Social pharmacology: expanding horizons

In the current modern and global society, social changes are in constant evolution due to scientific progress (technology, culture, customs, and hygiene) and produce the freedom in individuals to take decisions by themselves or with their doctors toward drug consumption. In the arena of marketed drug products which includes society, individual, administration, and pharmaceutical industry, the young discipline emerged is social pharmacology or sociopharmacology. This science arises from clinical pharmacology, and deals with different parameters, which are important in creating knowledge on marketed drugs. However, the scope of “social pharmacology” is not covered by the so‑called “Phase IV” alone, but it is the science that handles the postmarketing knowledge of drugs. The social pharmacology studies the “life cycle” of any marketed pharmaceutical product in the social terrain, and evaluates the effects of the real environment under circumstances totally different in the drug development process. Therefore, there are far‑reaching horizons, plural, and shared predictions among health professionals and other, for beneficial use of a drug, toward maximizing the benefits of therapy, while minimizing negative social consequences

Social pharmacology: expanding horizons

In the current modern and global society, social changes are in constant evolution due to scientific progress (technology, culture, customs, and hygiene) and produce the freedom in individuals to take decisions by themselves or with their doctors toward drug consumption. In the arena of marketed drug products which includes society, individual, administration, and pharmaceutical industry, the young discipline emerged is social pharmacology or sociopharmacology. This science arises from clinical pharmacology, and deals with different parameters, which are important in creating knowledge on marketed drugs. However, the scope of “social pharmacology” is not covered by the so‑called “Phase IV” alone, but it is the science that handles the postmarketing knowledge of drugs. The social pharmacology studies the “life cycle” of any marketed pharmaceutical product in the social terrain, and evaluates the effects of the real environment under circumstances totally different in the drug development process. Therefore, there are far‑reaching horizons, plural, and shared predictions among health professionals and other, for beneficial use of a drug, toward maximizing the benefits of therapy, while minimizing negative social consequences

Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials

Background To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases. Methods The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months. Conclusions PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions

Practitioners section - Atherosclerosis in diabetes mellitus: Role of inflammation

Inflammation plays a central role in the pathophysiology of atherosclerosis, starting from initiation, through progression, and ultimately the thrombotic complications of atherosclerosis. Diabetes mellitus is a major risk factor for atherosclerosis. Hyperglycemia-induced endothelial dysfunctions, along with hypercoagulable potential of diabetes mellitus, accelerate the process of atherothrombotic complications. Therefore, clinically feasible markers to monitor subtle systemic inflammatory burden and specific add-on therapy for the same constitute need of the present day. The understanding of the concept of inflammation in diabetes-accelerated atherosclerosis can be used practically to predict future cardiovascular risk by evaluating inflammatory biomarkers and to design clinical trials making inflammation as a therapeutic target

Dasiglucagon for the Treatment of Insulin-induced Hypoglycemia in Patients with Type 1 Diabetes Mellitus: A Meta-analysis

Background:The use of conventional glucagon for managing insulin-induced hypoglycemia is obscured by its chemical instability and the need for reconstitution of the lyophilized powder, leading to delayed rescue. Dasiglucagon, a glucagon analog, may potentially overcome these shortcomings.Aims:To evaluate the efficacy and safety of dasiglucagon in insulin-induced hypoglycemia in patients with type 1 diabetes mellitus (T1DM).Study Design:Meta-analysis.Methods:PubMed/MEDLINE, Scopus, Embase, and Cochrane databases along with clinical trial registries were searched to include data from five randomized controlled trials conducted using dasiglucagon for the treatment of insulin-induced hypoglycemia in T1DM patients published until May 2023. We performed a risk of bias assessment to determine the quality of the included studies and a random-effects model analysis for determining the effect size. Subgroup analysis and meta-regression were done as applicable.Results:The time to recovery (in minutes) with dasiglucagon was earlier than placebo [mean difference (MD): -24.73; 95% confidence interval (CI): -30.94 to -18.52; p < 0.00001) or oral glucose (MD: -15.00; 95% CI: -20.33 to -9.67; p < 0.00001); however, the difference between dasiglucagon and glucagon was not statistically significant (MD: -0.76; 95% CI: -2.19 to 0.66; p = 0.29).Conclusion:Dasiglucagon is safer and more effective than placebo or oral glucose for insulin-induced hypoglycemia in T1DM patients; however, it is not superior to conventional glucagon

