Promoting the proper use of medicines in rural school children of India

Background: The problem of irrational use of medicines is prevalent in rural India. For safe and proper use of medicines there is a need to understand the proper way of taking medicines. Teaching proper use of medicines is the most neglected domain of the school health curriculum. So this study targeted school going children in rural area of India as the earlier the intervention, the more firmly longer lasting health related behavior can be successfully inculcated. The objectives of the study were (1) To study base level knowledge about use of medicines and (2) To implement and see the effect of an intervention to increase medicine knowledge in the form of information, education and communication (IEC) in rural school children.Methods: This was an interventional, questionnaire based (quantitative) study in which an intervention in the form of lectures which was given to school children. Rural school going children in age group of13-15 years were selected from 3 different schools of rural areas of Nagpur district, India. 500 school children were included after obtaining permission from school authorities and informed consent from their parents. Pretesting done by administering a questionnaire containing 20 questions to assess children's base level knowledge about medicine use. The same questionnaire was repeated on 16th and 45th day of intervention i.e. daily lectures of 25-30 minutes for 15 days on proper use of medicines, to judge the improvement.Results: It was observed that the interventions brought about a positive change in the knowledge of the students as well as increased awareness about proper use of medicines.Conclusions: This study showed that properly timed and meticulously implemented intervention can bring about a positive change in the attitude and knowledge of school children

Anti-hyperalgesic effect of paracetamol in rat model of thermal hyperalgesia: implications for the treatment of neuropathic pain

Background: Neuropathic pain conditions are prevalent in general population and difficult to treat. Most currently available therapies do not provide adequate benefit in all treated patients. Though Paracetamol is available for more than 100 years and have huge safety data, it is still not included in any treatment guidelines for neuropathic pain, as very few studies have evaluated its effects in neuropathic pain conditions. The aim of this study was to evaluate antihyperalgesic activity of paracetamol and to compare it with antihyperalgesic effect of amitriptyline and gabapentin in rat model of thermal hyperalgesia.Methods: Male albino wistar rats weighing 200-250 g of body weight and 4-6 months old were used. After anaesthetizing rats with 2% halothane, mild thermal injury was induced using hot plate analgesiometer. Drugs were administered intraperitoneally 30 minutes after thermal injury. Paw withdrawal latencies were measured at 30, 60, 90 and 120 minutes after drug administration. Statistical analysis done using GraphPad Prism version 5.01 and one way ANOVA followed by post hoc Dunnett's test or Tukey's test were used.Results: Paracetamol showed both dose as well as time dependent antihyperalgesic activity. Gabapentin demonstrated significantly more antihyperalgesic activity compared to amitriptyline (p< 0.05) and paracetamol (p< 0.01).Conclusions: Paracetamol showed antihyperalgesic activity however, it was less as compared to drugs like gabapentin and amitriptyline. Considering the excellent safety profile of paracetamol, it might be useful adjuvant drug for treatment of neuropathic pain conditions

A comparative study of efficacy and safety of combination of indacaterol and tiotropium versus formoterol and budesonide in moderate to severe COPD

Background: COPD patients suffer persistent airflow obstruction and exacerbation despite treatment with LABA and ICS. Presently LABA+LAMA is least tested combination hence we want to compare efficacy and safety of combination of indacaterol and tiotropium versus formoterol and budesonide in moderate to severe COPD.Methods: This was an open labelled, parallel group trial involving 60 patients. of moderate to severe COPD having baseline postbronchodilator FEV1 ≥30% predicted and less than 80% predicted already on some kind of COPD treatment were included and, efficacy on lung function (FEV1)  and  safety in two  groups, indacaterol+tiotropium once daily dpi versus formoterol+budesonide twice daily bd dpi were testedi24 hours postdose (trough) DPI in symptomatic patients of COPD of moderate to severe grade. Statistical analysis was done using repeated measures of ANOVA followed by Turkeys test. P value less than 0.05 were considered statistically significant.Results: Patient with baseline/post bronchodilator FEV1 ≥30% predicted and less than 80% predicted were included. The mean age was 55±5 years. At 4 weeks mean±SEM in peak FEV1 in indacaterol+tiotropium was 85.77±4.002 and in formoterol+budesonide was 77.33±5.598. At 12 weeks, mean ±SEM in peak FEV1 in indacaterol+tiotropium was 112.30±4.69 and formoterol+budesonide was 103±6.35. At 24 weeks, mean ±SEM in peak FEV1 in indacaterol+tiotropium= 125.3±5.18 and formoterol+budesonide=112.7±5.89. Adverse events were less in indacaterol+tiotropium group. No serious adverse event occurred. Indacaterol+tiotropium once daily is efficacious and safe as compared to formoterol+budesonide twice daily with less exacerbation.Conclusions: In patients having poorly controlled COPD despite background therapy (LABA, etophylline+theophylline, etc.) the introduction of indacaterol+tiotropium once daily compared to formoterol+budesonide twice daily DPI significantly improved the FEV1 by sustained bronchodilation, decreased exacerbation and is safe. Further studies are needed to assess quality of life and cost analysis

