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   2013| January-March  | Volume 4 | Issue 1  
    Online since February 22, 2013

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Critical appraisal skills programme
Jatinder Singh
January-March 2013, 4(1):76-77
  23,936 5,130 32
Accessibility and use of essential medicines in health care: Current progress and challenges in India
Dipika Bansal, Vilok K Purohit
January-March 2013, 4(1):13-18
DOI:10.4103/0976-500X.107642  PMID:23662019
Essential Medicine Concept, a major breakthrough in health care, started in 1977 when World Health Organization (WHO) published its first list. Appropriate use of essential medicines is one of the most cost-effective components of modern health care. The selection process has evolved from expert evaluation to evidence-based selection. The first Indian list was published in 1996 and the recent revision with 348 medicines was published in 2011 after 8 years. Health expenditure is less in India as compared to developed countries. India faces a major challenge in providing access to medicines for its 1.2 billion people by focusing on providing essential medicines. In the future, countries will face challenges in selecting high-cost medicines for oncology, orphan diseases and other conditions. There is a need to develop strategies to improve affordable access to essential medicines under the current health care reform.
  10,302 938 6
The dawn of hedgehog inhibitors: Vismodegib
Selvarajan Sandhiya, George Melvin, Srinivasamurthy Suresh Kumar, Steven Aibor Dkhar
January-March 2013, 4(1):4-7
DOI:10.4103/0976-500X.107628  PMID:23662017
Cancer, one of the leading causes of death worldwide is estimated to increase to approximately 13.1 million by 2030. This has amplified the research in oncology towards the exploration of novel targets. Recently there has been lots of interest regarding the hedgehog (Hh) pathway, which plays a significant role in the development of organs and tissues during embryonic and postnatal periods. In a normal person, the Hh signaling pathway is under inhibition and gets activated upon the binding of Hh ligand to a transmembrane receptor called Patched (PTCH1) thus allowing the transmembrane protein, smoothened (SMO) to transfer signals through various proteins. One of the newer drugs namely vismodegib involves the inhibition of Hh pathway and has shown promising results in the treatment of advanced basal-cell carcinoma as well as medulloblastoma. It has been granted approval by US Food and Drug Administration's (US FDA) priority review program on January 30, 2012 for the treatment of advanced basal-cell carcinoma. The drug is also being evaluated in malignancies like medulloblastoma, pancreatic cancer, multiple myeloma, chondrosarcoma and prostate cancer. Moreover various Hh inhibitors namely LDE 225, saridegib, BMS 833923, LEQ 506, PF- 04449913 and TAK-441 are also undergoing phase I and II trials for different neoplasms. Hence this review will describe briefly the Hh pathway and the novel drug vismodegib.
  5,491 1,072 34
Effect of addition of either sitagliptin or pioglitazone in patients with uncontrolled type 2 diabetes mellitus on metformin: A randomized controlled trial
Shalini Chawla, Nitin Kaushik, Narinder Pal Singh, Raktim Kumar Ghosh, Alpana Saxena
January-March 2013, 4(1):27-32
DOI:10.4103/0976-500X.107656  PMID:23662021
Objective: To compare and study the dipeptidy1 peptidase-4 (DPP-4) inhibitors in combination with metformin against established combination therapies. Materials and Methods: This 16-week study was designed to compare sitagliptin versus pioglitazone as add-on therapy in patients of type 2 diabetes mellitus inadequately controlled with metformin alone. Fifty-two patients were randomized into two groups to receive either sitagliptin 100 mg (group 1) or pioglitazone 30 mg (group 2) in addition to metformin. The primary efficacy end point was change in HbA1c. Secondary end points included change in fasting plasma glucose (FPG), body weight and lipid profile. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire. Both the groups had a significant decrease in HbA 1c . Results: There was no significant difference between mean reductions in FPG in both the groups. There was a significant decrease in the mean body weight and body mass index in group 1 in contrast to the significant increase in the same in group 2. Both the treatment groups reported a significant decrease in High-density lipoprotein (HDL-C) and Triglyceride. Conclusion: Sitagliptin was well tolerated without any incidence of hypoglycemia. It was concluded that sitagliptin as an add-on to metformin is as effective and well tolerated as pioglitazone.
  4,582 1,140 9
Strategies and challenges for safe injection practice in developing countries
Sudesh Gyawali, Devendra Singh Rathore, P Ravi Shankar, KC Vikash Kumar
January-March 2013, 4(1):8-12
DOI:10.4103/0976-500X.107634  PMID:23662018
Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.
