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   Table of Contents - Current issue
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July-September 2020
Volume 11 | Issue 3
Page Nos. 87-127

Online since Wednesday, December 23, 2020

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MINI REVIEW  

Warfarin: Looking Beyond Vitamin K in Diet Highly accessed article p. 87
Navneet Attri, Lenora Farnam-Fard
DOI:10.4103/jpp.JPP_102_20  
Warfarin has been widely used for its anticoagulant properties. It has a narrow therapeutic range with complex interactions with various dietary products, herbal supplements, and with other medications. We recently encountered a case of warfarin coagulopathy in a patient that had been on stable doses of warfarin since 2011 with successful maintenance of international normalized ratio in the therapeutic range. By the process of elimination, the cause was attributed to the patient's recent inclusion of pineapple papaya smoothies in her diet. This study highlights the importance of detailed history taking with a focus on diet changes and supplements in patients on warfarin. Warfarin has an extensive list of interactions with prescription and over-the-counter medications, various vegetables, fruits, and herbal supplements through an effect on warfarin metabolism by cytochrome 450 enzymes. While it is a well-known fact that green leafy vegetables diminish warfarin therapeutics due to their high Vitamin K content, warfarin interactions with fruits are less well known. The focus of this article is a review of the literature about the plausible interactions of pineapple and papaya with warfarin. We have briefly touched on the interactions of warfarin with other fruits.
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REVIEW ARTICLE Top

Current medicines for malaria including resistance issues p. 90
Dejen Nureye, Mohammed Salahaddin, Ameha Zewudie
DOI:10.4103/jpp.JPP_23_20  
Malaria is an old disease and continues to be a major health problem in many countries. In spite of decrement in morbidity and mortality due to malaria, the transmission is still active throughout the world. Hence, appropriate treatment is needed to handle malaria in addition to preventive measures. However, unavailability of new drugs and the occurrence of resistant Plasmodium strains toward many conventional antimalarial drugs including artemisinins are the major obstacles in combating malaria infection. Thus, experts from all directions of our planet are in search of novel compounds, and many new chemical entities, such as artefenomel, ferroquine, KAE609, KAF156, DSM265, methylene blue, MMV39048, DDD107498, SJ733, and MMV253, have been under drug development process. While many agents are in the pipeline, most of them are not able to kill both gametocytes and hypnozoites.
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RESEARCH PAPERS Top

