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      Evaluation of the Analgesic Activity of the Methanolic Stem Bark Extract of Dialium Guineense (Wild)

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          Abstract

          Background:

          Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State, Nigeria for treatment of fever, headache and other diverse ailments.

          Objectives:

          The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant.

          Method:

          Acetic acid-induced abdominal constriction or writhing, tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250, 500, 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug, acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan.

          Result:

          In the acetic acid-induced writhing reflex model, D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0% in the negative control group to 71% at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models.

          Conclusion:

          Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism.

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          Most cited references33

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          Ethical guidelines for investigations of experimental pain in conscious animals.

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            Anti-inflammatory, analgesic activity and acute toxicity of Sida cordifolia L. (Malva-branca).

            Sida cordifolia L. (Malvaceae) is used in folk medicine for the treatment of inflammation of the oral mucosa, blenorrhea, asthmatic bronchitis and nasal congestion. The anti-inflammatory, analgesic effects and acute toxicity of an aqueous extract of S. cordifolia were evaluated in animal models. The extract was prepared using leaves collected before the flowering period. The aqueous extract (AE) showed a significant inhibition of carrageenin-induced rat paw edema at a dose of 400 mg/kg administered orally, but did not block the edema induced by arachidonic acid. The AE also increased the latency period for mice in the hot plate test, and inhibited the number of writhes produced by acetic acid at the oral dose of 400 mg/kg. The aqueous extract of S. cordifolia showed low acute toxicity in mice.
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              Clinical Pharmacology

