Evaluation of efficacy of Aloe vera (L.) Burm. f. gel solution in methylcellulose-induced ocular hypertension in New Zealand white rabbits.

Objectives The present study aimed to evaluate the efficacy of Aloe vera in the methylcellulose-induced ocular hypertension model. Methods Fifty-six rabbits were randomly divided into seven groups. Intraocular pressure (IOP) was raised by anterior chamber injection of 2% methylcellulose in all the groups except the normal control group. Disease control animals were treated with sterile water and active control with topical 0.5% timolol 12 hourly; 6 and 12% A. vera gel topical solutions 8 hourly were given in group IV and V, respectively; 6 and 12% A. vera gel solutions along with timolol were given in group VI and VII animals, respectively. Mean IOP values and percentage of reduction in IOP were compared at 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 36 h, and 48 h. Results A. vera gel solutions (6 and 12%) showed a significant reduction in mean IOP from 4 to 2 h time points, respectively, whereas, A. vera gel solutions (6 and 12%) + timolol showed significant less mean IOP from a 30 min time point as compared with disease control. A. vera gel solutions (6 and 12%) showed 8.6 and 10.4% more reduction in IOP, respectively (66.8 ± 4.9% and 68.6 ± 5.4% vs. 58.2 ± 2.3%; p > 0.05), whereas 6 and 12% A. vera gel solutions along with timolol showed 14.5 and 16.2% more reduction in IOP, respectively (72.7 ± 4.7% and 74.4 ± 4.1% vs. 58.2 ± 2.3%; p < 0.05), than disease control group at 48 h. Conclusions Six and twelve percent A. vera gel solutions reduced the IOP effectively. Concurrent treatment with 12% A. vera gel and timolol produced the maximum reduction in IOP.

Fenofibrate Nanocrystals Embedded in Oral Strip-Films for Bioavailability Enhancement.

The aim of the present study was to make a fenofibrate (FNB) nanocrystal (NC) by wet media milling, characterizations and formulates into oral strip-films (OSFs). Mechanical properties, redispersion study, and solid-state characterizations results suggested that reduction of drug crystal size at nanoscale and incorporation into OSFs does not affect the solid-state properties of the drug. In vitro dissolution kinetics showed enhanced dissolution rate was easily manipulated by changing the thickness of the OSF. In situ UV-imaging was used to monitor drug dissolution qualitatively and quantitatively in real time. Results confirm that the intrinsic dissolution rates and surface drug concentration measured with this device were in agreement with the USP-IV dissolution profiles. In vivo pharmacokinetics in rabbits showed a significant difference in the pharmacokinetics parameter (1.4 fold increase bioavailability) of FNB NC-loaded OSFs as compared to the marketed formulation "Tricor" and as-received (pristine) drug. This approach of drug nanocrystallization and incorporation into OSFs may have significant applications in cost-effective tools for bioavailability enhancement of FNB.

A Case Report of Antitubercular Drugs Induced Exanthematous Reaction Complicated by Acute Onset Levofloxacin Induced Toxic Epidermal Necrolysis (TEN).

BACKGROUND: We report a case of 25 years old male patient with antitubercular drugs induced exanthematous reaction and hepatotoxicity that was complicated by levofloxacin induced toxic epidermal necrolysis. The patient was allergic to ciprofloxacin and ofloxacin. Cross reactivity between ciprofloxacin and levofloxacin might be responsible for causing this reaction. CONCLUSION: Issues of cross sensitivity should be kept in mind and the same class of drugs should strictly be avoided to prevent such complications.

Effects of ethanolic extract of Jasminum grandiflorum Linn. flowers on wound healing in diabetic Wistar albino rats.

OBJECTIVE: To evaluate wound healing activity of ethanolic extract of Jasminum grandiflorum Linn. (J. grandiflorum) flowers in diabetic rats. MATERIALS AND METHODS: Streptozotocin-induced diabetic Wistar albino rats were divided into six groups (n=6).Three groups - diabetic control, positive control (that received Glibenclamide) and treatment (that received J. grandiflorum Linn. Flower extract) were operated for excision wounds (EW). These groups were evaluated for wound contraction and re-epithelization. The other three groups were operated for incision wounds (IW) and dead space wounds (DW). Incision and dead space wounds were produced in the same rats. IWs were analyzed for wound breaking strength and the granulation tissues from DWs were analyzed for dry weight, hydroxyproline content, and histology. RESULTS: IWs and DWs showed significant improvement in wound breaking strength (265.8±10.4 vs 332.5±8.2; p<0.05), granulation tissue dry weight (26.1±0.6vs 40.4±0.3; p<0.01) and hydroxyproline content (19.3±0.5 vs 32.6±0.8; p<0.01) in treatment group as compared to control group. Neo-angiogenesis was also high in treatment group. Wound contraction was earlier (day 14) in treatment group compared to diabetic control (day 20). No significant improvement was seen in re-epithelization in treatment group. CONCLUSION: Ethanolic extract of J. grandiflorum Linn. flowers increases granulation tissue formation as well as neo-angiogenesis. It also enhances wound contraction; however, re-epithelization was not significantly affected. J. grandiflorum Linn. flowers could be potentially effective in promotion of diabetic wounds healing by increasing granulation tissue formation and enhancing wound contraction; however, further studies are required for its clinical application.

