Atorvastatin as an adjuvant with betamethasone valerate reduces disease severity and cardiovascular risks in Psoriasis

Objectives: To evaluate the effect of Atorvastatin as an adjuvant with betamethasone valerate on disease severity and cardiovascular risks in chronic plaque type psoriatic patients

Methods: It is an interventional study conducted in Pharmacology Department of BMSI, JPMC with the collaboration of Dermatology Department of JPMC, Karachi. The duration of study was from June 2013 to June 2016. Seventy five psoriatic patients were prescribed Tablet Atorvastatin 40-20 mg/day [40mg for first three months twice daily followed by 20mg once daily for the next three month] plus topical Betamethasone Valerate 0.1% once daily for 6 months [three week apply than one week interval]. The efficacy and safety profile of drugs was measured by PASI, DLQI, hsCRP, LFTS and Lipid profile

Results: The percentage change of PASI is 86.749+/-0.547, DLQI is 82.697+/-.2.61 and hsCRP is 40.371+/-8.505, which showed highly significant improvement in patient at the end of last follow up. LFTs and CPK for safety profile of therapy showed non-significant results

Conclusion: Atorvastatin used as an adjuvant therapy with currently existing standard therapy [topical betamethasone] in patients having mild to moderate plaque type psoriasis reduces disease severity and cardiovascular risks

Anti-diarrheal effects of methanol extract of curcuma longa

Objective: To evaluate the anti-diarrheal effect of Methanol extract of Curcuma Longa, and to compare it with Loperamide in albino rats

Methodology: This experimental animal study was performed in the Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC], Karachi, in collaboration with BMSI Animal house, from May 2013 to December 2014. Dried rhizomes of Curcuma longa were purchased from local market of Karachi and soaked in 100% methanol, which was later evaporated to yield a semisolid extract. Seventy-two albino rats were used, which were randomly assigned into 3 groups of 24 rats. Each group was further divided into 4 subgroups. In each group, one subgroup was control, one was standard [loperamide group] and two subgroups were given 100mg/kg and 200mg/kg of methanol extract of Curcuma Longa orally. Anti-diarrheal effect was assessed by counting total number of feces after castor oil-induced diarrhea, castor oil-induced enteropooling and gastrointestinal motility test

Results: The methanol extract of Curcuma Longa showed significant anti-diarrheal activity evidenced by the reduction in defecation, decreased intestinal transit of charcoal meal and decreased enteropooling after castor oil-induced diarrhea

Conclusion: Curcuma Longa had potent anti-diarrheal affect and can replace synthetic drugs like loperamide. These effects were related to phytochemicals present in it

role of allopurinol and angiotensin receptor blockers in serum uric acid reduction in gouty and hypertensive patients

To evaluate the effect of Allopurinol in combination with angiotensin receptor blockers on hyperuricemia in gouty and hypertensive patients. Randomized, open label, prospective, comparative trial. This study was conducted in the Department of Pharmacology and Therapeutics; BMSI/JPMC, Karachi from April 2010 to November 2010. 80 hypertensive and hyperuricemic patients were enrolled from OPD and medical wards and were divided into two groups. Group DR-1[40 Patients] were given allopurinol 300mg plus candisartan 8mg daily and group DR-2 [40 patients] were given allopurinol 200mg Plus Losartan 50mg, daily four 4 months. 6 patients were unable to continue the follow-up 3 patients in each group. DR-1 combination therapy decreased serum uric acid level from 8.92 +/- 0.19mg/dl at day 0 to 5.33 +/- 0.11 mg/dl at day120. DR-2 group also showed a significant reduction in serum uric acid level from 9.14 +/- 0.19mg/dl at day 0 to 4.74 +/- 0.09mg/dl at day 120 [p<0.001]. When effects were compared in both treatment groups, the effect of group 2 regimens on serum uric acid level was more marked due to Losartan combination which also have uricosuric effects than in group 1 regimen, with average percentage decrease in serum uric acid - 40.35% in group DR-1 and -48.24% in group DR-2. The allopurinol 200mg and Losartan 50mg is more effective than allopurinol 300mg+ candesartan 8mg, to decrease serum uric acid level and group DR-2 drugs combination useful in those hyperuricemic patients who cannot tolerate high doses of uric acid lowering drugschromatogram obtained indicated the quantity of pesticide residues. Milk samples and serum samples were analyzed using HPLC technique. Pesticides such as malathion, permethrin, deltamethrin and Polytrin-C were detected in different concentrations. The levels were significantly higher than the maximum residual limit. It is concluded that the presence of pesticides in the human body is a major concern in the development of various ailments because of possible immunotoxic, mutagenic and carcinogenic potential of pesticides