Targeting oxidative stress, transforming growth factor beta-1, and the mammalian target of rapamycin by valproic acid to ameliorate bleomycin-induced scleroderma p. 100
Maaly A Abd Elmaaboud, Mohamed S Omar, Ahmed M Kabel
DOI:10.4103/jpp.JPP_99_20  
Objective: To explore the possible ameliorative effect of valproic acid on the experimental model of skin fibrosis induced by bleomycin. Materials and Methods: Forty male BALB/c mice were divided into four equal groups as follows: control group, bleomycin group, bleomycin + Valproic acid group, and Valproic acid group. Mice were assessed for their body weight every 3 days throughout the whole study. Skin tissues were used to evaluate the oxidative stress parameters, transforming growth factor beta 1 (TGF-β1), tumor necrosis factor alpha, interleukin 15, and mammalian target of rapamycin (mTOR). Skin fibrosis was evaluated by measuring dermal thickness and staining the skin tissues with Masson trichrome stain. Furthermore, the skin tissues were immunostained with alpha smooth muscle actin (α-SMA). Results: Administration of Valproic acid to bleomycin-treated mice resulted in the restoration of the body weight with significant decrease in the dermal thickness, amelioration of oxidative stress, suppression of TGF-β1 and mTOR expression, and significant reduction of the percentage of α-SMA immunostaining and the proinflammatory cytokine levels compared to mice treated with bleomycin alone. Conclusion: Valproic acid has an antifibrotic effect on skin fibrosis which may represent a beneficial therapeutic modality for the management of scleroderma.
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Magnesium sulfate versus clonidine as an adjuvant to ultrasound-guided supraclavicular brachial plexus block in upper limb surgery: A double-blind randomized controlled trial p. 107
Archana Mohanakumar, Ramyavel Thangavelu, Anju Annie Paul, RV Ranjan, Sagiev Koshy George
DOI:10.4103/jpp.JPP_98_20  
Objective: To compare the efficacy of clonidine and magnesium sulfate (MgSO4) when administered as an adjuvant to supraclavicular brachial plexus block in upper limb surgery. Materials and Methods: Sixty patients belonging to the American Society of Anesthesiologists classification (ASA) 1 and 2 undergoing upper limb surgical procedures were randomized to receive either 30 μg injection clonidine or 200 mg injection MgSO4 added to 18 ml of 0.5% levobupivacaine + 7 ml of 2% lignocaine with adrenaline. The primary objective of the study was to compare the duration of sensory (postoperative analgesia) and motor block between the two groups. The secondary objectives were to compare the onset time of motor and sensory block along with heart rate and mean arterial pressure between the two groups, which was recorded at regular intervals by the blinded anesthesiologist intraoperatively. Unpaired Student's t-test and repeated-measures analysis of variance were used for the analysis of parameters between the two groups. Results: There was no statistically significant difference between clonidine and MgSO4 groups in terms of primary outcome, i.e., the duration of postoperative analgesia (12.10 ± 3.86 h vs. 10.93 ± 3.68 h, P = 0.236) or duration of motor block (10.67 ± 3.70 h vs. 9.50 ± 2.89 h, P = 0.180). The mean onset time for motor block was relatively faster in clonidine group compared to MgSO4 with a borderline significance (P = 0.049). No clinically significant difference was observed in the mean onset of sensory block or hemodynamics between the two groups. Conclusion: Both, clonidine and MgSO4, as an adjuvant to supraclavicular brachial plexus block were found to have a similar onset time and duration of analgesia and motor block.
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Effect of oral isotretinoin on anxiety and depression in patients with acne p. 113
Balkrisha Nikam, Varsha Jamale, S Tapdia Ravikumar
DOI:10.4103/jpp.JPP_17_20  
Objective: To study the side effect profile of systemic isotretinoin (ITT) and its association with anxiety and depression in the Indian population. Materials and Methods: In this prospective observational study, 300 patients of either gender, aged >12 years, taking oral ITT were evaluated for severity of acne by the visual analog scale (VAS) and psychiatric side effects with the Hamilton anxiety rating scale (HAM-A) and Montgomery Asberg Depression Rating scale (MADRS) at baseline up till the fourth visit. Software R version 3.6.0. was employed to analyze the data. Results: A significant improvement in VAS score was observed at baseline to final visit (P = 0.001). Significant increase in MADRS score was observed at baseline to final visit (P < 0.05) with mild and moderate depression in four (1.3%) and two patients (0.6%), respectively. On the contrary, a significant decrease in HAM-A score was observed over the visits (P < 0.05). Xerosis-Pruritus (79.7%) and cheilitis (82.7%) were the most common side effects observed. A trend from regular menstrual cycles to irregular menstrual cycles was found with ITT. With respect to lipid profile, a significant difference was observed at baseline values to the final visit (P < 0.05). Conclusion: ITT has proven its efficacy in reducing the severity of acne. Although it showed an improvement in anxiety, a negligible association was found with depression. Hence, ITT can be used safely as its benefits outweigh its side effects.
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Uropathogens causing urinary tract infection in adults in a tertiary care hospital p. 119
R Abisha Rezia, R Vijendra, Anjana Gopi
DOI:10.4103/jpp.JPP_100_20  
Objective: To study the profile of uropathogens, causing UTI in adults in our hospital and research center, assess their pattern of antimicrobial susceptibility, the clinical course, and outcome. Materials and Methods: This prospective observational study included all participants with suspected UTI whose urine samples grew a positive culture of uropathogens. The study was done in the department of microbiology from July 2019 to December 2019. The urine samples were processed by standard methods, and antimicrobial susceptibility was performed using the Kirby–Bauer disk diffusion method. The details of the pathogens grown and their antimicrobial sensitivity and resistance patterns were recorded, and the participants were followed up during their course in the hospital. Results: A total of 549 urine samples from adult participants showed positive cultures. Ceftriaxone (33.3%; n = 50) and piperacillin + tazobactam (31.3%; n = 47) were the empirical antimicrobials used. Escherichia coli (37.5%; n = 195) was the most common uropathogen, followed by Enterococcus spp. (17.3%; n = 90) and Klebsiella pneumoniae (12.1%; n = 63). E. coli was resistant to amoxicillin + clavulanic acid, cephalosporins, and ciprofloxacin and sensitive to meropenem, amikacin, and piperacillin + tazobactam. Conclusion: The changing etiology of UTI and emergence of drug resistance is highlighted. Different uropathogens and their antimicrobial resistance are a concern for future treatment options in UTI.
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RESEARCH LETTER Top

Assessment of utilization and rationality of analgesic drugs in perioperative setting in a tertiary care teaching institute p. 125
Nirmik Dongre, Sujata Dudhgaonkar, Kavita M Jaiswal, Nandkishore Jaiswal, Lohit S Vaishnao
DOI:10.4103/jpp.JPP_71_20  
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ERRATUM Top

Erratum: Curcumin improves the behavior and memory in mice by modulating the core circadian genes and their associated micro-RNAs p. 127

DOI:10.4103/0976-500X.300357  
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