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2017| July-September | Volume 8 | Issue 3
Online since
September 27, 2017
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REVIEW ARTICLES
An overview of the extraarticular involvement in rheumatoid arthritis and its management
Subham Das, Prasanta Padhan
July-September 2017, 8(3):81-86
DOI
:10.4103/jpp.JPP_194_16
PMID
:29081614
Rheumatoid arthritis (RA) is an autoimmune systemic disease characterized by long-standing inflammation and significant joint destruction. Despite significant research and success toward the treatment modalities, complete remission still remains a challenge. Even then a number of early and late extraarticular manifestations (EAMs) of the disease further complicate the disease progression. Various EAM encountered in RA can involve more than one organ or system in the body and their clinical features also show lot of variations, mostly involving cutaneous, cardiovascular, and pulmonary systems. The mortality associated with EAM may also be quite high in RA, sometimes more than the disease itself. These EAMs are difficult to diagnose and even more difficult to treat since no clear consensus exists among the rheumatologists as to their correct classification and also due to the fact that no clearcut guidelines are available for their treatment. With this background knowledge, the present review focuses on the various EAMs of RA, their classification, clinical features, and general management overview.
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RESEARCH PAPERS
Efficacy and tolerability of olmesartan, telmisartan, and losartan in patients of stage I hypertension: A randomized, open-label study
Mrunalini Kalikar, Kundan S Nivangune, Ganesh N Dakhale, Chaitali S Bajait, Smita D Sontakke, Vijay M Motghare, Ritu Budania
July-September 2017, 8(3):106-111
DOI
:10.4103/jpp.JPP_39_17
PMID
:29081617
Objectives:
To compare the efficacy and tolerability of losartan, telmisartan, and olmesartan as antihypertensive agents and evaluate and compare their effects on lipid profile and blood glucose.
Materials and Methods:
This was a randomized, open-label, parallel-group, comparative study conducted in sixty patients of Stage I hypertension. The eligible patients were randomly allocated into three treatment groups: (1) Tablet olmesartan (20 mg), (2) Tablet telmisartan (40 mg), and (3) Tablet losartan (50 mg). Blood pressure (BP) was assessed at an interval of 2 weeks for 3 months. Fasting blood glucose (FBG) and lipid profile were estimated at baseline and then at 12 weeks.
Results:
Olmesartan and telmisartan were more efficacious than losartan in reducing diastolic BP (DBP). There was a statistically significant decrease in mean blood glucose level (
P
< 0.02) after 12 weeks of treatment in telmisartan group when compared to baseline. Serum total cholesterol, triglycerides, and low-density lipoproteins decreased significantly after 12-week treatment with olmesartan and telmisartan.
Conclusions:
The most efficacious drug in reducing BP is Olmesartan whereas telmisartan and losartan show equal efficacy. Telmisartan shows the most favorable effects on FBG and lipid profile.
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4,167
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CASE REPORTS
Ceftriaxone for the treatment of methicillin-susceptible
Staphylococcus aureus
Bacteremia: A case series
Rachel Amanda Lowe, Katie Elizabeth Barber, Jamie Leigh Wagner, Allison Miriam Bell-Harlan, Kayla Renay Stover
July-September 2017, 8(3):140-144
DOI
:10.4103/jpp.JPP_5_17
PMID
:29081626
Methicillin-susceptible
Staphylococcus aureus
(MSSA) causes 45% of
S. aureus
bloodstream infections (BSI) and is the most important cause of BSI-associated death. The standard of care therapy is an anti-staphylococcal penicillin or cefazolin, but dosing frequencies for these agents are often infeasible; multiple daily doses tie up infusion lines and are impractical for outpatient antibiotic infusion. Ceftriaxone represents a promising alternative, with once daily dosing and a short infusion time. Currently, treatment with ceftriaxone for invasive MSSA infections is infrequent, with minimal data supporting the clinical utility of ceftriaxone for MSSA BSI. In this case series, we identified 15 patients receiving ceftriaxone for treatment of MSSA BSI, either following standard of care therapy or as initial therapy. Patients were evaluated for clinical cure (CC)(clearance of BSI and normalization of white blood cell count) and microbiological cure (MC)(clearance of blood cultures and no recurrence of organism within 60 days). CC was observed in seven patients, with MC observed in all patients. Only one patient was readmitted to the hospital. This case series provides vital data to support ceftriaxone for treatment of MSSA BSI. With few readmissions and recurrences of infection, ceftriaxone was an effective option for maintenance therapy after resolution of the BSI. Ceftriaxone appears to be a viable alternative for the treatment of MSSA BSI.
