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   Table of Contents - Current issue
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October-December 2022
Volume 14 | Issue 4
Page Nos. 193-246

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EDITORIAL  

Sugar tax and its implications on health Highly accessed article p. 193
Ullal Anand Nayak, Prathibha Anand Nayak, Butchi Raju Akondi
DOI:10.4103/ajprhc.ajprhc_106_22  
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ORIGINAL ARTICLES Top

Satisfaction of the clients attending integrated counseling and testing center in a teaching hospital of North-Eastern India: An observational study p. 195
Arpita Debnath, Tarun Kumar Roy, Himadri Bhattacharjya
DOI:10.4103/ajprhc.ajprhc_75_22  
Background: Integrated Counseling and Testing Centers (ICTC) provide counseling and testing for HIV to the clients. Satisfaction of the clients attending an ICTC determines its acceptance among people, and it is crucial for preventing this disease. Objectives: To estimate the level of satisfaction and to determine its association with sociodemographic parameters of the clients attending ICTC in a teaching hospital. Methodology: This hospital-based cross-sectional study was conducted in October 2019 among 213 clients attending ICTC of Agartala Government Medical College, chosen by census technique. An interview schedule containing information regarding age, sex, marital status, education, socioeconomic class, along with a component for evaluating HIV counseling and testing services initially used by UNAIDS, was used for data collection. Results: Among the clients, 54.5% (116) were male, 45.5% were aged between 35 and 80 years, 79.3% were from rural areas, 87.8% were Hindu by religion, 33.8% belonged to scheduled caste community, 63.4% were primary educated, 35.2% belonged to BG Prasad's Class II socioeconomic status, 83.6% were married, and 10.3% attended ICTC by self-initiated approach. Only 39% of the clients were found to be satisfied with the services of this ICTC. Waiting time in queue was found to be significantly associated with client's satisfaction. Conclusion: The client's satisfaction level was found to be low. Reduction in queuing time, caring attitude, and use of the client's own language might improve the scenario.
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Response surface methodology-based quantification of lamivudine and zidovudine using reverse-phase high-performance liquid chromatography in pharmaceutical formulation p. 200
Anjali A Chauhan, Neeti J Yadav, Aarchika G Shah, Darshil B Shah, Dilip G Maheshwari, Jignesh S Shah
DOI:10.4103/ajprhc.ajprhc_74_22  
Objective: A novel reverse-phase high-performance liquid chromatography (RP-HPLC) method for estimation of lamivudine and zidovudine by using an experimental design approach applying the response surface technique was developed and validated using a C18 column and its application in marketed formulation. Multivariate optimization of experimental conditions was achieved using experimental design employing organic content in the mobile phase, pH, and flow rate of the mobile phase as three independent variables. The aim of this study was to apply response surface methodology and to study the effect of the independent variables on the separation and estimation of both drugs by the RP-HPLC method using a faced central composite experimental design. Materials and Methods: Derringer's desirability function was used to optimize the retention period of the last eluting peak and peak symmetry, and it was discovered that the optimal conditions were potassium dihydrogen phosphate buffer and acetonitrile in an isocratic ratio of 55:45 w/v, pH 3.5, and 0.4 ml/min flow rate. Baseline separation of both medications with good resolution and a run time of more than 7 min was accomplished using this ideal condition. Results: For lamivudine and zidovudine, a linear response was seen over the concentration range of 2–12 and 4–24 μg/mL, respectively. Lamivudine's limit of detection and limit of quantitation were determined to be 3.08 and 9.18 μg/mL, respectively, whereas zidovudine's values were 3.24 and 10.17 μg/mL. According to the ICH guidelines acceptance criteria for linearity, accuracy, precision, specificity, and robustness, the method was successfully validated.
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A stability indicating novel analytical method for the determination of lamivudine and dolutegravir in bulk and its tablets using reverse phase high-performance liquid chromatography p. 209
KV Lalitha, J Raveendra Reddy, Devanna Nayakanti
DOI:10.4103/ajprhc.ajprhc_38_22  
Aim: A simple and sensitive analytical method was developed to simultaneously estimate lamivudine (LAM) and dolutegravir (DOL), anti-retroviral drug combination in bulk and dosage forms. Materials and Methods: Separation of analytes was done on a BEH Shield RP18 (2.1 mm × 100 mm × 1.7 mm, 5 μm Particle size) using sodium dihydrogen phosphate pH 4.9 adjusted with orthophosphoric acid: Methanol (60:40, %v/v) as mobile phase pumped at 1.0 ml/min. A photodiode array detector was used to find the detection wavelength at an isosbestic point of 292 nm while maintaining the column temperature at 30°C. With a total run period of 8 min, the mobile phase was utilized as a diluent. The International Council on Harmonization guidelines were followed in the method's validation. The method's capacity to indicate stability was confirmed by experiments on forced degradation. Results: LAM and DOL eluted at 2.88 and 3.83 min, respectively. Both the drugs exhibited excellent linearity between 105.00–315.00 and 17.50–52.50 μg/ml for LAM and DOL, respectively. The LOD and LOQ were found to be 4.51 and 15.03 μg/ml for LAM and 5.82 and 19.41 μg/ml for DOL, respectively, which are very minute concentrations. Conclusion: The method was therefore found to be quite sensitive. The proposed high-performance liquid chromatography technique was thereby sensitive, reproducible, accurate, and reliable for the measurement of LAM and DOL.
