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Background: Androgenetic alopecia (AGA) is the most common cause of hair loss in males which remains a therapeutic challenge. Objectives: To compare the efficacy of topical 5% minoxidil and 0.25% finasteride combination (MNF) over 5% minoxidil (MNX) or 0.25% finasteride (FNS) alone by assessing hair count, physician assessment score (PAS), and patient satisfaction score (PSS). Materials and Methods: Pilot randomized open-label study where 60 male patients with AGA = III grade were randomized into three treatment groups and evaluated over 24 weeks. Improvement in hair count was assessed manually using dermoscopy. Global photographs were used to assess PAS. Side effects were evaluated using relevant laboratory investigations. Results: At the 12th and 24th week, all three groups showed significant improvement in total hair density as compared to baseline (P < 0.001). None of the groups was superior to the other (P > 0.05) at the 12th week but at 24th week, MNF was comparatively superior (P < 0.02). At the 12th week and 24th week, all three groups showed significant improvement in terminal hair density as compared to baseline (P < 0.001). In the 12th week, MNF was comparatively superior (P = 0.028) and at the 24th week, MNF was comparatively superior (P < 0.02). PAS and PSS were significantly better with MNF and MNX compared to FNS (P < 0.004). Side effects such as scaling and itching were reported with MNF and MNX. Conclusion: Topical minoxidil 5% and finasteride 0.25% had an overall better efficacy compared to monotherapy without significant side effects. [ABSTRACT FROM AUTHOR]

AIMS: Angiopoietin-like growth factors (ANGPTLs) regulate glucose, lipid homeostasis, and insulin sensitivity. This study aimed to find whether long-term glycemic control (glycated hemoglobin [HbA1c]) has any correlation with serum ANGPTL6 levels in patients of type 2 diabetes mellitus. MATERIALS AND METHODS: It was an open-label, observational, prospective clinical study. Sixty-five participants (41 diabetic patients receiving daily dose of oral metformin for a minimum of 3 months and 24 matched controls) completed the study. A single venous blood sample was taken from each participant to determine serum HbA1c and serum ANGPTL6 levels. Comparison of serum ANGPTL6 levels according to the HbA1c levels, in groups A, B, and C ranging from 6.5%-8%, 8.1%-9.5%, and >9.5%, respectively, was done using Kruskal-Wallis H-test followed by pairwise comparisons. RESULTS: Serum HbA1c and serum ANGPTL6 levels were raised significantly (P < 0.05) in diabetic patients when compared with control participants. A positive correlation was observed between serum HbA1c and serum ANGPTL6 levels (r = 0.88, 95% confidence interval 0.81, 0.92). Mean ANGPTL6 level for Group A (n = 20) was 394.3 pg/ml, for Group B (n = 8) 692.8 pg/ml, and for Group C (n = 13) 896.2 pg/ml. CONCLUSIONS: Serum ANGPTL6 levels were significantly higher in type 2 diabetic patients in comparison with healthy controls. Poor glycemic control in diabetes mellitus as reflected by higher serum HbA1c levels is associated with raised serum ANGPTL6 levels. [ABSTRACT FROM AUTHOR]

Background: Safety of oral sucrose, commonly used procedural analgesic in neonates, is questioned.Aim: To evaluate the effect of sucrose analgesia, for repeated painful procedures, on short-term neurobehavioral outcome of preterm neonates.Methods: Stable preterm neonates were randomized to receive either sucrose or distilled water orally, for every potentially painful procedure during the first 7 days after enrollment. Neurodevelopmental status at 40 weeks postconceptional age (PCA) measured using the domains of Neurobehavioral Assessment of Preterm Infants scale.Results: A total of 93 newborns were analyzed. The baseline characteristics of the groups were comparable. No statistically significant difference was observed in the assessment at 40 weeks PCA, among the groups. Use of sucrose analgesia, for repeated painful procedures on newborns, does not lead to any significant difference in the short-term neurobehavioral outcome. [ABSTRACT FROM AUTHOR]

