripathi
January-March 2014, 5(1):15-20
DOI:10.4103/0976-500X.124411  PMID:24554905
Objective: To evaluate drug utilization pattern in terms of defined daily dose along with pharmacoeconomic analysis in geriatric patients admitted in medical ward of a tertiary care hospital. Materials and Methods: Retrospective medical record analysis was performed for indoor cases of the geriatric patients (age ≥65 years) admitted in medicine ward from January 2010 to December 2010 were analyzed for demographics, indications for admission, various systems involved, duration of hospital stay, various drugs prescribed, and adverse drug reaction. The drugs were categorized by anatomical therapeutic classification and defined daily dose was calculated. The World Health Organization prescribing indicators were assessed. Cost of the drugs was calculated to assess the economic burden. Results: Cardiovascular diseases were the common cause for admission. Antiplatelet drugs-B01AC (93%), H 2 blockers-A02BA (77.22%), antiemetics-A03FA (67.6%), vasodilators-C01D (55%), and hypolipidemic drugs-C10AA (52%) were commonly utilized groups. Average number of drugs per patient was 9.37 (95% CI: 9.09-9.64). Average number of antimicrobials prescribed per patient was 0.91 (95% CI: 0.82-0.99). Cefotaxime was the commonly prescribed antimicrobial drug. Average cost of treatment was ₹540.5 (95% CI: ₹458.0-623.0). Patients shared 45% of the economic burden for prescribed medicines. The average economic burden for drugs was significantly higher in expired than survived patients (₹749.49 vs. 457.59). Conclusion: Polypharmacy and irrational use of medicines are common problems in geriatric prescription. Prescription guidelines should be formatted for them.
  4,439 1,075 1
The new factor Xa inhibitor: Apixaban
Sangeeta Bhanwra, Kaza Ahluwalia
January-March 2014, 5(1):12-14
DOI:10.4103/0976-500X.124409  PMID:24554904
Cardiovascular diseases are still the most important cause of morbidity and mortality worldwide and anti-thrombotic treatment is widely used as a result. The currently used drugs include heparin and its derivatives, vitamin K antagonists, though efficacious, have their own set of limitations like unpredictable pharmacokinetic profile, parenteral route (with heparin and its derivatives only), narrow therapeutic window, and constant laboratory monitoring for their efficacy and safety. This lead to the development of novel factor Xa inhibitors which could be given orally, have predictable dose response relationship and are associated with lesser hemorrhagic complications. They include rivaroxaban, apixaban, and edoxaban among others. Apixaban has currently been approved for use in patients undergoing total knee or hip replacement surgery and to prevent stroke in patients with atrial fibrillation. Many trials are ongoing for apixaban to firmly establish its place in future, among the anti-thrombotic drugs.
  3,866 1,157 6
Studies on sensitivity of zebrafish as a model organism for Parkinson's disease: Comparison with rat model
Dinesh T Makhija, Aarti G Jagtap
January-March 2014, 5(1):39-46
DOI:10.4103/0976-500X.124422  PMID:24554909
Objective: To determine the utility of zebra fish as an animal model for Parkinson's disease (PD) in comparison with rat model. Materials and Methods: MTT assay was performed on rat and zebrafish brain synaptosomal fractions using rotenone as a neurotoxic agent. Quercetin and resveratrol were used as standards to compare anti-apoptotic activity in both organisms. Catalepsy was induced in zebrafish by exposing them to haloperidol (9 μM) solution. Drug-treated groups were exposed to bromocriptine and pramipexole, 30 min prior to haloperidol exposure at the dose of 2, 5, and 10 μg/mL. Swimming speed, time spent in the bottom of the tank, and complete cataleptic time were evaluated to assess behavioral changes. In rats, catalepsy was induced using haloperidol (1.25 mg/kg i.p.). Drug-treated groups received bromocriptine (2.5 mg/kg.) and pramipexole (1 mg/kg) orally. Bar test, block test, and locomotor activity were carried out to assess behavioral changes. Results: Resveratrol and quercetin showed comparable inhibition of apoptosis in rats and zebrafish. In anti-cataleptic study, bromocriptine and pramipexole-treated groups showed significant difference (P < 0.05) in behavioral parameters as compared to haloperidol control group in both the experimental organisms. Results obtained from fish model were in correlation with rat model. Conclusion: Findings of the present study revealed that zebrafish model is highly sensitive and can be used for basic screening of drugs against PD.