  4,597 937 9
Efficacy and safety of Tinospora cordifolia lotion in Sarcoptes scabiei var hominis-infected pediatric patients: A single blind, randomized controlled trial
Agnes L Castillo, Marina O Osi, John Donnie A Ramos, Jean L De Francia, Marylaine U Dujunco, Peter F Quilala
January-March 2013, 4(1):39-46
DOI:10.4103/0976-500X.107668  PMID:23662023
Objective: To evaluate the clinical efficacy and safety of Tinospora cordifolia lotion including its cure rate and clearance time compared with permethrin lotion . Materials and Methods: A single blind, randomized, controlled, pilot clinical study was performed in three government institutions to investigate clinical efficacy of T.cordifolia lotion in sixty-six clinically-diagnosed scabies-infected patients. The patients were treated with T.cordifolia or permethrin lotions for three consecutive days for two weeks and clinical assessment of each patient was performed for five weeks. Results: T. cordifolia lotion and permethrin significantly reduced the mean global evaluation score after four weeks of treatment. The two lotions showed comparable effects as anti-scabies agent. Moreover, the clearance time (days) and cure rate using the two lotions did not differ. Clinical improvement, mean clearance time and cure rate of T.cordifolia lotion are comparable with permethrin . Conclusions: Tinospora cordifolia lotion exhibits anti-scabies activity comparable with permethrin. Its incorporation as therapeutic reagent in Sarcoptes scabiei infections is highly recommended.
  4,675 545 2
Comparison of the efficacy and tolerability of ivabradine and ranolazine in patients of chronic stable angina pectoris
Aditi Chaturvedi, Yogendra Singh, Harish Chaturvedi, Vijay Thawani, Sakshi Singla, Deepak Parihar
January-March 2013, 4(1):33-38
DOI:10.4103/0976-500X.107663  PMID:23662022
Introduction: To compare the efficacy and tolerability of Ivabradine (IVA) and Ranolazine (RAN) in chronic angina patients. Materials and Methods: This was a follow-on, open-label trial conducted in a tertiary care hospital of Uttarakhand. Thirty patients each taking IVA 5 mg twice daily or RAN 500 mg twice daily were distributed to the respective groups. Patients were asked to fill a pretested questionnaire on frequency of anginal attacks and adverse reactions before and 2, 4 and 8 weeks after taking the respective medicines. Their blood pressure, heart rate and routine hematological and biochemical estimations were performed at baseline and after intervention. Results were statistically analyzed using different statistical tests, with P < 0.05 considered as significant. Results: There was no significant difference in the frequency of anginal attacks per week between the groups. The adverse drug reactions (ADRs) reported in the IVA group were dizziness (30%), headache (16.6%), backache (16.6%), vertigo (13.3%), blurred vision (13.3%), muscle cramps (10%), arthralgia (10%), cough and dyspnea (6.6%), hypersensitivity rash (6.6%), fever (3.3%) and nausea (3.3%). The ADRs in the RAN group were nausea (26.6%), dizziness (23.3%), vomiting (3.3%), constipation (3.3%) and vertigo (3.3%). The blood pressure, heart rate and routine hematological and biochemical evaluations did not show any significant difference in the pre-post values. IVA significantly decreased the resting heart rate after eight weeks of intervention. Conclusions: Both antianginal agents appeared equiactive. However, RAN had a better safety and tolerability profile than IVA. Serum sickness-like reaction was an adverse event noticed with IVA, which needs causality establishment.
  4,258 841 5
When angels fall…are we lowering the standards of medical education in India?
Gitanjali Batmanabane
January-March 2013, 4(1):1-3
DOI:10.4103/0976-500X.107627  PMID:23662016
  3,127 1,173 -
Oleanolic acid prevents progression of streptozotocin induced diabetic nephropathy and protects renal microstructures in Sprague Dawley rats
Vishal K Dubey, Chandragouda R Patil, Sarika M Kamble, Priti S Tidke, Kalpesh R Patil, Pragnesh J Maniya, Ramchandra B Jadhav, Sudha P Patil
January-March 2013, 4(1):47-52
DOI:10.4103/0976-500X.107678  PMID:23662024
Objective: To study the effect of oleanolic acid (OA) on streptozotocin induced diabetic nephropathy in Sprague Dawley rats. Materials and Methods: Four weeks after intra-peritoneal injection of streptozotocin (STZ; 55 mg/kg), the rats with proteinuria were grouped as: Control (non-diabetic, treated orally with vehicle), diabetic control (treated orally with vehicle) and three diabetic groups receiving 20, 40 and 60 mg/kg/day oral doses of OA. At the end of 8 weeks, urine and serum samples from the rats were processed for determination of creatinine, BUN and GFR. The kidney samples were processed for determination of weight changes, oxidative stress related parameters like catalase, superoxide dismutase and reduced glutathione levels. A part of one kidney from each rat was used for transmission electron microscopy (TEM). Result: As evident in TEM, OA inhibited the nephropathy induced alterations in podocyte integrity, basement membrane thickness and spacing between the podocytes at 60 mg/kg dose. It increased GFR and reduced oxidative stress in the kidneys in a dose dependent manner. These findings conclusively demonstrate the efficacy of OA in diabetic nephropathy. Significant decrease in the oxidative stress in kidneys indicates the role of anti-oxidant mechanisms in the effects of OA. However, OA is known to act through multiple mechanisms like inhibition of the generation of advanced glycation end products and improving the insulin secretion. These mechanisms might have contributed to its efficacy. Conclusion: These results conclusively demonstrate the efficacy of OA in diabetic nephropathy through its possible antioxidant activity.