              (2008)
              001 ‘Fixing’ the FDCS: We need to do it now Singh J, Gautam CS, Sandhu G Government Medical College and Hospital, Sector-32, Chandigarh - 160 030, India. Introduction: Indian pharmaceutical market is flooded with countless fixed dose combinations (FDCs). Senseless combination of drugs is risky and unethical in a country like ours where virtually any drug is ‘over the counter.’ Methods: To get a glimpse of the countless FDCs available in India we looked into all FDCs of five drugs - three highly efficacious - Atorvastatin, Amlodipine, Amoxycillin and two with question on safety issues, yet highly prescribed in India - Nimesulide and Rosiglitazone (CIMS July - Oct 2007) and analyzed these FDCs for rationality. Results: A total of 47 FDCs were listed. Atorvastatin had 09 (19.14%) FDCs, Amlodipine 08 (17.02%), Amoxycillin 12 (25.53%), Nimesulide 13 (27.65%) and Rosiglitazone 5 (10.63%) FDCs. Rationality analysis revealed shockingly few rational FDCs - 1/9 (11.01%) for Atorvastatin, 3/8 (37.05%) for Amlodipine, 1/12 (8.33%) for Amoxycillin and none for Rosiglitazone and Nimesulide. Overall 89.36% (42/47) FDCs were deemed irrational and only 10.63% (5/47) FDCs were rational. Discussion: That 89.36% FDCs are irrational gives enough idea of the status of innumerable FDCs dumped in the market. This representative analysis reveals a ground reality - Indian pharma industry thrives on irrational FDCs. Irrational FDCs not only cause economic burden on patients, can lead to ADRs and foster careless prescribing attitude. The lure of FDCs has entangled even ‘research-based’ companies. It is our duty as medical teachers to instill the concept of rational drug use in students and train the prescribers to shun irrational combinations. Further work to limit the glut of irrational FDCs is required. Conclusions: Its high time legal enactment regarding irrational FDCs be implemented in India to protect unsuspecting patients from the gullible ones. Prescribers should refrain from putting their patients on dubious combinations and help in ‘fixing’ irrational FDCs. 002 Effect of noni fruit juice on lipid profile in diabetic patients Sabitha P 1, Adhikari PM1, Kamath A2 1Kasturba Medical College, Mangalore; 2Kasturba Medical College, Manipal, India. Introduction: Noni (Morinda citrifolia L) fruit juice [NFJ] is used for atherosclerosis and diabetes in alternative medicine. This randomized placebo controlled double-blind study aimed at investigating the lipid lowering efficacy of NFJ in diabetics. Methods: 34 diabetic patients were enrolled into the study. After measuring fasting plasma lipid profile [LP], subjects were randomized into two groups, either to receive NFJ or placebo at a dose of 15mL, twice daily for 21 days. On day 22, LP was repeated. The mean changes in LP from baseline were calculated in each group and were compared between groups using repeated measures ANOVA. P 92%, Rapid normalization of cell counts, Patient wellbeing in comparison to group -1 patient. Pulmonary function test showed rapid improvement in functions like increase in FEV-1 in Group-2 patients showed less frequency of hospital admission. Conclusion: Inhaled aminoglycoside tobramycin therapy showed significant improvement in COPD patient in terms of less duration of hospital stay and improvement in pulmonary function tests. 004 Study of reservoir effect of topical corticosteroid in an experimental animal model Abidi A, Ahmad F, Kumar A, Singh SK J.N.Medical College, A.M.U Aligarh, India. Introduction: Topical corticosteroids, the most commonly used preparations in the treatment of skin diseases have potent vasoconstrictive, antiproliferative, anti-inflammatory and immunosuppressive actions. But there usage several times a day led to an increased risk of side effects. Hence the aim of this study was to demonstrate a reservoir of topically applied corticosteroid (Clobetasol propionate) experimentally in rabbits as rabbit skin is akin to human skin so that one can maximize their efficacy and safety as therapeutic agents. Methods: The work was carried out on albino rabbits using the topical steroid Clobetasol propionate 0.05% cream. It was applied on the back of rabbit and after 1 hour occlusion histamine induced wheal suppression test was performed and wheal area measured at 10 mins till day 7. Results: Maximum wheal suppression was seen on day 1(p value .05) on day 2, 3 and 4 as compared to day 1. Day 5-7 showed highly significant difference (p value 160/110 mmHg). The patients were randomly assigned to 3 treatment arms-Group1: pioglitazone (15mg OD) + atorvastatin (10mg OD); Group2: pioglitazone (30mg OD) alone; Group3: Atorvastatin (10mg OD) alone. The midterm interim analysis was done after enrolling 13, 8 and 9 patients in groups 1, 2 and 3 respectively using biochemical markers (hsCRP, sICAM-1 and sVCAM-1 using human ELISA kits) of endothelial dysfunction before and after 12 weeks of administration of drugs. Results: Both atorvastatin and pioglitazone monotherapy showed significant (P 1µm/L at approximately 42 hours have been associated with increased risk of toxicity despite increased leucovorin rescue. Threfore, Therapeutic Drug Monitoring(TDM) has an important role in the cancer chemotherapy using Methotrxate. High Performance Liquid Chromatography (HPLC) is used to monitor the plasma concentration of Methotrexate. Blood samples of patients treated with Methotrexate at the Rotary Cancer Hospital of our Institute is being screened for MTX levels. Therapeutic Drug Monitoring of MTX is found to be useful in leucovorin dose adjustments in patients of HDM administration. Blood level is monitored up to 72 hours or till the level reaches >0.2µm/L. Blood sample is taken in an EDTA vial and plasma is separated. Agilent HPLC 1200 series with Chemstation software is in use. RP 8 Column is used. Methotrexate is estimated at 307nm using a UV detector. Concentration of Methotrexate in blood is calculated from the area of the chromatogram corresponding to the concentration using calibration curve. Reproducibility and linearity within a range from 0.250 to 16mg/L of MTX is observed. 