Emerging antimicrobial resistance and newer tools to address the resistance Pardeep Kumar Goyal, Ankita Semwal, Ajay Prakash, Bikash Medhi Indian Journal of Pharmacology 2019 51(5):291-295

Nicorandil: A drug with ongoing benefits and different mechanisms in various diseased conditions Lamiaa Ahmed Ahmed Indian Journal of Pharmacology 2019 51(5):296-301 Nicorandil is a well-known antianginal agent, which has been recommended as one of the second-line treatments for chronic stable angina as justified by the European guidelines. It shows an efficacy equivalent to that of classic antianginal agents. Nicorandil has also been applied clinically in various cardiovascular diseases such as variant or unstable angina and reperfusion-induced damage following coronary angioplasty or thrombolysis. Different mechanisms have been involved in the protective effects of nicorandil in various diseases through either opening of adenosine triphosphate-sensitive potassium (KATP) channel or donation of nitric oxide (NO). The predominance or participation of any of these proposed mechanisms depends on the dose of nicorandil used, the location of diseased conditions, and if this mechanism is still functioning or not. The protection afforded by nicorandil has been shown to be mainly attributed to KATP channel opening in experimental models of myocardial and pulmonary fibrosis as well as renal injury or glomerulonephritis, whereas NO donation predominates as a mechanism of protection in hepatic fibrosis and inflammatory bowel diseases. Therefore, in different diseased conditions, it is important to know which mechanism plays the major role in nicorandil-induced curative or protective effects. This can bring new insights into the proper use of selected medication and its recommended dose for targeting certain disease.

A systematic review and meta-analysis of the prevalence and complications of paraphenylenediamine-containing hair dye poisoning in developing countries Akshaya Srikanth Bhagavathula, Deepak Kumar Bandari, Moien Khan, Abdulla Shehab Indian Journal of Pharmacology 2019 51(5):302-315 BACKGROUND: Suicide is a public health problem, and the number of paraphenylenediamine (PPD)-containing hair dye poisoning with suicidal intentions is increasing in developing countries. In order to better understand this situation, we aimed to conduct a systematic review and meta-analysis to estimate the prevalence and complications associated with hair dye poisoning in developing countries. METHODS: We conducted a systematic review of epidemiological studies using MeSh terms and text keywords to identify studies from the inception to March 2016 about hair dye poisoning with suicidal intentions in developing countries. A meta-analysis was used to calculate the pooled prevalence proportion of hair dye poisoning and its major complications. Data extraction, data analysis, and risk of bias assessment were performed. RESULTS: Thirty-two studies were included in the systematic review and 29 of these studies containing 5,559 subjects covering six countries were included in the meta-analysis. The pooled prevalence proportion of hair dye poisoning with suicidal intentions was 93.5% (95% confidence interval [CI] = 91.6–95.4) with a mortality rate of 14.5% (95% CI = 11.1–17.9). Of these, 73.8% were female, and 26.2% were male (sex ratio: 2.7:1). The occurrence of angioneurotic edema in hair poisoning patients was 67.1% (95% CI = 56.6–77.6), and tracheostomy intervention was considered in 47.9% (95% CI = 22.7–73.2) patients with respiratory distress. Acute renal failure was noticed in 54.7% (95% CI = 34.5–74.9) of the pooled samples and mortality rates were 14.5% (95% CI = 11.1–17.9). The pooled rate of the population studied from Asia and Africa showed 94.6% (95% CI = 92.5–96.7) and 82.9% (95% CI = 70.6–95.3), respectively, ingested hair dye with suicidal intentions. Further, studies carried out in Africa showed slightly higher mortality of 15.1% (95% CI = 6.56–23.7) than the Asians 14.3% (95% CI = 10.5–18.1). CONCLUSION: This meta-analysis provided clear evidence of the prevalence of hair dye poisoning among individuals with suicidal intentions and had given robust evidence for policy making to curtail emerging PPD-containing hair dye poisoning in developing countries.