Evaluation of efficacy of budesonide in prevention of cardiovascular risks in chronic obstructive pulmonary disease patients

Cardiovascular disease is a major cause of mortality and morbidity in COPD patients. Systemic inflammation plays a major role in the pathogenesis of cardiovascular disease in COPD. It has, therefore, been suggested that anti-inflammatory agents may prevent cardiovascular disease. It would be plausible that inhaled steroids, such as Budesonide, reduce the local inflammation and subsequent cardiovascular morbidity, thus a local effect on the lung resulting in diminished spill-over of inflammation systematically to the cardiovascular system is an attractive hypothesis. To assess the impact of Budesonide in reducing the cardiovascular risk in COPD patients. Experimental Randomized Study. This study was conducted in the Department of Pharmacology and Therapeutic, Basic Medical Sciences Institute, JPMC Karachi in collaboration with Department of chest medicine, JPMC, Karachi from Dec. 2010 to March, 2011. Thirty five patients with moderate stable COPD, hsCRP level >3mg/lit, were evaluated in an open label, intention to treat clinical trial. The patients were assigned to give Budesonide [Pulmicort] inhaled 200mcg BD for 12 consecutive weeks. The primary study outcome was to evaluate the reduction in cardiovascular risk by evaluating the improvement in FEV1 and reduction in hsCRP levels, was evaluated at day 30, 60 and day 90. Thirty four [96%] patients were completed the study. At baseline hsCRP levels was 6.68 +/- 0.26 which decrease to 5.82 +/- 0.20 [P<0.010] at day 90. FEV1[L] at baseline was 2.12 +/- 0.05 and at day 90 FEV1 increased up to 2.40 +/- 0.04 [P<0.001]. This shows that, the Budesonide can statistically significant decrease the hsCRP levels and increase the FEV1. In conclusion, Budesonide effectively decrease the cardiovascular risk by decreasing the systemic inflammation which were indicated by decreasing the hsCRP levels and also improve pulmonary functional capacity in COPD patients

Comparison of efficacy and adverse effects of trazodone and paroxetine in major depressive disorder

It is an open-label comparative study, conducted at the Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. The study comprised of two drugs of different groups; total eighty adult patients were enrolled [44 female and 36 male] from the department of psychiatry. Enrolled patients received trazodone 50 mg daily which was gradually increased to 150 mg in divided doses and paroxetine 20 mg daily for a period of 90 days. The results revealed that paroxetine is more effective and has less adverse effects than the trazodone. There was significant improvement in symptoms of sexual disturbance and weight loss of major depressive disorder patients receiving paroxetine

To study the efficacy of losartan on urinary uric acid excretion in thiazide induced hyperuricemic and hypertensive patients

The precise relationship of Hyperuricemia found in hypertensive patients is still obscure; this study is a urinary uric acid lowering intervention with Losartan in hypertensive patients induced by Thiazide diuretics. A number of pharmacological agents like loop diuretics, similarly low doses of aspirin [<3g daily] aggravate Hyperuricemia. The effect of Losartan on urinary uric acid excretion In Hypertensive patients with Thiazide induced Hyperuricemia were investigated in the Department of pharmacology and therapeutics, Basic Medical Sciences Institute Jinnah Postgraduate Medical Centre Karachi. It was randomized, open label, prospective, comparative study. Total 60 hypertensive Hyperuricemic patients were enrolled one by one in this study, selected from medical OPD and wards of Jinnah Postgraduate Medical Centre, Karachi. Patients were divided in three groups. Group-1 patients were treated with Thiazide 50 mg/day, Group-2 with Losartan + Thiazide 50 mg/day, and Group-3 with Losartan 50 mg/day. The effect on urinary uric acid level was measured, after every fortnightly. Treatment with Thiazide + Losartan group and Losartan group showed significantly increase in urinary uric acid excretion. Whereas, Thiazide group decrease in urinary uric acid level. In contrast to Thiazide and Losartan alone Thiazide + Losartan led to a greater increased in urinary uric acid excretion. The average percentage increase in urinary uric acid excretion in Thiazide + Losartan group was -13.27% and the average percentage increased in urinary uric acid excretion was 6.7% in Losartan group. Thus it can be concluded from the present study that urinary uric acid excretion was more increased in combination therapies. Ultimately Losartan decrease serum uric acid level and uricosuric effect of Losartan might be particularly useful in Hyperuricemic patients those on Thiazide diuretic [for hypertension and heart failure]

