Duavee: a tissue-selective estrogen complex for menopausal symptoms and prevention of osteoporosis

Post-menopausal women suffer from a plethora of problems like vasomotor symptoms, vulvovaginal atrophy (VVA), bone loss, and all this can be attributed to estrogen deficiency. The conventional treatment till date for these hormone deficient manifestations have been estrogen replacement therapy in hysterectomized female or a combination of estrogen and progesterone therapy in women with an intact uterus. The reason for adding progesterone is to protect the endometrium from estrogenic stimulation. The drawback with the combination therapy was irregular vaginal bleeding and breast discomfort, which led to the discontinuation of this therapy. The United States Food and Drug Administration, has recently approved a novel tissue selective estrogen complex comprising of conjugated estrogen (0.45 mg) and a selective estrogen receptor modulator, bazedoxifene (BZA) (20 mg) for the treatment of moderate to severe vasomotor symptoms and prevention of osteoporosis in non-hysterectomized post-menopausal women. This combination retains the benefits of estrogen on vasomotor symptoms, VVA and bone density along with the protective effect of BZA on endometrium and breast tissue. The results of clinical trials have been promising but what still needs to be evaluated is the long term safety of this pair on venous thromboembolism, stroke, and breast cancer

Linaclotide: a guanylate cyclase agonist for treatment of irritable bowel syndrome with constipation and chronic constipation in adults

Linaclotide, a 14 aminoacid peptide is an intestinal secretagogue and works by stimulating guanylate cyclase (GC-C) present in the intestinal epithelium, which leads to improvement in symptoms of irritable bowel syndrome with constipation and chronic constipation in adults. Treatments available currently for these gastrointestinal problems have not been very satisfactory and many new options are therefore being explored to provide relief to these patients. Linaclotide has shown promising results in various clinical trials and hence was approved by US Food and Drug Administration (FDA) in 2012

Student’s perception and experience of computer assisted learning as a teaching method in experimental pharmacology

Background: The decline in the use of animals for teaching in experimental pharmacology due to ethical concerns has led to the introduction of non-animal alternatives. These methods not only try to simulate the live experiment results but also offer the advantages of being time saving, reproducible and have minimum errors. One such alternative is computer assisted learning (CAL) which demonstrates the effect of drugs on living tissue in a virtual environment. In the present study, we assessed the outcome of CAL session among the medical students with the help of a questionnaire and compared it with the pre-CAL questionnaire to study the effectiveness of simulation experiments.Methods: A total of 109 students participated in the study. They were divided into two Batches I and II. Batch I students were given a pre-CAL questionnaire on a selected topic, followed by a CAL session on that topic and a post-CAL questionnaire. Whereas for Batch II students, we directly started with demonstration of CAL session on the same topic followed by a post-CAL questionnaire. A student feedback form based on five point Likert scale was also given to all the students to get their views about the simulation experiments.Results: The students in Batch I, after the CAL session had better average score % as compared to pre-CAL test (80.7% vs. 32.4%). Furthermore, when we compared the post-CAL scores of Batch I and Batch II, it was seen that the average score % was higher for Batch I (80.7%) than Batch II (55.4%).Conclusion: The study demonstrates the effectiveness of CAL in teaching experimental pharmacology concepts and the students felt that this method helped them in a better understanding of the topic as the effects were clearly visualized on the screen and that such simulations need to be a part of the standard curriculum

Cannabinoids and their medicinal potential

Cannabis sativa L preparations have been used therapeutically since many years. Inspite of their medicinal value, the danger of its abusive potential led to the ban on its use in clinical practice in many countries. The recent research and in depth knowledge about the cannabinoid system which throw a light on their disease management potential has paved way for the cannabinoids to become a new therapeutic focus of attention. Cannabinoids are a group of compounds that mediate their effects through cannabinoid receptors which include CB1, predominantly expressed in the brain and CB2 which is primarily found in the cells of the immune system. Despite the addictive properties of cannabis, the therapeutic value of cannabinoids is too high to be put aside. Numerous diseases such as anorexia, pain, inflammation, obesity, cardiovascular disorders, neurodegenerative diseases, cancer, gastrointestinal diseases, hepatic disorders, skin related diseases, respiratory disorders like asthma and eye diseases like glaucoma have suggested cannabinoid agonists/ antagonists/ cannabinoids related compounds as potential treatment options.  Developments of new specific ligands for the cannabinoid receptors are now underway and it needs to be seen, if in future, they can prove to be a boon for the medical world. The paper reviews the current understanding of the cannabinoid receptors, their ligands and their possible role in various diseases supported by preclinical and clinical studies

Student feedback on teaching-learning methodology and evaluation methods in pharmacology