Comparison of efficacy, safety and cost-effectiveness of clotrimazole 1% cream and sertaconazole 2% cream in patients suffering from of mild to moderate tinea corporis, attending tertiary care hospital out-patient department: a randomized, open-labeled, comparative, parallel group trial

Background: Tinea corporis is a common dermatophytic infection of the body involving keratin layer of skin. This lesion presents as an annular plaque with an advancing border along with central clearing. Clotrimazole is topical, conventional imidazole antifungal drug and has given good efficacy in tinea corporis. Sertaconazole is new topical imidazole antifungal claimed to be superior to old topical imidazoles in tinea corporis. The aim of this study was to compare efficacy, safety and cost effectiveness of topical antifungals, clotrimazole 1% cream and sertaconazole 2% cream in patients suffering from mild to moderate tinea corporis attending out-patient department of tertiary care hospital in Vidarbha region of Maharashtra.Methods: This was a prospective, comparative, randomized trial with 2 parallel treatment arms of 4 weeks duration. Patients were diagnosed on the basis of clinical evaluation and microscopic findings of KOH mount. Hundred patients were randomly assigned into two groups of clotrimazole 1% cream, and sertaconazole 2% cream with 50 patients in each group. Evaluation was carried out at baseline, 1st week, 2nd week and 4th week for efficacy parameters viz. itching, erythema and scaling, physician’s global assessment (PGA), safety and cost effectiveness.Results: Topical sertaconazole 2% cream was highly efficacious and superior to clotrimazole 1% cream in improvement of clinical parameters, PGA and mycological cure at the end of the treatment phase. At end of the follow-up phase both the trial drugs were effective with no recurrence or relapse of tinea corporis. However, clotrimazole 1% cream was safe and cheaper.Conclusions: Topical clotrimazole 1% cream and sertaconazole 2% were effective and well tolerated in patients of tinea corporis. Effectiveness of sertaconazole was early and superior with tolerable side-effects. However, clotrimazole was cost-effective

Evaluation of effect of Calotropis gigantea root bark in some animal models of Wister albino rats

Background: Calotropis gigantea is a well-documented traditional medicinal plant useful for many disease conditions. The present study deals with the effect of alcoholic extract of roots bark of Calotropis gigantean in some animal models.Methods: Acute anti-inflammatory activity of root extract was assessed on carrageenin induced paw edema and chronic antiinflammatory activity on cotton pellet granuloma formation in rats and compared with standard diclofenac sodium. Antiasthmatic activity was assessed in histamine and actylcholine induced bronchoconstriction in guinea pigs.Results: 100 and 200 mg/kg p.o. root extract of CG showed significant anti-inflammatory and bronchodilator activity. Antiinflammatory activity was higher than Diclofenac Sodium 50mg/kg. The combination of low dose diclofenac sodium 25mg/kg potentiated the effect. Inhibitory effect on synthesis and release of various inflammatory mediators might contribute to both of these actions. Steroid like phytoconstituents might be responsible for these effects. Further research is needed to understand the exact mechanism behind these effects.Conclusions: In the present study Calotropis gigantea root bark exhibited anti-inflammatory activity in animal models.