Efficacy and safety of metformin in over weight and obese patients with polycystic ovary syndrome

To evaluate the efficacy and safety of metformin in overweight and obese women with polycystic ovary syndrome. Forty-four overweight and obese female patients with diagnosed polycystic ovary syndrome were evaluated in an open label study. Patients were assigned metformin SOOmg thrice daily for six months. The primary outcomes were to assess change in the fasting serum insulin level, fasting plasma glucose, insulin sensitivity, weight, BMI, Waist to hip ratio and ultrasonographic features of overweight and obese women. The secondary outcomes were systolic and diastolic blood pressure, menstrual cyclicity and hirsutism. The safety of intervention was assessed by recording the self-reported adverse effects and performing renal and hepatic profiles. The patients were evaluated at monthly intervals. Forty subjects [90.9%] completed the study. At the end of six months, there was a significant effect of the drug on all the clinical parameters. Weight decreased from 85.71 +/- 1.04 to 84.38 +/- 1.02, BMI from 33.2 +/- 0.32 to 32.8 +/- 0.33[p <0.05] and Waist to hip ratio from 0.85 +/- 0.003 to 0.83 +/- 0.002.Ultrasonographic features, systolic and diastolic blood pressure also showed statistically significant improvement. Menstrual cyclicity, hirsutism, and metabolic parameters [serum fasting insulin level, fasting plasma glucose, HOMA index] also showed statistically significant improvement. The drug was well tolerated by the patients. No change was observed in blood urea, ALT and serum creatinine levels. Metformin is a safe and effective drug for the treatment of obese and over weight, women with PCOS

Comparison of efficacy and safety profile of gabapentin and carbamazepine in painful diabetic neuropathy

Comparison of efficacy and safety profile of Gabapentin and Carbamazepine in painful diabetic neuropathy. open label 12 weeks randomized controlled trial. The present study was conducted in Department of Pharmacology and Therapeutics Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Center [JPMC] in collaboration of Diabetic Clinic of Medical Unit III of JPMC Karachi. December 2010 to May 2011. 60 diagnosed patients of painful diabetic neuropathy were selected for 12 weeks trial after taking written consent. The patients were randomly placed into two groups, 30 patients each. One group received Gabapentin [n=30] while the other received Carbamazepine [n=30]. The primary outcome was reduction in pain scale. It was compared on 11-point numerical visual analog scale [VAS]. In Gabapentin group the reduction in pain VAS was 6.17 +/- 0.15 on day 0 to 3.5 +/- 0.15 on day 90. The percentage of change was 43.3% from baseline [p-value 0.001]. In carbamazepine group the reduction in pain VAS was 6.07 +/- 0.13 on day 0 to 4.23 +/- 0.13 on day 90. The percentage of change was 30.4% [p-value 0.001]. The secondary outcome was improvement in sleep interference that is measured on 11-point numerical VAS of sleep interference. It also improved in both groups which is highly significant. In patients of diabetic painful neuropathy treatment of Gabapentin and Carbamazepine both are effective but Gabapentin is superior in relieving symptoms than Carbamazepine

