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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.

Adverse drug reactions are crucial events related to drug usage that ought to be reported and the effects of which can be minimized by careful and vigilant use of drugs. Pharmacovigilance refers to the systematic practice of reporting, assessing and preventing such events. Although such practice is vital in any healthcare system, its actual implementation has been found to be very limited in a country like Nepal. With the aim of disseminating information about such events and the role of healthcare professionals in pharmacovigilance, a one-day workshop was organized with international and national speakers on this subject at Nepal Cancer Hospital and Research Center, Lalitpur, Nepal, which also has a regional pharmacovigilance center . The workshop included lectures and hands-on training and had an audience from diverse fields of healthcare such as pharmacy, medical, surgical and radiation oncology, pathology and nursing staff. The feedback from the participants revealed that practical demonstration and hands-on training with extensive topic coverage were the best feature of the workshop, while less interaction during the lectures was a source of dissatisfaction with a recommendation to conduct more events focused on similar topics in the future.

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.

Adverse drug reactions are crucial events related to drug usage that ought to be reported and the effects of which can be minimized by careful and vigilant use of drugs. Pharmacovigilance refers to the systematic practice of reporting, assessing and preventing such events. Although such practice is vital in any healthcare system, its actual implementation has been found to be very limited in a country like Nepal. With the aim of disseminating information about such events and the role of healthcare professionals in pharmacovigilance, a one-day workshop was organized with international and national speakers on this subject at Nepal Cancer Hospital and Research Center, Lalitpur, Nepal, which also has a regional pharmacovigilance center . The workshop included lectures and hands-on training and had an audience from diverse fields of healthcare such as pharmacy, medical, surgical and radiation oncology, pathology and nursing staff. The feedback from the participants revealed that practical demonstration and hands-on training with extensive topic coverage were the best feature of the workshop, while less interaction during the lectures was a source of dissatisfaction with a recommendation to conduct more events focused on similar topics in the future.

Background: History of epilepsy is intertwined with the chronicles of humankind, with millions of people worldwide living with epilepsy, still the current available antiepileptic drugs (AEDs) only suppress seizures without correcting the natural course of epilepsy. Growing limitations of available AEDs have motivated this study to divert our attention towards other safe and natural resources available for the treatment of epilepsy. Aim and Objective: This study aims to investigate the antiepileptic and cognition-enhancing effects of Citrus aurantium (CA) in a mouse model of pentylenetetrazole (PTZ)-induced generalized tonic–clonic seizures. Materials and Methods: Kindling was induced by administering 35 mg/kg PTZ to 6-month-old Swiss albino mice for 28 days. Mice were divided into following groups: PTZ control group; CA peel extract group, and Valproic acid (VA) group. The methods used for validating the antiepileptic and cognition-enhancing effects were Behavioral seizure evaluation and Cook’s pole climbing apparatus. Results: Acute treatment with CA effectively attenuated the seizures induced by PTZ. The antiepileptic and cognition-enhancing effects of CA peel extract were comparable with the standard treatment, that is, VA. Conclusion: CA showed remarkable antiepileptic and memory-enhancing effects in PTZ-induced seizures and the effects were comparable to VA.

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.

Introduction: Topical corticosteroids used in various dermatological diseases are available in different potencies and different formulations. The reservoir effect of different potency corticosteroids in the stratum corneum will help the clinicians to choose an appropriate topical steroid to maximize their efficacy and safety as therapeutic agents. Aims: This study was designed to compare the duration of reservoir of different potency topical corticosteroids experimentally in rabbits using histamine-induced wheal suppression test. Materials and Methods: The study was carried out in albino rabbits (as their skin is similar to humans) using four different concentrations of topical steroids, namely mometasone furoate ointment (0.1%), fluticasone propionate ointment (0.005%), betamethasone valerate cream (0.1%), and hydrocortisone butyrate cream (0.1%). These were applied on the back of rabbit on one side and the vehicle was applied on the other. One hour later, histamine-induced wheal suppression test was performed on both sides and wheal area was measured at 10 min for 7 days. Statistical analysis was done by ANOVA followed by post hoc test. Results: Maximum wheal suppression was seen on day 1 (P

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: The study has been performed to evaluate the efficacy of budesonide delivery by different form of devices like nebulizer, metered dose inhaler and dry powder inhaler to adult patients of chronic stable bronchial asthma. The changes in pulmonary function test parameters have been consider for evaluation.Methods: This prospective study was undertaken to assess the relative efficiency of budesonide administered from devices like nebulizer, metered dose inhaler and dry powder inhaler in adult patients of chronic stable bronchial asthma. Fifty subjects where administered budesonide (1mg) via nebulizer, budesonide (400 microgram) by metered dose inhaler and dry powder inhaler consecutively each week for four weeks under direct supervision. To analyze the effect of budesonide delivered through different devices pulmonary function test was carried out on the subject before and one hour after administration of the drug on each visit.Results: No significant difference in Peak expiratory flow rate (P=0.77), forced expiratory volume in one second (P=0.851), forced vital capacity (P=0.178) and forced expiratory volume in one second and forced vital capacity ratio (P=0.298) was seen after giving budesonide by different devices.Conclusions: Budesonide delivered by different devices (nebulizer, metered dose inhaler, and dry powder inhaler) have similar effect on lung function in patients of chronic stable bronchial asthma. In the daily clinical practice, the correct choice of an inhaler device should be related with the patient's characteristics. They may be used interchangeably depending on availability, cost and compliance of the patients.

