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   2015| July-September  | Volume 6 | Issue 3  
    Online since August 4, 2015

 
 
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REVIEW ARTICLE
Inhaled insulin: A “puff” than a “shot” before meals
Dick B. S. Brashier, Anjan Khadka, Tejus Anantharamu, Ashok Kumar Sharma, AK Gupta, Sushil Sharma, N K. Dahiya
July-September 2015, 6(3):126-129
DOI:10.4103/0976-500X.162013  PMID:26311994
Diabetes is a metabolic disorder characterized by relative or absolute deficiency of insulin, resulting in hyperglycemia. The main treatment of diabetes relies on subcutaneous insulin administration by injection or continuous infusion to control glucose levels, besides oral hypoglycemic agents for type 2 diabetes. Novel routes of insulin administration are an area of research in the diabetes field as insulin injection therapy is burdensome and painful for many patients. Inhalational insulin is a potential alternative to subcutaneous insulin in the management of diabetes. The large surface area, good vascularization, immense capacity for solute exchange and ultra-thinness of the alveolar epithelium facilitates systemic delivery of insulin via pulmonary administration. Inhaled insulin has been recently approved by Food and Drug Administration (FDA). It is a novel, rapid-acting inhaled insulin with a pharmacokinetic profile that is different from all other insulin products and comparatively safer than the previous failed inhaled insulin (Exubera).
  3,573 876 1
RESEARCH PAPERS
Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome
Sushant Khurana, Surabhi Gupta, HiraLal Bhalla, Shefali Nandwani, Varad Gupta
July-September 2015, 6(3):130-135
DOI:10.4103/0976-500X.162011  PMID:26311995
Objectives: To compare anti-inflammatory effect of atorvastatin and rosuvastatin in patients of acute coronary syndrome. Materials and Methods: The study was a prospective, open-labeled, randomized and single-center study conducted on 100 patients of acute coronary syndrome. Patients were assigned to atorvastatin 40 mg daily or rosuvastatin 20 mg daily for 4 weeks. C-reactive protein (CRP) levels, lipid profiles, erythrocyte sedimentation rate (ESR) and adverse effects were measured at beginning and at the end of 4 weeks. Results: Baseline parameters and clinical profile did not differ between the two groups. CRP levels significantly decreased from beginning to the end of 4 weeks in both atorvastatin and rosuvastatin groups (from 35.48 to 23.07 mg/l and from 35.88 to 19.91 mg/l respectively, both P < 0.001). However, there was significant difference between the levels of CRP in patients of the rosuvastatin group as compared to the atorvastatin group (19.91 ± 6.32 vs 23.07 ± 7.47, P < 0.05). In addition, both the drugs were associated with a reduction in total cholesterol, LDL levels and ESR at the end of 4 weeks as compared to the beginning (P < 0.001 for all comparisons). Conclusion: Both atorvastatin (40 mg) and rosuvastatin (20 mg) are effective in decreasing CRP and LDL cholesterol levels even in a short duration of 4 weeks. Rosuvastatin was found to be more effective in decreasing CRP levels.
  3,119 1,065 9
EDITORIAL
Are we moving towards a new definition of essential medicines?
S Manikandan
July-September 2015, 6(3):123-125
DOI:10.4103/0976-500X.162008  PMID:26311993
  3,104 698 4
MOLECULES OF THE MILLENNIUM
Naloxegol: First oral peripherally acting mu opioid receptor antagonists for opioid-induced constipation
Tejus Anantharamu, Sushil Sharma, Ajay Kumar Gupta, Navdeep Dahiya, Dick B Singh Brashier, Ashok Kumar Sharma
July-September 2015, 6(3):188-192
DOI:10.4103/0976-500X.162015  PMID:26312011
Opioid-induced constipation (OIC) is one of the most troublesome and the most common effects of opioid use leading to deterioration in quality of life of the patients and also has potentially deleterious repercussions on adherence and compliance to opioid therapy. With the current guidelines advocating liberal use of opioids by physicians even for non-cancer chronic pain, the situation is further complicated as these individuals are not undergoing palliative care and hence there cannot be any justification to subject these patients to the severe constipation brought on by opioid therapy which is no less debilitating than the chronic pain. The aim in these patients is to prevent the opioid-induced constipation but at the same time allow the analgesic activity of opioids. Many drugs have been used with limited success but the most specific among them were the peripherally acting mu opioid receptor antagonists (PAMORA). Methylnaltrexone and alvimopan were the early drugs in this group but were not approved for oral use in OIC. However naloxegol, the latest PAMORA has been very recently approved as the first oral drug for OIC. This article gives an overview of OIC, its current management and more specifically the development and approval of naloxegol, including pharmacokinetics, details of various clinical trials, adverse effects and its current status for the management of OIC.