010 Effects of simultaneous administration of cypermethrin and chlorpyriphos on pharmacokinetics and biochemical profiles in mice Paul S 1, Kundu T1, Dutta S1, Khargharia S2 Mandal T K2 Chakraborty A2 1Medical College, Kolkata; 2West Bengal University of Animal and Fisheries Sciences, West Bengal, India. Objective: To evaluate the blood and tissue concentration as well as biochemical parameters after administration of commonly used pesticides: cypermethrin, chlorpyrifos and co-administration of both in mice. Materials and Methods: Swiss albino mice of either sex were divided into 4 groups (n=18) Group II received Cypermethrin (25 mg/kg), group III received chlorpyrifos (6mg/kg) and group IV received both cypermethrin (25 mg/kg) and chlorpyrifos (6mg/kg) orally daily for 21 days. Group I was considered as control. Six animals from each group were sacrificed on 7, 14 and 21 days post dosing and blood samples and tissues (muscle, liver, heart, brain and kidney) were collected. Concentration of both cypermethrin and chlorpyrifos was measured (µg ml-1) and biochemical parameters were analyzed in all the blood samples. The amount of cypermethrin and chlorpyrifos (µg gm-1) was estimated in individual tissues. A mean of six replicates were taken and data analyzed statistically. Results: Both cypermethrin and chlorpyrifos were recovered from blood and different tissue samples from 7th day onwards. Their concentration was found to be less when co administered in comparison to individual dosing at the end of study. Highest concentration was observed in the liver in all the treated groups. AST, ALT and blood glucose levels were increased considerably in treated groups while protein level was decreased. Conclusions: The results indicate that concomitant administration of both cypermethrin and chlorpyrifos may have some pharmacokinetic type of drug interaction which influences both biochemical parameters as well as tissue concentrations favorably. 011 Prophylactic use of antimicrobials in hysterectomy Heethal JP, Sarala N, Kumar TN, Hemalatha MS Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Introduction: Antimicrobial prophylaxis has been common in surgical field. Antimicrobial prophylaxis in gynaecological surgeries decrease morbidity and mortality. Objective: To analyse prophylactic use of antimicrobials in hysterectomy and the frequency of post operative complications. Methods: A prospective study including seventy five patients undergoing hysterectomy admitted to R L J hospital and research centre, Kolar was undertaken. Patient’s age, socioeconomic status, Hb% and indication for sugery was noted. Antimicrobial used, dosage schedule, timing of administration was recorded. Pus, blood and urine of patients with post operative complications were subjected to culture and sensitivity. Results: The mean age of the patients was 42.6±7.6. Thirty two patients were of low socioeconomic status with Hb% of 8.9±1.3g%. Fibroid uterus was the common indication for the surgery. Antimicrobials used were ceftriaxone, cefotaxime and metronidazole. Use of two drug(84%) or three drug combinations(16%) were common which included third generation cephalosporins with metronidazole, and gentamicin was added in three drug combinations. Antimicrobials were administered 1-4 hours before surgery in 61 patients and continued upto 5-8 days. Post operative complications (24/75 patients) like wound infection, urinary tract infection and fever were significantly (P 60 years). The commonest cause of discontinuation of therapy was unacceptable adverse effects.Etoricoxib was associated with better GI tolerability, better clinical efficacy compared to diclofenac. 028 Evaluation of plant isoflavone effect on platelet aggregability and RBC antioxidant parmamters in oophorectomised women: A randomized double-blind placebo controlled clinical trial Hota D, Mittal N, Dutta P, Suri V, Ahluwalia J, Chakrabarti A Postgraduate Instutute of Medical Education and Research, Chandigarh, India. Phytoestrogens by virtue of their potential to act as selective estrogen response modifiers (SERMs) and cardioprotective effects have received attention as alternatives to hormone replacement therapy for post menopausal women. Inhibition of platelet aggregation and antioxidant action are among the number of mechanisms postulated to be responsible for their cardioprotective effects. This randomized, double blind, placebocontrolled trial evaluated the effect of soy isoflavones (75 mg/day for 12 weeks) on ADP and epinephrine induced platelet aggregation and RBC antioxidant parameters (lipid peroxidation, superoxide dismutase, catalase, glutathione peroxidase) in 34 women who had undergone bilateral oophorectomy. The outcomes were assessed at baseline and 12 weeks after randomization to either group. The two study groups were comparable in terms of demographic, clinical characteristics, platelet aggregation and RBC antioxidant parameters at baseline. There was no significant alteration in ADP and epinephrine induced platelet aggregation and RBC antioxidant parameters (lipid peroxidation, superoxide dismutase, catalase, glutathione peroxidase) in either of the two groups at 12 week compared to the baseline. Mean change in the various parameters at 12 week from baseline also did not show significant difference between two groups. Isoflavones (75 mg of isoflavones daily for 3 months) did not produce any significant alteration in ADP and epinephrine induced platelet aggregation and RBC antioxidant parameters suugesting their safety. However, future studies are needed to provide a conclusive proof regarding the use of isoflavones in clinical practice. 