Essential medicines: An Indian perspective

The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world′s poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers

Multifold C–C Coupling and Unorthodox Cyclization Catalysis for Selective Synthesis of Indolotriarylmethanes, Indolocarbazoles, and Their Analogues: A Control Experiment Study

The selective construction of medicinally and synthetically important indole-based unsymmetrical triarylmethanes using indoles and aldehydes is challenging because the significant nucleophilicity of indole leads to C–C coupling with an azafulvene intermediate to build up the alternative bis­(indolyl)­methane products, which may be useful synthons. A new, straightforward, ligand-free Cu^II catalytic strategy for easy syntheses of unsymmetrical indolotriarylmethanes and new bisindolylbenzoyl analogues is established through the dual C–C coupling of an assembly of three reaction partners comprising aldehydes, indoles, and arylboronic acids. More importantly, this approach is exploited for multifold C–C coupling cyclization reactions with C–C cleavage using symmetrical bisindolylbenzoylmethanes in the presence of an organic base and aerial molecular oxygen as a stoichiometric oxidant. In contrast to the formation of a simple cyclocondensation product indolocarbazole, it undergoes unprecedented selective pseudo-four-component tandem oxidative cyclization with fragmentation from a 1,3-dicarbonyl compound to produce valuable fused 5,7-dihydroindolo­[2,3-<i>b</i>]­carbazoles through the functionalization of two indole C­(sp²)–H and one C­(sp³)–H bond of the active methylene residue. For a better understanding of the new reactions, we have studied various competition experiments and ESI-MS and 3D Mid-IR-ATR spectral analyses of the ongoing reactions. The predicted DFT transition state model is also in agreement with the experimental results

Cilostazol reduces inflammatory burden and oxidative stress in hypertensive type 2 diabetes mellitus patients

Objectives: Inflammation and oxidative stress cause genesis and progression of atherosclerosis in diabetes. This study aimed to assess effects of Cilostazol on these factors in hypertensive type 2 diabetic patients. Materials and Methods: In randomized, open, add-on preventive controlled clinical trial design, 60 hypertensive type 2 diabetics aged ≥45 years were evaluated clinically and for total leukocyte count, erythrocyte sedimentation rate, serum albumin, serum hsC-reactive protein, plasma malondialdehyde, blood reduced glutathione and HbA1c levels. After informed consent, 30 patients received Cilostazol (100 mg) twice daily orally as add-on therapy. At 1 month follow-up, 26 patients in control group and 22 patients in Cilostazol group completed the trial and particular parameters were re-evaluated. Results: The mean age and duration of diabetes were 55 ± 7 years and 8 ± 6 years, respectively. At follow-up, the Cilostazol group showed significant (p &#60; 0.001) decrease in hsC-reactive protein (23.6%), erythrocyte sedimentation rate (38.7%), total leukocyte count (12.6%), plasma malondialdehyde (17.6%), HbA1c (0.17%, p = 0.002) and increase in serum albumin (11.9%), blood reduced glutathione (3.5%) from baseline. UKPDS 10 years risk of coronary heart disease decreased by 6% (p = 0.002). The control group did not show significant improvement in inflammatory profile, oxidative status and HbA1c. Conclusion: Inflammatory and oxidative stress is high in hypertensive type 2 diabetic patients. Cilostazol reduces these factors as well as coronary heart disease risk in diabetes mellitus