  3,558 675 6
Aceclofenac induced Stevens-Johnson/toxic epidermal necrolysis overlap syndrome
Kaderthambi Hajamohideen Nooru Ameen, Rakesh Pinninti, Swathi Jami
January-March 2013, 4(1):69-71
DOI:10.4103/0976-500X.107691  PMID:23662031
The purpose of this paper is to report a rare occurrence of Stevens-Johnson/Toxic epidermal necrolysis (SJS/TEN) overlap syndrome after the use of aceclofenac. A 38 year old healthy adult male presented with rapidly evolving rash over face and upper body with ulceration of buccal mucosa and breathlessness after taking aceclofenac tablet. Naranjo score for this adverse drug event was six, thereby making it a probable adverse drug reaction. Despite aggressive fluid resuscitation and use of antihistamines and systemic steroids, patient's health rapidly worsened and died within six hours of presentation. Aceclofenac induced SJS/TEN overlap is an extremely rare clinical association previously reported only once in medical literature. To the best of our knowledge, this is the first case report of such an association in the Indian population. We are presenting this case to highlight the serious adverse reactions possible from a routinely prescribed drug.
  3,333 390 4
Genetic variation and haplotype structure of the gene Vitamin K epoxide reductase complex, subunit 1 in the Tamilian population
Dhakchinamoorthi Krishna Kumar, Deepak Gopal Shewade, Adithan Surendiran, Chandrasekaran Adithan
January-March 2013, 4(1):53-58
DOI:10.4103/0976-500X.107683  PMID:23662025
Objective: To study the genetic variation and haplotype structure of Vitamin K epoxide reductase complex, subunit 1 (VKORC1) gene in the Tamilian population. Materials And Methods: The study was performed on 210 unrelated, healthy volunteers of the Tamilian population, of either sex between the age group of 18-60 years. Five ml of venous blood sample was collected using sodium ethylene diamine tetra acetic acid (EDTA) as anticoagulant. DNA was extracted using phenol-chloroform extraction method. Eight single nucleotide polymorphisms (SNPs) VKORC1 rs9923231 (G), rs7196161 (T), rs2884737 (T), rs17708472 (C), rs9934438 (C), rs8050894 (G), rs23596121 (C), and rs7294 (A) were studied using real-time quantitative Polymerase Chain Reaction (qPCR) method and they were included for constructing five-major haplotype blocks of VKORC1 gene. Results: The major alleles of VKORC1 rs9923231 (G), rs7196161 (T), rs2884737 (T), rs17708472 (C), rs9934438 (C), rs8050894 (G), and rs23596121 (C), were found to be at frequencies of 90.0%, 89.2%, 90.9%, 94.1%, 90.7%, 89.5% and 91.2%, respectively. The variant allele of VKORC1 rs7294 (A) was more frequent (83.6%) in the Tamilian population. The frequencies of haplotypes HAP1 (GTTCCGCA), HAP2 (ACGCTCTG), HAP3 (GTTTCGCG), HAP4 (GTTCCGCG) and HAP5 (GCTCCCCG) were found to be 80.0%, 7.4%, 4.7%, 1.5% and 1.1%, respectively. Conclusion: In the present study the allele- frequency distributions, genotype and haplotype frequencies of the VKORC1 gene was considered. The findings of this study provide the genetic information required for learning the association of VKORC1 genetic variation and oral anticoagulant dose variability among patients receiving oral anticoagulants in the Tamilian population.