Background: Pharmacology as a medical subject undergoes constant update and thus is ever expanding. Periodic review of the teaching-learning tools along with the evaluation methods and then improvisation of the same to make the curriculum effective as well as student friendly can help in making the medical student grasp the difficult subject easily. The present study was undertaken to get the students’ feedback regarding the various teaching methodologies used in the Department of Pharmacology and the evaluation techniques to assess them.Methods: A prevalidated and anonymous questionnaire was given to the second professional MBBS students at the end of their session. The questionnaire had both closed ended and open ended questions. The data were compiled and evaluated as counts and percentages. Approval was taken from Institutional Ethics Committee.Results: About 57.9% students found the subject useful and interesting and the most common topics of interest among the students were general pharmacology (29.5%), cardiovascular system (17.9%), and autonomic nervous system (15.8%). Interactive lectures, audio-visual aids with demonstrations and tutorials were considered the most interesting method of learning pharmacology (42.1%, 31.6%, and 31.6%, respectively). The majority of the students (61%) wanted clinical case studies to be incorporated in the routine teaching of pharmacology for better understanding and better correlation of drugs used in diseases. The best method of evaluation according to the students was a combination of written and viva exam (51.6%), followed by written class test only (33.7%), and tutorials (22.1%). The suggestions about improvement in pharmacology teaching which were highlighted by the students were inclusion of clinical case studies with drug management, incorporation of multiple choice questions, and computer simulations.Conclusion: It is important to take regular feedbacks from the students to make the teaching more useful and interesting so that synchronization between teaching-learning, evaluation and assessment can be achieved for improved outcome

Assessment of knowledge, attitude and practice of dengue in factory workers of Amritsar, Punjab

Background: Dengue, a mosquito borne, arboviral disease has become a major cause of health concern in the recent times throughout the world. In India, we have been witnessing annual outbreaks for the past few years and lack of knowledge about prevention and treatment of dengue among majority of the population leads to increased mortality. Apart from Delhi, many cases of dengue have been reported from Punjab. In spite of this fact, very few studies have been done to know about the knowledge of people regarding dengue fever and whether proper preventive measures are being practiced by the community to limit its spread. The objective of the study is to assess the knowledge, attitude & practices (KAP) regarding dengue in factory workers in Amritsar, Punjab.Methods: The present study was conducted among 162 factory workers of old focal point area of Amritsar in the month of November, 2015. Pre validated, self-structured questionnaires were distributed among the workers after explaining them about the purpose of the study. The questionnaire was also typed in the vernacular language (Punjabi) for the ease of the participants. A written informed consent was obtained from them. The data collected was compiled and analyzed in a pre-structured format.Results: Among 162 workers enrolled for the study, 98.6% were literate and majority (99.4%) had heard about dengue fever. Almost everyone (98.8%) was aware that it is caused by the bite of a mosquito. The major sources of information were television (54.9%) and newspaper (30.9%). High fever was the most common sign and symptom (49.4%) mentioned by the workers. Only 30.9% respondents knew that aspirin should be avoided in a dengue patient. Many workers (94.4%) were aware that standing water can be a common breeding place for the mosquitoes but still, regular cleaning of coolers or water containers was not practiced by all.Conclusions: The present study shows that literacy status of an individual is not associated with adequate knowledge and its application. The study population had insufficient information about dengue while the preventive measures which were known to them for limiting the spread of dengue was not satisfactorily practiced. We as health care professionals should undertake more of these studies to know about the knowledge status of the community and hold health awareness camps. The government should also adopt frequent measures to spread such information through television, newspapers, posters and campaigns

Comparison of awareness, attitude and use of non-prescription drugs among medical and non-medical undergraduates: a questionnaire based study

Background: The use of non-prescription drugs for self-treatment of common ailments is becoming increasingly popular in our society. Trends in the use of non-prescription drugs is expected to vary among medical students and the general population, as medical students have more knowledge about drugs and an easy access to them. In the present study we have done a comparison regarding the awareness, attitudes and use of over the counter drugs among medical and non-medical undergraduates to evaluate these parameters.Methods: A total of 139 third year medical students and 101 non-medical students were included in our study. An anonymous, pre-validated questionnaires containing questions about their knowledge, attitude and perception of non-prescription drugs were filled by them. The data collected was compiled and analyzed by frequency analysis and percentages.Results: Majority of the medical (99.3%) and non-medical students (95.1%) had purchased non-prescription drugs from either a local pharmacy (83.4%, 61.4% medical & non-medical students respectively) or from seniors, friends & family members (18% medical & 18.8% non-medical students). The commonest indication for self-medication in both the groups was cough & cold (80.6% medical & 55.4% non-medical group) followed by fever in medical students (77.7%) and headache in non-medical students (39.6%). Antipyretics (66.9%) in medical students and analgesics (39.6%) in non-medical students were the commonest drug groups used. The medical students preferred to buy brand drugs (47.5%) as compared to generic drugs (26.6%) while the non-medical students had no preference (48.5%) about the form of drugs. About 57.6% medical and 61.4% non-medical students never experienced any side effect with over the counter drugs. Many medical (57.5%) and non-medical (40.6%) students supported the sale of non-prescription drugs for minor ailments.Conclusions: There is an increasing trend of self-medication among the youth today. Medical students have a better access to such drugs hence are expected to self-medicate more. But the easy availability about drug information on the internet and their unrestricted supply in the pharmacies are escalating the practice of self-medication among the general population too. It therefore becomes imperative to create awareness against the injudicious use of over the counter drugs without a valid medical prescription to promote rational drug use

