Indian Journal of Pharmacology (Indian J Pharmacol) 2018 | September-October | Volume 50 | Issue 5

EDITORIAL
	Developing and sustaining India's capacity for preclinical drug discovery	p. 225
	David I Lewis, Bhagirath K Patel, B Dinesh Kumar, Bikash Medhi DOI:10.4103/ijp.IJP_641_18
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RESEARCH ARTICLES
	Effect of Vaccinium macrocarpon on MK-801-induced psychosis in mice	p. 227
	Disha Shukla, Rajesh A Maheshwari, Kirti Patel, R Balaraman, Ashim Kumar Sen DOI:10.4103/ijp.IJP_74_17   OBJECTIVES: This study was aimed to investigate the effect of aqueous cranberry extract (ACE) on MK-801-induced psychosis in mice.MATERIALS AND METHODS: MK-801-treated mice were administered ACE (1 and 2 g/kg, p.o.) for 14 days. Various behavioral parameters and neurochemical estimations such as dopamine (DA), 5-hydroxytryptamine (5-HT), norepinephrine (NE), gamma-aminobutyric acid (GABA), glutamate, and glycine as well as markers of oxidative stress such as nitrite levels were measured.RESULTS: Psychosis-induced mice showed a significant elevation of immobility time in forced swim test, locomotor activity, and reduction in time of permanency in rota-rod test, escape latency time in Cook's pole test while treatment with ACE showed a significant alteration in above-mentioned behavioral parameters in MK-801-induced psychosis. Moreover, MK-801-induced psychosis in the mice showed a significant increase in DA, 5-HT, and NA levels and decrease in GABA, glutamate, and glycine levels in the brain. In contrast, treatment with ACE at both doses remarkably altered the neurochemical parameters. In addition, ACE-treated mice showed a substantial reduction in acetylcholinesterase, D-amino acid oxidase enzyme activity, and nitrite levels which were elevated by the administration of MK-801. CONCLUSIONS: Treatment with ACE once for 14 days (1 and 2 g/kg) significantly ameliorated the behavioral symptoms in experimentally induced psychosis by virtue of neuromodulation and decreased oxidative stress.
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	Efficacy of melatonin on sleep quality after laparoscopic cholecystectomy	p. 236
	Vaibhav Vij, Divya Dahiya, Lileswar Kaman, Arunanshu Behera DOI:10.4103/ijp.IJP_250_18   CONTEXT: Postoperative sleep and circadian rhythm disturbances were associated with prolonged postoperative convalescence, respiratory, and cardiovascular morbidity. Sleep disturbances have been shown to be due to decreased levels of circulating melatonin after surgery. If this sleep pattern and circadian rhythm are recycled, outcome after surgery could be improved. AIMS: The aim of this study was to observe the effect of melatonin on the quality of sleep in patients undergoing laparoscopic cholecystectomy (LC).SUBJECTS AND METHODS: Hundred patients of LC participated in this randomized, placebo-controlled, double-blind, clinical trial. Patients were randomized equally into Group A who received 6 mg melatonin tablets 45 min before sleep for 3 days after surgery and Group B who received placebo. RESULTS: Melatonin usage results in decrease in sleep latency (SL) as compared to placebo (13.6 ± 14.95 vs. 20.10 ± 16.18 min, P = 0.04). There was also increased total sleep duration (TSD) on postoperative day (POD) 1 (P = 0.004) and POD 2 (P = 0.001) in Group A. There was a decrease in daytime naps and night awakenings after surgery in Group A though it was not significant statistically. Subjective assessment of sleep on visual analog scale showed reduced sleep scores (P = 0.001 on POD 1 and 2) and decreased pain (P = 0.02 on POD 1) in Group A. Statistically significant difference was not observed in fatigue or general well-being among groups. CONCLUSIONS: Results in this study could demonstrate that melatonin as a single agent could improve the quality of sleep after LC by decreasing SL and increasing TSD.
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	In silico approach to study the metabolism and biological activities of oligomeric proanthocyanidin complexes	p. 242
