International Journal of Basic & Clinical Pharmacology
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Study of antidiabetic activity of Aegle marmelos in streptozotocin-induced hyperglycemic Wistar rats in a tertiary care hospital
Background: Diabetes has become a major metabolic disorder disease that is increasingly becoming a killer disease worldwide. The aim of this study was to evaluate (bael tree) Aegle marmelos whole plant extract has the potential efficiency to control hyperglycemia, that affects kidney and lipid profile, in streptozotocin induced rats. This study aimed to evaluate the Antidiabetic activity of, Aegle marmelos in streptozotocin-induced hyperglycemic Wistar rats.
Methods: Wistar rats of either sex were used grouped into six groups of six rats each. The first group was used as control, the second group was induced diabetes by inducting streptozotocin 70 mg/kg i.p., The 3rd,4th, 5th and 6th group was induced diabetes and treated with Metformin 600 mg/kg, A. marmelos methanol whole plant extract in the increasing dosage of 100 mg/kg, 200 mg/kg and 400 mg/kg body weight from the 7th to 28th day respectively. The blood samples were collected at day 0,7 and 28th day for estimation of fasting blood sugar, serum cholesterol, triglycerides and creatinine. Results was presented as the mean standard deviation (SD). A one-way analysis variance was performed using SPSS-17 and Graphpad Prism 5 statistical software.
Results: After administration of Aegle marmelos extract in increasing level, fasting glucose level was significantly (p < 0.05) reduced. Also, there is significant reduction in serum cholesterol level, triglyceride level and creatinine level. The effect was more after 28 days of treatment.
Conclusions: The study results indicate the active compounds in the Aegle marmelos whole plant methanol extract has antidiabetic and antilipidemic activity. It can also protect kidney to some extent
Formulation and evaluation of herbal gel containing ethanolic extract of Momordica charantia against socransky’s periodontal pathogens of the oral cavity-an in vitro study
Background: Periodontitis is a multifaceted disease initiated by periodontal pathogens which when left untreated results in inflammation of the supporting tissues of the teeth, resorption of alveolar bone, loss of the periodontal ligament attachment, periodontal pocket formation and/or recession of the gingiva. Hence, the current study aimed at evaluating the efficacy of Momordica charantia leaves extract on Socransky’s periodontal pathogens and formulating a herbal gel for subgingival local drug delivery for the potential treatment of moderate periodontitis.
Methods: M. charantia leaves were authenticated from a recognized taxonomist. They were coarsely powdered following which an ethanol-based extract preparation was done. The extract obtained was then assessed for minimum inhibitory concentration, minimum bactericidal concentration followed by gel formulation which was then subjected to time kill assay and zone of inhibition on periodontal pathogens, the efficacy of which was comparatively evaluated against 0.12% chlorhexidine (CHX) gluconate. Kruskal-Wallis Test was employed with the statistical significance set at p≤0.05.
Results: The concentration of M. charantia ethanolic extract against periodontal pathogens was determined to be 1 gm/100 ml and a statistically significant difference was found in the effectiveness between the gel so formulated and CHX.
Conclusion: The antibacterial activity was evident in the ethanolic extract of M. charantia which when used to formulate a herbal gel against anaerobic periodontal pathogens demonstrated efficacy comparable to that of CHX
Questionnaire-based assessment on knowledge, attitude and practice of fixed-dose combination in medical undergraduates of a tertiary care teaching hospital, Kanpur
Background: Aim was to assess knowledge, attitude and practice of second-year medical undergraduates towards FDC.
Methods: A cross-sectional questionnaire-based study was conducted among second-year medical undergraduates of GSVM, medical college, Kanpur in the form of a pre-test, and after sensitizing the students about FDC, the same questionnaire was given as a post-test.
Results: A total of 251 students, 157 students participated in the pre-test and 140 participated in the post-test. The percentage of male students in pre and post-test were more (58% and 61.4%) compared to female students (42% and 38.6%). After conducting a post-test survey, there is a significant improvement in knowledge and attitude toward FDC.
Conclusions: The inclusion of FDC in the undergraduate curriculum is a good initiative by NMC but there is a need to conduct more CME, symposiums, and workshops in medical colleges to update the knowledge regarding FDC among medical undergraduates.