The Antidepressant like action of ethanolic extract of areca catechu on behavioral models of depression in rats

Background: The objective was to investigate the anti-depressant like activity of areca catechu nut ethanolic extract (ACEE) using behavioural tests in rats.Methods: Forced swim test (FST) and tail suspension test (TST) were used to assess the anti-depressant like effect of ACEE rats. Motor coordination was also assessing using rota-rod test in rats to see generalised CNS depression. Fluoxetine was the reference standard drug. Rats were divided into four groups with six rats in each group namely control group, fluoxetine 10 mg/kg group, ACEE 50 mg/kg group and fluoxetine 5 mg/kg plus ACEE 25 mg/kg. All treatments were administered orally.Results: The areca nut ethanolic extract (ACEE) (50mg/kg oral) exhibited anti-depressant like activity i.e. decrease the duration of immobility time (sec) in acute forced swim test (FST) and in acute tail suspension test (TST) in rats (104±1.7, 95%CI 99.65 to 108.4, p <0.01) Vs control and (136.3±1.94, 95%CI 131.3 to 141.3, p<0.01) Vs control respectively. ACEE in low dose of 25 mg potentiated the anti-depressant activity of low dose fluoxetine 5 mg/kg in both the test 102.3±2.60, CI 95.64 to 109.0 p<0.01) Vs control. The ACEE did not produce motor incoordination in rats.Conclusions: The results of present study suggest that the areca catechu nut ethanolic extract 50mg/kg possess potential anti-depression like effect without generalized CNS depression. Further studies are needed to confirm this

Haematological abnormalities and pharmacotherapy in severe acute respiratory syndrome corona virus 2

The first case of SARS-CoV-2 (severe acute respiratory syndrome corona virus 2) was reported in Wuhan, China at the end of year 2019. It shows flu-like symptoms, but anosmia, fatigue, persistent cough and loss of appetite, that collectively might spot individuals with COVID-19. The aim of writing this review was to gather the information about blood abnormalities and pharmacotherapy for COVID-19 as a resource for healthcare professionals. A blood workup as well as continuous tracking hematological changes could divulge the risks of disease progression. The indirect indicators such as C-reactive protein (CRP), D-dimer, albumin, ferritin and LDH levels which are used as markers to estimate the severity of COVID-19 infection and prognosis. The most common hematological findings include lymphocytopenia, neutrophilia, eosinopenia, mild thrombocytopenia and less frequently, thrombocytosis. Clinical management includes prophylactic and therapeutic measures. Supportive care including supplemental oxygen and mechanical ventilatory support as and when indicated. Several class of drugs like anti-malarial, anti-viral, anti-inflammatory drugs are being used for the treatment and prevention of COVID-19. The target for development of most of the vaccine for COVID-19 is S protein of the corona virus. Various vaccines available for use across the globe are COVAX, Covishield, Moderna, Johnson and Johnson, Sputnik V, Novavax, Sinopharm, SinoVac. Serial monitoring of hematological manifestations is recommended and the treating doctor should stay vigilant and consider proper screening. The therapeutic intention is to decrease viral load and pharmacological thrombo-prophylaxis in high risk patients

The irrational fixed dose combinations in the Indian drug market: an evaluation of prescribing pattern using WHO guidelines

Background: Evaluation of the pattern of fixed dose combinations (FDCs) prescribing amongst the practitioners in a tertiary care hospital in Central India. Methods: Nine hundred and ninety four prescriptions, containing 639 FDCs were scrutinized in the tertiary care hospital. After excluding the total and the interdepartmental repetitions, the numbers of FDCs were 278, which were considered for final analysis. Inclusion criteria were FDCs from the major out-patient department (OPD) of the tertiary care hospital from January 2011 to December 2011. FDCs from the wards, casualty, infectious disease unit, intensive cardiac care unit (ICCU), tuberculosis and chest and HIV unit were excluded from the study. FDCs were analysed for the different pattern of prescribing and rationalism. Results were expressed as percentages. Results: Out of 639 FDCs, the most commonly prescribed FDCs were B complex (12.20%), pantoprazole plus domperidone (9.55%) and amoxicillin plus clavulanic acid (7.35%). Seventy percent of the FDCs were prescribed to the age group of 21-60 years. The FDCs were maximum from the department of medicine (25.59%), followed by surgery (15.47%) and ENT 13.69%. Out of 278 FDCs, only 5.4% were rational, and rest of the FDCs were irrational. Ninety five percent of all FDCs were brand names. The physicians were unaware of the active pharmacological ingredients (APIs) of 20.86% FDCs. Ninety two percent FDCs were available as over the counter (OTCs). Forty eight percent FDCs were costing from Rs. 0-50. There were 2.87% FDCs whose price was above Rs. 500.Conclusions: Irrational FDCs are prescribed by all the departments. Physicians were ignorant about the essential drugs and FDCs. Patients didn’t have access to rational medicines. Therefore, physicians and regulators should be alerted in time. Regulatory actions or government laws should be made mandatory. Availability and access to 348 essential medicines for basic health care should be the priority of the government. Implementation of central drug standard control organisations (CDSCO) guidelines on industries for manufacture of FDCs must be made compulsory