	Sankar Jamuna, Ashokkumar Rathinavel, Sakeena Sadullah Mohammed Sadullah, Sivasitambaram Niranjali Devaraj DOI:10.4103/ijp.IJP_36_17   OBJECTIVES: Over the past three decades, numerous studies have focused on the biological activities of oligomeric proanthocyanidins (OPCs) in the prevention of many diseases such as neurodegeneration, atherosclerosis, tumorigenesis, and microbial infections. OPC has redox-active metabolites which could modulate the intracellular redox equilibrium to maintain the antioxidant homeostasis. This redox-modulating efficiency of OPC could provide new insights into therapeutic approaches that could reduce the burden of cardiovascular diseases. The main objective of this study was to explore the biological and metabolic activities of OPC using in silicoapproaches. METHODS: To validate the above objective, chemoinformatic tools were used to predict the metabolism of OPC after ingestion, based on both the ligand and structure of the constituent compounds. RESULTS: OPC showed possible sites for Phase I metabolism by cytochrome P450, and the metabolites obtained thereafter may be responsible for its biological activities. Absorption, distribution, metabolism, elimination, and toxicity properties showed efficient absorption, distribution, and metabolism of OPC, without toxicity. CONCLUSION: Thus, from the results obtained, OPC could be strongly recommended as a cardioprotective drug.
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	Antidiabetic potential of active fraction obtained from methanolic extract of Ichnocarpus frutescens: A possible herbal remedy	p. 251
	Mallu Srujana, Ranjana Ramesh, Lakshmi Devi Nanjaiah DOI:10.4103/ijp.IJP_24_18   OBJECTIVES: Ichnocarpus frutescens is a common plant used by tribal people and in Ayurveda for its high medicinal value. The purpose of the study was to investigate whether I. frutescens has any persuasive medicinal property to manage diabetes mellitus.MATERIALS AND METHODS: Initially, male albino Wistar rats were given intraperitoneal injection of streptozotocin-nicotinamide to induce diabetes, followed with the administration of active fraction obtained from the methanolic extract of I. frutescens for the next 28 consecutive days. Glibenclamide (25 mg/kg) was used as positive control. RESULTS: According to the results obtained, active fraction at a dose of 50 mg/kg body weight exhibited significant antihyperglycemic activity, which was evident with reduced blood glucose level up to 58.84%. The active fraction also showed improvement in serum lipid profile as well as regeneration of pancreatic β-cells in diabetic rats. Concurrent histopathological studies reinforce the effect of active fraction in healing pancreas, thus justifying the possible mechanism of its antidiabetic activity. CONCLUSION: The results of the present investigation lead credence to the use of I. frutescens in ameliorating the diabetic condition.
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	A comparative randomized study on effect of vaginally administered glyceryl trinitrate placebo on cervical ripening prior to induction of labor in overdue pregnancies	p. 260
	Özlem Dülger, Bulat Aytek Sik, Yilda Arzu Aba DOI:10.4103/ijp.IJP_182_18   OBJECTIVE: The aim of this study is to examine the effectiveness and adverse effects of local glyceryl trinitrate (GTN) application during labor compared with a placebo group. METHODS: The study consisted of 70 pregnant women with overdue pregnancies who presented to the hospital for labor induction between January 2009 and January 2011 in the Obstetrics Clinic of Istanbul Süleymaniye Gynecology and Obstetrics Education and Training Hospital. Vaginal suppositories-containing GTN (36/70) or placebo (34/70) was administered to the participants in a randomized fashion. The placebo and GTN involving vaginal ovules used in the study were prepared in the Pharmacy Department of Istanbul University Faculty of Pharmacy. Maternal effects during labor, rates of normal vaginal and C/S deliveries, the interval between the initial medication and delivery, and amount of total oxytocin used were compared between the GTN and placebo groups. RESULTS: There were no significant differences between the GTN and placebo groups regarding bishop scores, the interval between medication and delivery, delivery types, indications for cesarean section, and complications including hyperstimulation, tachysystole, uterine rupture, placental abruption, and uterine atony (P > 0.05). CONCLUSION: Our results revealed that there were no differences between GTN and placebo regarding their effect on cervical ripening in overdue pregnant women.
