Objective: To study the effect of metformin on amelioration of hepatotoxicity induced by methotrexate. Materials and Methods: After a 2-weeks of acclimatization period, the animals were randomly separated into three groups (seven rabbits each), all groups were maintained on standard chow diet throughout the experiment (8 weeks). Group 1 was treated with normal saline water (control), Group 2 with methotrexate (MTX, hepatotoxic), and Group 3 with MTX plus metformin. Induction of hepatotoxicity was carried out by administration of MTX to the rabbit in a dose of 0.25 mg/kg /day i.m. for 8 weeks. Results: The treatment with MTX to rabbits for 8 weeks resulted in significant changes in serum liver enzymes, as compared to the baseline group. SGOT, SGPT, ALP, and bilirubin were significantly increased (P < 0.001), while total serum protein was significantly decreased. Similarly, 8 weeks of MTX treatment produced significant (P < 0.001) prolongation in PT. PTT was not significantly changed. It was found that serum MDA levels and SOD activity were significantly increased (P < 0.001), while serum GSH levels were significantly decreased (P < 0.001). Adding metformin to MTX is found to be significantly (P < 0.001) reduced the liver function test and shortening of PT and a significant increase in TSP (P < 0.001). Conclusion: It can be concluded that administration of metformin restored the altered liver function parameters and produced significant improvement in liver histopathological findings. Therefore, this additive drug possesses hepatoprotection against MTX-induced hepatotoxicity.

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MicroRNAs (miRNAs) are a novel group of universally present small noncoding endogenous RNAs that regulate gene expression and protein coding by base pairing with the 3′ untranslated region (UTR) of target mRNAs. So they have been associated with several physiological processes and play an important role in the manifestation of diverse diseases. miRNAs expression is associated with the normal and diverse pathophysiological state including cardiac hypertrophy, neurodegenerative diseases, diabetes and its complication, and cancer because individual miRNAs are associated with the regulation of the expression of multiple target genes. Modulating the expression of a single miRNA can influence an entire gene network and thereby modify complex disease phenotypes. From recent studies, it has been confirmed that miRNA has a potential physiological role in various body systems. But in some specialized condition over expression of miRNA within the cytoplasm also leads to some pathological condition in the body. Here, we summarize the roles of miRNAs in various pathological conditions and consider the advantages and potential challenges of miRNA-based therapeutic approaches compared to conventional drug-based therapies.

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Objective: To study the prevalence and patterns of sexual dysfunctions in female patients receiving antidepressants. Materials and Methods: Eighty married female patients with a diagnosis of depressive disorder, currently in remission, and receiving a single antidepressant at least for 3 months, were assessed for sexual dysfunction on female sexual function index (FSFI) scale. Results: Thirty four patients (42.5%) receiving antidepressants had FSFI score less than 26.55 and were considered to have sexual dysfunction. When only the domain cutoff scores were used for the whole study sample (n=80), it was found that 95% had decreased desire, 60% had decreased arousal, 37.5% had decreased lubrication, 63.8 had decreased orgasm, 55% had decreased satisfaction and 25% had pain during sexual activity. Conclusions: To conclude, our study suggests that sexual dysfunction is quite prevalent in married female patients receiving antidepressants and all the domains of sexual functioning are impaired by antidepressants.

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Objectives: Zornia diphylla (L.) Pers is an ethnomedical herb. The aim of the study is to scientifically verify the traditional use of Z. diphylla as an anticancer medicine. Materials and Methods: Different extracts, fractions, and chemical isolates of the whole plant were screened for cytotoxicity to Dalton's lymphoma ascites (DLA) cells by the Trypan blue exclusion method and MTT assay. Column chromatographic and preparative TLC techniques were used for the isolation of active fraction (AF) and active principle. Cytotoxicity of AF to different cell types was tested. The apoptotic activity of AF was evaluated by morphological observations, nuclear condensation, and comet assay. In vivo antitumor activity of AF was determined in DLA-challenged mice. Short-term (29 days) preliminary toxicity evaluation of AF was done in mice. Results: n-Hexane extract (but not water and ethanol extracts) showed significant cytotoxicity. AF, isolated from n-hexane extract, induced apoptotic cell death (in vitro) to DLA cells, but not to normal thymocytes and macrophages. A steroid positive active principle was isolated which showed 100% cytotoxicity at 5 μg/mL level. Interestingly, AF (50 mg/kg) protected all the mice challenged with one million DLA cells/mouse. AF (up to 10 times higher than the therapeutic dose) did not exhibit any conspicuous adverse toxic symptoms in the toxicity evaluation. Conclusion: Z. diphylla (AF) showed promising in vitro and in vivo anticancer activity against DLA cells, and it was devoid of any toxicity to mice in short-term toxicity evaluation. The herb is promising for the development of a valuable anticancer medicine.