  2,669 622 5
RESEARCH PAPERS
Effectiveness of vitamin D3 in severe persistent asthmatic patients: A double blind, randomized, clinical study
Muhasaparur Ganesan Rajanandh, Arcot D Nageswari, Giridharan Prathiksha
July-September 2015, 6(3):142-146
DOI:10.4103/0976-500X.162022  PMID:26311997
Objective: To assess the pulmonary function and quality of life in asthma patients receiving vitamin D3 supplementation with inhaled budesonide and formoterol. Materials and Methods: This was a double blinded, randomized, comparative study. Patients were recruited as per the study criteria and randomized into two groups: usual care group (n = 69) patients received budesonide (800 μg) with formoterol (24 μg) and intervention care group (n = 72) patients received vitamin D3 (1000 IU) supplementation along with budesonide (800 μg) plus formoterol (24 μg) for a period of 6 months. Results: A total of 140 patients completed the study. Significant within-group improvement and non-significant between-group improvement is observed with respect to FEV1. In terms of health-related quality of life, within-group comparison revealed a significant (P < 0.05) improvement in all the domains of SGRQ. However, between-group comparisons showed statistically significant (P < 0.05) improvement in symptom, impact and total scores. Conclusion: On the basis of our findings, we conclude that supplementation of vitamin D3 is effective in improving the quality of life rather than pulmonary function in severe asthmatics. However, further studies are warranted to substantiate the present findings.
  2,501 572 6
CASE REPORTS
Complete resistance after maximal dose of rocuronium
Annalisa Capuano, Maria Giuseppa Sullo, Concetta Rafaniello, Liberata Sportiello, Pierfrancesco Fusco, Macella De Vizia, Fausto Ferraro
July-September 2015, 6(3):175-178
DOI:10.4103/0976-500X.162012  PMID:26312006
Rocuronium is a non-depolarizing neuromuscular blocking agent (NDNMBA), employed in the clinic as an adjunct to general anesthesia to facilitate tracheal intubation rapid sequence, and to provide skeletal muscle relaxation during surgery. Many cases of resistance to neuromuscular blocking agents (NMBAs) have been anecdotally reported. There are specific pathologic states, such as upper motor neuron lesions, severe thermal injuries, liver disease, renal failure, disuse atrophy, all of which show an increased resistance to the effects of nondepolarizing muscle relaxants. Also concurrent drug therapy can alter the efficacy of NMBAs such as some classes of antibiotics, furosemide, β receptor agonists, phosphodiesterase inhibitors, calcium antagonists, respiratory stimulants but also ketamine, propofol and barbiturates at high concentrations. In this scenario we describe an unusual case of 20-years-old man who showed a complete resistance to rocuronium maybe due to a glucocorticoids concomitant therapy.
  2,286 367 3
RESEARCH PAPERS
Inhibition by sildenafil of contractility of isolated non-pregnant human myometrium
Aruldhas Blessed Winston, Kaysina Vazhudhi, Sumalya Sen, Elsy Thomas, Santhosh Benjamin, Jacob Peedicayil
July-September 2015, 6(3):136-141
DOI:10.4103/0976-500X.162020  PMID:26311996
Objective: To investigate the ability of sildenafil to inhibit the contractility of isolated non pregnant human myometrium. Materials and Methods: The inhibitory effect of three concentrations (3, 10, and 30 µM) of sildenafil on 55 mM KCl-induced contractility of isolated non-pregnant human myometrium was studied. The ability of the guanylyl cyclase inhibitor ODQ (10 µM), the adenylyl cyclase inhibitor MDL-12,330A (10 µM), the non-specific potassium channel blocker TEA (2 mM), and the calcium-sensitive potassium (BKCa) channel blocker iberiotoxin (100 nM) to reverse the inhibition of 10 µM sildenafil on KCl-induced myometrial contractility was also studied. Results: Sildenafil produced a concentration-dependent inhibition of KCl-induced myometrial contractility that was statistically significant at all three concentrations of sildenafil used. The inhibition by 10 µM sildenafil of KCl-induced myometrial contractility was not reversed by the concurrent administration of ODQ or MDL-12,330A. The inhibition of 10 µM sildenafil of myometrial contractility was partially reversed by concurrent administration of TEA and totally and significantly reversed by the concurrent administration of iberiotoxin. Conclusions: These results suggest that sildenafil inhibits the contractility of isolated non-pregnant human myometrium. The results suggest that sildenafil does so by opening BKCa channels.
