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   2018| January-March  | Volume 9 | Issue 1  
    Online since July 11, 2018

 
 
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REVIEW ARTICLE
The blood blues: A review on methemoglobinemia
Sheba Rani David, Nora Syahirah Sawal, Muhammad Nur Salam Bin Hamzah, Rajan Rajabalaya
January-March 2018, 9(1):1-5
DOI:10.4103/jpp.JPP_79_17  
Methemoglobinemia is a blood disorder in which there is an abnormal amount of methemoglobin (MetHb) formation, thus unable to release oxygen effectively to body tissues. This is mainly because MetHb is the altered state of hemoglobin (Hb) wherein the ferrous iron of heme has been oxidized to the ferric state. This review paper discusses in detail about the different types of methemoglobinemia and their causes with biochemical pathway and mechanisms. Patients with high MetHb in the blood will appear blue when they have cyanosis but can be cured with the methylene blue solution. However, a proper management should be laid out for strategic treatment. This review will be useful to health-care providers, pharmacists, biochemists, and researchers to understand the basics of methemoglobinemia and its current treatment with guidelines. This review will benefit the readers to understand and will be a ready reference for methemoglobinemia.
  9,313 763 -
RESEARCH PAPERS
Efficacy and safety of nadifloxacin and benzoyl peroxide versus adapalene and benzoyl peroxide in acne vulgaris: A randomized open-label Phase IV clinical trial
Arijit Ghosh, Kapildev Das
January-March 2018, 9(1):27-31
DOI:10.4103/jpp.JPP_20_18  
Objective: To compare the efficacy and safety of nadifloxacin and benzoyl peroxide versus adapalene and benzoyl peroxide in acne vulgaris. Materials and Methods: Patients fulfilling the inclusion criteria were divided into two groups. Patients in Group A received nadifloxacin and benzoyl peroxide. Patients in Group B received adapalene and benzoyl peroxide. Duration of treatment was 12 weeks. Changes in noninflammatory lesion count (NILC), inflammatory lesion count (ILC), total lesion count (TLC), investigator global assessment score (IGA) score, and Cardiff acne disability index (CADI) score was determined at weeks 0, 4, 8, and 12. Results: Combination of adapalene and benzoyl peroxide significantly decreased NILC, ILC, TLC, IGA score, and CADI score compared to the combination of nadifloxacin and benzoyl peroxide in acne vulgaris. Conclusion: Combination of adapalene and benzoyl peroxide is significantly more effective compared to the combination of nadifloxacin and benzoyl peroxide in the treatment of acne vulgaris.
  5,338 336 -
COMMENTARY
The new Indian ethical guidelines for biomedical and health research-delving new vistas
Gerard Marshall Raj, Rekha Priyadarshini
January-March 2018, 9(1):56-61
DOI:10.4103/jpp.JPP_143_17  
  4,564 373 -
CASE REPORTS
Oseltamivir-induced neuropsychiatric symptoms
Arshad Basha Shaik, Mukhyaprana Prabhu, Smita Shenoy, Sereen Rose Thomson
January-March 2018, 9(1):43-45
DOI:10.4103/jpp.JPP_121_17  
Oseltamivir is a viral neuraminidase enzyme inhibitor commonly prescribed for prevention and management of influenza. Common adverse effects of oseltamivir are gastrointestinal side effects such as nausea, vomiting, diarrhea, and pain abdomen; others are headache, insomnia, cough, skin rashes, and sadness. In 2006, US Food and Drug Administration added a warning to the label of oseltamivir drawing attention to the risk of developing neuropsychiatric adverse events (NPAE). However, the incidence of NPAE with oseltamivir has been underreported in India. Hence, in our report, we present the occurrence of neuropsychiatric symptoms such as aggressive behavior, restlessness, hallucinations, paranoid ideas, and insomnia following administration of oseltamivir in a young adult female patient.
