Shalini Adiga

Prevalence of menopausal symptoms and quality of life after menopause in women from South India

Objectives: This study was carried out to establish the age at onset of menopause and the prevalence of menopause and menopausal symptoms in South Indian women.

Hypoglycemic effect of aqueous extract of Trichosanthes dioica in normal and diabetic rats

Background: Trichosanthes dioica is used to treat diabetes mellitus, epilepsy, alopecia, and skin disease in folklore medicine. The leaf extract of the plant is used in diabetes mellitus but there have been no scientific studies reported. Aims: To study the effect of Trichosanthes dioica on serum glucose level in glucose loaded, normal and hyperglycemic rats. Settings: Kasturba Medical College, Manipal, Karnataka, India. Design: Experimental. Materials and Methods: The aqueous extract of leaves of Trichosanthes dioica are compared with glibeclamide for their influence on fasting blood sugar in glucose loaded, normoglycemic and streptozotocin induced (45 mg/kg ip) hyperglycemic rats. Statistical Analysis: The data was analyzed by one way ANOVA followed by Scheffes post hoc test. Results: In glucose loaded rats, normal rats and hyperglycemic rats the aqueous extract at both the doses (800 mg/kg/p.o and 1600 mg/kg/p.o) reduced blood glucose significantly when compared to control but it was not as effective as glibenclamide. Conclusion: The aqueous extract of Trichosanthes dioica has antihyperglycemic action.

Evaluation of the effect of Ferula asafoetida Linn. gum extract on learning and memory in Wistar rats

Objective: Memory loss is universal and is the first symptom to manifest in majority of the patients suffering from Alzheimers disease. This study is designed to investigate the effect of Ferula asafoetida linn. (F. foetida) extract on learning and memory in rats. Materials and Methods: Learning and memory were evaluated using elevated plus maze and passive avoidance paradigm after the oral administration of two doses (200 mg/kg and 400 mg/kg) of F. foetida aqueous extract with rivastigmine as positive control. Brain cholinesterase activity, serum thiols and cholesterol were also estimated. Results: Extract produced significant improvement in memory score i.e. step through latency at 400 mg/kg dose in passive avoidance model (P< 0.05) and dose-dependent improvement of transfer latency in elevated plus maze model (P< 0.001). Dose-dependent inhibition of brain cholinesterase (P< 0.001) and significant improvement in antioxidant levels (P< 0.05) were also noted. Conclusions: Memory enhancing potential of F. foetida can be attributed to acetylcholinesterase inhibiting and antioxidant properties. Hence, dietary usage of F. foetida is beneficial and can also be employed as an adjuvant to existing anti-dementia therapies.

Effect of Punica granatum peel extract on learning and memory in rats

To evaluate potential memory enhancing effect of Punica granatum peel extract on rats. Methods: Healthy adult male albino rats of Wistar strain were used. Each group of 6 rats were administered either distilled water or 50mg/kg of extract or 100mg/kg of extract for 15 days and subjected to passive avoidance test or T-maze test. In the next phase rats were administered distilled water or 100mg/kg of extract for 15 days and the rats were given injection diazepam before subjecting them to the tests. Results: The overall performance was better in test groups compared to control groups. Among the test groups, 100mg/kg rats performed better than 50mg/kg. The effect on spatial learning parameters like mean number of alternations and mean percentage bias was more marked compared to retention testing parameters like latency. 100mg/kg Punica extract treated group also improved performance of diazepam treated rats. Conclusions: There is a definite trend of memory improvement by Punica granatum peel with effects being more marked on spatial learning tendency and long term memory than on retention capacity.

Effect of ethanolic extract of Acacia auriculiformis leaves on learning and memory in rats

Background: The effects and benefits of Acacia auriculiformis on health are not well established. This study was planned to evaluate the effect of ethanolic extract of Acacia auriculiformis leaves on learning and memory in rats. Materials and Methods: Learning and memory were evaluated using passive avoidance paradigm and rewarded alternation test (T-maze) after the oral administration of two doses (200mg/kg and 400mg/kg) of ethanolic extract of Acacia auriculiformis with rivastigmine as positive control. Forty eight rats were divided into 4 groups in each study model. Estimation of brain cholinesterase activity was done to substantiate the results of the above mentioned tests. Data was analyzed using one way Analysis of Variance (ANOVA) followed by Tukeys post-hoc test using GraphPad InStat software, version 3.06. Results: The extract produced a dose-dependent improvement in the memory score namely the step through latency in passive avoidance model (P < 0.001) and the percentage of correct responses in rewarded alternation test (P < 0.05). Dose-dependent inhibition of brain cholinesterase activity (P < 0.001) was also noted. Conclusion: The acetylcholinesterase inhibiting property of Acacia auriculiformis contributes to its memory enhancing potential. Further large scale studies are required to elucidate its benefits on cognitive function. This may offer a promising new option for the treatment of dementia and other cognitive deficits.

Adverse drug reaction profile of microtubule-damaging antineoplastic drugs: A focused pharmacovigilance study in India.

