Prescribing patterns of tramadol in hemodialysis patients

Background: Pain is the most common complaint in hemodialysis patients. Tramadol had become analgesic of choice in these patients, and its prescription is increasing day by day. With this background, we evaluated the prescribing trends of tramadol in patients undergoing maintenance hemodialysis.Methods: A total of 70 prescriptions were audited to assess the prescribing trends of tramadol (usually prescribed as a combination of 37.5 mg tramadol and 325 mg of paracetamol two times a day). Included prescriptions were from both male and female patients above 18 years of age undergoing maintenance hemodialysis. Demographic, clinical and medication use were recorded from the patients.Results: The mean age of patients was 48±11.7 years, duration of dialysis 2.2±1.4 years. Tramadol consumptions were observed in 40/70 (56%) of patients. Majority of tramadol consumption was found in 30/40 (75%) males, 23/40 (59%) between 40-59 years and 28/40 (70%) undergoing two dialyses per week and 13/40 (32.5) were diabetics. During our exploratory analysis, we found that 15/40 (38%) of tramadol users, were concurrently prescribed with clonidine as add on antihypertensive. We noticed that the tramadol pill count during the preceding week was 81 in patients concurrently using clonidine and 139 in the patients who were not using clonidine (p>0.05).Conclusions: In our study, tramadol consumptions were observed in 56% of patients. We also noticed analgesic interaction between clonidine and tramadol

Antibacterial susceptible pattern of ear, nose and throat in paediatric patient infections

Background: To study the bacterial pathogens of ear, nose and throat (ENT) to determine the frequency and sensitivity pattern of ENT infections in paediatric patients.Methods: The study was conducted during the period of June 2016 to May 2017 in Kerala Medical College Hospital. A total 225 samples were collected and evaluated for microbiological investigations. Antimicrobial susceptibility profile was determined by modified Kirby Bauer disc diffusion method.Results: Out of 225 samples, 140 (62.22%) were found positive growth and 85 (37.77%) of samples were found negative culture. The frequency of different organisms isolated was as follows: Pseudomonas 43 (30.71%), Staphylococcus aureus 32 (22.85%), Proteus spp. 18 (12.85%) Klebsiella spp. 17 (12.14%) etc., Antibiotic susceptibility pattern gram positive bacteria were vancomycin (100%) followed by amikacin (97.14%), and in gram negative bacteria; sulbactam/ cefoperazone (97.14%), piperacillin/tazobactam (95.23%) and meropenem (94.28%) were the most effective drugs.Conclusions: Pseudomonas aeruginosa, Staphylococcus aureus, Proteus spp. and Klebsiella spp. are the leading ENT pathogens in paediatric patients. Most of the isolates showed high resistance to cephalosporins. Showed high effectiveness to sulbactam/ cefoperazone, piperacillin/tazobactam

Change from baseline as an outcome illustrates escape behaviour of rats in hot plate method

Background: The Hot Plate test is a thermal hyperalgesia model to assess the analgesic activity of many compounds. Traditional analysis compares reaction times with controls, reports only analgesic activity without considering escape reflex. Escape reflex to pain sensation also provides an indirect measure of analgesic activity. However, it requires repeated exposure of rats to hot plate. We explored the learning activities and escape behaviour of rats by calculating the change from baseline of reaction times.Methods: Male Wister strain albino rats, weighing between 150-200mg were used for assessment of hot-plate induced hyperalgesia. Author analysed the analgesic activity of aspirin (100mg/Kg) and compared with animals receiving saline. Aspirin and saline were administered 1hr orally before the commencement of the experiment. The reaction time was recorded at every 30 min up to 6hrs.Results: With traditional analysis, we can observe that the onset of action, peak action and duration of analgesic activity of aspirin was at 0.5, 2.0 and 5.0 hours respectively. Peak inhibition of reaction time was seen at 2 hours with a magnitude of 474%. When we applied a statistical procedure, absolute change from baseline statistics, we found that animals treated with aspirin also exhibited escape reflex after fading of drug response and animals treated with saline demonstrated early (0.5hr) escape behaviour from the hot plate and continued throughout the rest of the experiment.Conclusions: Change from baseline as an outcome illustrates escape behaviour of rats in hot plate method and it should be employed along with percentage inhibition during assessment of analgesic activity

Evaluation of analgesic and anti-inflammatory properties of the Allium cepa extract in rats