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	Oxaceprol versus tramadol for knee osteoarthritis: A randomized controlled trial	p. 266
	Kaushik Mukhopadhyay, Parasar Ghosh, Partha Ghorai, Avijit Hazra, Amal Kanti Das DOI:10.4103/ijp.IJP_633_16   OBJECTIVES: To assess efficacy and safety of oxaceprol, a hydroxyproline derivative with putative mechanism of action different from traditional nonsteroidal anti-inflammatory drugs, in symptomatic knee osteoarthritis, in comparison to tramadol. MATERIALS AND METHODS: A parallel group, double-blind, randomized controlled trial was conducted with ambulatory patients over 50 years age suffering from knee osteoarthritis causing pain of at least moderate intensity. Patients were randomized to receive either oxaceprol 200 mg thrice daily or tramadol 50 mg thrice daily for 12 weeks. The primary efficacy variable was symptom relief as assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) version 3.1 for pain, stiffness, and physical function. Responder rate (50% pain relief), patient's Clinical Global Impression (CGI), and rescue medication use were other outcomes measured. Vital signs, routine blood counts, tests of hepatorenal function and treatment-emergent adverse events were recorded for safety assessment.RESULTS: From 91 patients recruited, 43 on oxaceprol and 36 on tramadol were evaluable. The WOMAC scores declined significantly from baseline in each arm but remained comparable between groups throughout the 12-week study period. The CGI ratings and 50% responder rates were also comparable at the final visit. Differences in dose up-titration and rescue medication requirements were statistically nonsignificant. So also were the adverse event counts. Compliance was satisfactory in both groups. CONCLUSIONS:Efficacy and tolerability of oxaceprol were comparable to tramadol, and the drug can be considered as an alternative to low-potency opioids in the management of knee osteoarthritis.
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	A retrospective analysis of reporting of adverse drug reactions to oncology drugs: An experience from a national center of clinical excellence	p. 273
	Pramod Kumar Sharma, Arup Kumar Misra, Ajay Gupta, Surjit Singh, Puneet Dhamija, Puneet Pareek DOI:10.4103/ijp.IJP_544_17   INTRODUCTION: Adverse drug reaction (ADR) is a public health problem which constitutes one of the leading causes of morbidity and mortality worldwide. In India, only a few studies reported cancer chemotherapy-induced ADRs. The objectives of the present study were to assess the organ system involved, frequency, severity, and preventability of the ADRs occurred. MATERIALS AND METHODS: Data on ADRs of retrospective cohorts were extracted from the filled ADR forms received from the department of radiation oncology. Descriptive statistic was used to summarize and analyze the available data, namely patient demography, causality, severity, and preventability of the event. RESULTS: A total of 191 chemotherapy-induced ADR reports were received from 164 patients during the period March 2015 to August 2017. Almost three-fourth of the ADRs occurred in patients who were receiving regimens involving multiple drugs. Taxanes, alkylating agents, and platinum compounds were the common drug groups involved. The skin (n = 90) was the most frequently involved organ with alopecia and hyperpigmentation as most common manifestations. The severity (Hartwig and Siegel) and preventability scales (Modified Schumock and Thornton) indicated that most reactions were mild (54.45%) in nature and the majority of them were preventable. More than