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OBJECTIVES: Psoriasis is a chronic inflammatory disease showing co-existence with metabolic syndrome (MS), as has been confirmed by numerous epidemiologic studies in recent times. In this study, the aim was to ascertain the beneficial effects of pioglitazone in psoriasis, simultaneously targeting the improvement of MS parameters. MATERIALS AND METHODS: We conducted a prospective randomized open-labeled parallel-group interventional study in patients of moderate-to-severe chronic plaque psoriasis. A total of 90 patients were inducted in study and divided into three groups of standard treatment (methotrexate 7.5 mg/week for 12 weeks), active treatment (pioglitazone 15 mg tablets once daily for 12 weeks), and their combination. Primary outcome was taken as percentage Psoriasis Area and Severity Index (PASI) improvement from baseline; secondary outcomes were PASI-75, safety profile, and MS parameters. RESULTS: Intergroup evaluation of PASI score showed that standard treatment methotrexate and active treatment pioglitazone were comparable. Combination of methotrexate and pioglitazone proved superior in efficacy from both standard and active treatment in 8 and 12 weeks. Adverse drug reactions were mild and treated symptomatically. Pioglitazone and combination group also demonstrated beneficial efficacy in parameter of MS hence establishing it as a potential therapy in psoriasis with MS. CONCLUSIONS: Pioglitazone alone or in combination with standard treatment may be a safe alternative drug for psoriasis coexisting with MS proving beneficial for both.

Objective: The objective of our study is to assess the prescription and drug utilization pattern in a tertiary care teaching and referral hospital in Uttar Pradesh, to investigate the rational use of drugs. Methods: The study was carried out in the general medicine outpatient department (OPD) setting for a period of 3 months in our tertiary care teaching and referral hospital. The prescriptions were randomly sampled and the photocopies of all the prescriptions were obtained from the OPD during the period of the study and were processed and analyzed for the demographic profile, drug profile, fixed-dose combinations, therapeutic classes of antibiotic prescribed, morbidity profile according to the disease pattern, and prescription pattern including the errors in prescription and the assessment of polypharmacy. Results: A total of 350 prescriptions were randomly sampled, out of which 312 prescriptions were fit to be analyzed. The total number of drugs in 312 prescriptions was 1022. Basic information of patient was written in 79.25% prescriptions, 84.25% prescriptions were legible, and only 71.21% prescriptions were complete. The majority of prescriptions had at least five drugs ordered which constituted around 43.14% of total number of prescriptions leading to polypharmacy. Conclusions: Our study highlights that there is a scope for improvement in prescribing patterns in areas of writing legible and complete prescriptions. To lay down the principles of rational pharmacotherapeutics, proper training of the prescribers on rational prescription writing is the need of an hour for improving the quality of prescriptions.

Dry eye disease (DED) is an inflammatory disorder of ocular surfaces leading to severe disability, especially in the elderly age group. The mainstay of therapy includes artificial tears, punctual plugs, topical anti-inflammatory agents, and corticosteroids. In the past few years, only cyclosporine-A emulsions have been added to the existing therapy, but it is discontinued by most patients as it causes burning sensation in the eye. Hence, progress in new research for a better therapeutic option led to the discovery of lymphocyte function-associated antigen intercellular adhesion molecule 1 antagonist, lifitegrast. It hinders the T-cell activation, release of inflammatory mediators, and consequently inhibits the inflammatory pathways in DED. It was approved by the US Food and Drug Administration in July 2016 for the treatment of DED. This review highlights the development process and approval of lifitegrast.

Recent advances in the management of prostate cancer have shown considerable development with time and many novel therapeutic agents have been approved over the past years. For patients with metastatic castration-resistant prostate cancer (mCRPC), initially docetaxel was the standard chemotherapy but once they became refractory to docetaxel, no treatment improved survival. This scenario changed in June 2010 when the US Food and Drug Administration (FDA) approved Cabazitaxel as a new therapeutic option for patients with mCRPC resistant to docetaxel. Cabazitaxel, being a novel tubulin-binding taxane with poor affinity for P-glycoprotein, decreases the chances of resistance. It has shown antitumor activity in preclinical, phase I, II and III clinical studies in docetaxel-resistant tumors. This article summarises the background, pharmacodynamic, kinetics and clinical development of cabazitaxel for the treatment of castration-resistant prostate cancer. Future development and rational use of this drug in other tumors is under therapeutic investigation.