  2,252 281 -
WEBWISE
International conference on harmonization of technical requirements for registration of pharmaceuticals for human use
Jatinder Singh
July-September 2015, 6(3):185-187
DOI:10.4103/0976-500X.162004  PMID:26312010
  2,234 288 14
CASE REPORTS
Exercise-induced anaphylaxis and antileukotriene montelukast
Sapna Gajbhiye, Rajendra Prasad Agrawal, Shubham Atal, Vikalp Tiwari, Pradeep Phadnis
July-September 2015, 6(3):163-165
DOI:10.4103/0976-500X.162007  PMID:26312002
We report a rare case of exercise-induced anaphylaxis (EIA), occurring exclusively with exercise, without any other associated trigger, detected in the prodromal phase, and prevented from additional anaphylaxis episodes by treatment with cetirizine and 10 mg daily of antileukotriene montelukast to date. EIA is a syndrome in which patients experience a spectrum of the symptoms of anaphylaxis ranging from mild cutaneous signs to severe systemic manifestations such as hypotension, syncope, and even death after increased physical activity. Many people have triggers, such as, a variety of foods, various medications, alcohol, cold weather, humidity, and seasonal and hormonal changes along with exercise that cause the symptoms. Typically, either exercise or the specific trigger alone will rarely cause symptoms. It is differentiated from cholinergic urticaria by the absence of response to passive body warming and emotional stress.
  1,996 283 1
RESEARCH LETTERS
Therapeutic drug monitoring of modified release once daily tacrolimus in de novo renal transplant with conversion to a twice daily generic in the stable period
Binu Susan Mathew, Ratna Prabha, Gopal Basu, Pradeep Rajkumar, Veerasamy Tamilarasi, Denise Helen Fleming
July-September 2015, 6(3):156-159
DOI:10.4103/0976-500X.162019  PMID:26312000
  1,958 298 -
CASE REPORTS
Double trouble: Cyclosporine-induced thrombocytosis in a patient with methotrexate toxicity: Are they related?
Cherukuri Tejaswi, Saritha Mohanan, Rangaraj Murugaiyan, Kaliaperumal Karthikeyan
July-September 2015, 6(3):160-162
DOI:10.4103/0976-500X.162005  PMID:26312001
Psoriasis is a common, chronic, disfiguring, inflammatory, and proliferative condition of the skin. It manifests with varying degrees of severity and can be treated with various immune modulators. This is a case report of a 57-year-old male patient of psoriasis on long-term oral methotrexate, who developed methotrexate toxicity when given an injection of methotrexate for unstable psoriasis. After recovery, the patient was started on cyclosporine 100 mg twice a day. After a week, he developed thrombocytosis, which reverted a week after cyclosporine was stopped. The patient is currently being managed with acitretin. The aim of this case report is to emphasize the various unpredictable adverse reactions encountered during treatment of psoriasis, especially when a combination or sequential treatment is used. There is a need for caution, as late sequelae of long-term administration of the systemic agents used in the treatment of psoriasis are still unknown.
  1,957 247 1
Life-threatening bradyarrhythmia with oral phenytoin overdose
Giridharan Srinivasan, Mukta Wyawahare, Pratheesh George Mathen, Dharanipragada K Subrahmanyam
July-September 2015, 6(3):179-181
DOI:10.4103/0976-500X.162017  PMID:26312007
We report a case of a 41-year-old lady, who developed severe hypotension and sinus bradycardia, following oral consumption of 20 g of phenytoin and 500 mg of glibenclamide. She required high dose of inotropes and a temporary transvenous pacer for her hemodynamic instability. This life-threatening cardiotoxicity of phenytoin could have been due to its interaction with sulphonylurea. It is imperative to be aware of drug interactions, due to which, life-threatening cardiovascular manifestations following phenytoin toxicity can occur.
  1,905 260 1
RESEARCH PAPERS
The effects of A2B receptor modulators on vascular endothelial growth factor and nitric oxide axis in chronic cyclosporine nephropathy
Leena Patel, Aswin Thaker
July-September 2015, 6(3):147-153
DOI:10.4103/0976-500X.162014  PMID:26311998
Introduction: To investigate the actions of adenosine A2B receptor modulators on VEGF and NO levels in CsA nephropathy. Materials and Methods: Nephropathy was induced by administrating 25 mg/kg (s.c) of CsA for 5 weeks. The VEGF and NO levels were measured in kidney tissue. Serum creatinine, creatinine clearance, urinary albumin excretion, blood urea nitrogen, kidney pathology score were measured to assess renal function. The analysis of mRNA expression of A2B receptor and VEGF was performed. Results: Administration of CsA for 5 weeks induced adverse renal function. The mRNA expression of VEGF was reduced in renal tissue after 5 weeks of CsA treatment. The renal VEGF and NO levels were also reduced in these animals. In vivo administration of A2B adenosine receptor agonist increased renal VEGF which was inhibited by a selective A2BAR antagonist (MRS1754) in CsA-treated animals. The increase in VEGF was associated with reversal of adverse renal functions. The effects of A2BAR modulators were prominent in CsA-treated animals compared with control animals suggesting CsA treatment may upregulate A2BARs. The mRNA expression of A2BAR was increased after 5 weeks of CsA. Conclusions: A2BAR modulators may provide new therapeutic options to retard CsA nephropathy by mediating renal VEGF and NO.