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Objective: To analyze clinical pharmacist interventions in the intensive care units (ICUs) setting of a tertiary care Indian hospital and to assess the pharmacoeconomic impact on drug-related problems (DRPs). Materials and Methods: A postgraduate clinical pharmacist reviewed drug prescriptions over a period of 7 months. Whenever a DRP is identified, it was discussed with a physician and appropriate suggestions were provided, later it was documented on a preprepared form. Clinical significance of each intervention was graded based on the predicted clinical outcome. Acceptance of the interventions is entirely at the discretion of the medical staff. Each intervention was analyzed with respect to potential cost saving and/or additional cost incurred to existing drug therapy. An independent clinical panel was convened, and all the interventions made by the intervening pharmacist were critically reviewed for potential cost savings. Results: The intervening pharmacist made 117 recommendations, of which 94% was accepted by the medical professionals. The most frequent DRP identified was overdose (24%). The total net cost savings made was Rs. 77260.13 (USD 1796.73). This corresponds with Rs. 965.75 per patient and an annualized savings of Rs. 135205.22. Conclusion: Clinical pharmacist interventions had a significant impact on the cost of drug therapy and the patient outcome in intensive care settings of our hospital.

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Despite comprehensive and stringent phases of clinical trials and surveillance efforts, unexpected and serious adverse drug reactions (ADRs) repeatedly occur after the drug is marketed. ADR reporting is an important aspect of an efficient and effective pharmacovigilance program. Although Medwatch, Yellow Card, CDSCO form, etc. are the protocol forms of ADR collection and reports, a number of countries design and use their respective ADR forms. This review compares similarities and dissimilarities of 13 ADR forms of countries representing their geographical location. This study extracted 73 data elements mentioned in 13 different ADR forms. Only 13 elements were common. An ADR form of Malaysia and Canada covers the highest number of data 43, while Brazil falls to the opposite end with a number of 17 data elements in lieu with the Generic ADR Form. The result of this review highlights 58 data elements of the proposed generic ADR form which ensures that requisite reporting information essential for correct causality assessment of ADRs are included. The proposed "Generic ADR form" could be adopted worldwide mandatorily for reporting any/all ADRs associated with marketed drugs.

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Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN) are rare but serious dermatologic disorders. These grave conditions present as medical emergency, requiring prompt diagnosis and management. These are often drug induced and various groups of drugs, such as sulfa drugs, NSAIDS, etc., have been implicated as to cause TEN. Fluconazole is a commonly used drug with mild side effects. TEN caused by fluconazole is rare, and till now only few cases have been reported in the literature. We present a case of TEN in a human immunodeficiency virus infected man following fluconazole therapy in view of its rare occurrence.

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Aripiprazole is the third generation atypical antipsychotic and a dopamine serotonin system stabilizer (DSS) effective against positive and negative symptoms of schizophrenia. It has a low propensity for extrapyramidal side effects, causes minimal weight gain or sedation, produces no elevation in serum prolactin levels, and does not cause prolongation of QTc interval. This case report is of a patient suffering from schizophrenia (paranoid). The patient developed oculogyric crisis (acute dystonia) with aripiprazole dose uptitration. Dystonic reaction resolved with promethazine administration. Naranjo's causality assessment reveals probable association of aripiprazole with oculogyric crisis. A thorough workup and vigilance is required prior to initiation of aripiprazole in the case of schizophrenia.

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Objective: To determine the effectiveness of dexamethasone on post tonsillectomy morbidities in patients with chronic tonsillitis. Materials and Methods: In this randomized double-blind study, 100 patients who underwent tonsillectomy were enrolled and were randomly allocated into control or dexamethasone group (pre operative, intra operative and post operative groups). Patients were assessed for pain nausea, vomiting and oral intake in the post operative period at 24 h. Results: Patients treated with dexamethasone particularly in the pre and intra operative groups (Group B, Group C) showed a general trend towards lower pain score than post operative group (Group D). The scores were about 1.72±0.84 and 2.20±1.19 in Groups B and C respectively, and 2.64±0.99 in Group D. Overall pain score was found to be more in the control Group A about 4.84±1.21 at 6 h post operatively and showed similar trend for next 24 h. Total number of patients with nausea was significantly high about 84% in control group compared to dexamethasone groups (Group B, C and D) about 20%, 8% and 24% respectively and also incidence of vomiting episodes showed a similar trend. Oral intake was significantly delayed in control group (6.16 ±1.52), P < 0.001 than dexamethasone group. Pre operative and intra operative groups showed early intake (3.68±0.68) and (3.60±1.12) respectively than the postoperative group (5.08±0.95). Conclusions: A single intravenous dose of dexamethasone, given following induction of anaesthesia and at the time of surgery, provided prolonged analgesia, reduced nausea and vomiting and resulted in earlier oral intake.

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Amongst the illicit drugs cocaine, amphetamines and cannabis have been studied and documented well to cause myocardial infarction by different mechanisms but there is very sparse data available on myocardial involvement after heroin abuse. We report a young man who developed acute myocardial injury after heroin inhalation and alcohol binge drinking. Heroin induced cardio toxic effect and vasospasm compounded by alcohol were suspected to be the cause of this.

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