Background: Oral submucous fibrosis (OSMF) is a chronic condition which has characteristics of inflammation and fibrosis in the oral cavity which is progressive in nature. Steroids are the standard treatment of OSMF, but considering their side effect profile, we thought of taking herbal preparations as these have minimal side effects. Aims and Objectives: This study aims to compare the efficacy of curcumin and tulsi gels in OSMF. Materials and Methods: This is a prospective, randomized study conducted in ENT OPD on 60 patients who were diagnosed on the the basis of clinical criteria of OSMF. Patients were divided into two groups, one group was given tulsi gel and other group curcumin gel and each group was given topical steroids along with the test drugs. Follow-up was done for 6 weeks and patients were assessed on the basis of improvement in interincisal distance, burning sensation, and tongue protrusion at 2, 4, and 6 weeks. Results: There was an improvement in all the three parameters at subsequent visits, but the curcumin gel showed better improvement than tulsi gel in burning sensation after 6 weeks of treatment which was highly statistically significant P < 0.01. Conclusion: Curcumin gel and tulsi gel are effective in improving OSMF symptoms, but curcumin gel is more efficacious without any side effects. Hence, we can advocate these drugs as adjuvant treatment in addition to the recommended treatment.

Background: Metabolic syndrome (MS) is a group of interconnected disorder linked to obesity, insulin resistance hypertension, and dyslipidemia. It is a risk factor for the development of Type II diabetes and cardiovascular diseases. Thus, there is a need to search for therapeutic options for the treatment of MS. Aims and Objective: The present study was conducted to evaluate the protective effect of Pterocarpus marsupium (Bijasar) in animal model of high carbohydrate diet-induced MS. Materials and Methods: Adult male Wistar rats were divided into three groups. All the animals were given 20% sucrose in drinking water ad libitum for 8 weeks for the induction of MS along with the following treatment. Group I (Control): Distilled water; Group II (PM group): Aqueous extract of P. marsupium (200 mg/kg/day); and Group III (Standard treatment): Metformin 100 mg/kg/day + Atorvastatin 10 mg/kg/day. Body weight, abdominal circumference (AC), blood glucose, and serum triglycerides were evaluated at the end of 4 weeks and 8 weeks. Results: The aqueous extract of P. marsupium at a dose of 200 mg/dl caused a significant reduction (P < 0.05) in the body weight, AC, blood sugar and serum triglyceride levels when compared to the control group. Similar results were seen in the standard treatment group. Conclusion: PM was effective in the treatment of major components of MS in rat model of high carbohydrate diet‑induced MS.

Background: Bronchial asthma being a chronic inflammatory disease of airways has numerous treatment options none of which have disease modifying properties. Curcumin, a yellow dietary pigment has varied pharmacological activities, prominent among which is an anti-inflammatory activity which may be crucial in bronchial asthma as has been proved by various in vitro and in vivo animal studies. Aims: To determine the efficacy and safety of curcumin as an ‘add-on’ therapy in patients of bronchial asthma. Settings and Design: This study was conducted on 77 patients of mild to moderate Bronchial asthma who had a documented positive bronchodilator reversibility test with ≥15% improvement in forced expiratory volume one second (FEV1). Materials and Methods: Seventy seven patients were recruited for the study and randomized into either of the two groups, but 17 patients were lost to follow up. Thus Group A – Receiving standard therapy for bronchial asthma for 30d (n=30) and Group B – Receiving standard therapy for bronchial asthma + Cap Curcumin 500mg BD daily for 30d (n=30). The predefined primary endpoints were clinical assessments of dyspnoea, wheezing, cough, chest tightness and nocturnal symptoms, change in the pre-bronchodilator FEV1 during the treatment and hematological improvement. The secondary end points were assessed by the change in the post-bronchodilator FEV1, C-reactive protein (CRP) concentration and incidence of adverse events. Statistical Analysis used: The data was analysed by SPSS 17.0 software using one-way ANOVA or Paired t-test. Results and Conclusion: The results showed that curcumin capsules help in improving the airway obstruction which was evident by significant improvement in the mean FEV1 values. There was also significant improvement in the hematological parameters and absence of any clinically significant adverse events indicates dependable safety profile of curcumin capsules, though there was no apparent clinical efficacy. Therefore, it is concluded that curcumin is effective and safe as an add-on therapy for the treatment of bronchial asthma.