Cephalosporins Associated Pseudomembraneous Colitis in an Elderly Male Patient - A Case Report.

INTRODUCTION: Incidence of antibiotic- associated diarrhoea is a common (10-30%) but pseudomembranous colitis (PMC) is less frequent (1-5%). Fluoroquinolones, clindamycin, penicillins, cephalosporins (mostly third generation) are commonly associated with PMC. The association between cephalosporins and PMC is now well established. CASE PRESENTATION: A 78 year old male patient developed pseudomembraneous colitis after administration of Ceftriaxone and Cefazoline for the treatment of pleural effusion. The reaction was confirmed by ultrasonography and CT scan. Causative agents were stopped and patient was managed by systemic therapy. Patient was expired due to respiratory complications as there was complexity in management of disease due to development of pseudomembraneous colitis. CONCLUSION: Increase awareness of prescribers for high-risk drugs, close monitoring, with immediate withdrawal of the culprit drug can reduce the complexity of management that occur due to development of such adverse drug reaction.

EVALUATION OF ANTICOAGULANT EFFECT OF SULFATED POLYSACCHARIDE (SPS) FROM CODIUM DWARKENSE BORGESEN IN κ-CARRAGEENAN INDUCED HYPERCOAGULABLE STATE IN WISTAR ALBINO RATS.

Our aim of the present study was to evaluate the anticoagulant effect of sulfated polysaccharides (SPS) from Codium dwarkense Bergesen in ic-carrageenan induced hypercoagulable state in Wistar albino rats. 48 Wistar albino rats of either sex were randomly divided into 6 groups - disease control, active control, treatment lowmand high dose and preventive low and high dose. K-Carrageenan (3 mg/kg) single dose intravenously was given in rat tail vein at pre-decided time to produce hypercoagulable state. Baseline, 24, 48 and 72 hours duration blood samples were collected for PT, INR, aPTT, platelet count and fibrinogen level, FDP and D-Dimer measurements. At the end of experiment, animals were sacrificed for histopathology analysis of lung, liver and mesentery. Sulfated polysaccharide (SPS) significantly restored altered coagulation parameters (PT, INR, aPTI, platelet count and fibrinogen level) without affecting fibrinolytic parameters (FDP and D-Dimer). Administration of SPS both as a treatment and preventive therapy reduced the number of microthrombi along with less structural damage in histopathology of lung, liver and mesentery. Heparin served as active control and its administration significantly prolonged aPT' and restored PT. This study shows, anticoagulant activity of SPS extracted from Codium dwarkense Bergesen in Wistar albino rats.

Evaluation of wound healing activity of cow urine ark in diabetic Wistar albino rats.

AIM: To evaluate wound healing activity of cow urine ark in diabetic rats. MATERIALS AND METHODS: Streptozotocin-induced diabetic Wistar albino rats were randomly divided into six groups (n = 6). Three groups - diabetic control, active control (glibenclamide), and treatment (cow urine ark) were operated for excision wounds (EWs). Rats in these groups received distilled water 1 ml/day, glibenclamide 0.5 mg/kg body weight/day, and cow urine ark 5.5 ml/kg body weight/day orally till complete healing of the EWs. EWs were evaluated for wound contraction on 3rd, 7th, and 11th day and for reepithelization on 11th day. The other three groups were operated for incision wounds (IW) as well as dead space wounds (DW) in the same animal which received the above agents orally for 11 days. IWs were analyzed for wound breaking strength and DWs were analyzed for dry weight, hydroxyproline content, and histology of granulation tissue. RESULTS: EWs showed significantly increased wound closure in the treatment group as compared to the diabetic as well as active control groups at 3rd (P < 0.001) and 11th (P < 0.05) post-wounding day and to the only diabetic control group at 7th (P < 0.01) post-wounding day. IWs showed significant improvement in wound breaking strength in the treatment as compared to diabetic (P < 0.001) and active control (P < 0.01) groups. DWs showed significant increase in hydroxyproline content of granulation tissue in the treatment as compared to diabetic control (P < 0.001) and active control (P < 0.001) groups. Wound breaking strength and hydroxyproline content also significantly increased in the active control group compared to diabetic control (P < 0.001 and P < 0.05, respectively). Granulation tissue dry weight was significantly increased in treatment and active control groups as compared to diabetic control (P < 0.001). CONCLUSION: Cow urine ark increases granulation tissue formation as well as collagen content. Wound contraction was also significantly improved. The cow urine ark could be potentially effective in promoting healing of diabetic wounds by increasing granulation tissue formation and collagen content, however, further studies are required for its clinical application.

