Online since Monday, March 23, 2009
Still in search of a herbal medicine… p. 1
Urmila Thatte
The effect of dyslipidemic drugs on mortality: A meta-analysis p. 4
Shuchi Jain, Vikas Vaishnavi, Bhaswat S Chakraborty
Most of the previously published meta-analyses include studies exploring the effect of statins, rather than all dyslipidemic drugs, on mortality. We explored the overall effect of all dyslipidemic drugs on coronary artery disease mortality, cardio-vascular disease mortality and all-cause mortality. A meta-analysis of all randomized controlled trials that were published before February 2006 was carried out. Data sources were published articles in bibliographic electronic databases and medical journals. The article selection criteria included all randomized placebo-controlled trials of at least one year duration and those which measured at least one of the following clinical endpoints: coronary artery disease mortality, cardio-vascular mortality or all-cause mortality. Information on sample size, follow up period, drug used, and clinical outcomes was abstracted independently by two authors. Disagreements were resolved by consensus. The meta-analysis (19 trials, 59033 patients) showed a significant relative risk reduction of coronary artery disease mortality of 23% (P<0.00001), cardiovascular disease mortality of 19% (P<0.00001) and all-cause mortality of 14% (P<0.0001), without any significant heterogeneity and inconsistency between the trials. It was concluded from this meta-analyses that dyslipidemic drugs are indeed highly effective medicines and confer benefit to patients, in terms of primary and secondary prevention of coronary artery disease.
Comparison of safety, efficacy, and cost effectiveness of benzyl benzoate, permethrin, and ivermectin in patients of scabies p. 9
Narendra P Bachewar, Vijay R Thawani, Smita N Mali, Kunda J Gharpure, Vaishali P Shingade, Ganesh N Dakhale
Objective: To compare three treatment modalities in scabies for safety, efficacy, and economy in a local population of Nagpur. Materials and Methods: This was a prospective, randomized, comparative clinical trial conducted in 103 participants, randomly allocated to three groups. First group received benzyl benzoate (BB) 25% lotion, second group received permethrin 5% cream, whereas third group received tablet ivermectin 200 µg/kg as a single dose. The participants were recalled after one week for follow-up evaluation. If there were no signs of cure, the same intervention was repeated. The participants were followed up for two weeks for cure rate, adverse drug reaction (ADR) monitoring, and postintervention observation. The follow-up was stopped after two weeks. Statistics: Fischer's exact test using Graph pad Instat v 3.05. Results: Ivermectin showed 100% cure rate after two weeks of treatment. Permethrin decreased pruritus by 76% at the end of one week and had significantly better cure rate than ivermectin. At the end of two weeks treatment, this finding was reversed, that is, cure rate in ivermectin group was 100%. For cost-effectiveness analysis, treatment regimens were formulated hypothetically for comparison from Markov population tree for decision analysis. It was found that BB and ivermectin each consecutively for two weeks were most cost effective regimens giving complete cure in four weeks, while ivermectin was the fastest regimen giving the same results in two weeks. Conclusion: Benzyl benzoate as first line intervention and ivermectin in the remaining gave best cost-effective results in the study patients of scabies.
Reversal of pentylenetetrazole-induced seizure activity in mice by nickel chloride p. 15
Ashish K Rehni, Nirmal Singh
Objective: The present study was designed to investigate the anticonvulsant potential of nickel which is shown to selectively block t-type calcium channels by using nickel choride on pentylenetetrazole (80 mg/kg) induced seizure activity model in mice. Materials and Methods: Seizures were assessed in terms of onset of Straub's tail phenomenon and onset of jerky movements of the whole body, convulsions, and death. Sodium valproate served as a standard control in the present study. Results: Nickel chloride (5 mg/kg i.p. and 10 mg/kg i.p.) attenuated pentylenetetrazole-induced seizure activity in mice, as reflected by a significant increase in the onset time of Straub's tail phenomenon and onset of jerky movements of the whole body, convulsions, and death. High dose of nickel chloride showed more pronounced anticonvulsant action than sodium valproate. Conclusions: The anticonvulsant action of nickel chloride was noticeable in this study. However, further studies are required to elucidate its full anticonvulsant potential.
Protective effect of Cassia glauca Linn. on the serum glucose and hepatic enzymes level in streptozotocin induced NIDDM in rats p. 19
Mamta Farswan, Papiya Mitra Mazumder, V Percha
Objective: The objective of the present study was to investigate the hypoglycemic and hepatoprotective effect of Cassia glauca leaf extracts on normal and non insulin dependent diabetes mellitus (NIDDM) in rats. The study was further carried out to investigate the effect of different fractions of the active extract of Cassia glauca, on normal and NIDDM rats, and the effect of active fraction on the blood glucose and hepatic enzymes level. Methods: Diabetes was induced by streptozotocin (STZ) at a dose of 90mg/kg, i.p. in neonates. Different extracts of cassia glauca (100mg/kg, p.o.) were administered to the diabetic rats. Acetone extract was found to lower the serum glucose level significantly in diabetic rats. Further, the acetone extract was subjected to column chromatography and four fractions were obtained on the basis of TLC. All the four fractions (100mg/kg, p.o.) were administered to the diabetic rats. Fraction 1 (F1) caused the maximum reduction in the blood glucose level. The results of the test were compared with the standard antidiabetic drug glibenclamide (5mg/kg, p.o.). Results: Fraction 1 of acetone extract caused a significant reduction in the levels of hepatic enzyme Aspartate transaminase (AST), alanine transaminase (ALT), creatine kinase (CK), and lactate dehydrogenase (LDH) in STZ-induced diabetic rats. Conclusion: Improvement in the blood sugar level and normalization of liver functions by Cassia glauca indicates that the plant has hepatoprotective potential, along with antidiabetic activity, and it provides a scientific rationale for the use of Cassia glauca as an antidiabetic agent.