029 Prescription pattern of nonspecific upper respiratory tract infection in ent outpatient department of tertiary care hospital Jain V, Jain IP, Singh SP, Singh S, Saeed S G.S.V.M Medical College, Kanpur, India. Objective: To analyze the prescription pattern of nonspecific upper respiratory tract infection in ENT outpatient department of LLR hospital Kanpur. Materials and Methods: A prospective study of prescription scripts was done from 1st July 08 to 30th July 08. Prescription related to nonspecific respiratory tract infection were collected and scrutinized. Study include classification of drug, number of drugs per prescription, age and sex distribution and advice related to upper respiratory tract infection. Results: 484 prescription scripts were analyzed. The age of patient ranged from 15-65 years. Age group distribution was 60yrs-7.4%.There were 55% male and 45% female patients. The overall mean of total number of drug per prescription was 3.2.Frequency of prescribing antimicrobial is 100% out of which 85.1% is cephalosporins, 8% macrolide, 4.95%quinolones, 1.85% others. Frequency of antihistaminic is 92%, analgesic 57%, vitamins B complex 66%, antacids 23%, gargles 9%, advice of rest, gargles, increase fluid intake found only in 13% of 4prescription. Conclusion: This study provides a baseline data for monitoring future prescribing trends. Theory states that most of the nonspecific upper respiratory tract infection caused by viruses so it is irrational to use antimicrobials in every case and advice related to rest, gargles, increase fluid intake which are mandatory in upper respiratory tract infection is missing from most of prescription so there is need of regular auditing and discussion with prescribing physician for improving prescribing habit. 030 Analysis of fixed dose combinations of vitamin A, folic acid and iron for use in pregnancy Gupta Rachna Dept of Pharmacology, Indraprastha Dental College and Hospital, Ghaziabaad, U.P. India. Background: A number of preparations containing Vitamin A, folic acid and iron in varying amounts are available in the market. The variation of amount of components can result in adequate intake of some while inadequate/excess intake of others. This becomes crucial in pregnancy when deficiency of any of these can result in a number of complications. Materials and Methods: All fixed dose preparations of iron with folic acid and / or vitamin- A that are included in May- June 2008 issue of IDR were analyzed. Dose needed to meet iron needs in a pregnant female was calculated for each preparation. At the same dose intake of other components- Vitamin A and folic acid for each preparation was also calculated. Results: A total of 443 preparations were analyzed. Only 77 % provided appropriate amount of Vitamin A and/or folic acid in pregnancy. Conclusion: Special attention needs to be paid regarding choice of fixed dose preparations of Vitamin A, folic acid and iron in pregnancy. 031 A drug utilization study of antimicrobial agents in the intensive care units in a medical college hospital of North India Gupta A, Mahajan B, Garg S, Kaushal S, Chopra SC Dayanand Medical College and Hospital, Ludhiana, India. The APACHE (Acute Physiology and Chronic Health Evaluation) is prognostic scoring system for classifying patients in ICU on the basis of physiological scores and current health status. The chances of survival increase with a decrease in the score. AMAs play a major role in management of such illnesses and can dramatically improve patient outcome. This study was undertaken to study AMA use and patient outcome in each category of APACHE II. Data was collected from 49 patients admitted in Surgery and Neurosurgery ICUs after IEC approval. APACHE II score calculation was done at 24 hours of ICU-admission. The use of AMAs was studied in terms of average number of AMAs used per patient in each category of APACHE score; most commonly prescribed AMA in each category and its route of administration. The patients who went LAMA were excluded from the outcome study. The highest use of AMAs was 4.3 in APACHE score group >25; and least was 3.1 per patient in 16-20 score group, overall average being 3.61 per patient. The most commonly used AMA group was cephalosporins and route of administration was intravenous. There was a significant difference in the outcome of patients of both the ICUs amongst the patients shifted to the wards and patients who died (P = 0.03). AMA use policy is in place. There is no difference in the quality of care among the patients in either of the ICUs and sub categories of APACHE scoring. 