  4,133 230 -
Severely prolonged vancomycin half-life in a patient with normal serum creatinine and creatinine clearance
Jeffrey W Jansen, Ryan P Moenster
January-March 2018, 9(1):52-55
DOI:10.4103/jpp.JPP_101_17  
Vancomycin remains the antibiotic of choice to treat resistant Gram-positive infections and is dosed utilizing weight-based protocols or pharmacokinetic calculations. Pharmacokinetic calculations are a more proactive approach to vancomycin dosing but are occasionally limited as certain patient-specific variables such as volume of distribution, renal function, and severity of illness do not allow all patients to follow population estimates. In these situations, if the above-mentioned variables are adjusted for an individual patient rather than the population estimates, the kinetic models reflect accurate vancomycin dosing. We present a patient with apparently normal renal function (Cockcroft–Gault) following a significant renal injury who had sustained supratherapeutic vancomycin serum concentrations and a calculated peak elimination half-life of 346 h. Importantly, this patient had adequate clearance of other highly renally eliminated medications (digoxin and meropenem), which suggests limited long-term deficit due to the previous sustained renal injury. In this patient case, vancomycin's chemical properties and pharmacokinetics are explored to best explain the patient's highly unusual response. In addition, an analysis of vancomycin's less well-described pharmacokinetics such as active secretion, tubular reabsorption, and nonrenal elimination pathways is explored. Ultimately, this patient represents a perplexing case which highlights the continued need for therapeutic drug monitoring with vancomycin.
  2,312 196 -
Toxic epidermal necrolysis versus staphylococcal scalded skin syndrome: A diagnostic confusion in a 2-year-old child with ceftriaxone therapy
Vybhava Krishna, Sadhana N Holla, Sweenly V Sunny, Srikiran A Hebbar
January-March 2018, 9(1):46-48
DOI:10.4103/jpp.JPP_152_17  
Toxic epidermal necrolysis (TEN) is a rare, but serious condition characterized by widespread death of epidermis involving skin and mucous membrane. Ceftriaxone-induced TEN in the pediatric age group is rare. Hereby, we present a child of 2 years, who was treated for food poisoning with ceftriaxone, amikacin, and ranitidine. The child developed generalized rash and hyperpigmentation with mucosal involvement. A diagnosis of staphylococcal scalded skin syndrome (SSSS) was considered initially, and ceftriaxone was advised to continue. Since the lesions aggravated and therapy was ineffective, ceftriaxone was discontinued. A diagnosis of ceftriaxone-induced TEN was made and treated symptomatically. The patient was discharged with complete recovery. Naranjo's algorithm showed a possible relationship with the adverse event. Ceftriaxone is generally considered safe in the pediatric population but still needs a watchful eye on the development of TEN as it closely resembles SSSS.
  2,266 206 -
RESEARCH PAPERS
Valproic acid reduces tumor cell survival and proliferation with inhibitors of downstream molecules of epidermal growth factor receptor pathway
Bhuvanesh Sukhlal Kalal, Vinitha Ramanath Pai, Dinesh Upadhya
January-March 2018, 9(1):11-16
DOI:10.4103/jpp.JPP_129_17  
Objectives: To evaluate the beneficial effect of treating tumor cells with valproic acid (VPA) in combination with inhibitors of various downstream molecules of epidermal growth factor receptor pathway for limiting tumor cell growth. Materials and Methods: Cytotoxic effect of VPA was tested with various combinations of inhibitors of PI3K-AKT, ERK1/2, Jun N-terminal kinases (JNK) as well as p38 kinases in A375 cells using methyl-thiazol-tetrazolium assay, clonogenic assay, and caspase assay. Antiproliferative effect of the combination was tested with ethynyl-2′-deoxyuridine incorporation assay. Results: Among the combinations tested, a combination of VPA with PI3K-AKT inhibitor showed enhanced tumor cell death and reduced tumor cell proliferation compared to the combination of VPA with ERK1/2, JNK, and p38 inhibitors at lower doses. Conclusions: Combination of VPA with PI3K-AKT inhibitor at lower concentration reduced tumor cell growth.