  3,147 439 6
Ticagrelor: An emerging oral antiplatelet agent
Shivani Juneja, Kanchan Gupta, Sandeep Kaushal
January-March 2013, 4(1):78-80
DOI:10.4103/0976-500X.107698  PMID:23662033
  2,648 620 4
Prescribing pattern of gastroprotective agents with non-steroidal anti-inflammatory drugs
VS Manohar, M Vinay, T Jayasree, PV Kishan, S Ubedulla, Rohit Dixit
January-March 2013, 4(1):59-60
DOI:10.4103/0976-500X.107684  PMID:23662026
  2,429 447 2
Effect of Casilan® on 13 C-caffeine metabolism in overnight-fasted healthy Nigerian children
Kazeem A Oshikoya, Ken Smith
January-March 2013, 4(1):19-26
DOI:10.4103/0976-500X.107648  PMID:23662020
Objective: To determine the effect of Casilan® on 13 C-caffeine metabolism in healthy Nigerian children. Materials and Methods: Twelve healthy Nigerian children (male: six, female: six) aged 3-8 years were studied on three occasions. After an overnight fast, the children were studied after ingesting Casilan® only (Week 1). They were restudied after ingesting 3 mg/kg of labeled caffeine only (Week 2), and further re-studied after ingesting both Casilan® and labeled caffeine (Week 3). Breath samples were collected by blowing via a straw into an exentainer bottle. The cumulative percentage of 13 C-caffeine exhaled as 13 CO 2 was measured over 2 h. Results: The time courses of 13 C-enrichments in exhaled CO 2 for all the children, after they had ingested labeled caffeine only and after they had ingested both Casilan® and labeled caffeine, were identical. There was a gradual rise and peak of the enrichments at about 60-75 min, followed by a gradual fall (II) or a plateau (III). Contrarily, the time course of 13 C-enrichments for all the children was consistently low and stable after they had ingested Casilan® only (I). The mean values of cumulative percent 13 C-doses recovered in the CO 2 exhaled over a 2-h period, after ingesting labeled caffeine only (8.59 ± 1.10 δ%/mg) and after ingesting both Casilan® and labeled caffeine (8.58 ± 1.33 δ%/mg), were identical, with no statistically significant difference (P = 0.972). This suggests that Casilan® did not affect the CYP1A2 metabolic pathway. Conclusions: Casilan® is a safe, reliable and quantitative food supplement for overnight-fasted children undergoing caffeine breath test.
  2,347 336 -
A study of non-prescription usage of antibiotics in the upper respiratory tract infections in the urban population
Sangeeta Bhanwra
January-March 2013, 4(1):62-64
DOI:10.4103/0976-500X.107687  PMID:23662028
  2,225 445 3
An unusual cause of cardiac arrest in a hospitalized patient
K Ranjan Shetty, Anil Tumkur, Krishnamurthy Bhat, Biby Chacko
January-March 2013, 4(1):72-73
DOI:10.4103/0976-500X.107692  PMID:23662032
We present an unusual case of 24 year old male who was hospitalized for dental procedure and developed cardiac arrest 2 days after the procedure. The patient presented with swelling of buccal cavity for which a biopsy was taken. Two days after the procedure, apparently normal patient suddenly presented at mid night with VT and VF, which were intractable requiring multiple DC shocks. During this period arterial blood gas analysis revealed severe acidosis. The circumstances led us to suspect poisoning as one of the cause for his medical condition. We looked for commonly available toxins. One of the commonly available toxins is hand sanitizer which contains Isopropyl alcohol, glycerin and perfume. Due to prolonged cardiac arrest and intractable arrhythmia patient had sustained hypoxic brain injury. Patient remained hemodynamically stable for next 9 days although his CNS status did not improve. Patient succumbed to sepsis on 9 th day. Healthcare professionals should be aware of such possibilities and treat the patients at the earliest and put a check on the easy availability of IPA based hand sanitizers.
  2,177 324 -
Effectiveness of ellagic acid on isoniazid-rifampicin induced liver damage in rats
Samuel Stephen Ambrose, Ponnu Solairaj, Appian Subramoniam
January-March 2013, 4(1):60-62
DOI:10.4103/0976-500X.107685  PMID:23662027
  2,085 394 5
Fish-oil-rich diet lowers bedsore symptoms by 20-25%
G Sivagnanam
January-March 2013, 4(1):74-74
  2,006 272 -
A structured course in laboratory animal science for postgraduates: Is it a necessity?
Syed I Shehnaz, Anoop K Agarwal
January-March 2013, 4(1):67-68
DOI:10.4103/0976-500X.107689  PMID:23662030
  1,684 314 1
Calcium channel blocking activity of a dihydropyrimidine derivative (BKVIII) on rabbit's aortic strip
Rakesh Kumar, Balbir Kaur, VK Bajaj
January-March 2013, 4(1):64-66
DOI:10.4103/0976-500X.107688  PMID:23662029
  1,522 252 -
Severe morning sickness patients get relief from anti-seizure drug
G Sivagnanam
January-March 2013, 4(1):75-75
  1,512 258 -
Continuing β-blockers after noncardiac surgery improves patient outcomes and lowers mortality
G Sivagnanam
January-March 2013, 4(1):74-75
  1,060 189 -