Background: Qurse-e-istisqua (Q-e-I), an Unani medicine commonly prescribed to treat liver disorders. Objectives: To study efficacy and safety of Q-e-I in hepatitis C virus (HCV) infection. Methods: In this randomized double-blind exploratory study, 60 naive patients of HCV infection were assigned to receive either interferonα2a (IFNα2a) (3 mIU, subcutaneous, thrice weekly), ribavirin (RBV) (1000 mg, orally, twice daily in divided doses) and placebo (n = 30) or IFNα2a, RBV and Q-e-I (5 g, orally, thrice daily in divided doses) (n = 30). HCV RNA levels, serum hyaluronic acid (SHA), ultrasound image scoring for fibrosis, liver and renal function test, prothrombin time, were done at the baseline and thereafter periodically. Results: Early virologic response (EVR), end of treatment response (ETR) and sustained virologic response (SVR) were 90%, 96.6% and 90% in the control group and 86.6%, 90.0% and 83.3% in the treatment group. SHA level was lower in the treatment group at the end of the treatment as compared to the control group. Mean end of follow-up ultrasound image scoring for fibrosis in the control and the treatment group was 1.37 ± 0.07 and 1.22 ± 0.06 respectively. Aspartate aminotransferase (AST) levels were significantly lower in the treatment group than the control group at 1-month. Commonly observed adverse drug reactions included fever, hair fall, fatigue, anemia, and diarrhea. Conclusion: Q-e-I was well tolerated and showed anti-fibrotic activity. EVR, ETR and SVR suggested that Q-e-I do not have any anti-HCV activity. Early recovery in AST and inhibition of progress of fibrosis in Q-e-I group was probably due to the anti-inflammatory and antioxidant activity of its ingredients. [ABSTRACT FROM AUTHOR]

Objective: To study the analgesic activity of ash of silver used in Indian system of medicine and to explore its safety. Materials and Methods: Albino mice of either sex (20-30 gm) were used to investigate the role of ash of silver against noxious stimuli: thermal (Eddy's hot plate and analgesiometer), mechanical (tail clip), and chemical (0.6% acetic acid induced writhing). An effort was made to find nature and site of action of ash of silver following naloxone pre-treatment. Maximum tolerated dose (MTD) and lethal dosage 50 (LD50) were also studied along with toxicological aspects of ash of silver. Results: Test drug (ash of silver) at a dose of 50 mg/kg p.o exhibited analgesic activity against thermal, mechanical, and chemical stimuli. Analgesic effects were compared with the standard drug, morphine, in thermal and mechanical noxious stimuli and to aspirin in chemical stimulus. Analgesic activity of the test drug was reduced following naloxone pre-treatment. MTD was found out to be greater than 1.5 g/kg p.o. LD50 was 2 g/kg p.o. Fraction of mice showed symptoms of argyria as explained by autopsy reports. Conclusion: Test drug exhibited moderate analgesic activity at 50 mg/kg p.o against all type of noxious stimuli, also suggesting a role of opioidergic system. The ash of silver was been found to be safe upto a dose of 1.5 g/kg p.o. in mice without any untoward toxicity. Further studies are required to explore the effect of ash of silver on pain mediators and excitatory neurotransmitters like glutamate, aspartate, or N-methyl-D-aspartic acid (NMDA). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Are we moving towards a new definition of essential medicines?" by S. Manikandan.

Introduction: The adverse events of sutures used for the closure of surgical incisions influence clinical outcomes. Literature on the safety profile of the application of unidirectional barbed sutures in oral and maxillofacial surgery is scarce. Hence, focused materiovigilance was done to monitor and compare the adverse events of unidirectional barbed and poliglecaprone 25 nonbarbed sutures for intraoral incision closure., Methods: In a prospective randomized comparative study, 64 patients requiring intraoral incision closure were randomized to receive either unidirectional barbed or poliglecaprone 25 nonbarbed sutures. Postoperatively, patients were monitored for any adverse events for 15 days. Causality association of adverse events with sutures was done using the European Commission directives on safety reporting of medical devices., Results: Adverse events observed with unidirectional barbed suture were suture extrusion (n = 7; 21.875%) and suture discomfort (n = 3; 9.375%). While subjects who received poliglecaprone 25 suture experienced suture discomfort (n = 6; 18.75%) and knot unraveling (n = 2; 6.25%). The number of adverse events in both groups was statistically comparable (P = 0.78). Causality assessment of adverse events was probable for suture extrusion and discomfort with nonbarbed and barbed sutures, while it was possible for knot unraveling for nonbarbed sutures., Conclusion: Both types of study sutures were associated with minor severity adverse events when used for the closure of intraoral surgical incisions. Suture extrusion had a probable causal association with barbed suture. Knot unraveling was possibly associated with the nonbarbed suture. Both types of suture materials were equally safe in oral and maxillofacial intraoral surgical incision closure., Competing Interests: None