Background: The onion plant (Allium cepa) is the most widely cultivated species of the genus Allium. It has antibiotic, antidiabetic, antihypercholesterolemic, antioxidant, hemostatic, antimutagenic effects. The current study is aimed to evaluate analgesic and anti-inflammatory properties of Allium cepa extracts in rat models.Methods: In this study analgesic activity in rats is tested by Eddy’s hot plate method, tail flick method. In Eddy’s hot plate method rats are individually placed on the heated plate of the analgesic meter maintained at 550C and mean reaction time was calculated at regular time intervals. In tail flick method the tail withdrawal from the heat (flicking response) is taken as the end point. Anti-inflammatory property is studied by carrageenan induced paw edema model, in which the paw volume is measured with a plethysmograph.Results: In Eddy’s hot plate method the mean reaction time increased significantly (p<0.05) with high dose of Allium cepa at 1 hour and 2 hours when compared to control. In tail flick method the mean reaction time is increased significantly (p<0.05) with high dose of Allium cepa at 1 hour and 1.5 hour when compared to control. In carrageenan induced paw edema method Allium cepa exhibited anti-inflammatory activity by significant (p<0.05) suppression of paw edema when compare to control at 1 hour after carrageenan injection to rat paw.Conclusions: Allium cepa has significant analgesic and anti-inflammatory activity in hot plate, tail flick and carrageenan induced paw edema model

A randomized open label parallel group study comparing the safety, effectiveness and adherence between 2% fusidic acid cream versus 1% retapamulin ointment in children with impetigo

Background: Impetigo is a contagious bacterial skin infection that affects both adults and children. Topical antibacterials such as mupirocin and fusidic acid are the most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of retapamulin in the treatment of secondary impetigo. However, its use in primary impetigo is limited. To this purpose, we compared the safety, efficacy and adherence to treatment of fusidic acid with retapamulin in primary impetigo.Methods: A total of 50 patients with a clinical diagnosis of primary impetigo, between 2-12 years of age, having 0.05). Both drugs were well tolerated.Conclusions: Both fusidic and retapamulin showed similar clinical success in patients with primary impetigo. Since fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidic acid-resistant impetigo

Anti-stress activity of Ocimum sanctum and alprazolam in animal models

Background: Stress is the physiological, psychological and behavioral response by individuals when they perceive a lack of equilibrium between the demands placed upon them and their ability to meet those demands, which over a period of time leads to ill health. There are several ways of coping with stress. Some techniques of time management may help a person to control stress.Methods: Forced swim test- mice were randomized into two groups according to the body weights. Each group contains six animals. Each individual animal was allowed to swim inside the jar (25-12-25 cm) containing fresh water up to 15 cm height. Mice were allowed swim for 6 min. After initial struggle to escape the animal became immobile. Total immobility period was measured. Rotarod test- mice were randomized into two groups according to body weights. Each group contains six animals. Rats were placed on the lanes. Latency period was recorded at which each rat falls off the rod.Results: In first experiment, anti-stress activity of Ocimum sanctum in mice was demonstrated by measuring the immobility period during forced swim test and in the second experiment the measurement of the latency period of rats in rotarod apparatus was performed. Both the experimental procedures were compared with standard anti stress drug alprazolam.Conclusions: The present study suggests that Ocimum sanctum possess significant anti stress activity but less when compared to alprazolam

Assessment of Morus alba (mulberry) leaves extract for anti-psychotic effect in rats

Background: Morus alba commonly known as white mulberry has been widely cultivated to feed silkworms. This widely grown plant has been in use by tribals of this country for ailments such as asthma, cough, bronchitis, edema, insomnia, wound healing, diabetes, influenza, eye infections and nose bleeds. Various parts of morus alba linn are used as an cardioprotective, hepatoprotective anti-inflammatory, hypoglycemic, free radical scavenging activity and neuro-protective agent. In this study, anti-psychotic property of M. alba leaves extract (MAE) was evaluated by Haloperidol induced catalepsy model in rats.Methods: In this study Haloperidol induced catalepsy model was used to evaluate antipsychotic effects in rats. Haloperidol (1 mg/kg) was injected intraperitoneally to rats (n=6) pretreated with vehicle (0.5 mg/kg, i.p.) or MAE (100, 200 and 400 mg/kg, i.p).Results: In control treated animals, haloperidol produced the maximum catalepsy at 90 min 212.66 ±10.23. In animals treated with MAE at dose of 100 mg/kg, 200 mg/kg and 400 mg/kg significantly potentiated haloperidol induced catalepsy at each time interval, in a dose dependent manner. At dose 100, 200 and 400 mg/kg, animals treated with MAE showed maximum cataleptic score of 228.33±12.29, 265.66±7.33 and 274.16±8.86 respectively at 120 min (p<0.001).Conclusions: Results indicate that the MAE have anti-psychotic effects in haloperidol induced catalepsy model in rats