Unveiling supply chain efficiency: exploring ABC-VED analysis studies on drug inventory management in India
About one-third of annual hospital budget is spent on buying materials and supplies including medicines. In any health facility, be it small health center or a big teaching institution, drugs forms an essential and indispensable element. Non-availability of drugs particularly in the developing countries is due to lack of proper material management. A poor management in a public pharmaceutical supply can result in wastage or blockade of financial resources, irrational utilization of drugs, shortage or overage of essential drugs, increased holding cost, and reduction in flexibility and decline in quality of health care services. Adaptation of a scientific approach of inventory management in healthcare manages all the issues regarding stocking of pharmaceutical items, ensuring safety, stability, efficacy, availability and maintenance of quality of drugs to provide better healthcare services. This review will focus on inventory management and its importance with special emphasis on always better control-vital, essential, desirable (ABC-VED) analysis technique on essential medicine concept and report of various research studies conducted on ABC-VED analysis in different parts of country
Efficacy and safety of paracetamol, phenylephrine, chlorpheniramine maleate and sodium citrate in Indian paediatric patients with common cold: an active post-marketing surveillance study
Background: The common cold, mainly caused by viruses, brings discomfort to children with symptoms like sneezing, congestion, runny nose, and sore throat. As no specific antiviral treatments are available to relieve common cold symptoms, it is typically managed using decongestants, antihistamines, and antipyretics. This study aims to assess the safety and efficacy of a fixed-dose combination (FDC) of paracetamol, phenylephrine, chlorpheniramine maleate and sodium citrate in children aged 2 to 12 years with common cold.
Methods: This non-randomized, open-label, non-comparative, active post-marketing surveillance (PMS) study was conducted across multiple centres in India, involving 417 patients. The study assessed efficacy using the total symptom score (TSS) scale over 5 days with visits on days 1, 3, and 5. Safety was evaluated based on adverse events reported by patients on days 3 and 5 of the trial.
Results: Initially, 417 patients were enrolled in the active PMS, of which 309 completed the study. The mean TSS showed a notable decrease from 8.95 at visit 1 to 0.19 at visit 3, depicting a significant reduction i.e., 97.90% as compared to baseline. At visit 1, most patients (95.79%) exhibited severe symptoms, whereas by visit 3, 83.82% were symptom-free, with only 16.18% experiencing mild symptoms.
Conclusions: This active PMS study examined the safety and efficacy of an FDC of paracetamol, phenylephrine, chlorpheniramine maleate and sodium citrate in treating common cold in children in India. The findings indicate a significant reduction in symptoms, with many patients becoming symptom-free by the third visit, demonstrating its efficacy and safety
Mavacamten: a novel avenue towards hypertrophic obstructive cardiomyopathy
Hypertrophic obstructive cardiomyopathy (HCM) is the most common heterogeneous genetic cardiovascular disorder. Its pathophysiology involves left ventricular hypertrophy, increased fibrosis, hypercontractility, and reduced compliance. The symptomatic obstructive HCM presents as dyspnoea, syncope, chest pain, palpitations, arrhythmias, or sudden death, usually after provocative manoeuvres like exercise. Until April 2022, treatment options were disease non-specific like Beta blockers, Cardio-selective Calcium Channel Blockers, Dipyridamole, and Ranolazine. Mavacamten is a first-in-class, FDA-approved drug molecule for HCM. It works by selective and reversible inhibition of the cardiac myosin ATPase thereby decreasing the formation of actin- myosin cross- bridges in systole and diastole. The excessive actin-myosin cross-bridging is the hallmark of disease and is responsible for the compromised functioning of the heart in both the systole and diastole phase due to left ventricular outflow tract (LVOT) obstruction and increased ventricular filling pressure respectively. Mavacamten acts by producing super-relaxed state of heart which is then translated into decreased LVOT obstruction and improved cardiac filling pressures thereby improving the functional capacity and symptoms in patients with New York Heart Association (NYHA) stage II, and III symptomatic or obstructive heart failure. Mavacamten is administered orally 2.5-15 mg per day with titration guided by lab investigations and clinical symptoms. Its bioavailability is 85%, undergoes metabolism by CYP2C19 and CYP3A4 and is excreted mainly in urine. It is also an enzyme inducer and shows considerable drug interactions. Common adverse effects are dizziness and syncope. Sometimes the drug may worsen heart failure or completely block ventricular function. Mavacamten has raised hopes for the possibility of managing this potentially lethal intrigue disorder with medicines alone
Medication error in general medicine department of tertiary care Koshi Zonal hospital in Nepal
Background: Medication errors are the leading cause of patient harm, injuries and even death in hospitalized patients. It endangers patient safety and also increases the cost of treatment leading to enhanced financial burden to the individuals and the community as well. The study was aimed to determine the pattern of occurrence of medication errors.
Methods: A cross-sectional study was conducted in 188 hospitalized patients in medical ward at a Zonal Hospital. Medication errors were identified and categorized by reviewing the cardex. The data were analyzed to determine the cause of medication errors including rates of harm to patients. The descriptive statistics frequency and percentage were calculated using Microsoft Excel 2007. The findings were presented as tables and graphs.
Results: A total of 985 medication errors were found in 650 (38.3%) drugs prescribed in 177 (94.1%) patients. Approximately 72.9% of the errors reached the patients and 32.39% of the errors were harmful. The most common observed errors were administration errors (41.6%) followed by prescribing errors (36.5%), transcription errors (14.3%) and monitoring errors (7.5%). Omission of prescribing information (63.88%) and wrong dosing schedule (34%) were the most common type of prescribing and transcription errors respectively. Omission of dosages administration (57.32%) to patients was the most common types of administration error. All types of medication errors were highest in the alimentary tract and metabolism class of drugs (32.39%).