Randomized controlled trial of topical mupirocin versus mupirocin with sucralfate combination in chronic skin ulcers Subhrangsu Chatterjee, Sumit Sen, Avijit Hazra, Amal Kanti Das Indian Journal of Pharmacology 2019 51(5):316-322 OBJECTIVES: The objective of this study was to carry out a head-to-head comparison of topical sucralfate combined with mupirocin versus mupirocin alone in the treatment of chronic skin ulcers with respect to both effectiveness and safety. MATERIALS AND METHODS: A parallel-group, open-label, randomized, controlled trial (CTRI/2015/12/006443) was carried out with patients suffering from skin ulcers of Wagner grading 1 or 2 persisting for over 4 weeks. Ninety-six patients were recruited in total, and the modified intention-to-treat analysis dataset included 44 participants treated with mupirocin 2% and 46 treated with combined mupirocin 2% and sucralfate 7% ointment. Both medications were applied topically thrice daily for 6 weeks. Ulcer area assessed using millimeter graph paper and wound infection score assessed on a three-point scale were effectiveness measures. Treatment-emergent adverse reactions that were reported by patients or observed by the investigators were recorded. RESULTS: The median ulcer area was significantly reduced in the combined treatment group at the end of treatment. Clinically, 41.3% of the participants in the combined group showed complete ulcer healing at 6 weeks compared to 18.18% in the mupirocin alone group (P = 0.022). The wound infection score declined significantly from baseline by the end of 3 weeks of treatment in both the groups. The frequency of qualitative wound attributes, namely pain, discharge, and erythema, remained comparable between the groups except for discharge which disappeared completely from all remaining ulcers in the combined group but was still present in 11.36% of the participants treated with mupirocin alone (P = 0.025) at 6 weeks. Adverse events were few, all local, mild, and tolerable. CONCLUSIONS: The wound healing effect of topical sucralfate adds to the antimicrobial effect of mupirocin toward the overall improvement of chronic skin ulcers. The effect of combined topical treatment needs comparison with other topical medications and wound healing strategies.

Evaluation of drug utilization in cardiovascular disease at a teaching and referral hospital in Northern Telangana Chandana Naliganti, Chandrasekhar Valupadas, Raghuram Rao Akkinepally, Shivarani Eesam Indian Journal of Pharmacology 2019 51(5):323-329 OBJECTIVES: Cardiovascular disease (CVD) is the primary cause of death globally despite the advanced health-care facilities. Extensive disparity exists in pharmacotherapy pattern among CVD patients where rational drug use plays a pivotal role in promoting safety and efficacy. The study focused to evaluate drug utilization using the World Health Organization (WHO) prescribing indicators and defined daily dose (DDD) in patients admitted to a teaching/referral hospital in Northern Telangana. MATERIALS AND METHODS: A total of 1120 medical records were analyzed for drug utilization for a period of 7 months. Prescription pattern was assessed using the WHO prescribing indicators and DDD to measure individual drug utilization categorized under anatomical–therapeutic–chemical classification. RESULTS: Of the total admissions, 58.57% (55.19 ± 15.19 years) were male and 41.43% (56.64 ± 15.28 years) were female where coronary artery disease was the most common cause of admission followed by cardiomyopathy. Among prescribing indicators, percentage of drugs with generic names was least accounted with 26.86% and 18.95% during hospitalization and discharge, respectively. A mean of 11.55 (hospitalization) and 6.55 (discharge) drugs were prescribed per prescription. Antiplatelet (72.86%) and statin (80.62%) use was predominate during complete therapy. The DDD of furosemide (109.33) was found to be high, followed by atorvastatin (64.6), enalapril (58.44), aspirin (58.14) and clopidogrel (53.2). CONCLUSION: Polypharmacy and least use of generic name were observed in the study which may affect the rationality. The use of antiplatelets, statins, and angiotensin-converting enzyme-inhibitors was appropriate, but furosemide overuse is of major concern. Therefore, appropriate prescription writing improvises treatment compliance in the patients, which results in rationality.

Effect of a polyherbal formulation in streptozotocin-induced diabetic nephropathy in wistar rats Kanala Somasekhar Reddy, Akkiraju Sudheer, Bhupalam Pradeepkumar, Chappidi Suryaprakash Reddy Indian Journal of Pharmacology 2019 51(5):330-336 OBJECTIVES: Chronic kidney failure among people with diabetes mellitus (DM) is a burgeoning health problem that affects up to 25% of patients with type 2 DM. Current pharmacological treatment for diabetic nephropathy (DN) does not stop the attainment of renal complications. The intention of the current study was to explore the role of a polyherbal formulation (PHF) in diabetic-induced nephropathy in experimental animals. MATERIALS AND METHODS: Diabetic rats were grouped as follows and underwent the following treatment for about 16 weeks: Group I – normal rats – no treatment, Group II – DN rats – only vehicle (p.o), and Group III and IV – DN rats – PHF orally at 250 and 500 mg/kg, respectively. After the treatment, the animals were sacrificed, and lipid, renal function, and inflammatory markers were estimated. The observed microscopic changes in kidney were analyzed. RESULTS: Animals administered with PHF exhibited noteworthy decrease in triglycerides, total cholesterol, very low-density lipoprotein (LDL), LDL, serum creatinine, urinary protein, urinary albumin excretion rate, advanced glycation end products, type IV collagen excretion, interleukin-6, transforming growth factor-ß, and tumor necrosis factor-alpha and showed significant increase in high-density lipoprotein, urine volume, urinary urea, and urine creatinine. Histopathological examination established that administration of PHF prohibited kidney damage. CONCLUSION: Treatment with PHF showed beneficial effect on DN which may be due to the improvement of renal function parameters and hyperlipidemic and inflammatory mediators.