Hepatoprotective activity of Eugenia jambolana Lam. in carbon tetrachloride treated rats p. 23
SS Sisodia, M Bhatnagar
Objective: To estimate the hepatoprotective effects of the methanolic seed extract of Eugenia jambolana Lam. (Myrtaceae), in Wistar albino rats treated with carbon tetrachloride (CCl 4 ). Materials and Methods: Liver damage in rats treated with CCl 4 (1ml/kg/Bw, administered subcutaneously, on alternate days for one week) was studied by assessing parameters such as serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphatase (ALP), acid phosphatase (ACP) and bilirubin (total and direct). The effect of co-administration of Eugenia jambolana Lam. (doses 100, 200 and 400 mg/kg p. o.) on the above parameters was investigated. These biochemical observations were supplemented by weight and histological examination of liver sections. Liv.52® was used as positive control. Data were analyzed by one way anova, followed by Scheff's/Dunnett's test. Results: Administration of Eugenia jambolana Lam. (doses 100, 200 and 400 mg/kg p. o.) significantly prevented carbon tetrachloride induced elevation of serum SGOT, SGPT, ALP, ACP and bilirubin (total and direct) level. Histological examination of the liver section revealed hepatic regeneration, after administration of various doses of Eugenia jambolana Lam. The results were comparable to that of Liv.52®. Conclusion: The study suggests preventive action of Eugenia jambolana Lam. in carbon tetrachloride induced liver toxicity. Hepatic cell regeneration process was dose dependent.
Anti-stress activity of hydro-alcoholic extract of Eugenia caryophyllus buds (clove) p. 28
Anand Kumar Singh, Sunil S Dhamanigi, Mohammed Asad
Objective: The present study was undertaken to evaluate the anti-stress effect of the hydro-alcoholic extract of clove. Methodology: The anti-stress effect was evaluated on cold restraint induced gastric ulcers, sound stress induced biochemical changes and anoxic stress induced convulsions. Clove extract was administered orally at two different doses of 100 and 200 mg/kg. Zeetress, a known anti-stress formulation (14 mg/kg p.o) was used as the standard drug. Results: Both the doses of clove extract showed good anti-stress effect in all the tested models. The clove extract reduced the development of cold restraint induced gastric ulcers and prevented the biochemical changes induced by sound stress such as increase in plasma levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, glucose, cholesterol and corticosterone. Clove extract was also effective in increasing the latency of anoxic stress induced convulsions in mice. Conclusion: The hydro-alcoholic extract of clove at doses of 100 and 200 mg/kg orally possesses good anti-stress activity.
Leishmanicidal activity of saponins isolated from the leaves of Eclipta prostrata and Gymnema sylvestre p. 32
Venkatesan Gopiesh Khanna, Krishnan Kannabiran, Giulia Getti
Objective: To evaluate the leishmanicidal activity of saponin, dasyscyphin C of Eclipta prostrata and sapogenin, gymnemagenol from Gymnema sylvestre leaves under in vitro conditions. Materials and Methods: Dasyscyphin C/Gymnemagenol were dissolved in phosphate buffered saline (PBS) and diluted with liquid medium to obtain concentrations ranging from 1000 to 15 µg /ml. The leishmanicidal activity against leishmanial parasites, Leishmania major, Leishmania aethiopica and Leishmania tropica promastigotes was studied by the MTS assay. Result: The Dasyscyphin C isolated from E. prostrata showed good leishmanicidal activity at 1000µg/ml concentration, with the IC 50 value of 450µg/ml against L. major promastigote and the percentage of parasitic death was 73; whereas, gymnemagenol of G. sylvestre showed only 52% parasitic death at 1000 µg/ml concentration. The other Leishmania species, L. aethiopica and L. tropica promastigotes, were less sensitive to the saponins of E. prostrata and G. sylvestre. Conclusion: From this study, it can be concluded that the dasyscyphin C of E. prostrata has significant leishmanicidal activity against L. major promastigote.