Clinical Profile and Outcome of Conservatively Managed Emphysematous Pyelonephritis

Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection characterized by production of intraparenchymal gas. EPN predominantly affects female diabetics and immunocompromised patients. In a three-year period 2008–2011, a total of 8 patients were admitted to our hospital. All of them were diabetics, and both males and females were equally affected. These patients showed vague symptoms at admission and frequently presented with fever, loin pain, dysuria, and pyuria necessitating urgent medical attention. EPN required radiological diagnosis. CT scan revealed bilateral EPN with urinary obstruction and hydronephrosis in 50% of patients. Escherichia coli was found to be the causative organism in all the patients. Treatment comprised of resuscitation, normalization of serum electrolytes and blood sugars, administration of parenteral antibiotics, and relieving ureteric obstruction if present. All the patients improved with conservative management without any mortality

Assessment of Morus alba (Mulberry) leaves extract for anti-convulsant property in rats

Background: The mulberry tree, a plant of the family Moraceae and the genus Morus, has been widely cultivated to feed silkworms. Various parts of Morus alba linn used as an Anti-inflammatory, hypoglycemic, cardioprotective, hepatoprotective, free radical scavenging activity and neuroprotective agent. The plant contains flavonoids, moranoline, albanol, morusin coumarine, and stilbene, which have. In this study, anticonvulsant property of Morus alba leaves extract (MAE) was evaluated by using MES and PTZ induced convulsion in rats.Methods: Effects of MAE were evaluated in experimental models of electro convulsions, maximal electro shock (MES) and chemoconvulsion induced by pentylenetetrazole (PTZ) in rats (n=6), which were treated intraperitonially with doses of 100, 200 and 400mg/kg.Results: The duration of tonic hind limb extension (seconds) with MAE in MES induced convulsions at dose of 100, 200, 400 mg/kg is 8.33±1.21, 6.83±1.16 & 3.16±0.98 respectively. In the dose of 400 mg/kg of MAE showed highly significant results by reducing the duration of tonic hind limb extension in MES induced convulsions. And onset of jerky movements (seconds) with MAE in PTZ induced convulsions at dose of 100, 200, 400mg/kg is 157.83±8.99, 195.66±17.02 and 295.50±21.10 respectively. In the dose of 400mg/kg of MAE showed highly significant results by delaying the onset of convulsions.Conclusions: Results indicate that the MAE have anticonvulsant effects in MES induced convulsions and in PTZ induced convulsions

Analgesic and anti-inflammatory properties of the aqueous extract leaves of Murraya koenigii linn in small animal models

Background: The present study was carried out to evaluate the analgesic activity of aqueous extract leaves of Murraya koenigii linn in Albino rats using tail flick method, Eddy’s hot plate methods and anti-inflammatory activity in Carrageenan induced paw edema in rats.Methods: The analgesic activity was evaluated using Eddy’s hot plate induced hyperalgesia and tail flick method, which served as thermal induced pain, where the animal were placed on the hot plate and the reaction time to (lick the paw/jump out) from the hot plate was observed, 0, 30, 60, 90 mins. Murraya 300 mg, 600 mg/kg/body weight (BW) and ibuprofen (5 mg/kg BW) was administered per oral. The anti-inflammatory activity was measured by Carrageenan induced paw edema volumes at 0, 1, 2, 3 and 4 hrs using mercury plethysmometer, which served as chemical induced pain models.Results:  The mean reaction time in Murraya at a dose of 600 mg/kg at 0 min 5.45±0.72, at 30 mins 6.52±1.03, at 60 mins 7.6±0.81, at 90 mins 8.8±0.63 respectively. The mean reaction time increased significantly with Murraya at dose of 600 mg/kg when compared with control.In the ibuprofen group, the mean reaction time at 0 hr was 0.28±0.04, at 1 hr 0.34±0.05, at 2 hrs 0.46±0.03, at 3 hrs 0.61±0.05, at 4 hrs 0.76±0.05. The mean reaction time Murraya in group 600 mg/kg at 0 hr 0.27±0.04, at 1 hrs 0.39±0.03, at 2 hrs 0.48±0.06, at 3 hrs 0.68±0.05, at 6 hrs 0.80±0.03, respectively.Conclusions: The results indicate that the aqueous extract of Murraya (leaf) extract revealed significant analgesic and anti-inflammatory in thermal and chemical induced pain models