two-third (69%) of the reactions were related "possible" to the suspected drug as determined by the World Health Organization causality assessment. CONCLUSION: Chemotherapy-related ADRs among cancer patients are worrisome. It has a negative impact on patient quality of life and in addition increases cost of therapy. It is found that timely reporting of chemotherapy-related ADRs and having an effective ADR monitoring system in place ensure preventability of the ADRs in many cases. Oncologists, Radiotherapists and Onco-surgeons should be actively involved in ADR reporting (Onco-Pharmacovigilance) and exchange constructive information, update and educate each other about appropriate use of anticancer drugs. Onco-pharmacovigilance is the need of the hour and could be of immense value in reducing morbidity and mortality if practiced with utmost importance.
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	Ten units intravenous oxytocin over 2–4 h is as effective as 30 units over 8–12 h in preventing postpartum hemorrhage after cesarean section: A randomized controlled trial	p. 279
	Maria Cecilia, Reeta Vijayaselvi, Ramandeep Bansal, Latha Lakshmi, Ruby Jose DOI:10.4103/ijp.IJP_419_18   OBJECTIVES: Currently, recommended high-dose oxytocin regimen for the prevention of postpartum hemorrhage (PPH) following cesarean delivery (CD) is associated with maternal side effects frequency of which is greater with a higher cumulative dose and rapid administration of oxytocin. Here, we evaluated the efficacy of single-dose intravenous oxytocin over 2–4 h (total = 10 units) with oxytocin maintenance infusion for 8–12 h (total = 30 units) in postoperative CD women for the prevention of PPH. METHODS: The current double-blinded randomized controlled trial was carried out in a tertiary care institute in Southern India. The primary outcome measures included the following: (a) the need for additional uterotonics to control PPH and (b) significant deterioration of vital signs as assessed by pulse rate and blood pressure in the postoperative period. The secondary outcome measures were as follows: (a) significant difference (≥10% between preoperative and postoperative packed cell volume) and (b) need for blood transfusion. RESULTS AND CONCLUSIONS: Two hundred and seventy-one women were randomized into Group A (oxytocin = 10 units; n = 135) and Group B (oxytocin = 30 units; n = 136). Both the groups were comparable with regard to demographic characteristics. There was no difference in any of primary or secondary outcome measures in the two groups. Thus, low-dose oxytocin regimen is as effective as high-dose oxytocin regimen in the prevention of PPH in postoperative CD women.
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DRUG WATCH
	Rare occurrence of hand-foot syndrome due to paclitaxel: A rare case report	p. 284
	Pritam S Kataria, Pradip P Kendre, Apurva A Patel, Nahush Tahiliani, Vijay Bhargav, Honey Parekh DOI:10.4103/ijp.IJP_547_17   Hand-foot syndrome (HFS) is a relatively frequent adverse reaction to certain anticancer drugs. HFS is a type of dermatitis which has been most commonly described with 5-fluorouracil and capecitabine. However, HFS with paclitaxel is rare and has been reported sparingly in the literature. A 52-year-old male patient with recurrent carcinoma of the buccal mucosa was started on palliative chemotherapy regimen, injection paclitaxel (175 mg/m2) in combination with injection carboplatin. On post-chemotherapy day 13, the patient started developing pain, dysesthesia followed by bullae formation, and desquamation over palms and soles. Clinically, the patient had Grade 3 HFS characterized by symmetrical, tender skin lesions over the dorsal aspect of palms, and soles with desquamation necessitating interruption of treatment. Therefore, this case has been presented to be cognizant with this rare form of side effect with one of the most commonly used drug in oncology.
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A novel anatomy-based five-points eight-line-segments technique for precision subtotal tongue reconstruction: A pilot study