Triamcinolone Acetonide and Bevacizumab Induced Raised Intraocular Pressure in An Elderly Male Diabetic Patient - A Case Report.

Intravitreal triamcinolone and bevacizumab are emerging treatment modalities for the patients of macular oedema; however, they are known to raise intraocular pressure. A 61 year old diabetic male patient developed glaucoma after administration of triamcinolone acetonide and bevacizumab intravitreally for treatment of macular oedema. His intraocular pressure was raised up to about 42 mm Hg. Such high and sustained rise in intraocular pressure may lead to vision loss by damaging the optic nerve. The patient was managed by local as well as systematic therapy and was recovered after 1 month from the occurrence of an event. Intraocular pressure should be monitored in patients receiving intravitreal triamcinolone and bevacizumab. Risk benefit analysis must be done before using IVTA and IVB in patients with diabetic macular oedema.

Steroid Induced Bilateral Avascular Necrosis of Head of Femur in an Adult Male Patient - A Case Report.

A 28 year old male patient, known case of pemphigus vulgaris was on dexamethasone pulse therapy. Total 7 pulses were given after that he developed avascular necrosis of head of femur on both sides, which was confirmed by digital X- ray and MRI. Avascular necrosis is a disabling and progressive condition in young patients gradually leads to femoral head collapse and eventual total hip arthroplasty. As per WHO-UMC causality assessment criteria, the association between reaction and drug was possible, Naranjo's score was 7. According to Modified Schumock and Thornton's criteria, this reaction was not preventable. The Modified Hartwig and Siegel's scale showed that the reaction was severe (level 6). Here we present a case where the use of steroid for pemphigus vulgaris resulting in the development of bilateral avascular necrosis of head of femur.

Griseofulvin and/or Terbinafine Induced Toxic Epidermal Necrolysis in an Adult Female Patient - A Case Report.

An 18 years old female patient, who was taking treatment for tinea cruris developed Toxic Epidermal Necrolysis (TEN) due to therapeutic dose of griseofulvin with concomitant use of terbinafine. Both the drugs were stopped; patient's condition was gradually improved after starting the treatment. As per WHO-UMC causality assessment criteria, association between reaction and drug was possible (for both griseofulvin and terbinafine). Griseofulvin and terbinafine, both are widely used as an oral antifungal agent to treat fungal infections, careful monitoring is required in the initial periods of the treatment to prevent such type of serious adverse drug reaction. We report a case of TEN possibly caused by griseofulvin with concomitant use of terbinafine resulting in diagnostic difficulty.

Effectiveness and tolerability of short course co-trimoxazole, norfloxacin and levofloxacin in bacteriological cure of uncomplicated urinary tract infection in outpatient setting. An open label, parallel group, randomized controlled trial.

To compare the bacteriological cure rate of short-course (3-day) treatment of uncomplicated urinary tract infection (UTI) using co-trimoxazole, norfloxacin and levofloxacin, patients with uncomplicated UTI were randomized to receive either co-trimoxazole (960 mg) twice a day or norfloxacin (400 mg) twice a day or levofloxacin (250 mg) once a day for three days. Urine culture was done at the end of treatment and evaluated for bacteriological cure rate in each group. Among a total of 175 patients, Escherichia coli (74.29%) was the most common organism isolated followed by Klebsiella (11.43%), Streptococcus (6.29%), Staphylococcus saphrophyticus (5.14%), and Pseudomonas (2.86%). At the end of three days' treatment, bacteriological cure rates were 86.2%, 87.7% and 83.3% for co-trimoxazole, norfloxacin and levofloxacin, respectively (p>0.05). Therefore short-course treatment with co-trimoxazole 960 mg twice a day, norfloxacin 400 mg twice a day and levofloxacin 250 mg once a day are almost equally effective for treatment of uncomplicated UTI.