  1,868 278 2
CASE REPORTS
Acalculous pyelonephritis and cholecystitis occurring simultaneously in a diabetic patient on sitagliptin therapy
Jayaprakash Sahoo, Sadishkumar Kamalanathan, Muthupillai Vivekanandan, Rathinam Palamalai Swaminathan
July-September 2015, 6(3):172-174
DOI:10.4103/0976-500X.162016  PMID:26312005
Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of anti-diabetic drugs. They control both fasting and postprandial hyperglycemia by inhibiting degradation of incretin hormones, such as, glucagon-like peptide-1(GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Sitagliptin is the first DPP-4 inhibitor to be marketed in India. In addition to its glucose lowering effect, it also suppresses immunity resulting in various infections in a diabetes patient. Here, we describe the simultaneous development of two infections (acalculous pyelonephritis and cholecystitis) in a postmenopausal female patient, well-controlled on sitagliptin-based anti-diabetic therapy.
  1,874 257 2
Intestinal pseudo-obstruction following oral baclofen: An unusual complication
Vilvapathy Senguttuvan Karthikeyan, Kuppusamy Senthilkumaran, Bettaiyagowder Easwaran, Rajamariappan Rajbhaskar
July-September 2015, 6(3):169-171
DOI:10.4103/0976-500X.162010  PMID:26312004
Baclofen is a gamma- aminobutyric acid B (GABA B) agonist used for the management of spasticity associated with spinal cord injury. Oral baclofen might cause constipation, but intestinal pseudo-obstruction is very rare. We report a 50-year-old male with spasticity following cervical discectomy (C3-4) on oral baclofen for 6 months with intestinal pseudo-obstruction. He had undergone open suprapubic cystostomy for traumatic urethral injury, 45 days prior to the presentation and adhesive intestinal obstruction was also considered a possibility. However, there were no air fluid levels on abdominal radiographs and ultrasound abdomen was non-contributory. Withdrawal of baclofen was therapeutic in this patient. This case is being reported to highlight the rare possibility of oral baclofen induced intestinal pseudo-obstruction.
  1,735 231 1
RESEARCH LETTERS
Identification and characterization of primate P-glycoprotein
Mesfin Yimam
July-September 2015, 6(3):154-156
DOI:10.4103/0976-500X.162021  PMID:26311999
  1,716 248 -
NEWS AND VIEWS
New drugs: New hope in the treatment of MRSA
Podila Karuna Sree, Yadala Venkata Rao
July-September 2015, 6(3):184-184
DOI:10.4103/0976-500X.162018  
  1,439 293 -
CORRESPONDENCES
Prescription errors in cancer chemotherapy: Omissions supersede potentially harmful errors
Subodh Kumar
July-September 2015, 6(3):182-182
DOI:10.4103/0976-500X.162053  PMID:26312008
  1,440 178 -
ERRATUM
Stevens-Johnson syndrome caused by Cefepime: Erratum

July-September 2015, 6(3):193-193
DOI:10.4103/0976-500X.162023  PMID:26312012
  1,405 188 -
CORRESPONDENCES
Authors' reply
Jayanthi Mathaiyan, Tanvi Jain, Biswajit Dubashi, K Satyanarayana Reddy, Gitanjali Batmanabane
July-September 2015, 6(3):182-183
DOI:10.4103/0976-500X.162054  PMID:26312009
  1,337 150 -
CASE REPORTS
Nebivolol-induced gynecomastia
Erkan Köklü, Şakir Arslan, İsa Öner Yüksel, Nermin Bayar, Deniz Demirci
July-September 2015, 6(3):166-168
DOI:10.4103/0976-500X.162009  PMID:26312003
Adverse drug reactions play a substantial role in the etiology of gynecomastia. Gynecomastia as an adverse drug reaction, related to some cardiovascular drugs, has been reported in literature. Nebivolol is a third generation beta-blocker, and gynecomastia as an adverse effect on the consumption of this drug has not been reported in any article yet. We herein present the case of a 42-year-old male, who developed bilateral gynecomastia following nebivolol use and complete regression after discontinuation of nebivolol. Other reasons causing gynecomastia were excluded. Discontinuation of the responsible drug is quite sufficient with regard to the treatment of drug-induced gynecomastia, without any pharmacological or surgical treatment.
  853 190 2
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