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Song Fan, Hanqing Zhang, Qunxing Li, Faya Liang, Zhiqiang Bai, Weixiong Chen, Sheng Sun, Peirong Yu, Jinsong Li

Abstract

Objectives

A no-flap design based on actual tongue anatomy has been reported to achieve precise reconstruction, but large carcinologic tongue defects remain extremely challenging to treat. The aim of this pilot study was to explore an anatomy-based flap design for precision subtotal tongue reconstruction.

Material and methods

Thirty-five patients were randomly divided into two groups, a "five-points eight-line-segments" (FIPELS) technique flap design group (18 patients) and a conventional surgery group (17 patients), to undergo subtotal tongue reconstruction. All patients received an anterolateral thigh flap with nerve coaptation to the lingual or glossopharyngeal nerve. Swallowing function, speech intelligibility, and cosmetic results were assessed with a Likert scale, and epicritic and proprioceptive sensitivity and thermosensation of the neotongue were investigated. Outcomes were analyzed, and a p-value < 0.05 was considered significant.

Results

The FIPELS flaps were significantly larger than conventionally designed flaps. All flaps healed uneventfully, except in two patients who presented with partial necrosis. Relative to patients in the conventional group, patients in the FIPELS group showed significantly improved swallowing function (p = 0.043) and cosmetic results (p = 0.017) but not speech intelligibility (p = 0.154). Patients in the two groups recovered comparably in terms of epicritic and proprioceptive sensitivity and thermosensation.

Conclusion

The anatomy-based FIPELS technique is an innovative and effective solution for subtotal tongue reconstruction.

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Regional recurrence rate of lymph-node-positive thyroid carcinoma after selective or comprehensive neck dissection

Publication date: Available online 13 December 2018

Source: Oral Oncology

Author(s): Linkai Deng, Yubin Cao, Jie Lin

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Changing face of orofacial pain: The diagnostic impact of working with Neurology on an orofacial pain clinic

Publication date: Available online 13 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. Karamat, J.G. Smith, G. Lambru, T. Renton

Abstract

This study assessed the impact of collaborative working with a headache neurologist on diagnoses of patients attending orofacial pain (OFP) clinic. Patient diagnostic data was collected from adult patients attending an Orofacial Pain Service from January 2013 to January 2017. A liaison headache neurologist was appointed late 2015; OFP clinics were co-run with the neurologist specialist thereafter. Overall, 639 patients attended the service; 315 in 2013–2015 and 324 in 2016–2017. Compared to 2013–2015, there were increased rates of diagnoses related to neurovascular (27.5% vs. 19.0%; P = .012) and musculoskeletal pain (36.9% vs. 26.0%; P = .003) in the 2016–2017 cohort and decreased rates of neuropathic (55.6% vs. 70.2%; P < .001) and atypical/idiopathic pain (1.3% vs. 5.4%; P = .003) diagnoses. There was a trend towards an increased rate of comorbid diagnoses (26.3% vs. 20.3%; P = .077), especially those relating to headache conditions. The findings suggest that introduction of a specialist headache neurologist into the OFP clinic widened its remit of assessment, increasing recognition of (co-morbid) neurovascular-related pain and decreasing atypical/idiopathic pain diagnoses in patients with complex OFP. The increase rate of musculoskeletal pain diagnosis in the later cohort is likely attributable to service expansion and normalisation of diagnostics reportedly seen in other OFP services.

Statement of clinical relevance: Orofacial pain is a complex diagnosis, it requires a multidisciplinary approach that includes neurological input.

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Synergistic convergence of microbiota-specific systemic IgG and secretory IgA

Publication date: Available online 13 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jehane Fadlallah, Delphine Sterlin, Claire Fieschi, Christophe Parizot, Karim Dorgham, Hela El Kafsi, Gaëlle Autaa, Pascale Ghillani-Dalbin, Catherine Juste, Patricia Lepage, Marion Malphettes, Lionel Galicier, David Boutboul, Karine Clément, Sébastien André, Florian Marquet, Christophe Tresallet, Alexis Mathian, Makoto Miyara, Eric Oksenhendler

Background

Commensals induce local IgA responses essential to the induction of tolerance to gut microbiota, but it remains unclear whether antimicrobiota responses remain confined to the gut.

Objective

The aim of this study was to investigate systemic and intestinal responses against the whole microbiota under homeostatic conditions and in the absence of IgA.

Methods

We analyzed blood and feces from healthy donors, patients with selective IgA deficiency (SIgAd), and patients with common variable immunodeficiency (CVID). Immunoglobulin-coated bacterial repertoires were analyzed by using combined bacterial fluorescence-activated cell sorting and 16S rRNA sequencing. Bacterial lysates were probed by using Western blot analysis with healthy donor sera.

Results

Although absent from the healthy gut, serum antimicrobiota IgG are present in healthy subjects and increased in patients with SIgAd. IgG converges with nonoverlapping secretory IgA specificities to target the same bacteria. Each individual subject targets a diverse microbiota repertoire with a proportion that correlates inversely with systemic inflammation. Finally, intravenous immunoglobulin preparations target CVID gut microbiota much less efficiently than healthy microbiota.