Study of inhibitory potential and percent inhibition of oil of Syzygium aromaticum and leaves of Ocimum sanctum on ESBL enzyme from Escherichia coli in broilers of Jabalpur Arpita Shrivastav, RK Sharma, Neeraj Shrivastava, Vidhi Gautam, Sachin Kumar Jain Indian Journal of Pharmacology 2019 51(5):337-342 OBJECTIVE: The inhibitory potential and percent inhibition of Syzygium aromaticum oil and fresh juice of Ocimum sanctum leaves on beta-lactamase enzyme of cecal samples of healthy broilers were studied on samples phenotypically positive for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. MATERIALS AND METHODS: Four hundred cecal samples screened for ESBL-producing E. coli were collected from 38 poultry sale outlets located in Jabalpur. The effect of S. aromaticum oil and O. sanctum leaves was seen by colorimetric assay with CENTA and Nitrocefin as chromogenic substrate. RESULTS: Mean absorbance value was inversely propotional to the inhibitory potential. Syzigium aromaticum exhibited 0.4±0.02 and 0.41±0.03 mean absorbance value, 28 per cent and 27 per cent of inhibition with CENTA and Nitrocefin respectively. Ocimum sanctum mean absorbance value and per cent inhibition with CENTA and Nitrocefin was 2.03±0.02 and 10.0 ; 1.97±0.06 and 10.0 respectively (p>0.05) showing non- significant difference in CENTA and Nitrocefin activity. Tazobactum (100 μM) as standard control exhibited a mean absorbance value of 0.12 ± 0.01 and 0.13 ± 0.01 and percent inhibition of 99.88 and 98 against CENTA and Nitrocefin, respectively. Combination of Ocimum sanctum and Syzigium aromaticum showed range of 1.69±0.05 to 1.90±0.08 1.61±0.06 to 1.92±0.08 of absorbance value with per cent inhibition of 14 to 15.9 with CENTA and Nitrocefin respectively. CONCLUSION: The results depicted that the inhibition of beta-lactamase enzyme activity with S. aromaticum oil was higher than that of O. sanctum leaf juice, and combination of both the herbs showed not much difference in activity.

Congenital ichthyosiform erythroderma: A rare neonatal dermatoses responding to acitretin Nibedita Patro, Maitreyee Panda, Pankaj Kumar Mohanty Indian Journal of Pharmacology 2019 51(5):343-345 Congenital ichthyosiform erythroderma is a rare and severe form of ichthyosis manifesting in the neonatal age group. We report a child with diffuse peeling of skin and erythroderma presenting on the 2nd day of birth. With aseptic nursing care along with emollients and oral acitretin, the child's quality of life improved remarkably, hence highlighting the point of early and judicious use of acitretin in reducing disease morbidity.

Case report on premature hair graying treated with Melitane 5% and oral hair supplements Jagdish J Sakhiya, Dhruv J Sakhiya, Mehul R Patel, Feral R Daruwala Indian Journal of Pharmacology 2019 51(5):346-349 With chronological aging, hair turns gray. Untimely premature hair graying (PHG) may tremendously influence on cosmesis, self-credibility, and social life of the affected individuals. Consequently, early treatment is required to improve cosmetic appearance. To the best of our knowledge, until today, only one case of PHG is reported in the literature, and it occurred due to iron deficiency and successfully treated with ferrous sulfate. Herein, we delineate a case of PHG in a 14-year-old female treated with the topical formulation of Melitane 5% and oral hair supplements which resulted in boosting improvement in hair color.

Anaphylactic reaction induced by intravenous diclofenac: A case report Dinesh Kumar Badyal, Gaurav Gulrez, Divya Mahindru Indian Journal of Pharmacology 2019 51(5):350-351 Among the immune-mediated reactions, anaphylaxis is the most severe form. As a postoperative analgesia, diclofenac sodium, and nonsteroidal anti-inflammatory drug is commonly used. Intravenous (IV) diclofenac sodium-induced anaphylaxis is very rare. We are presenting a case of IV diclofenac-induced anaphylactic reaction, occurred during the surgery in a female patient of 21 years of age. The sign and symptoms of the reaction resembled an anaphylactic reaction. Temporal relationship with IV diclofenac administration and development of the clinical features of the reaction found to be probable. The health-care professionals should be aware of such rare and serious reactions so that it can be diagnosed and treated early. The clinical importance associated with the case encouraged us to report this rare complication of IV diclofenac.