Background: Corticosteroids are extremely useful in the treatment of inflammatory skin disorders. Topical steroid applications are the most effective treatment for all types of psoriasis. Aims: To compare the efficacy of once daily versus alternate day application of topical steroid clobetasol propionate 0.05% (Tenovate cream®) in patients who have mild to moderate plaque psoriasis. Settings and Design: This study was conducted on 89 patients of plaque psoriasis, who attended the skin OPD in our hospital. Methods and Material: The patients who had a mild to moderate severity of plaque psoriasis were selected. Those patients who required systemic corticosteroids, those who were already undergoing any psoriasis treatment, those who had any other debilitating illness and pregnant and lactating women were excluded from the study. Eighty nine patients were enrolled for the study after taking written informed consent from them and they were randomly allocated into two groups. Two patients dropped out, one in each group and 1 of group 2 was prescribed systemic corticosteroids. Group 1- once daily application (n= 44) Group 2- alternate day application (n= 42) An objective scoring was done on the basis of the PSI (Psoriasis Severity Index) score, which was graded from 0-4. Follow ups were done in the 2nd, 4th and 6th weeks. Statistical Analysis: It was done by the Student’s ‘t’ test and ANOVA. Results and Conclusions: The results showed that there was equal improvement in both the groups in the 2nd week, since the p-value was not significant (P> 0.05), but in the 4th and 6th weeks, there was less improvement in the alternate day group (P< 0.05). An intra group comparison indicated that clobetasol was effective both in the once daily and the alternate day groups, but clinical and symptomatic improvement occurred more quickly in the once daily group after 6 weeks of assessment. Thus, it can be concluded that the alternate day application of the topical steroid clobetasol propionate cream is as effective as the once daily application in the initial 2 weeks, but by 6 weeks, its efficacy decreases. Therefore, initially, we can advocate a less frequent application of potent topical steroids but for the complete remission of the disease, the application frequency should be once daily.

Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population. Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons. Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral -93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases - 16.03 % and diseases of digestive system - 13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription were four in 39.24% of prescriptions. The prescriptions also had other minor anomalies. Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions. Polypharmacy was also evident from our study. Establishment and implementation of appropriate clinical guidelines, use of essential medicines list, public education about medicines and regular update to the clinicians will help in implementing the principles of rational pharmacotherapeutics.

Background: Topical corticosteroids used in various dermatological diseases several times a day led to an increase risk of side effects. By demonstrating a significant reservoir of corticosteroids in the stratum corneum, one can maximize their efficacy and safety as therapeutic agents. Aim: The study was designed to demonstrate a reservoir of topically applied corticosteroid clobetasol propionate cream experimentally in rabbits using histamine-induced wheal suppression test. Materials and Methods: The work was carried out on albino rabbits, as rabbit skin is akin to human skin, using a topical steroid. The topical steroid clobetasol propionate 0.05% cream was applied on the back of rabbit, and after 1-h occlusion histamine-induced wheal suppression test was performed and wheal area measured at 10 min till day 7. Statistical analysis was done by ANOVA followed by "Post Hoc" test. Results: Maximum wheal suppression was seen on day 1 (P < 0.001). Interday comparison of mean wheal size showed no significant difference (P > 0.05) on day 2, 3, and 4 as compared to day 1. Day 5-7 show highly significant difference (P < 0.001) as compared to day 1, thereby suggesting that the reservoir effect of topical clobetasol propionate 0.05% cream persisted till day 4. Conclusions: This work demonstrated that histamine-induced wheal by the topical steroid clobetasol propionate 0.05% cream was suppressed till day 4, indicating that the reservoir of topical corticosteroid persisted till day 4.