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: The present work has been planned to find out the effect of Punica granatum and Rosuvastatin on learning and memory in Scopolamine induced cognitive deficits in rats. Scopolamine being an anticholinergic agent is used fervently in experimental models for memory deficits and has been widely implicated for the screening of cognitive dysfunction. Punica granatum (Pomegranate) has shown to suppress tumor neuronal cells, hence it can be a potential agent in providing neuroprotection for preventing the development and progression of AD. There are conflicting reports indicating the role of statins as a neuroprotective agent. This contradiction led us to investigate the effect of the role of Rosuvastatin on memory. The test agents were further compared to the standard treatment group acetylcholinesterase inhibitor i.e. Donepezil.Methods: Male wistar rats 150-200gms were divided into 4 groups of 6 rats each. Amnesia was induced by scopolamine 3mg/kg ip at day 5 in all the groups. Group1 (amnesic control) given distilled water; group 2(standard treatment i.e. Donepezil 0.5mg/kg orally); group 3(Rosuvastatin group10mg/kg orally); group 4 (Punica granatum juice 500mg/kg orally) The methods for validating cognition deficits were behavioural tests like Cook’s pole response and Passive Avoidance response.Results: It was evident from our research that the Punica granatum juice and Rosuvastatin effectively antagonized the scopolamine induced cognitive impairment in the paradigms studied. The neuroprotective effect of Punica granatum juice was better as compared to the Rosuvastatin group and the effects of the former were comparable with the standard treatment i.e. Donepezil group.Conclusions: Punica granatum has a remarkable protective role in memory function, learning, cognition and behavior in Scopolamine induced amnesia model of Alzheimer’s disease which was better than Rosuvastatin treatment.

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.

Calcipotriol is a newer topical treatment option available for plaque psoriasis and coal tar being one of the oldest treatment and still in use.To evaluate and compare the differences in terms of efficacy, safety and relapse with Calcipotriol 0.005% (50 mcg/gm) and 6% coal tar and 3% salicylic ointment in patients with Plaque psoriasis. SETTING andStudy conducted on 60 patients of plaque psoriasis, who attended the skin OPD in our hospital.The patients with mild to moderate plaque psoriasis were selected. 60 patients were enrolled for the study after obtaining informed consent. Subjects were asked to apply Calcipotriol 0.005% (50 mcg/gm) (Heximar Win care) twice a day on the right side plaques and on left side plaques, Petroleum jelly (Vaseline) in the morning and 6% coal tar and 3% salicylic ointment (Protar® Percos) at nighttime. PASI score was used to assess the reponse to therapy at 2nd, 4th, 6th and 8th week. After treatment subjects were observed for 6 weeks for any relapse.It was done by paired t-test and independent sample t-test.The results showed that statistically significant difference was seen in the mean percentage reduction of PASI score between both the groups, at all the assessment visits, 2, 4, 6, and 8 weeks, the mean percentage reduction at 2 weeks for calcipotriol being 21±12.06 and for coal tar being 13.44±11.19 (P=0.000), at 4 weeks for calcipotriol was 40±16.71 and for coal tar 25±99 (P=0.000), at 6 weeks for calcipotriol was 53.99+-22.43 and for coal tar 41±21.23 (P=0.002), at 8 weeks for calcipotriol was 62.73±24.04 and for coal tar was 51.53±23.27 (P=0.11). Relapse was seen in 5/60 (8.3%) of patients on calcipotriol treated side and 9/60 (15%) of patients with coal tar treated side. Thus it can be concluded that calcipotriol cream is more efficacious when compared with coal tar and does have a quick response. It is well tolerated and acceptable cosmetically.

The Hedgehog signaling pathway is one of the major regulators of cell growth and differentiation during embryogenesis and early development. It is mostly quiescent in adults but inappropriate mutation or deregulation of the pathway is involved in the development of cancers. Therefore; recently it has been recognized as a novel therapeutic target in cancers. Basal cell carcinomas (BCC) and medulloblastomas are the two most common cancers identified with mutations in components of the hedgehog pathway. The discovery of targeted Hedgehog pathway inhibitors has shown promising results in clinical trials, several of which are still undergoing clinical evaluation. Vismodegib (GDC-0449), an oral hedgehog signaling pathway inhibitor has reached the farthest in clinical development. Initial clinical trials in basal cell carcinoma and medulloblastoma have shown good efficacy and safety and hence were approved by U.S. FDA for use in advanced basal cell carcinomas. This review highlights the molecular basis and the current knowledge of hedgehog pathway activation in different types of human cancers as well as the present and future prospects of the novel drug vismodegib.

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.