Isoniazid induced convulsions at therapeutic dose in an alcoholic and smoker patient.

We report a case of isoniazid induced convulsions in 35 years old male alcoholic and smoker patient receiving intensive phase therapy for pulmonary tuberculosis. A case was confirmed by accidental positive de-challenge and rechallenge as well as ruled out other conditions. Use of isoniazid in alcoholic and smoker patient required a caution for prevention of neurological adverse reactions. Pyridoxine should always be prescribed to such patients for the prevention of such adverse reaction.

Hypolipidemic activity of a hydroalcoholic extract of Cyperus scariosus Linn. root in guinea pigs fed with a high cholesterol diet.

Lipid-lowering and antioxidant activities of a hydroalcoholic extract of Cyperus scariosus Linn. root (HCS) were evaluated in guinea pigs fed with a high cholesterol diet. Serum lipid profile (total cholesterol, triglycerides, LDL-C, VLDL-C, and HDL-C), atherogenic indices and serum enzymes (ALT, AST, ALP, LDH, and CK-MB) were performed in each group at 0 days and at the end of 60 days. Histological study of liver and kidney was done in groups 1, 2, 5, 6 and 7. The total phenolic and flavonoid content in HCS and its antioxidant activity were evaluated by the DPPH assay. Both doses of HCS decreased serum lipid profile and atherogenic indices (P < 0.05). HCS has lipid lowering, immunosuppressive and antioxidant properties, and mays have value in atherosclerosis prevention. The higher dose of HCS also reduced serum AST, ALP, and LDH levels and rosuvastatin increased AST and ALP levels (P < 0.05). Histology of the liver showed decreased lipid accumulation and improvement in hepatocytes in HCS-treated animals. The antioxidant activity of HCS may be responsible for its lipid lowering and cytoprotective action. HCS had significant lipid lowering and antioxidant activity, which; may be due to the phenolic compounds. HCS may be a safe and cost effective alternative to current statin therapy for patients with dyslipidaemia.

Lipid-lowering activity of Cow urine ark in guinea pigs fed with a high cholesterol diet.

OBJECTIVES: Cow urine ark (CUA), known as "Amrita" as mentioned in Ayurveda, contains anti-hyperglycemic and antioxidant effects. Therefore, we designed the present study to evaluate the lipid lowering activity of CUA and its possible implication in metabolic syndrome. MATERIALS AND METHODS: Thirty guinea pigs of either sex were divided into five groups: Group 1 and 2 serving as a vehicle and sham control, received normal and high fat diet for 60 days respectively; Group 3, 4 and 5 received high fat diet for 60 days with CUA 0.8 ml/kg, 1.6 ml/kg and rosuvastatin (1.5 mg/kg) on the last 30 days of study period, respectively. Serum lipid profile (total cholesterol, triglycerides, LDL- C, VLDL-C, HDL-C, total Cholesterol/HDL-C) and serum enzymes (ALT, AST, ALP, LDH and CK-MB) were performed in each group at the beginning and end of the study. Histological study of liver and kidney was done in each group. RESULTS: CUA (0.8 ml/kg) significantly decreased the serum triglycerides and VLDL-C, but CUA (1.6 ml/kg) decreased the total serum Cholesterol, triglycerides and VLDL-C (p < 0.05). Higher dose (1.6 ml/kg) of CUA also increased HDL-C level, significantly (p < 0.05). CUA reduced serum AST, ALP and LDH level, which was statistically significant as well, while it also decreased the accumulation of lipid in hepatocytes as compared to sham control. CONCLUSIONS: CUA reduced triglycerides, increased HDL-C and found to be hepatoprotective in animals that are on a high fat diet.

Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India.

AIM: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. MATERIALS AND METHODS: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer's criteria (2012) and PRISCUS list (2010). RESULTS: A total of 676 geriatric patients (52.12% females) were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer's criteria, at least one inappropriate medicine was prescribed in 590 (87.3%) patients. Metoclopramide (54.3%), alprazolam (9%), diazepam (8%), digoxin > 0.125 mg/day (5%), and diclofenac (3.7%) were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06%) patients. CONCLUSION: Use of inappropriate medicines is highly prevalent in elderly patients.

Evaluation of anti-urolithiatic effect of aqueous extract of Bryophyllum pinnatum (Lam.) leaves using ethylene glycol-induced renal calculi.