To study therapeutic effect and benefit on quality of life in scabies patients

To determine the quality of life by using 5% permethrin cream in scabies patients. Scabies is a contagious, itchy ectoparasitic infection caused by sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 to 400 million cases. They increases day by day due to resistance/ recurrence and largely effect the quality of life. 5% permethrin is one of the effective treatment of scabies it is highly effective, well tolerated, poorly absorbed and rapidly metabolized by skin. Open Label Clinical Trail study approved by ethics committee of Jinnah Postgraduate Medical Centre, Karachi. This study was conducted in Basic Medical Sciences Institute with Collaboration of Dermatology Department of JPMC, Karachi from 1st Dec 2010 to 30th Jan. 2011. This study sample involved 65 clinically diagnosed scabies patients who were treated with 5% permethrin cream. Clinical data was collected by using questionnaire. Patients were divided into three age groups and given two applications of permethrin cream on first and 15 day. Follow ups was done on Day 3, Day 15 and Day 30 and there quality of life assessed using dermatological life quality index on day 0 and 30. It was found that quality of life in scabies patients was low and treatment with permethrin cream clinically improved the symptoms of patients and their quality of life significantly. Scabies has a social stigma and the quality of life of patient get effected because of night itching and lack of sleep which improves significantly following proper local therapy

Study to assess the effect of topical clindamycin gel in acne vulgaris

Acne vulgaris is very common and all individuals of either sex suffer from this ailment at adolescent. The areas involved are cheeks, nose fore head, sometimes back also. Number of treatment options are available but clindamycin gel as topical preparation has been found effective. To find the suitability of clindamycin topically used. Study was performed on 40 patients of either sex, age group 14-29 years they were instructed to apply clindamycin topically twice daily up to three months. The results were significant at the end of treatment. The results were discussed with other studies. Clindamycin topical in the form of gel is suitable and effective for treatment of acne

Evaluation of the effectiveness of azithromycin in the treatment of uncomplicated enteric fever in local population

Many drugs have been used for the treatment of enteric fever. Azithromycin is a newer macrolide antibiotic also said to be effective against Salmonella typhi. In order to evaluate its effectiveness in our population, suspected typhoid patients were randomly selected from the OPD's of JPMC, Department of Medicine and were subjected to blood culture. 40 blood culture positive patients were given capsule Azthromycin in a dose of 500 mg per day for 10 days. Patients were observed for settlement of fever and/or any adverse effect during this period. Their CBC, ALT and creatinine levels were measured before the start of treatment. They were again subjected to blood culture on day 14, 4 days after the cessation of treatment. Fever settled in all patients between days 4 to 5. Blood cultures were negative in all patients after treatment. It was concluded that Azithromycin was effective in treating cases of enteric fever

Psyllium husk to increase HDL- Cholesterol; placebo controlled study

To examine the effects of Psyllium husk on HDL-Cholesterol. Single blind placebo controlled study. Study was conducted at department of pharmacology and therapeutics at Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Karachi, from January 2006 to July 2006. Forty hyperlipidemic patients were included, among which 20 patients were on placebo as control group, and 20 were on Psyllium husk, 3 gram daily, in divided doses for the period of three months. Patients with peptic ulcer, renal disease, hepatic disease, hypothyroidism, diabetes mellitus, and alcoholism were excluded from the study. HDL- Cholesterol was determined by using kit Cat. #303210040 by Eli Tech Diagnostic, France. Data were expressed as the mean +/- SD and [t] test was applied to determine statistical significance as the difference. A probability value of <0.05 was the limit of significance. Two patients were dropped from the study due to low compliance of metallic taste of psyllium husk. Psyllium husk has increased HDL-Cholesterol, in 90 days of treatment, from 34.61 +/- 1.85 to 36.77 +/- 1.96 [mg/dl], which was highly significant statistically when paired [t] test was applied for results. Percentage change was +6.24. It is concluded from this study that Psyllium husk decreases the risk of CHD by increasing HDL-Cholesterol

Comparison of effectiveness of topical tacrolimus and betamethasone with soft paraffin in the treatment of patchy alopecia areata

To compare the effectiveness of Topical Tacrolimus and Betamethasone with soft paraffin in the treatment of patchy alopecia areata. Sixty patients with mild to moderate patchy alopecia areata were evaluated in a non-randomized, open label, intention to treat clinical trial. Patients were assigned to Tacrolimus [n=20] or to Betamethasone [n=20] or to soft paraffin [n=20]. All the three groups were advised to apply the treatment on the affected areas twice a day for 12 consecutive weeks. The primary study outcome was to compare the hair regrowth rate. Efficacy was evaluated at weeks 4, 8 and 12, using hair regrowth score [RGS] with a scale ranging from 0 [regrowth<10%] to 4 [regrowth>75%]. Fifty six subjects [93%] completed the study. At week 12, the RGS was 3.5 +/- 0.11in Betamethasone group [p<0.001], 2.2 +/- 0.15 in Tacrolimus group [p<0.005] and 0.85 +/- 0.08 [ns] in control group respectively. RGS>3 was observed in 70% of patients in Betamethasone group as compared to 45% in Tacrolimus group and none of the patients in control group. Betamethasone is more effective than Tacrolimus in promoting hair regrowth as compared with soft paraffin in patients with mild to moderate patchy alopecia areata