Evaluation of hepatoprotective activity of Cleome viscosa Linn. extract p. 36
Nishant Kumar Gupta, Vinod Kumar Dixit
Objectives: To evaluate the hepatoprotective activity of ethanolic extract of Cleome viscosa Linn. (Capparidaceae) against carbon tetrachloride (CCI 4 ) induced hepatotoxicity in experimental animal models. Materials and Methods: Leaf powder of Cleome viscosa was extracted with ethanol. The hepatoprotective activity of the extract was assessed in CCI 4 induced hepatotoxicity in rats. Various biochemical parameters were estimated and histopathological studies were also performed on rat liver. The hepatoprotective activity was also supported by determining a functional parameter, i.e. thiopental-induced sleep of mice poisoned with CCl 4 . Results: The test material was found effective as hepatoprotective, through in vivo and histopathological studies. The extract was found to be effective in shortening the thiopental induced sleep in mice poisoned with CCl 4 . The hepatoprotective effect of ethanolic extract was comparable to that of silymarin, a standard hepatoprotective agent. Conclusion: The results of the present study show that ethanolic extract of Cleome viscosa has significant hepatoprotective activity.
Influence of nebivolol on anticonvulsant effect of lamotrigine p. 41
Radha Goel, Amit Goel, Anshu manocha, KK Pillai, Rashmi S Srivastava
Objective: The present study describes the effect of nebivolol (NBV) either alone or in combination with lamotrigine (LTG) using increasing current electroshock seizures (ICES) model in mice. Materials and Methods: Male albino mice of Swiss strain each weighing 18-30 g were used. Lamotrigine (Lamitor tablets, Torrent; 1.5 and 3.0 mg/kg) and NBV (Nebicard tablets, Torrent; 0.25 and 0.5 mg/kg) were suspended in 0.25% of carboxy methyl cellulose (CMC) in 0.9% saline and administered orally in volumes of 10 mg/kg. Control animals received an equivalent volume of 0.25% CMC in 0.9% saline suspension. The anticonvulsant effects of the drugs were measured using ICES model whereas cognitive behavior was measured by the spontaneous alternation behavior and grip-strength test. The biochemical estimation was done by measuring the lipid peroxidation and reduced glutathione (GSH). Results: Both NBV and LTG produced significantly enhanced seizure threshold (ST), decreased grip strength, inhibited lipid peroxidation, and increased brain GSH levels in acute and chronic dosages likened to control group, whereas there was no significant effect on alternation scores. The combination of NBV with LTG significantly potentiated the ST when compared to LTG. Conclusion: Nebivolol showed antiepileptic effects in addition to its reported antihypertensive effect, which could be attributed to action of the two drugs through different mechanisms or due to drug interaction that may be pharmacodynamic or pharmacokinetic needing elucidation.
Emergence of pristinamycin resistance in India p. 47
Shyam Sunder Keshari, Arun Kumar Kapoor, Nira Kastury, Dharmendra Kumar Singh, Anudita Bhargava
Quinupristin and dalfopristin combination has been advocated as a drug of choice for multi-drug resistant (MDR) gram-positive cocci (GPC). We are reporting two cases of neonatal septicemia, caused by the methicillin resistant Staphylococcus aureus (MRSA), showing primary in vitro pristinamycin resistance. The Minimum inhibitory concentrations (MIC) for pristinamycin in these two cases were 30 µg and 25 µg, respectively. Universal advocacy of pristinamycin for the therapy of MDR GPC infections should be re-evaluated.
Pedal edema with olanzepine p. 49
Veena Nayak, Bharti Chogtu, Virupaksha Devaramane, PV Bhandary
Olanzapine, an atypical antipsychotic is considered superior to its conventional congeners. Here we report two cases of pedal edema secondary to olanzapine. In both cases the systemic causes of pedal edema were ruled out. On reducing the dose of olanzapine, pedal edema regressed and completely resolved after stopping the drug. So we attribute the edema to olanzapine therapy. As the definitive cause and further consequences of pedal edema are not known , hence stringent monitoring of adverse effects of this drug is required.
Upper gastrointestinal bleeding in a patient with depression receiving selective serotonin reuptake inhibitor therapy p. 51
Deepak Kumar, Tanuj Saaraswat, SN Sengupta, Saurabh Mehrotra
Background: Serotonin plays an important role in the normal clotting phenomenon and is released by platelets. Platelets are dependent on a serotonin transporter for the uptake of serotonin, as they cannot synthesize it themselves. Selective serotonin reuptake inhibitors (SSRIs) block the uptake of serotonin into platelets and can cause problems with clotting leading to bleeding. Aim: This case report highlights the occurrence of upper gastrointestinal bleeding in the index case on initiating SSRI therapy for depression and the prompt resolution of the same on its discontinuation on two separate occasions. Conclusion: SSRIs may cause upper gastrointestinal (GI) bleeding. Physicians should be aware of the same and should try to rule out previous episodes of upper GI bleed or the presence of other risk factors which might predispose to it before prescribing SSRIs; they should also warn the patients about this potential side effect. Also, the presence of thalassemia trait in the index patient deserves special attention and needs to be explored to see if it might in any way contribute in potentiating this side effect of SSRIs.
Surrogate end points and their role in clinical trial p. 54
Jaykaran
Surrogate end points and their role in clinical trials: Reply from authors p. 55
Coronary flow and perfusion pressure p. 56
Pradeep Kumar, Manish Goyal