Multiple myeloma: the disease and its treatment

Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone. The tumor, its products and the host response to it result in a number of organ dysfunctions and symptoms of bone pain, fracture, anemia, hypercalcemia, susceptibility to infection, neurologic symptoms, clotting abnormalities and manifestations of hyperviscosity. The cause of myeloma remains unexplained but it is associated with few occupations, inflammatory conditions, autoimmune illnesses, viral infections and genetic heterogeneity. Direct interaction between multiple myeloma cells and bone marrow cells activates pleiotropic signalling pathways that mediate growth, survival, migration of multiple myeloma cells and also resistance to chemotherapy. Although myeloma remains incurable, but the use of novel drugs like thalidomide, lenalidomide and bortezomib have resulted in a paradigm change in the therapy of myeloma. Their inclusion in current multiple myeloma treatment regimens have extended median overall survival especially in younger patient population. Recent advances in the molecular genetics have provided opportunities to design highly specific inhibitors of signal transduction pathways that may enhance the efficacy of standard chemotherapy drugs by reducing or altering the pathways associated with cell survival. Despite therapeutic advances, multiple myeloma ultimately relapses and remains an incurable disease. Current research goals are to further increase our knowledge, to identify additional targeted therapies, and to reduce adverse effects and improve response rate. This review focuses on recent clinical advancement in ant myeloma strategies with additional discussion dedicated to emerging drugs that may prove beneficial to patients with this disease

Comparative evaluation of voglibose versus pioglitazone on glycaemic control and lipid profile in patients of type 2 diabetes mellitus on glimepiride and metformin in punjabi population

Background: Type 2 Diabetes mellitus (DM) is a heterogeneous group of disorders associated with both microvascular and macrovascular complications. Due to progressive nature of type 2 DM, dual / triple drug therapy produce additive effects, less side effects and allows the use of submaximal doses of individual agents. Therefore, the present study was designed to study the effect of voglibose in comparison to pioglitazone on glycaemic and lipid profile as an add-on drug in patients with DM whose glycaemic status was uncontrolled with glimepiride and metformin.Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a six months period. Sixty patients of either sex in the age group of 30-75 years, suffering from type 2 DM, with FBG> 126 mg/dl and HbA1c between 7- 10 % were selected at random. The effect of voglibose and pioglitazone were observed on various parameters i.e. FBG, PPBG, HbA1c and lipid profile (Total cholesterol, TG, LDL, VLDL).Results: At the end of 6 months it was observed that though both pioglitazone and voglibose reduced FBG, PPBG and HbA1C significantly but pioglitazone caused a significantly greater percentage change in FBG as well as in PPBG whereas the difference in mean percentage change in HbA1C was not significant. Also, fall in total cholesterol, TG, LDL and VLDL was significantly greater with pioglitazone than voglibose. Few side effects were observed with voglibose and not with pioglitazone.Conclusions: Though pioglitazone and voglibose were equally effective in lowering HbA1C levels yet pioglitazone showed better results in improving FBG, PPBG and lipid profile as compared to voglibose. Pioglitazone had minimal side effects as compared to voglibose

Porphyromonas gingivalis : Its virulence and vaccine

Background: The microbial florae in adult periodontitis lesions are comprised of anaerobic rods with Porphyromonas gingivalis as one of the major components (Slots 1976; Slots 1979; and Tanner et al., 1979). P. gingivalis is a black-pigmented gram-negative anaerobic rod and a secondary colonizer of dental plaque requiring antecedent organisms. The presence of this organism either alone or as a mixed infection with other bacteria and with the absence of beneficial species appears to be essential for disease activity. It is a predominant member of the subgingival microbiota in disease. It possesses and "excretes" numerous potentially toxic virulence factors. Aim of this study is to perform a systematic review of studies on P. gingivalis and its virulence factors with a special focus on its vaccine. Materials and Methods: An electronic and manual search based on agreed search phrases between the primary investigator and a secondary investigator was performed for the literature review till January 2014. The articles that were identified by this systematic review (total of 190) were analyzed in detail, which included the study of inference and conclusion. Conclusions: Within the limits of this systematic review, it can be concluded that P. gingivalis induce immune inflammatory response in periodontitis subjects. Therapeutic vaccines need to be developed and studied for their efficacy in controlling periodontitis