032 Response of long term aspirin administration in patients of ischemic heart disease Kaura R, Laller KS, Singh J, Sen R Department of Pharmacology, Cardiology, Pathology P.G.I.M.S. Rohtak, India. Objective: To study the effect of long term aspirin administration on platelet aggregation and adhesiveness in patients with ischemic heart disease. Materials and Methods: Thirty male patients aged (40-75yrs) who attended cardiology OPD with evidence of stable angina and thirty age matched healthy volunteers were enrolled for the study. Group I- Control group; Group II- Aspirin treated. Platelet aggregation and adhesive indices in control, aspirin (150mg, p.o., daily for 12 months) treated patients were estimated by O’Brien and Salzman’s method. Blood samples for platelet aggregation and adhesiveness were collected in separate vials containing sodium citrate and EDTA respectively. Platelet rich plasma (PRP) was obtained by centrifuging blood at 150-200 G for15 minutes. Platelet aggregation was induced by adding 20 µg of ADP. Platelet aggregation induced alterations in optical density were measured with photoelectric colorimeter. Results: Platelet aggregation time was significantly (P 60 mg.h/L) range specifically with diarrhea and reflux disease subscale scores, though there was no significant difference in GIQLI scores. Conclusion: This study suggests the potential of therapeutic drug monitoring of MPA with limited sampling strategy in improving clinical efficacy of MPA. 054 Comparative study of chlorpromazine and resperidone on positive and negative symptoms of schizophrenia Gupta RK, Singam AP Mahatma Gandhi Institute of Medical Sciences, Sewagram, Dist. Wardha, India. Introduction: Schizophrenia is a devastating mental disease that affecting human population worldwide with prevalence of about 1%. Typical and atypical antipsychotics are mainly used to treat schizophrenia. The typical antipsychotic have autonomic side effects and EPS but the drugs are cheaper and was found to more effective in treating positive symptoms. Atypical antipsychotic takes care of both positive and negative symptoms. Still there is need for research in pharmacological intervention to treat symptoms of the disease both positive and negative. Therefore it was decided to conduct the study to assess the efficacy of typical (chlorpromazine)l and atypical antipsychotic (Resperidone). Materials and Methods: It was a longitudinal single blind prospective study 100 patients attending Psychiatry OPD at KHS Sevagram, with Schizophrenia were selected (50 receiving Chlorpromazine and 50 receiving Risperidone).They were interviewed and were administered test drug and were followed up every 3 monthly for 1 year. Scoring was done according to PANSS (Positive and Negative Symptom Scale for Schizophrenia). Results: Typical antipsychotics are better to treat positive symptoms but not much effective in treating negative symptoms of schizophrenia. Atypical antipsychotics take care of both positive and negative symptoms. Compliance is better with atypicals. Discussion and Conclusion: After assessing the patient, whether he has predominant positive or negative symptoms the psychiatrist can decide either of typical or atypical antipsychotic and this might be helpful for the better treatment of the patient. 055 Natural course of autoimmune thyroiditis in type 2 diabetes: Association with gender, age, diabetes duration and dyslipidemia Thakkar NV, Jain SM Dept. of Pharmacology, L.M. College of Pharmacy, Ahmedabad, India. Aim: To investigate the natural history of autoimmune thyroiditis (AIT) in female patients with type 2 diabetes mellitus. Methods: Since July 2007, annual screening for thyroid disease has been performed in type 2 diabetic patients. Serum HbA1c, LDL and TSH levels were measured in 109 female diabetic patients (53 on oral hypoglycemic agents and 56 on Insulin therapy) and 56 hypothyroid patients against 50 normal female subjects. Anthropometric association and effect of drug therapy was also taken into the consideration. Results: Serum HbA1c levels were found to high (P 50 years. Most patients presented with fever (9), fatigue (8), loss of appetite (7) while few presented with bleeding from nose and gums (2), swelling of orbit and maxillary sinusitis (1), herpetic lesion (1), erythematous maculo-papular rash (1). 2 patients had prior myelodysplasia. 5 patients had hepatomegaly, 2 had splenomegaly and 1 had cervical lymph node enlargement. In most patients no cardiovascular, respiratory, neurological, hepatic or renal co-morbid conditions were present. 8 patients had hemoglobin less than 6 g/dL, 4 patients had platelet count less than 30, 000/mm3. Five patients had M2, three M3, two M4 and one M5 sub type AML (1 patient did not turn up for further investigations and treatment). 7 patients received cytarabine and daunorubicin, 1 patient had received mitoxantrone as induction chemotherapy, 1 patient didn’t turn-up for treatment. 6 patients developed febrile neutropenia during induction (1 had central line infection). 5 received 3 cycles of cytarabine consolidation chemotherapy, 2 received 2 cycles, and 1 patient received 1 cycle of cytarabine. 3 patients with M3 subtype received all-trans-retinoic acid. Conclusion: Most patients with acute myeloid leukemia in this study were in 20-40 year age group with out any associated co-morbid conditions and they well tolerated chemotherapy. 