Conclusions: Medication errors were associated with the majority of hospitalized patients signifying the requirement of immediate preventive strategies and policies to ensure patient safety
The results of using the combination of letrozole and misoprostol in comparison with laminaria and misoprostol in preparing the cervix for miscarriages under the second trimester of pregnancy
Background: Therapeutic abortion in the second trimester pregnancy is the choice treatment in cases with severe anomalies or intrauterine fetal death. It can be done by a number of medical (e.g. misoprostol and letrozole) or mechanical methods (e.g. laminaria). The aim of this study was to compare the efficacy of vaginal misoprostol with and without letrozole and combination of misoprostol and laminaria for preoperative cervical ripening among women with under second trimester abortion.
Methods: In this interventional study, 80 pregnant women in the second trimester pregnancy (Gestational age under 20 weeks) were randomly divided in two groups (n=40). One group received vaginal misoprostol in combination with laminaria and oral placebo and other group received vaginal misoprostol in combination with letrozole. Patients regularly examined every 4 hours and in the absence of abortion, vaginal misoprostol repeated after 4 hours. No report of products of conception abortion considered as complete abortion and the patient discharged. Data collected in a cheklist and then analyzed by statistical methods in SPSS version 21.
Results: Complete abortion was reported in 70 (87.5%) of all patients which in group letrozole+misoprostol in 34 (85%) and in laminaria+misoprostol was reported in 36 (90%). 6 (15%) Curettage was reported in group letrozole+misoprostl and 4 (10%) in laminaria+misoprostol and the difference were not statistically significant.
Conclusions: Results showed that both of combination are effective in the abortion but misoprostol in combination with laminaria is recommended for the induction of second trimester therapeutic abortion
Influence of SLC22A1 gene polymorphisms on gastrointestinal adverse effects with metformin therapy in South Indian type 2 diabetes mellitus patients
Background: Metformin, a first-line agent in Type 2 diabetes mellitus, causes gastrointestinal adverse effects in 20-30% of patients, leading to discontinuation in 5-10% of them. Organic cation transporter 1 (OCT1) encoded by SLC22A1, transports metformin from the enterocytes into the bloodstream. Reduced function OCT1 variants could lead to increased luminal concentration of metformin leading to gastrointestinal adverse effects. Two single nucleotide polymorphisms in the SLC22A1 gene were studied in this cross-sectional study with cases and controls. Objective was to determine the association between genetic polymorphisms rs628031 (1222A>G) and rs622342 (1386C>A) in SLC22A1 gene and gastrointestinal adverse effects to metformin therapy in South Indian type 2 diabetes mellitus patients.
Methods: The study was conducted in JIPMER, Puducherry, India in T2DM patients (n=300) of South Indian origin, who were categorized into case (N=100) and control (N=200) groups, based on their gastrointestinal tolerance to metformin. DNA was extracted from the patients using whole blood by phenol-chloroform method and genotyping was done using real-time PCR.
Results: Minor allele frequency of rs628031 (A allele) and rs622342 (C allele) were 33.8% and 26.5% respectively. Genotype frequencies did not differ significantly between the case and control groups (rs628031, p=0.45, rs622342, p=0.28). Female gender (AOR 3.77; 95% CI 2.07, 6.85; p<0.001) and proton pump inhibitor usage (AOR 7.66; 95% CI 3.01, 19.47; p<0.001) had higher association with metformin intolerance.
Conclusions: No significant association was found between the genotypes of single nucleotide polymorphisms (rs628031 and rs622342) in the SLC22A1 gene and gastrointestinal adverse effects to metformin therapy in South Indian type 2 diabetes mellitus patients
Heart rate lowering agents in acute coronary syndrome
Background: Heart rate is a key indicator of cardiovascular mortality, with ACS having the highest mortality risk when heart rate is elevated. With a target heart rate of <70 bpm, it is crucial to evaluate the effects of medications that lowers heart rate.
Methods: In this prospective observational study, 45 patients with ACS were studied, and it was determined whether or not the patients' heart rates at discharge from the hospital were within goal range. Additionally, we looked at demographics, drug-related issues, vitals and then statistical tests were performed.
Results: The demographic of 45 patients showed mean adult age was 47 years and most observed ACS was STEMI (53.3%). Patients prescribed with HRLA showed lower mean HR, SBP and DBP at discharge. Evaluated Optimal HR ≤70 bpm with HRLA therapy at discharge of the inpatients was achieved in 26.6% (63.5±5.5 bpm).
Conclusions: The current study showed HRLA therapy effectively reduced the heart rate at hospital discharge, but despite being on HRLA only 1/4th of patients achieved the optimal heart rate