Objectives: The aim of the study was to analyze the adverse drug reaction (ADR) profile of microtubule-damaging antineoplastic drugs (taxanes and vinca alkaloids) and to look for unexpected ADRs among the local population. Focused study on these drugs, rampantly used in oncology department for a wide variety of tumors including early and advanced malignancies, would enable better treatment care by physicians. Materials and Methods: Data on ADRs were collected from the cancer patients belonging to both gender and of all ages, on taxanes- or vinca-based cancer chemotherapy and reported in the Indian Pharmacopoeia Commission form. Causality was assessed using the WHO criteria and Naranjos Algorithm. Preventability and severity of ADRs were also assessed. Results: A total of 97 ADRs were reported among 488 patients on microtubule-damaging anticancer drugs admitted over a period of 1 year. The incidence rate was 19.87%. Gastrointestinal system (40.2%) was the most affected followed by bone marrow (33%) and skin (8.2%). The highest incidence of ADRs was reported among paclitaxel (54.6%), and vincristine (39.2%). Most of the reported ADRs were of milder nature and preventable. The WHO causality assessment scale indicated 71.1% possible reactions. Conclusions: This study showed that most ADRs are preventable with effective ADR monitoring. There is a great need to create awareness among healthcare professionals regarding the importance of the pharmacovigilance system. Judicious use of the preventive measures will lead to a reduction in the incidence of ADRs due to the drug armamentarium, thereby enabling additional economic benefit to the patient and society.

Safety profile of second-line agents as add-on to oral monotherapy or dual therapy in uncomplicated type 2 diabetes in South Indian population

Background: Nowadays, there is an abundance of many therapeutic options available for the management of type 2 diabetes mellitus (DM). Hence, shifting the trend toward personalized treatment that focuses on the differences among different classes of pharmacological agents with regard to the mechanism of action, efficacy, and most important - the safety. Most of the clinical guidelines reconcile the risk-benefit ratio of the individual therapies. Moreover, there is limited evidence comparing the efficacy and safety of second-line drugs in combination therapies. It becomes crucial to rationalize the combination therapies with respect to attainment of glycemic targets, reduction in the short- and long-term complications and providing a better quality of life. In clinical practice, optimal treatment of type 2 DM must take into account the various comorbidities and adverse drug reactions (ADRs). Aims and Objective: The aims of the study were to assess the ADRs associated with second-line antidiabetic drugs when used as add-on agent in uncomplicated type 2 DM. Materials and Methods: Patients aged ≥18 years of age, diagnosed as uncomplicated type 2 DM who were previously receiving at least one oral antidiabetic drug (metformin or sulfonylurea) or dual-combination therapy (metformin+sulfonylurea) and for the first-time initiated on a second-line add-on agent, i.e., pioglitazone or dipeptidyl peptidase-4 (DPP-4) inhibitor (sitagliptin/vildagliptin) or α-glucosidase inhibitor (voglibose) or insulin (pre-mixed insulin [30% regular/70% NPH]) were included in the study. The ADRs associated with second-line agents were assessed based on hypoglycemic events, weight changes, frequency of ADRs, liver and renal function tests, and medical events reported. Results: A total of 240 patients (mean age 56.79 ± 11.73 years) were prescribed one of four different class of hypoglycemic agents. Overall, the median weight gain of 1.5 kg was observed in the insulin group, with no change of median weight in DPP-4 inhibitor group; while pioglitazone and voglibose group demonstrated a median weight loss of 1 and 0.5 kg, respectively, at the end of 6 months. The maximum number of hypoglycemic episodes was reported in insulin treatment group, i.e., 33; while least with DPP-4 inhibitor, i.e., 12. Out of 274 ADRs, the most common were gastrointestinal adverse effects, i.e., 30.66% and least were the dermatological ADRs (5.11%). Conclusion: Henceforth, DPP-4 inhibitor add-on group was found to be safest in terms of least hypoglycemic episodes and side effects when used as add-on therapy.

Cefoperazone: A Rare Cause of Thrombocytopenia

Beta lactam antibiotics are one of the most commonly prescribed antibiotic drug classes in medical practice. Cephalosporins differ from other beta lactam antibiotics in both their structure and spectrum of action. Beta lactam antibiotics, in general, may cause platelet deficiency owing to their interference with normal platelet function. Cefoperazone, belonging to the group of 3rd generation cephalosporins, has been reported to cause hypoprothrombinemia and hence, bleeding manifestations. However, it is not known to alter platelet function and count at the routinely used therapeutic doses. This case report highlights a rare case of cefoperazone-induced thrombocytopenia.

Comparing the efficacy and influence on the quality of life of three classes of drugs used in bronchial asthma - a prospective study.

OBJECTIVES To compare the efficacy of formoterol, montelukast and acebrophylline when used in combination with budesonide in patients with bronchial asthma and to determine their role in the improvement of the quality of life of patients. MATERIALS AND METHODS A total of 75 patients were divided into 3 groups based on treatment given - formoterol 6 mcg/puff + budesonide 100 mcg/puff combination inhaler, 2 puffs twice daily; oral montelukast 10 mg once daily + budesonide 100 mcg/puff, 2 puffs twice daily and oral acebrophylline 100 mg twice daily + budesonide 100 mcg/puff, 2 puffs twice daily. The patients were followed-up for 4 wk after initiating treatment. Spirometry values - forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR), before and after treatment were recorded. The quality of life was assessed before and after treatment using Asthma Quality of Life Questionnaire (AQLQ). Analysis was done using repeated measures ANOVA followed by Bonferronis post-hoc test. RESULTS As compared to baseline values, FEV1, PEFR and Quality of Life showed significant improvement in all 3 groups after 4 wk of treatment (p-value < 0.01). Three patients in acebrophylline-treated group reported gastric irritation while no adverse effects were reported in the other groups. CONCLUSION Formoterol, montelukast or acebrophylline combined with inhaled corticosteroids have similar efficacy in the treatment of asthma.