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3,266
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REVIEW ARTICLES
Retrospection on the role of soluble guanylate cyclase in parkinson's disease
Mohankrishna Ghanta, Elango Panchanathan, Bhaskar V. K. S Lakkakula, Anbumani Narayanaswamy
July-September 2017, 8(3):87-91
DOI
:10.4103/jpp.JPP_45_17
PMID
:29081615
Soluble guanylate cyclase (sGC) is an important transducing enzyme of cyclic guanosine monophosphate (cGMP) signaling pathway in striatum which has been considered as a potential target for the treatment of Parkinson's disease. Etiology of Parkinson's disease is multifactorial, finally resulting in abnormal proteinopathies causing degeneration of nigrostriatal pathways. Understanding the pathological basis of Parkinson's disease at molecular level is still an achievable target for the researchers and clinical practitioners. sGCs may be one of the causative factors resulting in Parkinson's disease due to glutamate toxicity or other event. This review presents the literature from articles of past five decades nearly as still this enzyme protein and its role in Parkinson's disease is not that clearly understood or presented till date. Recent interventions of this protein inhibition in the treatment of Parkinson's disease preclinically gave a chance to review the literature about this enzyme and its correlation with factors causing Parkinson's disease. We explored literature using PubMed and EMBASE for the role of sGC in Parkinson's disease. Databases were searched using the following terms: Parkinson's disease, neurotoxins, guanylate cyclase, sGC-cGMP pathway, and neurodegeneration. This review listed out the factors that have probability for stimulating sGC which already have been listed as a neurotoxins causing Parkinson's disease.
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357
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RESEARCH PAPERS
Biological response modifiers in rheumatoid arthritis: Systematic review and meta-analysis of safety
Nitishkumar D Tank, Bharti N Karelia, Bhavisha N Vegada
July-September 2017, 8(3):92-105
DOI
:10.4103/jpp.JPP_155_16
PMID
:29081616
Objective:
To analyze available evidence on the safety of different biological response modifiers which are used for a treatment of rheumatoid arthritis (RA).
Materials and Methods:
We searched systematically for randomized controlled clinical trials on treatment of RA with different biological response modifiers, followed by a systematic review with meta-analysis. Trials were searched from MEDLINE and Cochrane Library databases. The following safety parameters reported in the selected trials were analyzed: number of patients suffering any adverse event (AE), withdrawal due to AEs, serious AE (SAEs), infections, serious infections, infusion reactions, injection site reactions, malignancies, and overall mortality. Undesired effects were estimated using combined relative risks (RR) and number needed to harm (NNH). Heterogeneity was evaluated by Cochrane's Q and
I
2
statistics.
Results:
According to inclusion criteria, a total of 43 trials (20,504 patients) were included in this study. A total number of AEs were found more with abatacept (RR: 1.05, NNH: 21.93). Withdrawal due to AEs was found with all biologicals, highest with anakinra (RR: 3.48, NNH: 15.70). Patients receiving newer tumor necrosis factor-alpha inhibitors, golimumab, were more likely to develop SAEs (RR: 2.44, NNH: 12.72) and infection (RR: 1.25, NNH: 10.09), and in certolizumab, serious infections (RR: 2.95, NNH: 37.31) were found more. Infusion reaction develops more with rituximab (RR: 1.52, NNH: 8.47). Etanercept showed the highest risk to develop infusion site reaction (RR: 5.33, NNH: 4.65). Biologicals showed no difference to their control counterparts in malignancy and mortality risk.
Conclusion:
This meta-analysis helps to clarify some frequently encountered and unanswered safety questions of different biological response modifiers, a new class of drugs, in the clinical care of RA patients.
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COMMENTARY
Why the Jan Aushadhi scheme has lost its steam in India?
Vijay Thawani, Abin Mani, Neeraj Upmanyu
July-September 2017, 8(3):134-136
DOI
:10.4103/jpp.JPP_38_17
PMID
:29081624
The Jan Aushadhi Scheme (JAS) initiated by the Government of India is a powerful intervention against the unjustifiable pricing of medicines by private pharmaceutical industry, to make the generic medicines available at affordable prices. The marginalized populations of India are not able to afford many branded medicines; hence, there is an urgent need for making the cheaper generics available to Indians in the best interest of populations. It has been observed that lack of awareness in the public, distribution of free medicines by state governments, lack of support for JAS, poor supply chain, and doctors not prescribing generic medicines are the major constraints faced by the JAS leading to its poor success.
[ABSTRACT]
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2,718
213
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RESEARCH PAPERS
Effect of lorazepam in reducing psychological distress and anticipatory nausea and vomiting in patients undergoing chemotherapy
Aloysius James, Malini Muraleedharan Nair, Dhanya Susan Abraham, Joel Sunny Kovoor, Wesley M Jose, Remya Reghu
July-September 2017, 8(3):112-115
DOI
:10.4103/jpp.JPP_54_17
PMID
:29081618
Objectives:
To evaluate the efficacy and safety of lorazepam in reducing psychological distress and chemotherapy-induced nausea and vomiting.