Safety of losartan in hypertensive patients with thiazide induced hyperuricemia

Objective: To determine the safety of Losartan in hypertensive patients with Thiazide induced hyperuricemia. Design: Randomized, open label, prospective, comparative study. Setting: Basic Medical Sciences Institute Jinnah Postgraduate Medical Centre Karachi from February 2006 to July 2006

Methods: Total 60 hypertensive hyperuricemic patients were enrolled in this study, selected from medical OPD of Jinnah Postgraduate Medical Centre, Karachi. Patients were divided in three groups. Group DR-1 patients were treated with Thiazide 50 mg/day, Group DR-2 with Losartan + Thiazide 50 mg/day, and Group DR-3 with Losartan 50 mg/day. The effect on serum uric acid level was measured fortnightly

Results: Treatment with Thiazide + Losartan group DR-2 and Losartan group DR-3 significantly showed decrease in serum uric acid level. Whereas, Thiazide group DR-1 increased serum uric acid level. In contrast to Thiazide and Losartan + Thiazide, Losartan alone led to a greater reduction in serum uric acid level. The average percentage reduction in serum uric acid level in Thiazide + Losartan group was -12.75% and the average percentage reduction of serum uric acid level was -24.60% in Losartan group

Conclusion: These finding suggest that, Losartan in hypertensive hyperuricemic patients is more effective drug in lowering serum uric acid level. It may be worth pointing out that the serum uric acid level lowering effect of Losartan might be particularly useful in hyperuricemic patients those on Thiazide diuretic [for hypertension and heart failure]

Interferon alpha - induced psychotic disorder in patient with chronic hepatitis B

Interferon has remained the mainstay for treating patients suffering from chronic viral hepatitis. However, its efficiency has been limited by the neuropsychiatric side effect profile that it carries; neurotransmitter alterations in the central nervous system [CNS] have been correlated to psychiatric complications of Interferon alpha. Although mood disorders such as depression occasionally develop during Interferon alpha therapy, psychotic disorders have been rarely reported. We present a case of Interferon alpha 2b induced psychotic symptoms in a young male with hepatitis B and review the relevant literature

Gender differences in age at onset of schizophrenia

To evaluate the gender differences in age at onset of schizophrenia. Prospective case control study. Department of Psychiatry, Aga Khan University Hospital, Karachi between January to December 2002. Patients and Sixty patients admitted consecutively to psychiatry ward and meeting the inclusion criteria were enrolled for the study. Age at onset of illness was defined as age at onset of gross psychotic symptoms, age at first contact with psychiatrist and age at index admission. Statistical method included two independent samples t-test. Data was dichotomized into those with family history of schizophrenia versus those without family history of illness and then Chi-square test of association was applied. The mean age of onset of illness was 23.96 years in females and 24.13 years in males. In all other measures used to assess the onset of illness, females were overrepresented at the younger age group. 56.7% patients had a family history of psychotic disorder. Among them the mean ages at onset of illness were 20.59 years in females and 21.85 years in males [c 0.04 df =58]. The illness occurred at a younger age in those with positive family history of schizophrenia [21.22 years] than those without it [25.14 years] with dissipation of gender difference in the former. There was no significant gender difference in age at onset of disorder in this study. Family history of schizophrenia appears to be the most significant factor that eliminates the gender differences in age at onset of schizophrenia

Depression in primary care: difficulties and paradoxes

The presentation of depression in primary care is in many ways different from that seen in psychiatric settings. The process of detection and treatment is also different. This is particularly so in developing countries like Pakistan, which has high prevalence rates of depression but poorly organized primary health care services and primary care physicians [PCPs] who have little psychiatric training, either at undergraduate or postgraduate levels. There is a need to review difficulties faced by primary care physicians in detection and management of depression. It is hoped this would lead to better and more effective management of depression at primary health care level