  1,756 299 -
Drug approval in India does not match the disease burden: A cross-sectional study
Jaykaran Charan, Jatin V Dhanani, Maulik Sumantbhai Doshi, Tea Reljic, Athanasios Tsalatsanis, Ambuj Kumar
January-March 2018, 9(1):6-10
DOI:10.4103/jpp.JPP_168_17  
Objectives: To assess the correlation between drug approval and disease burden in India. Materials and Methods: A cross sectional study was conducted and data on drug approval for the past 14 years (2000–2013) were downloaded from the central drug standard control organization website in India and the latest data on disease burden from the year 2012 were obtained the World Health Organization website. Mortality and disability (disease adjusted life year) were considered. Drug approval was correlated with disease burden using the Spearman's correlation test. Results: Between 2000 and 2013, a total of 1913 drugs were approved in India. Of these, 838 were fixed-dose combinations and 22 were veterinary drugs, which were excluded from the analysis. Due to a single-drug being used for multiple indications, the final analysis was performed on 1345 indications/drugs. Overall, there was a weak correlation between disease burden and drug approval for the outcomes of mortality (r = 0.207, P = 0.038) and disability (r = 0.278, P = 0.002). Conclusion: The results from this first study assessing the correlation between drug approval and disease burden in India shows a significant mismatch and the urgent need for syncing the research output with the disease burden.
  1,763 281 -
Effect of coexisting hypertension, blood pressure control, and antihypertensive treatment on QT interval parameters in type 2 diabetics: A cross-sectional study
Jayesh Dalpatbhai Solanki, Kruti J Patel, Nisha Lalwani, Hemant B Mehta, Chinmay J Shah, Matika N Lakhtaria
January-March 2018, 9(1):21-26
DOI:10.4103/jpp.JPP_139_17  
Objectives: To study the electrocardiogram (ECG) based QT parameters namely QTc (heart rate corrected QT), QTd (QT dispersion) in treated type 2 diabetics (T2D) and the effect of hypertension (HTN), blood pressure (BP) control, and antihypertensives used on the above parameters. Materials and Methods: We performed a cross-sectional study in a tertiary care hospital of Gujarat, India, on 199 T2D (67 males and 132 females). Standard 12-lead ECG was recorded to derive QTc (Bazett's formula), QTd, and ECG left ventricular hypertrophy (LVH). QTc >0.43 s in male and >0.45 s in female and QTd >80 msec were considered abnormal. Results: Hypertensives (n = 138) and normotensives (n = 61) were comparable for most confounders. Hypertensives had better profile of QTc and QTd than normotensives. T2D with controlled BP revealed slightly better, though insignificant; QTc, QTd than those with BP uncontrolled. QT parameters were not significantly correlated with age, heart rate, or BP. Qualitative differences exceeded quantitative difference in QTc and QTd evaluation. There was no significant effect of use or nonuse of preventive pharmacotherapy on QT parameters. Conclusion: Low-to-moderate prevailing cardiac repolarization abnormality in T2D with very low ECG LVH was unaffected by HTN as a disease, its control status, and treatment modalities suggesting primary preventive role of antihypertensive use without class difference.
  1,347 177 -
CASE REPORTS
Need of the hour: Warfarin-induced massive intraperitoneal bleed
Vinayaka Anuhya, Sharath Madhyastha, Veena Nayak, Gangaparameswari Soundarrajan, Raviraj Acharya
January-March 2018, 9(1):49-51
DOI:10.4103/jpp.JPP_151_17  
Warfarin is an oral anticoagulant which is a natural coumarin derivative used for the treatment of various diseases such as thromboembolic disorders, prosthetic heart valves, and atrial fibrillation. Bleeding tendencies have been the most commonly reported adverse effects of warfarin, limiting its use and requiring the need for regular monitoring. Despite many warfarin management strategies being taken for the prevention, bleeding still continues to be a problem to be dealt with. The authors report a case of spontaneous intraperitoneal bleeding due to warfarin use in a 54-year-old female patient.