  3,953 968 11
Nephrotoxicity of cefepime: A new cephalosporin antibiotic in rats
Mossad Gamaleddin Ahmed Elsayed, Ashraf Abdelhakim Ahmed Elkomy, Mahmoud Salem Gaballah, Mohamed Elbadawy
January-March 2014, 5(1):33-38
DOI:10.4103/0976-500X.124419  PMID:24554908
Objectives: To investigate the nephrotoxic effect and biochemical alterations induced by cefepime in rats. Materials and Methods: Cefepime was administered intramuscularly at doses of 45, 90 and 180 mg/kg b.wt. once daily for 5 consecutive days. The serum and urine samples were used for quantitative determination of urea, creatinine, glucose, total protein, calcium, sodium and potassium. The histopathological examination of kidney tissues was performed 1, 4 and 8 days after the last dose of cefepime administration. Results: Cefepime induced a significant increase in the total amount of urine per day, urea and creatinine concentration in the serum and urine and significant decrease in their clearance. Cefepime also caused a significant gluocosuria and proteinuria and significant decrease in their serum concentrations. The effect of cefepime on serum and urine concentrations of calcium, sodium and potassium were also determined. Cefepime injection in the three tested doses caused renal tubular, glomerular and vascular changes. The severity of these changes was dose dependent. In conclusion, these results suggest a possible contribution of cefepime in the nephrotoxicity and biochemical alterations, especially at high doses. Therefore, the renal functions should be monitored during the cefepime therapy.
  4,046 572 7
Cholestatic presentation of yellow phosphorus poisoning
CP Lakshmi, Amit Goel, Debdatta Basu, CP Lakshmi, Amit Goel, Debdatta Basu
January-March 2014, 5(1):67-69
DOI:10.4103/0976-500X.124430  PMID:24554916
Yellow phosphorus, a component of certain pesticide pastes and fireworks, is well known to cause hepatotoxicity. Poisoning with yellow phosphorus classically manifests with acute hepatitis leading to acute liver failure which may need liver transplantation. We present a case of yellow phosphorus poisoning in which a patient presented with florid clinical features of cholestasis highlighting the fact that cholestasis can rarely be a presenting feature of yellow phosphorus hepatotoxicity.
  4,230 371 -
Bedaquiline: A novel drug to combat multiple drug-resistant tuberculosis
Divya Goel
January-March 2014, 5(1):76-78
DOI:10.4103/0976-500X.124435  PMID:24554919
Tuberculosis (TB) is among the most common infectious diseases and continues as a major global health problem. The scenario is worsened by the emergence and spread of multiple drug-resistant tuberculosis (MDR-TB) and extensive drug-resistant tuberculosis (XDR-TB). Cure rates are high for drug sensitive strains of Myobacterium tuberculosis if treatment protocols are adhered to, but treatment of MDR-TB and extensive drug drug-resistant strains is virtually impossible. The treatment of MDR-TB and XDR-TB relies on the drugs, which are less potent, more toxic and more costly and have to be administered for the longer duration. No new drug had come in to market for last 40 years, but the emergence of MDR-TB and XDR-TB has spurred interest in the development of novel drugs. For the effective treatment outcome, there is a dire need of new drugs with a different mechanism of action that can tackle both drug sensitive as well as drug-resistant strains. Bedaquiline is one such new drug with unique mechanism of action. Food and Drug Administration has approved bedaquiline for MDR-TB in December 2012. This article reviews the available evidence of efficacy and safety of bedaquiline.
  3,526 904 5
Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: Case series
Maulin Mehta, Jay Shah, Tejas Khakhkhar, Rima Shah, KG Hemavathi, Maulin Mehta, Jay Shah, Tejas Khakhkhar, Rima Shah, KG Hemavathi
January-March 2014, 5(1):59-62
DOI:10.4103/0976-500X.124428  PMID:24554914
Hypersensitivity reactions are common adverse drug reactions (ADRs) associated with antiepileptics. Carbamazepine is one of the routinely prescribed drugs for the treatment of epilepsy and neuropathic pain. ADRs due to carbamazepine range from mild maculopapular rash to severe anticonvulsant hypersensitivity syndrome (AHS). AHS is the triad of fever, rash, and internal organ involvement occurring 1-8 weeks after exposure to an anticonvulsant (1 in 1,000 to 10,000 exposures). Spontaneously reported three cases of AHS-drug hypersensitivity reactions induced by carbamazepine are discussed here. Seven to ten days after starting therapy, patients developed maculopapular skin rashes, fever and liver or kidney involvement. The causal relationship between drug and ADR was found to be 'certain' in one case and 'probable' in other two cases with both WHO-UMC and Naranjo causality assessment scale. All the three cases show category 4a according to Hartwig's severity scale as ADR was the cause for hospital admission. On assessing preventability of ADRs by modified Schumock and Thorntons' scale, one case was falling into category of 'definitely preventable' and other two were 'not preventable'. AHS is rare but serious reaction with carbamazepine which requires vigilant monitoring by physicians to avoid major consequences.
  3,356 530 8
Dextropropoxyphene ban in India: Is there a case for reconsideration?