Methodology:
It was a prospective interventional study with seventy patients for a period of 1 year. In which, patients' anxiety, distress and status of nausea, and vomiting were assessed in the first four chemotherapy cycles before drug intervention. During the subsequent chemotherapy cycles, the outcomes of the intervention were reassessed along with patient's quality of life (QOL).
Results:
Out of seventy patients, 62 showed improvement in their distress level after the drug intervention and patient counseling. Lorazepam along with other antiemetic drugs reduced chemotherapy-induced delayed nausea and vomiting. During the course of the study, 15 patients experienced drowsiness as an adverse reaction to lorazepam. The overall QOL of the population was also improved with lorazepam.
Conclusion:
Lorazepam along with patient counseling can improve patient's psychological distress and thus their QOL. The off-labeled use of lorazepam can be utilized for controlling chemotherapy-induced nausea vomiting.
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2,312
401
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Treatment outcome of ovulation-inducing agents in patients with anovulatory infertility: A prospective, observational study
Kinjal Prajapati, Mira Desai, Samidh Shah, Sumesh Choudhary, Rohina Aggarwal, Vineet Mishra
July-September 2017, 8(3):116-121
DOI
:10.4103/jpp.JPP_43_17
PMID
:29081619
Objective:
To compare different treatment regimens on pregnancy rate and outcome in patients with anovulatory infertility.
Patients and Methods:
A prospective observational study was conducted on patients with infertility due to anovulation. Patients treated with clomiphene citrate (CC) 50/100 mg/day from 2
nd
to 6
th
day of menstrual cycle (MC) (
n
= 38), short gonadotropin-releasing hormone (GnRH) agonist regimen (leuprolide [0.5 mg subcutaneous] + recombinant follicle-stimulating hormone [rFSH] [225 IU intramuscular [IM] from 2
nd
to 10
th
day of MC [
n
= 32]), long GnRH agonist regimen (leuprolide from 21
st
day followed by leuprolide + rFSH from 2
nd
to 10
th
day of MC [
n
= 19]), and antagonist regimen (human menopausal gonadotropin [hMG] [150 IU IM] from 2
nd
day followed by hMG + cetrorelix from 7
th
to 10
th
day of MC) (
n
= 6) were recruited and followed up for follicular size, endometrial thickness, and pregnancy test. Data were analyzed using appropriate statistical test and
P
< 0.05 was considered statistically significant.
Results:
A significant increase in follicular diameter and endometrial thickness was observed in patients treated with gonadotropin regimens as compared to CC alone (
P
< 0.0001). The highest number of positive pregnancy test with ultrasonographic evidence of gestational sac was observed with leuprolide + rFSH (long regimen) (10/19, 52.6%) followed by leuprolide + rFSH (short regimen) (13/32, 40.6%) while least in antagonist regimen (2/6, 33.3%) and CC (1/38, 2.63%). All regimens were well tolerated.
Conclusion:
Treatment outcome was better with long agonist regimen.
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2,360
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CASE REPORTS
Looking beyond the obvious: Cefepime-induced nonconvulsive status epilepticus
Vinayaka Anuhya, Sushil Kiran Kunder, Sharath Madhyastha, Veena Nayak, Raviraja V Acharya, Kusugodlu Ramamoorthi, Avinash Arivazhahan, Rahul Sai Gangula
July-September 2017, 8(3):145-147
DOI
:10.4103/jpp.JPP_64_17
PMID
:29081627
Cephalosporins are a commonly used class of antibiotics in various types of infections. Cefepime, a fourth-generation cephalosporin, has been reported to cause neurotoxicity, which can present itself as varied manifestations. Nonconvulsive status epilepticus (NCSE) is a rare manifestation of this neurotoxicity. This condition often proves difficult to diagnose because it is chiefly an electroencephalogram-based diagnosis. The authors report a case of cefepime-induced NCSE in a 57-year-old female patient with compromised renal status.
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2,007
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Terlipressin-induced peripheral ischemic gangrene in a diabetic patient
Phulen Sarma, Gaurav Muktesh, Narender Dhaka, Rakesh Ruhela, Abhishek Mishra, Rahul Singh, Saroj K Sinha, Bikash Medhi, Rakesh Kochhar
July-September 2017, 8(3):148-150
DOI
:10.4103/jpp.JPP_42_17
PMID
:29081628
Terlipressin is used commonly in the management of hepatorenal syndrome and acute variceal bleeding. Like its parent compound vasopressin, it is also notorious for its ischemic complications. Terlipressin-induced ischemic complications can virtually affect any part of the body, but the incidence of serious complications is less than its parent compound vasopressin. Here, we report a case of terlipressin-induced peripheral ischemic gangrene in a diabetic male, which ultimately led to death of the patient.