057 Headache: A real “headache” for medical students Arora S, Chopra SC, Singh T Dayanand Medical College and Hospital, Ludhiana, India. Headache is a common medical complaint among medical students which affects the quality of life to a great extent due to limitation of daily activities. This project was undertaken to study the frequency of headaches among medical students and the pattern of medication followed. The study was carried out in 113 medical students (56 males and 57 females), aged 18-25 years, using a semi-structured questionnaire. A majority of respondents (53.9%) had 1-2 episodes of headache during the preceding 3 months whereas 23% had 3-4 and 17.7% had 5 or more episodes. Only 7 students (6 males and 1 female) had no reported episode of headache during the preceding 3 months. Triggering factors were reported by 65.5% cases, the major ones being mental (40.7%) and physical stress (18.6%). Nearly one fourth of the respondents had a positive family history for similar headaches. 72.6% of the respondents got relief by rest and 15.9% by head massage. Only 7 respondents had sought medical attention while the others relied on self medication or prescription by a friend or relative. Out of those who took NSAIDs as analgesics, 79.4% used a single drug, majority being Paracetamol (47%) or Nimesulide (22.7%), and 20.6% used a combination of NSAIDs, out of which 70.6% used Ibuprofen+Paracetamol. Only three respondents were on specific drugs for migraine, including ergotamine and propranolol. A majority of medical students are always under physical and mental stress which can result in headaches for which most indulge in self medication. 058 Comparative, randomized, double blind, parallel, multi-centric study of efficacy and safety of pregabalin + methylcobalamin versus gamma linolenic acid + methylcobalamin in patients with diabetic peripheral neuropathy JC Shobha, Sagar Vidya, Ramadoss K, Sitaramaih BS, Sankar K Ravi, Sridhar PVB, Chary NVS, Balamurugan, Bakthavatsalam, Shanmugasundram R, Senthivel N, Jayachandran K, Reddy B Mohan Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Punjagutta – Hyderabad. A.P., India Objective: To compare the clinical efficacy and safety of Pregabalin 75mg + methylcobalamin 750µg versus Gamma linolenic acid 120mg + methylcobalamin 500µg in patients with diabetic peripheral neuropathy. Methods: Demographic and clinical data like Total pain rating index (TOPRI); present pain intensity by VAS (PPI - VAS); overall intensity of total pain experience, rating scales for diabetic peripheral neuropathy (SF-McGill Pain Questionaire) were recorded at baseline, 4 and 8 weeks. Investigations were done at baseline and at the end of the study. Safety evaluation was done at each follow up visit. Global evaluation by the patient and as well as the investigator was done at the end of the study. Results: 231 patients were enrolled, 197 patients completed the study. In the pregabalin + methylcobalamin group (n = 106 (M73:F33)), as compared to baseline there was significant decrease in TOPRI from 15.4 ± 13.4 (baseline) to 2.6 ± 2.6 (8weeks) (P 0.1). In comparison to haloperidol group, patients treated with sodium valproate showed faster response, on day 5 significant reduction in YMRS score was observed in the group treated with sodium valproate (P<0.05). Total amount of lorazepam as additional sedative was less in patients treated with sodium valproate. Extrapyramidal episodes were observed in 60% of patients treated with haloperidol. There was however no difference in both the groups with regard to duration of stay in the hospital. Conclusion: Sodium valproate in the treatment of acute mania is as efficacious as haloperidol but provides faster response. It is relatively safer as compared to haloperidol. Further studies should be undertaken preferably double blind with large sample size to substantiate the observations. 063 A study on steroids as adjuvant in the treatment of pyogenic meningitis in children in paediatric ward in tertiary care centre at Kanpur Khan S, Jain IP, Singh SP, Singh S G.S.V.M. Medical College, Kanpur, UP, India. Objective: Assessment of the effectiveness of dexamethasone in management of acute bacterial meningitis in children. Materials and Methods: A prospective study was conducted in paediatric ward for the period of two months at LLR hospital Kanpur. In a double-blind controlled trial, we included 71 children aged below 15 years with pyogenic meningitis who had been admitted to the children’s ward. The primary outcome was overall death. Secondary outcomes included sequelae, in-hospital deaths. Inclusion Criteria: Children aged less than 15 years with pathological evidence of bacterial meningitis. Exclusion Criteria: Patients aged above15 years, viral meningitis, tubercular meningitis, fungal meningitis, space occupying lesion, subdural haemorrage. Results: Of the 71 included children belonging to age group <2 years: 20(29%), 2-5 years:34(48%), 5-15years:17(23%).37 (52%) were assigned to dexamethasone 0.15 mg / Kg /dose, 6 hourly for 48 hours and 34 (48%) to placebo. 41(58%) of 71 patients had Streptococcus pneumoniae, 22(32%) Haemophilus influenzae type b, 6(8.5%) Neisseria meningitidis and 2(1.4%) Salmonella spp. The number of overall deaths was the same in the two treatment groups. At final outcome, sequelae were identified in 16(23%) of children on steroids and in 22 (32%) on placebo. Conclusion: Study shows that Most of children belong to age group 2-5 years. Most common offending agent for meningitis was Streptococcus pneumoniae. Children receiving steroid had decreased in morbidity but overall mortality was same in both groups. 