Yatan Pal Singh Balhara
January-March 2014, 5(1):8-11
DOI:10.4103/0976-500X.124406  PMID:24554903
  3,450 400 2
Periodic paralysis: An unusual presentation of drug-induced hyperkalemia
Poonam Agrawal, Deepti Chopra, Surajeet K Patra, Himanshu Madaan, Poonam Agrawal, Deepti Chopra, Surajeet K Patra, Himanshu Madaan
January-March 2014, 5(1):63-66
DOI:10.4103/0976-500X.124429  PMID:24554915
Hyperkalemia is a life-threatening electrolyte abnormality. The most common cause of hyperkalemia includes renal disease and ingestion of medications. Drug-induced hyperkalemia may develop in patients with underlying renal impairment, disturbed cellular uptake of potassium load, excessive ingestion or infusion of potassium-containing substances. We report a case of "drug-induced severe hyperkalemia" presenting as periodic paralysis. A 67-year-old diabetic and hypertensive woman presented to emergency department with the complaint of intermittent episode of inability to walk for the past 5 days. Each episode lasted for 15-20 minutes and was associated with breathlessness and restlessness. There was no family history of periodic paralysis and drug history revealed that the patient was onolmesartan 20 mg per day (for past 2 years), perindopril 4 mg per day (for past 16 months), and torsemide 10 mg/day. On examination patient was found to be conscious, alert, and afebrile. Vitals were normal. Examination of cardiovascular and respiratory system did not reveal any significant finding. Blood report of the patient showed serum K+ level 8.6 mmol/l. All other investigations were within normal limits. A diagnosis of drug-induced hyperkalemia was made. Patient responded well to the symptomatic treatment. To the best of the author's knowledge, this is the first case report of drug-induced hyperkalemia presenting as periodic paralysis.
  2,889 391 -
Dry antibiotic pipeline: Regulatory bottlenecks and regulatory reforms
Sandeep Kumar Gupta, Roopa P Nayak
January-March 2014, 5(1):4-7
DOI:10.4103/0976-500X.124405  PMID:24554902
  2,581 569 5
Diethylentriaminepenta acetic acid glucose conjugates as a cell permeable iron chelator
Mona Mosayebnia, Mehdi Shafiee-Ardestani, Parvin Pasalar, Mojgan Mashayekhi, Massoud Amanlou
January-March 2014, 5(1):27-32
DOI:10.4103/0976-500X.124416  PMID:24554907
Objective: To find out whether DTPA-DG complex can enhance clearance of intracellular free iron. Materials and Methods: Diethylenetriaminepentaacetic acid-D-deoxy-glucosamine (DTPA-DG) was synthesized and examined for its activity as a cell-permeable iron chelator in human hepatocellular carcinoma (HEPG2) cell line exposed to high concentration of iron sulfate and compared with deferoxamine (DFO), a prototype iron chelator. The effect of DTPA-DG on cell viability was monitored using the 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide MTT assay as well. Results: There was a significant increase of iron level after iron overload induction in HEPG2 cell culture. DTPA-DG presented a remarkable capacity to iron burden reducing with estimated 50% inhibitory concentration value of 65.77 nM. In fact, glycosyl moiety was gained access of DTPA to intracellular iron deposits through glucose transporter systems. Conclusion: DTPA-DG, more potent than DFO to sequester deposits of free iron with no profound toxic effect. The results suggest the potential of DTPA-DG in chelating iron and permitting its excretion from primary organ storage.
  2,621 374 1
Evaluation of treatment of invasive fungal infections
Ilenia Casucci, Alessio Provenzani, Piera Polidori
January-March 2014, 5(1):47-52
DOI:10.4103/0976-500X.124423  PMID:24554910
Objective: To identify the risk factors associated with invasive fungal infections (IFI) in immunocompromised patients (IP), and monitor antifungal therapy appropriateness and costs. Materials and Methods: The 1-year observational retrospective study was performed on 101 IP, who received antifungal intravenous therapy with fluconazole (F), liposomal amphotericin-B (A), caspofungin (C), itraconazole (I) for ≥4 days. Patient therapy was divided into three groups: Prophylactic, empirical, and target. Immunosuppressive therapy (IT), total parenteral nutrition (TPN), dialysis, central line, steroid therapy, stent use, neutropenia, and mechanical ventilation were evaluated. Variables were therapy duration, defined daily dose (DDD) consumption, DDD average cost. Results: Main risk factors were central line (65.3%), TPN (56.4%), dialysis (46.5%), IT (42.6%), mechanical ventilation (32.7%), neutropenia (24.8%), steroid therapy (23.8%), and stent use (14.9%). Average duration of prophylaxis was 7 days; F (61%), A (26%), and C (13%) were used. Average duration of empirical therapy was 8 days; F (52.9%), A (26.5%), C (8.8%), I (2.9%), and in association A + C, A + F, C + F (8.9%) were used. Average duration of target therapy was 9 days; F (40.4%), A (23.1%), C (15.4%), I (7.7%), and in association A + C, A + F, C + F (13.4%) were used. DDD consumption and DDD average-cost were: C 50 mg vial: 273 DDD, €381.1; C 70 mg vial: 33.6 DDD, €389.6; F 200 mg vial: 768 DDD, €11.8; F 100 mg vial: 89 DDD, €10.6; I 250 mg vials: 62.5 DDD, €68.8; and A 50 mg vial: 2200 DDD, €93.4; respectively. Conclusions: Data showed an appropriate use of antifungals. Best alternative therapy (cheaper antifungal drug) was prescribed for most patients. The high cost of A and C was justified by IFI resolution.