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CASE SERIES
Sodium glucose transporter 2 inhibitors and diabetic ketoacidosis in three patients with diabetes: Underlying causation
Jordan L Kelley, Matthew Strum, Daniel M Riche, Andrew M Chandler
July-September 2017, 8(3):137-139
DOI
:10.4103/jpp.JPP_20_17
PMID
:29081625
Sodium glucose transporter 2 inhibitors (SGLT2i) inhibit the reabsorption of glucose in the renal tubules reducing glycemia and increasing glucosuria. The increased glucosuria causes a shift in normal flora and colonization of pathogenic microorganisms leading to an increase in mycotic genital infections. Recent Food and Drug Administration reported cases of diabetic ketoacidosis (DKA) after initiation of SGLT2i probes the question of safety with such agents. The mechanisms of ketoacidosis and the breakdown of lipids are often misunderstood, and blame is placed on lack of insulin or on medications used to treat diabetes. However, many patients living with diabetes do not experience DKA if the proper treatment and management of concomitant comorbidities are addressed. After a retrospective chart review of 250 patients, three patients were identified with DKA while on SGLT2i, but for three distinct contrasting reasons. Assessment of the pharmacodynamics of SGLT2i and the pathophysiology of DKA infers that emphasis for prevention of SGLT2i-associated DKA should be placed on appropriate diagnosis, infection, and electrolyte abnormalities.
[ABSTRACT]
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1,910
215
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RESEARCH PAPERS
Cardioprotective effect of coenzyme Q
10
on apoptotic myocardial cell death by regulation of bcl-2 gene expression
Najam Ali Khan, M Abid, Aftab Ahmad, Mohammed F Abuzinadah, Mohammed Basheikh, Kamal Kishore
July-September 2017, 8(3):122-127
DOI
:10.4103/jpp.JPP_47_17
PMID
:29081620
Objectives:
To investigate the effect of coenzyme Q10 (CoQ10) on apoptotic myocardial cell death in rat model of heart ischemia and reperfusion I/R injury.
Materials and Methods:
Eighteen rats (200–250 g) were divided into three groups of 6 rats in each. Group I (sham-operated control group): this is the control group. The animals received the surgical procedure without IR injury or any drug treatment. Group II (I/R group): ischemia was accomplished by the occlusion of coronary artery for 30 min followed by reperfusion for 45 min and Group-III (Coenzyme Q
10
treated group): Treated with CoQ
10
at a dose of 1 mg/kg, postoperative for 7 days before induction of IR injury.
Results:
The study revealed that pretreatment with CoQ
10
has shown protective effect on apoptotic rat heart and agreed with earlier reports that CoQ
10
significantly protects from oxidative stress and cytopathological changes caused by cardiac ischemia followed by reperfusion and attenuated decrease of antioxidant enzymes. Nitric oxide production in the heart of ischemic rats was significantly increased by the pretreatment with CoQ
10
in comparison with IR group.
Conclusions:
CoQ
10
protects against cardiac apoptosis induced by IR injury by significantly decreasing the apoptotic DNA and regulating the expression of
Bcl-2
gene.
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1,808
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ERRATUM
Erratum: Blood sample collection in small laboratory animals
July-September 2017, 8(3):153-153
DOI
:10.4103/0976-500X.215702
PMID
:29081629
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OBITUARY
A giant of indian pharmacology is no more: Rest in peace Prof. B. N. Dhawan
Syed Ziaur Rahman
July-September 2017, 8(3):151-152
DOI
:10.4103/jpp.JPP_105_17
[FULL TEXT]
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1,613
165
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RESEARCH LETTERS
Penetration of bromelain in serum and rhinosinusal mucosa in patients undergoing endoscopic sinus surgery
Desiderio Passali, Luisa Maria Bellussi, Codrut Sarafoleanu, Michele Loglisci, Claudiu Manea, Cristina Iosif, Francesco Maria Passali
July-September 2017, 8(3):128-129
DOI
:10.4103/jpp.JPP_169_16
PMID
:29081621
[FULL TEXT]
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1,562
186
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Cardiac safety of high-dose micafungin
Kayla R Stover, John D Cleary
July-September 2017, 8(3):132-133
DOI
:10.4103/jpp.JPP_37_17
PMID
:29081623
[FULL TEXT]
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1,507
241
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The basis for low-affinity herg potassium channel block by sotalol
Yi Hong Zhang, Christopher E Dempsey, Jules C Hancox
July-September 2017, 8(3):130-131
DOI
:10.4103/jpp.JPP_69_17
PMID
:29081622
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
1,418
175
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