UNLABELLED: Materials and Methods : Thirty-six Wistar male rats were randomly divided into six equal groups. Group A animals received distilled water for 28 days. Group B to group F animals received 1% v/v ethylene glycol in distilled water for 28 days and group B served as ethylene glycol control. Groups C and D (preventive groups) received aqueous extract of leaves of B. pinnatum 50 and 100 mg/kg intraperitoneally, respectively for 28 days. Groups E and F (treatment groups) received aqueous extract of leaves of B. pinnatum 50 and 100 mg/kg intraperitoneally, respectively from 15(th) to 28(th) day. On days 0 and 28, 24 hrs urine samples were collected for urinary volume and urinary oxalate measurement. On day 28, blood was collected for serum creatinine and blood urea level monitoring. All animals were sacrificed and kidneys were removed, weighed, and histopathologically evaluated for calcium oxalate crystals deposition. RESULTS: Administration of aqueous extract of leaves of B. pinnatum reduced urine oxalate level significantly, as compared with Group B (p<0.001). Serum creatinine and blood urea level were improved significantly in all aqueous extract of leaves of B. pinnatum-treated groups. Relative kidney weight and calcium oxalate depositions were found significantly reduced in animals received ABP as compared with Group B (p<0.001). CONCLUSIONS: B. pinnatum is effective in prevention and treatment of ethylene glycol-induced urolithiasis.

Anti-urolithiatic effect of ethanolic extract of Pedalium murex linn. fruits on ethylene glycol-induced renal calculi.

PURPOSE: To evaluate effect of ethanolic extract of Pedalium murex Linn. fruits on experimental model of calcium oxalate nephrolithiasis. MATERIALS AND METHODS: Thirty-six male Wistar albino rats were randomly divided in 6 groups.Normal controls received distilled water for 28 days. Other five groups received ethylene glycol(1% v/v) in distilled water for 28 days. Pedalium murex ethanolic extract was given 200 mg/kg and 400 mg/kg orally in distilled water for 28 days in prophylactic groups (III and IV) and from 15th to 28th days in treatment groups (V and VI). The urea, creatinine, random blood sugar, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, bilirubin and calcium were measured on 28th day. 24 hr urinary oxalate and volume were measured on day 0 and 28. On day 28, kidneys were removed, weighed and subjected to histopathological examination. Calcium oxalate crystallization was evaluated by renal histopathology and in-vitro method of mineralization.All parameters were analyzed by Kruskal-Wallis or one-way ANOVA with post-hoc test. RESULTS: Pedalium murex showed significant improvement in renal function and kidney weight inprophylactic groups as compared to ethylene glycol controls. It did not show any effect on urinary oxalate, urine volume and any other serological parameters. Calcium oxalate crystallization was significantly reduced in all the Pedalium murex treated groups (P < .05). Calcium oxalate and phosphate mineralization were also inhibited by 33% and 57%. CONCLUSION: Ethanolic extract of Pedalium murex fruits possess significant activity for prevention of renal calculi.

A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous drug reactions. No large scale epidemiological data are available for this disorder in India. AIMS: To carry out a systematic review of the published evidence of the drug-induced SJS and TEN in Indian population. METHODS: Publications from 1995 to 2011 describing SJS and TEN in Indian population were searched in PubMed, MEDLINE, EMBASE and UK PUBMED Central electronic databases. Data were collected for the causative drugs and other clinical characteristics of SJS and TEN from the selected studies. RESULTS: From 225 references, 10 references were included as per selection criteria. The major causative drugs were antimicrobials (37.27%), anti-epileptics (35.73%) and non-steroidal anti-inflammatory drugs (15.93%). Carbamazepine (18.25%), phenytoin (13.37%), fluoroquinolones (8.48%) and paracetamol (6.17%) were most commonly implicated drugs. Regional differences were observed for fluoroquinolones, sulfa drugs and carbamazepine. Total 62.96% of patients showed systemic complications. Most common complications were ocular (40.29%) and septicemia (17.65%). Higher mortality was observed for TEN as compared to SJS (odd ratio-7.19; 95% confidence interval (CI) 1.62-31.92; p = 0.0023). Observed mortality is higher than expected as per SCORTEN score 3. Duration of hospital stay was significantly higher in TEN (20.6 days; 95% CI 14.4-26.8) as compared to SJS (9.7 days; 95% CI 5.8-13.6; p = 0.020). Cost of management was significantly higher in TEN (Rs. 7910; 95% CI 5672-10147; p < 0.0001) as compared to SJS (Rs 2460; 95% CI 1762-3158). No statistical data were described for steroid use in the studies included. CONCLUSION: Carbamazepine, phenytoin, fluoroquinolones and paracetamol were the major causative drugs. TEN is showing higher mortality, morbidity and economic burden than SJS.