Saibal Das

Antidiabetic and antihyperlipidemic activity of hydroalcoholic extract of Withania coagulans Dunal dried fruit in experimental rat models

Objective: Evaluation of antidiabetic potential of the hydroalcoholic extract of Withania coagulans Dunal dried fruit (WCDF) alone and in combination with glipizide, in streptozotocin-induced diabetes, and evaluation of possible antihyperlipidemic activity of the same extract in high-cholesterol diet-induced hyperlipidemia, in albino rats. Materials and Methods: Experimental diabetes was induced in 30 albino rats with intraperitoneal injection of streptozotocin (55 mg/kg). The rats were divided into five groups receiving the following treatments orally for 4 weeks: Vehicle, glipizide (2.5 mg/kg), WCDF extract (1000 mg/kg), WCDF extract (1000 mg/kg) plus glipizide (1 mg/kg) and WCDF extract (1000 mg/kg) plus glipizide (2.5 mg/kg). Fasting and postprandial blood glucose levels were measured every week for 4 weeks. Endocrine pancreas histopathology was done at the end. In a separate set of experiment, five groups of six albino rats each, received orally for 4 weeks, vehicle, cholesterol (25 mg/kg/day), cholesterol (25 mg/kg/day) plus atorvastatin (7.2 mg/kg/day), cholesterol (25 mg/kg/day) plus WCDF extract (1000 mg/kg/day) and no treatment, respectively. Estimation of serum lipid profile and liver histopathology was done at the end of 4 weeks. Statistical Analysis: Between-group and within-group comparisons were respectively done by analysis of variance (ANOVA) and repeated measures ANOVA, followed by post hoc Tukeys test, with a significance level of P < 0.05. Results and Conclusions: The 4-week treatment with WCDF extract significantly reversed hyperglycemia in streptozotocin-induced diabetes that was comparable to glipizide. When combined with glipizide (2.5 mg/kg), WCDF extract produced a synergistic antihyperglycemic effect as well as improvement in pancreatic histopathology. Moreover, hydroalcoholic extract of WCDF was effective and comparable to atorvastatin in controlling the high-cholesterol diet-induced hyperlipidemia in rats.

Oral levofloxacin-induced optic neuritis progressing in loss of vision.

This case report highlights a rare adverse drug reaction caused by levofloxacin, resulting in optic neuritis progressing into unilateral loss of vision. A 49-year-old male patient was diagnosed to suffer from left maxillary and ethmoid sinusitis and was only prescribed oral levofloxacin 500 mg tablets once daily for 5 days. Within a few minutes after taking the first dose of the drug, the patient experienced respiratory distress, dizziness, confusion with pain, and loss of color vision, followed by almost complete loss of vision in the right eye. The left eye was normal. After ophthalmologic examinations and investigations, he was diagnosed to suffer from optic neuritis, probably (according to Naranjo adverse drug reaction probability scale) induced by levofloxacin.

Tetanus Toxoid Induced Anaphylaxis

This case report highlights an anaphylaxis reaction induced by intramuscular tetanus toxoid (TT) injection in a 6 year old girl having the first time exposure to this drug. TT is a commonly used vaccine used for active immunization against Clostridium tetani and is included in the National Immunization Schedule of India. Although TT is a very safe vaccine, its adverse reactions include local edema, tenderness, fever and may rarely induce life-threatening anaphylactic response, the potential causative agents can be TT antigens, aluminum phosphate or thimerosal preservative. Before its intramuscular administration, cutaneous hypersensitivity testing should be done routinely and there should be provisions for emergency measures in cases of anaphylaxis.

A new logical insight and putative mechanism behind fluoxetine-induced amenorrhea, hyperprolactinemia and galactorrhea in a case series

With the exception of fluoxetine, all selective serotonin reuptake inhibitors (SSRIs) commonly cause hyperprolactinemia through presynaptic mechanisms indirectly via 5-hydroxytryptamine (5-HT)-mediated inhibition of tuberoinfundibular dopaminergic neurons. However, there is little insight regarding the mechanisms by which fluoxetine causes hyperprolactinemia via the postsynaptic pathway. In this text, analysis of five spontaneously reported clinical cases of hyperprolactinemia resulting in overt symptoms of amenorrhea with or without galactorrhea, were scrupulously analyzed after meticulously correlating relevant literature and an attempt was made to explore the putative postsynaptic pathway of fluoxetine inducing hyperprolactinemia. Hypothetically, serotonin regulates prolactin release either by increasing oxytocin (OT) level via direct stimulation of vasoactitive intestinal protein (VIP) or indirectly through stimulation of GABAergic neurons. The pharmacodynamic exception and pharmacokinetic aspect of fluoxetine are highlighted to address the regulation of prolactin release via serotonergic pathway, either directly through stimulation of prolactin releasing factors (PRFs) VIP and OT via 5-HT2A receptors predominantly on PVN (neurosecretory magnocellular cell) or through induction of 5-HT1A-mediated direct and indirect GABAergic actions. Prospective molecular and pharmacogenetic studies are warranted to visualize how fluoxetine regulate neuroendocrine system and cause adverse consequences, which in turn may explore new ways of approach of drug development by targeting the respective metabolic pathways to mitigate these adverse impacts.