Objectives: The use of out-of-date medicines and improper disposal of pharmaceutical products harm consumers and environment. To limit pharmaceutical load on the environment, it is important that healthcare professionals (HCPs) are aware of and have good practices toward their disposal., Materials and Methods: A pretested instructor administered questionnaire containing 21 questions was used to assess knowledge, attitude, and practices (KAP) of 300 HCPs toward use and disposal of unwanted/expired medicines., Results: Nurses (76%) had significantly ( P < 0.01) better knowledge over doctors regarding the methods of drug disposal, whereas both doctors (63%) and nurses (64%) knew significantly ( P < 0.05) more than pharmacists about type of formulations not to be incinerated. The majority (88%) of overall respondents were unaware of validity of dispensing medicines before 15 days of mentioned expiry date. A large proportion of HCPs had a positive attitude toward checking the expiry date of medicines (96%), and a significant proportion of doctors and nurses believed that drug disposal is everyone's responsibility. Only 8% of the HCPs received unused/expired drugs back from the consumers. Nurses (59%) had better ( P < 0.01) practice than pharmacists regarding the disposal of expired medicines. Nearly half (44%) of all HCPs agreed that there existed a system for removing expiry and unused medicines from the inventory., Conclusions: The KAP of HCPs toward use and disposal of out-of-date and unused medicines need upgrading. The existing guidelines should be implemented to ensure patients' safety and to preserve the ecosystem., Competing Interests: There are no conflicts of interest.

An open label randomized controlled study was conducted to compare the quality of life (QoL) and safety of newly diagnosed stage I hypertensive patients randomized into two groups of 30 receiving either enalapril 5 mg or losartan 50 mg per-oral once daily for three months. QoL was assessed at the baseline and at the end of study using SF-36v2 health care questionnaire. Adverse drug reactions (ADRs) were monitored. Investigations at baseline were compared with those after intervention. Pre & post-intervention QoL transformed scores within each group and change in the same between two groups were analyzed using paired and unpaired t-test respectively. Transformed scores of role limitation due to energy/fatigue, emotional well being and general health domains improved significantly in both treatment groups. Scores of bodily pain improved significantly (p=0.0008) in losartan group only. Results were not significantly different between two groups (except for bodily pain). No serious ADR was reported.

In schizophrenia, efficacy of antipsychotic therapy might be better measured by quality of life (QoL) of caregiver, due to less reliability of patient's account and greater burden of management on caregiver. Hence, we compared QoL of the primary caregiver of schizophrenics prescribed either olanzapine or risperidone. In a cross sectional analytical study, caregivers of 120 schizophrenic patients' on either olanzapine or risperidone filled the WHOQOL-BREF questionnaire containing physical, psychological, social and environmental domains. Scores of these domains in both the groups were compared. Majority (33.3%) of caregivers in both groups were parents. The mean transformed scores in all domains viz. physical (p=0.358), psychological (p=0.352), social relationships (p=0.332) and environmental (p=0.448) were statistically similar. More than 75% of the subjects in both groups showed the highest satisfaction in work capacity, personal relations, physical pain, requirement of medications, frequency of negative feelings, safety and body appearanc, whereas ≤ 50% of the caregivers in both groups expressed dissatisfaction with their financial situation. Thus, QoL of caregivers in both groups was comparable. On the basis of QoL of caregivers, olanzapine and risperidone were similarly effective therapeutic agents for schizophrenia.

Objective: To document the significant sustained virological response with supervised conventional interferon α and ribavirin therapy in hepatitis C virus (HCV)-infected patients, this study was planned., Materials and Methods: Sixty chronic hepatitis C naive patients were included in this study. Complete blood counts, prothrombin time, ALT, AST, and qualitative HCV RNA were done. Conventional interferon (INF) α2a, 3MIU, S.C and ribavirin 1000 mg PO was given as supervised therapy for 24 weeks in genotype 3 and 48 weeks in genotype 1 and 4 HCV patients. Qualitative HCV RNA was repeated at 12 weeks, 24 weeks for HCV infections with genotype 1, 2, 3 and 4, at 48 weeks for genotype 1 and 4, and thereafter 6 months after completion of treatment. End virological and sustained virological responses were observed., Results: Out of 60 patients, 55 completed the study. Five patients were lost to follow-up. Overall SVR was seen in 47 patients (85.4%) and 4 patients had relapses., Conclusion: Significant sustained virological response rates were seen in patients with supervised conventional INF α2a and ribavirin therapy.