064 A prospective study on prescribing pattern of drugs in pediatric ward of Kathmandu university teaching hospital Khan GM 1, Jha AK2, Pokharel A1, Kumpakha A1, Regmi A1, Gochhe B1, Bajracharya1 1Kathmandu University, Dhulikhel, Nepal; 2Dhulikhel Hospital, Dhulikhel, Kavre, Nepal. Introduction: Infants and children are the most vulnerable population groups to contact illness. Antibiotic is commonly prescribed in pediatric patients. The key role of antibiotics for the treatment of infectious diseases. Objective: To obtain information on pediatric prescribing pattern of antibiotic in Nepal. Methods: This prospective study was performed in the pediatric ward. Results: Total number of 105 patients was taken for the study 89 from general ward and 16 from NICU. The disease of respiratory system (39.33%) and hyperbilirubinemia (68.75%) were predominant in general ward and NICU respectively. 53.93% of general ward patients received antibiotic where penicillin was most prescribed drugs, 75% were given only one antibiotic. Penicillin and aminoglycoside were most prescribed antibiotic in neonates. 56.25% of the total antibiotics were administered orally in ward patient and all antibiotics were administered parenterally in neonates. NSAIDs prescribed 55.05% of general ward patients. 54.15% of drugs prescribed by generic name and 70.59% of prescribed drugs from EDL. Significant difference found between age group of patient and disease encountered (χ2=36.6, P=0.05). There was significant difference between diseases of different system with respect to cost (F=7.69, P=0.01). Conclusion: While prescribing drugs in pediatric, the main challenges are choosing the right drug for them, hence physician should have good knowledge on choice of drug regimen in clinical situation, should emphasize on laboratory investigation for diagnosis and prescribing cost effective drugs. Also the increase in qualified and trained health worker like increase in hospital pharmacist would be helpful for the rational use of drugs. 065 Drug utilization study in a trauma care unit of a tertiary care hospital Mariguddi D.D, Jeevanagi S.R, Kakkeri R.H, Patil B.V, S.Manjunath M.R.Medical College, Gulbarga, India. Introduction: Trauma is major disease of modern mankind. The present study is to assess prescribing trends in a trauma care unit of a tertiary care hospital in Gulbarga City. Methods: A prospective cross-sectional study was conducted for 15 months in Basaweshwar Teaching and General Hospital Gulbarga. The data were analysed using WHO core indicators like prescribing indicators and patient care indicators. Results: A total of 110 patients where interviewed and their prescriptions were studied. The average number of drugs per prescription was 3.5 to 9.5. 46.77% of drugs were from WHO essential drug list and 2% were generics. The prescribing frequency of Diclofenac sodium (97%) was more, when compared to other analgesics. Among the drugs used to control oedema, Intravenous mannitol (47.27%) and oral glycerol (7.27%) were used. 79.09% of patients were given injection tetanus toxoid for tetanus prophylaxis. 96.5% prescriptions contain antimicrobials. The availability of the drug in the hospital was satisfactory (98%). The average cost of drugs per day per patient was ranging from Rs. 600-750/-. The average time given for consultation per patient was 12.5 minutes. Conclusion: The incidence of polypharmacy and use of non-generic names were very high. Drugs prescribed from essential drug list was only 50%. The newer antimicrobial and newer proton pump inhibitors were prescribed more, but tetanus prophylaxis is not 100%. Prescription by generics should be promoted for costeffective treatment. The results indicate that there is a considerable scope for improving prescribing habits according to rational drug use and to provide a feed back to hospital authority. 066 Efficacy and safety of antiretroviral therapy in prevention of vertical transmission of HIV infection Shashikala GH, Jayashree VN, Jyothi CH Department of Pharmacology, JJM Medical College, Davangere, Karnataka, India. Objective: To study efficacy of HAART (Highly active antiretroviral therapy) in preventing vertical transmission of HIV infection and observe for adverse drug reactions. Methods: Retrospective and prospective studies were done between June 2005 and 2008 at Child Health Institute, Davangere. The study included 177 babies born to HIV+ve mothers. They were given prophylactic Nevirapine 2mg/kg at birth, Zidovudine 4mg/kg×4wks as per WHO protocol. If they came after birth only Zidovudine was given. ELISA done at 9 and 18 months of birth indicated HIV status. Maternal data was analysed for antenatal prophylaxis received and type of delivery. Babies were observed for adverse reactions. Results: Of 177 babies, 173(97.74%) were non-reactive and 4(2.26%) were reactive to ELISA. In reactive group, 2 babies had complete prophylaxis but mothers received no prophylaxis. In other 2 babies and mothers prophylaxis was incomplete All were vaginal deliveries with average birth weight 2.41 kgs. In non-reactive group, 132 babies(76.30%) and 78 mothers (45.08%) received complete prophylaxis. 