  1,328 154 -
CORRESPONDENCE
The place of sulfonylureas in the modern treatment of type 2 diabetes mellitus: The end of an era or the beginning of a new one?
Theocharis Koufakis, Spyridon N Karras, Kalliopi Kotsa
January-March 2018, 9(1):40-41
DOI:10.4103/jpp.JPP_138_17  
  1,260 219 -
RESEARCH PAPERS
Therapeutic effect of fibroblast growth factor and olfactory ensheathing cells in rat models of spinal cord injury
Durai Murugan Muniswami, Bashir Ahmed, George Tharion
January-March 2018, 9(1):32-39
DOI:10.4103/jpp.JPP_173_17  
Objective: To compare the efficacy of individual and combined treatment of olfactory ensheathing cells (OECs) and acidic fibroblast growth factor (aFGF) in a rat model of spinal cord injury (SCI). Materials and Methods: Adult female Albino Wistar rats were anesthetized with ketamine (90 mg/kg) and xylazine (10 mg/kg) by intraperitoneal injection and T10 laminectomy was performed to expose the spinal cord, before drop-weight injury. Following injury, 2 μg of aFGF was administered at the site of injury and cultured rat olfactory mucosal OEC were transplanted as a single dose of 1 × 106 cells on the 9th day after SCI, used individually as well as in combination therapy. The outcome of the treatments was assessed using the hind-limb motor recovery-Basso, Beattie, Bresnahan (BBB) scale, transcranial motor-evoked potential, and histological studies. Results: All the treated groups showed improvement in hind-limb motor recovery when compared to the control group in BBB (P < 0.05). There was increased electromyography amplitude in treated rats as compared to controls (P < 0.05). Retrograde and anterograde tract tracing showed an increase of preserved axons and possible regeneration. Combination of aFGF with OEC transplantation demonstrated more beneficial effects following SCI than with individual therapy. Conclusion: aFGF and OEC transplantation have neuroprotective and regenerative therapeutic potentials for the future clinical application.
  1,152 152 -
Effect of etoksidol against sulfur-containing gas induced reduction in bone marrow microcirculation in different stages of ontogenesis in rats
Olga A Ovsyannikova
January-March 2018, 9(1):17-20
DOI:10.4103/jpp.JPP_196_16  
Objective: To investigate the state of femoral red bone marrow microvasculature of nonlinear white male rats in the course of an acute experiment. Materials and Methods: The ontogenesis of experimental animals were between 36 and 730 days: Intact ones, those subjected to the action of subtoxic doses of sulfur-bearing gas, and those receiving a protector-drug “Etoksidol”. The data on microcirculation were obtained using laser Doppler flowmetry. The industrial sulfur-containing natural gas of the Astrakhan gas condensate field was used as a toxic agent. It was revealed that the reducing intensity of blood microcirculation in the red bone marrow of intact rats is statistically more significance in the presenile period of ontogenesis compared with the earlier periods. Results: The use of “Etoksidol” along with the influence of sulfur-containing pollutant on the experimental animals of different age groups led to improvement of microcirculation in the bone marrow at all the studied stages of ontogeny. However, such improvement was statistically highly significant (P < 0.01) in the mature age I, very close to significant in the mature age II, and was not statistically significant in the young and presenile age. Conclusions: As a result, the following findings were obtained: The toxic effect greatly reduces the intensity of the microcirculation in the bone marrow, which is most pronounced in younger animals; the experimental results suggest that the drug “Etoksidol,” with an antihypoxic and antioxidant action, has a positive effect on red bone marrow microvasculature.
  1,071 169 -
CORRESPONDENCE
Does mirtazapine withdrawal induces mania or not?
Kamaldeep Sadh, Pooja Shatadal, Ekta Franscina Pinto, Sachin Nagendrappa, Harish M Tharayil, Chittaranjan Andrade
January-March 2018, 9(1):42-42
DOI:10.4103/jpp.JPP_27_18  
  840 116 -
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