Conclusion

Secretory IgA and systemic IgG converge to target gut microbiota at the cellular level. SIgAd-associated inflammation is inversely correlated with systemic anticommensal IgG responses, which might serve as a second line of defense. We speculate that patients with SIgAd could benefit from oral IgA supplementation. Our data also suggest that intravenous immunoglobulin preparations can be supplemented with IgG from IgA-deficient patient pools to offer better protection against gut bacterial translocations in patients with CVID.

Graphical abstract

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A Pediatric Asthma Risk Score to better predict asthma development in young children

Publication date: Available online 13 December 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jocelyn M. Biagini Myers, Eric Schauberger, Hua He, Lisa J. Martin, John Kroner, Gregory M. Hill, Patrick H. Ryan, Grace K. LeMasters, David I. Bernstein, James E. Lockey, S. Hasan Arshad, Ramesh Kurukulaaratchy, Gurjit K. Khurana Hershey

Background

Asthma phenotypes are currently not amenable to primary prevention or early intervention because their natural history cannot be reliably predicted. Clinicians remain reliant on poorly predictive asthma outcome tools because of a lack of better alternatives.

Objective

We sought to develop a quantitative personalized tool to predict asthma development in young children.

Methods

Data from the Cincinnati Childhood Allergy and Air Pollution Study (n = 762) birth cohort were used to identify factors that predicted asthma development. The Pediatric Asthma Risk Score (PARS) was constructed by integrating demographic and clinical data. The sensitivity and specificity of PARS were compared with those of the Asthma Predictive Index (API) and replicated in the Isle of Wight birth cohort.

Results

PARS reliably predicted asthma development in the Cincinnati Childhood Allergy and Air Pollution Study (sensitivity = 0.68, specificity = 0.77). Although both the PARS and API predicted asthma in high-risk children, the PARS had improved ability to predict asthma in children with mild-to-moderate asthma risk. In addition to parental asthma, eczema, and wheezing apart from colds, variables that predicted asthma in the PARS included early wheezing (odds ratio [OR], 2.88; 95% CI, 1.52-5.37), sensitization to 2 or more food allergens and/or aeroallergens (OR, 2.44; 95% CI, 1.49-4.05), and African American race (OR, 2.04; 95% CI, 1.19-3.47). The PARS was replicated in the Isle of Wight birth cohort (sensitivity = 0.67, specificity = 0.79), demonstrating that it is a robust, valid, and generalizable asthma predictive tool.

Conclusions

The PARS performed better than the API in children with mild-to-moderate asthma. This is significant because these children are the most common and most difficult to predict and might be the most amenable to prevention strategies.

Graphical abstract

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Effect of platelet-rich plasma on temporomandibular joint cartilage wound healing: experimental study in rabbits

Publication date: Available online 13 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Ummugulsum Coskun, Celal Candirli, Gokcen Kerimoglu, Fatih Taskesen

Summary

Purpose

The aim of the study is to evaluate the effect of platelet-rich plasma (PRP) injection on temporomandibular joint (TMJ) cartilage and subchondral bone healing.

Materials and Methods

Sixteen New Zealand rabbits were divided into two groups, including single PRP and multiple PRP injection groups. Sodium mono-iodoacetate (MIA) was injected bilaterally into the TMJ of all rabbits to create osteoarthritis (OA). PRP was injected once into the right TMJ in the single PRP group and was injected three times (once a week) into the right TMJ in the multiple injection group 4 weeks after injection of MIA. At the time of each PRP injection, isotonic NaCl solution was injected into the left TMJ in the control groups. All animals were sacrificed 30 days after the first PRP injection.

Results

As a result of the histological evaluation, there was no statistically significant difference in cartilage and subchondral bone regeneration between the groups (p>0.05).

Conclusions

Although there was no statistically significant difference between PRP and control groups, it was seen that improvement were better in PRP groups. According to the Results of our study, it seems that different methods should be tried to investigate the efficacy of PRP on the TMJ healing.

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