45 (26.01%) were caesarian deliveries with average birth weight 2.62kgs. Adverse effects included skin rashes (4) anemia (2). Conclusion: HAART given as per WHO protocol has good efficacy which can be further improved with strict adherence to treatment. Incidence of adverse effects observed is also low. 067 Prescribing pattern and cost-identification analysis of anti-infective use in respiratory tract infections in pediatrics department in a medical college hospital of North India Gupta K, Kaushal S, Chopra SC, Bains HS Dayanand Medical College and Hospital, Ludhiana, India. Respiratory tract infections are common in children requiring treatment with antimicrobial agents (AMAs). The aim was to identify prescribing pattern and cost-identification analysis of AMAs in respiratory tract infections in the pediatrics population in DMCH. The study was conducted over a period of two months (Nov-Dec, 2007) after approval by Institutional Ethics Committee. The data was collected daily in both Pediatric ward and ICU and entered in a structured proforma. Fifty nine patients were enrolled. The common diagnosis was bronchopneumonia (33.3%), bronchiolitis (17.5%) and bronchial asthma (7.9%). Average no. of AMAs received per patient was 3.9. The most common AMAs prescribed were cephalosporins 26.1%, aminoglycosides 20.9%, beta-lactams (except cephalosporins) 17.4%.and fluoroquinolones 11.1%.The group wise distribution shows that commonly prescribed AMAs were cefepime (35%), ceftriaxone (23.3%) and cefoperazone plus sulbactam (21.6%) among cephalosporins; amikacin (91.6%) among aminoglycosides; amoxicillin plus clavulanic acid (47.5%), cloxacillin (17.5%) and meropenem (15%) among beta-lactams (except cephalosporins). The preferred route of administration for AMAs was intravenous (86.1%), followed by oral (11.3%). Average cost of AMA per patient was Rs 6942. Beta-lactams contributed to 44% of the total AMA cost followed by cephalosporins (31.8%) and miscellaneous AMAs (8.5%). The outcome was favourable in 84.7% of the patients. DMCH being a major referral centre of the state, newer generation of AMAs are more commonly prescribed which leads to the increased cost. This preliminary study helped us to identify the pattern of AMA prescribing based on which future intervention studies may be planned to promote rational drug use. 068 Correlation between umbilical cord and maternal intrapartum serum retinol in very low birth weight neonates Mishra S, Thomas K, Agarwal R, Gupta YK, Deorari AK, Paul VK All India Institute of Medical Sciences, New Delhi, India. Introduction: Preterm very low birth weight (VLBW) neonates are known to be deficient in serum retinol at birth. There is paucity of data on vitamin A status of preterm neonates from India. Objectives: Primary: To evaluate the degree of correlation between maternal intrapartum (MI) and the umbilical cord (UC) serum retinol levels in preterm VLBW neonates. Secondary: To assess postnatal change in serum retinol level in these neonates at day-28 of age. Methods: Consecutively born 48 preterm VLBW neonates were enrolled in an institutional approved prospective study. Serum retinol was assayed by high performance liquid chromatography (HPLC). Enrolled neonates were followed till discharge/death/ or day-28 of life, whichever is later. Vitamin A intake of enrolled neonates was quantified and recorded prospectively till day-28 of age. Results: Average birth weight and gestation of the enrolled neonates was 1157±267 g and 31.6±2.7 weeks respectively. Mean vitamin A intake in first seven days and thereafter till day 28 was 1284±678 IU/day and 2475±930 IU/day respectively. Mean UC and MI serum retinol levels were 172.0±99.2 µg/L and 443.6±295.6 µg/L respectively. UC and MI serum retinol had a significant correlation (Correlation coefficient = 0.37; P=0.025). There was trend toward higher UC serum retinol levels in small for gestational age (SGA) compared to appropriate for gestational age (AGA) neonates (µg/L; mean difference, 95%CI: 34.9, 90.6 to -20.8; P=0.21). Serum retinol levels on day-28 of age were significantly higher compared to UC (µg/L; mean difference, 95% CI: 62.5, 14.4 to 110.5; P = 0.014). Conclusion: A significant correlation between UC and MI serum retinol was observed in preterm VLBW neonates. Serum retinol levels were significantly higher at 4 weeks of age.
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                Journal
                Ann Med Health Sci Res
                Ann Med Health Sci Res
                AMHSR
                Annals of Medical and Health Sciences Research
                Medknow Publications & Media Pvt Ltd (India )
                2141-9248
                2277-9205
                Jan-Jun 2011
                : 1
                : 1
                : 55-62
                Affiliations
                [* ]Department of Veterinary Physiology, Pharmacology and Biochemistry, Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria
                [** ]Department of Biochemistry, Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria
                Author notes
                Correspondence: Dr. M.I. Ezeja, Department of Veterinary Physiology, Pharmacology and biochemistry, Michael Okpara University of Agriculture, Umudike, Abia State, Nigeria. E-mail: ezejamaxwell@ 123456yahoo.com Phone: +2348033238975
                Article
                AMHSR-1-55
                3507093
                23209955
                d5cd663f-a68a-4a68-8935-fa6b9829fb7c
                Copyright: © Annals of Medical and Health Sciences Research

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                History
                : 21 July 2010
                : 08 August 2010
                : 10 August 2010
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