  2,344 537 2
Effects of angiotensin converting enzyme inhibition on adiponectin levels and lipid profile in the ovariectomized-aged rats
Turhan Dost, Samet Kafkas, Filiz Gokalp, Aslihan Karul, Mustafa Birincioglu
January-March 2014, 5(1):21-26
DOI:10.4103/0976-500X.124413  PMID:24554906
Objective: To investigate the relationship between angiotensin converting enzyme (ACE) and adiponectin and lipid profile in the ovariectomized-aged rats. Materials and Methods: Wistar albino rats were first divided into two groups; control (C) and ovariectomized (OVX). Bilateral ovariectomy were carried out on rats (n = 30) except control group (n = 10). After 6 weeks from ovariectomy, ovariectomized rats were subdivided into three groups; one group received no treatment (OVX), two groups received low dose (OVX + Cap5; 5 mg/kg/day) and high dose (OVX + Cap20; 20 mg/kg/day) captopril (Cap). Body weights were monitored weekly. Adiponectin, triglyceride, cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and very low density lipoprotein cholesterol (VLDL-C) levels were measured at the end of the 6 weeks. Results: In the OVX group, body weights increased (P < 0.001). In the OVX + Cap20 group, body weights significantly decreased compared with the OVX group during weeks 5 and 6 (P < 0.05). While adiponectin levels increased in the OVX + Cap5 group (P = 0.014), triglyceride and cholesterol levels decreased in the OVX + Cap20 group (P = 0.016 and P < 0.001, respectively) compared to the OVX group. HDL-C and VLDL-C levels decreased only in OVX + Cap20 group (P < 0.005). Conclusions: ACE inhibitors may be decreasing the ovariectomy-induced weight gain by increasing adiponectin levels, and by affecting lipid profiles. The adipose tissue renin-angiotensin system (RAS) may be playing an important role in the development of adiposity.
  2,396 443 3
Antidotes: Where are they when needed?
Gitanjali Batmanabane
January-March 2014, 5(1):1-3
DOI:10.4103/0976-500X.124403  PMID:24554901
  2,199 555 -
Seed germination: An alternative to animal model to teach bioassay principles
Nagendra I. M. Nayak, Prasanna Lakshmi
January-March 2014, 5(1):56-58
DOI:10.4103/0976-500X.124426  PMID:24554913
  1,892 388 2
Prescribing pattern of drugs for cardiovascular co-morbidities in type 2 diabetes mellitus in a tertiary care Indian hospital
Dakshinamurthy Nishanthini, Balan Aravinda Kumar, Chandrashekaran Girish, Sadasivam Balakrishnan
January-March 2014, 5(1):54-56
DOI:10.4103/0976-500X.124425  PMID:24554912
  1,845 423 -
Amikacin-triggered anaphylaxis: Should we go for skin test?
Sukhen Samanta, Sujay Samanta, Abhishek Jha
January-March 2014, 5(1):53-54
DOI:10.4103/0976-500X.124424  PMID:24554911
  1,813 336 1
A study with spoof paper - reflection of reviewing processes in open - access journals
Sridharan Kannan, Sivaramakrishnan Gowri, Sridharan Kannan, Sivaramakrishnan Gowri
January-March 2014, 5(1):70-70
DOI:10.4103/0976-500X.124427  PMID:24554917
  1,637 366 -
Essential medicines and health products information portal
P Ravi Shankar
January-March 2014, 5(1):74-75
DOI:10.4103/0976-500X.124434  PMID:24554918
  1,629 293 2
Antibiotics to end the curse of low back ache

January-March 2014, 5(1):71-71
  1,442 197 -
An evolving curse on paracetamol use in children
G Sivagnanam
January-March 2014, 5(1):72-73
  1,344 262 -
Antibiotics with a curse of cardiovascular risk

January-March 2014, 5(1):71-72
  1,279 234 -