Overview of Current and Upcoming Strategies Implied for the Therapy of Type 2 Diabetes Mellitus

Population explosion, urbanization, changes in lifestyle management, improper food habits and various other factors play focal contributors in the massive prevalence of type 2 diabetes mellitus in the developing countries. Although insulin is the cornerstone in the management of type 1 diabetes; insulin, anti-hyperglycemic and hypoglycemic agents are proved to be effective in type 2 diabetes, although their efficacy decreases with the progress of the disease. Moreover a significant number of side effects, mostly hypoglycemia and weight gain have put a bar in using these drugs confidently. Many novel therapeutic strategies with convincing efficacy and less adverse effects are currently emerging for providing efficient means of treatment of this disorder. This article mainly focuses on newer and unconventional pharmaceutical or biotechnical strategies that may or may not have been implied for the treatment of Type 2 Diabetes mellitus on a widescale basis so far. These strategies are supposed to be efficient in controlling glycemic levels and possess a significant potential to reduce the co-morbidities associated with this disease.

Probuphine® (buprenorphine implant): a promising candidate in opioid dependence:

Opioid dependence leads to physical dependence and addiction which finally results in profound medical, psychological and social dysfunction. One of the useful medications for opioid dependence is buprenorphine, the partial opioid agonist, which is used alone or in combination with naloxone. However, buprenorphine is the victim of its own success due to its illicit use and accidental poisoning in children. Also, buprenorphine typically requires daily self-administration and its effectiveness heavily depends on patient adherence. So, poor treatment adherence results in ineffective treatment manifesting as craving and withdrawal symptoms. Short-term use of buprenorphine in opioid dependence is also often followed by relapse. Buprenorphine when used sublingually often results in inadequate or fluctuating blood concentrations and poorer treatment retention compared with methadone. All of these led to the development of Probuphine®, a polymeric matrix composed of ethylene vinyl acetate and buprenorphine in the form of implants, that are implanted subdermally in office practice and deliver the active drug over 6 months. Buprenorphine release from such implant is fairly consistent, avoiding plasma peaks and troughs, and the implant is also reported to be safe. In this review article, we have highlighted these aspects of treatment of opioid addiction, stressing on the pharmacology of buprenorphine and Probuphine®, and relevant clinical trials addressing the efficacy and safety of Probuphine®. This sustained-release implantable formulation of buprenorphine has the potential to be a suitable alternative to daily or alternate day sublingual buprenorphine which can thereby eliminate the need for daily supervision, minimizing fluctuations in plasma concentrations, and allowing these patients to reduce clinic or pharmacy visits.

Quality of life of older people in an urban slum of India

The aim of this study was to examine different domains of quality of life (QOL) and their relationship to sociodemographic characteristics among older people in an urban slum in India.

Evaluation of hepatoprotective activity of aqueous extracts of leaves of Basella alba in albino rats

This study was done to evaluate possible hepatoprotective effects of aqueous leaf extracts of Basella alba in comparison with silymarin in paracetamol-induced hepatotoxicity in albino rats. Six groups of six albino rats each received orally for 6 weeks, vehicle, paracetamol (2 g/kg/day), paracetamol (2 g/kg/day) plus silymarin (50 mg/kg/day), paracetamol (2 g/kg/day) plus B. alba extract (60 mg/kg/day), paracetamol (2 g/kg/day) plus B. alba extract (80 mg/kg/day) and paracetamol (2 g/kg/day) plus B. alba extract (100 mg/kg/day). Hepatoprotective effect was evaluated by comparing serum bilirubin, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, proteins, alkaline phosphatase and liver histopathology. Results were represented as mean ± SEM. One-way ANOVA was done followed by post hoc Tukeys test with a highly significance level of P < 0.001. Aqueous leaf extracts of B. alba 100 mg/kg/day orally had significant hepatoprotective effect in paracetamol-induced hepatotoxicity in albino rats. The results were well comparable and even in some respects superior to standard drug silymarin.

An Epidemiological Study on the Awareness and Attitude of the Youths Toward AIDS in a Rural Area of West Bengal in India

Introduction: This community-based cross-sectional epidemiological study was performed to assess the awareness and attitude of youths toward AIDS in a rural area of West Bengal in India. Methods: Study population included 190 individuals (15–24 years). Data were collected using a semistructured, pretested questionnaire and analyzed using SPSS version 17 by logistic regression model. Results: It was revealed that older youths and particularly men compared to women had more comprehensive knowledge of AIDS than adolescents. Education, media exposure, marriage, and possessing above poverty level (APL) status, all had stronger positive association with youths (more in men) having comprehensive knowledge of AIDS. Older, never married youths, and particularly men were more likely than adolescents to have accepting attitudes toward people living with HIV/AIDS. Education, media exposure, and not having below poverty level card, all had stronger positive association with youths having accepting attitudes toward women than toward men. Surprisingly among the male APL population, this association was negative. Conclusion: Educational and socioeconomic setbacks should be overcome in order to impose a better and justified attitude toward HIV/AIDS. Improved health conditions, proper counseling, and knowledge are essential to break the barriers of communication and ignorance toward HIV/AIDS in these parts of the developing countries.

A case of losartan-induced severe hyponatremia.

This case report outlines a very rare case of losartan-induced severe hyponatremia in a 73-year-old type 2 diabetic patient. The patient was initiated with 50 mg daily oral losartan monotherapy for newly diagnosed moderate hypertension. After 3.5 months of taking the drug, he presented to the emergency department in a drowsy state with severe generalized weakness and occasional palpitations. He was a known diabetic for the last 3 years and well controlled by oral metformin alone. On examination, his serum sodium level was found to be 123 meq/L. There were no evidences of any other possible metabolic, infective, organic or other pathologic causes giving rise to that condition, except losartan itself. De-challenge was done and he was treated vigorously resulting in reversal of the diseased state. Naranjo adverse drug reaction probability scale suggested that it was “probable” that oral losartan was responsible for the development of severe hyponatremia in this patient.