Anti-inflammatory activity of edible oyster mushroom is mediated through the inhibition of NF-κB and AP-1 signaling

<p>Abstract</p> <p>Background</p> <p>Mushrooms are well recognized for their culinary properties as well as for their potency to enhance immune response. In the present study, we evaluated anti-inflammatory properties of an edible oyster mushroom (<it>Pleurotus ostreatus</it>) <it>in vitro </it>and <it>in vivo</it>.</p> <p>Methods</p> <p>RAW264.7 murine macrophage cell line and murine splenocytes were incubated with the oyster mushroom concentrate (OMC, 0-100 μg/ml) in the absence or presence of lipopolysacharide (LPS) or concanavalin A (ConA), respectively. Cell proliferation was determined by MTT assay. Expression of cytokines and proteins was measured by ELISA assay and Western blot analysis, respectively. DNA-binding activity was assayed by the gel-shift analysis. Inflammation in mice was induced by intraperitoneal injection of LPS.</p> <p>Results</p> <p>OMC suppressed LPS-induced secretion of tumor necrosis factor-α (TNF-α, interleukin-6 (IL-6), and IL-12p40 from RAW264.7 macrophages. OMC inhibited LPS-induced production of prostaglandin E2 (PGE₂) and nitric oxide (NO) through the down-regulation of expression of COX-2 and iNOS, respectively. OMC also inhibited LPS-dependent DNA-binding activity of AP-1 and NF-κB in RAW264.7 cells. Oral administration of OMC markedly suppressed secretion of TNF-α and IL-6 in mice challenged with LPS <it>in vivo</it>. Anti-inflammatory activity of OMC was confirmed by the inhibition of proliferation and secretion of interferon-γ (IFN-γ), IL-2, and IL-6 from concanavalin A (ConA)-stimulated mouse splenocytes.</p> <p>Conclusions</p> <p>Our study suggests that oyster mushroom possesses anti-inflammatory activities and could be considered a dietary agent against inflammation. The health benefits of the oyster mushroom warrant further clinical studies.</p

Comparison of sterols and fatty acids in two species of Ganoderma

<p>Abstract</p> <p>Background</p> <p>Two species of <it>Ganoderma, G. sinense </it>and <it>G. lucidum</it>, are used as <it>Lingzhi </it>in China. Howerver, the content of triterpenoids and polysaccharides, main actives compounds, are significant different, though the extracts of both <it>G. lucidum </it>and <it>G. sinense </it>have antitumoral proliferation effect. It is suspected that other compounds contribute to their antitumoral activity. Sterols and fatty acids have obvious bioactivity. Therefore, determination and comparison of sterols and fatty acids is helpful to elucidate the active components of <it>Lingzhi</it>.</p> <p>Results</p> <p>Ergosterol, a specific component of fungal cell membrane, was rich in <it>G. lucidum </it>and <it>G. sinense</it>. But its content in <it>G. lucidum </it>(median content 705.0 μg·g^-1, range 189.1-1453.3 μg·g^-1, n = 19) was much higher than that in <it>G. sinense </it>(median content 80.1 μg·g^-1, range 16.0-409.8 μg·g^-1, n = 13). Hierarchical clustering analysis based on the content of ergosterol showed that 32 tested samples of <it>Ganoderma </it>were grouped into two main clusters, <it>G. lucidum </it>and <it>G. sinense</it>. Hierarchical clustering analysis based on the contents of ten fatty acids showed that two species of <it>Ganoderma </it>had no significant difference though two groups were also obtained. The similarity of two species of <it>Ganoderma </it>in fatty acids may be related to their antitumoral proliferation effect.</p> <p>Conclusions</p> <p>The content of ergosterol is much higher in <it>G. lucidum </it>than in <it>G. sinense</it>. Palmitic acid, linoleic acid, oleic acid, stearic acid are main fatty acids in <it>Ganoderma </it>and their content had no significant difference between <it>G. lucidum </it>and <it>G. sinense</it>, which may contribute to their antitumoral proliferation effect.</p