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A-heal® in the management of chronic nonhealing ulcers: A case series p. 216
Ajay Kumar, Md Qamar Azam, Nilesh Y Jagne
DOI:10.4103/ajprhc.ajprhc_69_22  
Background and Objective: The aim of this study is to assess the efficacy of A-Heal® in the treatment of nonhealing ulcers (NHU). Patients and Methods: This is a case–control study involving 12 patients who applied A-Heal® 10 mg twice a day on an NHU till the complete healing of the ulcer. The control group had the standard treatment. A-Heal® is a 13 amino acid chain, which was initially isolated from the human placenta, is now synthesized, and has shown to be a powerful angiogenesis factor. Before starting the trial, morphologic features of the ulcers were noted including, size, shape, location, and associated diseases. The follow-up period was set at 6 months. Results: The average age of the treated patients was 52.5 ± 5.3 years in the study group and 51.9 ± 4.7 years in the control group. The mean duration of the ulcer was 13.7 ± 5.3 weeks. All the ulcers were located in the lower limbs. In 9 (75%) patients, there was total healing of ulcers in 22 days and three patients showed signs of wound healing with a reduction in wound size and required an additional 1 week for total healing of the ulcer. Regarding the secondary outcomes of preliminary efficacy, total healing and significant reduction of the area were observed in all patients. There were no adverse events recorded. Conclusion: This case series shows that A-Heal® has proved to be safe with a good preliminary efficacy to heal NHUs, according to the protocol and doses used. A larger clinical trial is needed to verify our results.
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Effect of respiratory muscle stretch gymnastics on chest expansion and peak expiratory flow rate among sawmill workers p. 220
E Shanmugananth, E Chandramouli, S Gopal Nambi, S Parthasarathy
DOI:10.4103/ajprhc.ajprhc_70_22  
Introduction: Sawmill workers are subjected to high levels of wood dust, which can significantly impair lung function. Many studies have found restrictive abnormalities associated with decreased breathing muscle strength and chest expansion. Respiratory muscle stretch gymnastics (RMSG) has been proposed as an additional form of rehabilitation for patients suffering from respiratory diseases. RMSG is intended to reduce chest wall stiffness, particularly in the respiratory muscles of the chest wall. Objective: The objective of this study was to look into the impact of RMSG on chest expansion and peak expiratory flow rate (PEFR) in sawmill workers. Methodology: Fifty randomly selected sawmill workers aged 30–50 years in Chidambaram town were given RMSG training twice daily, four times each of five patterns for 4 weeks. A structured questionnaire was used to interview the subjects. Height, weight, and chest measurements were all part of the physical examination. Before and after training, the physiological parameter PEFR was measured. The extent of chest expansion was the primary outcome measure. Data Analysis and Outcomes: The Statistical Package for Social Sciences (SPSS) version 16 was used to evaluate and analyze the data, with the level of significance set at P < 0.05. The dependent t-test revealed a significant difference in chest expansion between pre- and posttraining (2.441.11) and (3.780.616) with a P = 0.001. At P = 0.001, there was also a statistically significant difference in the mean values of PEFR (341.80 77.13) and (479.8058.24). Conclusion: The study found that RMSG training improves chest expansion and pulmonary function (PEFR). According to the findings, RMSG is a simple, safe, and effective technique for increasing the overall functional capacity of sawmill workers. Our study clearly demarcates the difference in an angle that 40° or 45° recumbency is useful. With not much literature in such workers, we can say that this study is one of the early works in this field.
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Effect of costus pictus D don methanolic leaf extract on induced prediabetic behavioral change in albino wistar rats p. 224
Jeneth Berlin Raj, S Parthasarathy, Manimekalai Kumarappan, AR Srinivasan
DOI:10.4103/ajprhc.ajprhc_80_22  
Background: Prediabetes is a hyperglycemic intermediate state with glycemic parameters above normal values but below the threshold of diagnosis of diabetes. While the diagnostic criteria for prediabetes differ between international professional organizations, it is still a high-risk state for getting diabetes, with an annual conversion rate of 5%–10%. Plants and plant-derived products have been the first treatment choice in ancient India. Of late, they have regained a preference for allopathic medicine. Prediabetes, if identified early and treated, the intermittent hyperglycemia, as well as its complications, can be prevented or reverted. Costus pictus D Don would serve this purpose. Materials and Methods: The present study was aimed to study the effect of methanolic leaf extract of Costus pictus D Don on glycemic status and cognitive behavior in induced prediabetic status. Prediabetic status was induced by 35% sucrose solution. Glycemic status was assessed by the Oral glucose tolerance test, homeostatic model assessment for insulin resistance, and QUantitative Insulin sensitivity Check Index. Cognitive and anxiety-like behavior was assessed by elevated T maze and open arena maze. After the termination of the study, all the animals were sacrificed and their brain was sectioned and stained with H and E strain to check for any associated change in the hippocampal region to correlate with the observed behavioral change. Results: Methanolic leaf extract of Costus pictus D Don had a significant effect on normalizing glycemic status in prediabetic rats. Meanwhile, they did not cause hypoglycemia when given to normal rats. Methanolic leaf extract of Costus pictus D Don reduces blood glucose level and insulin level in both doses of 100 mg and 200 mg/kg BW. The extract exhibited an anxiolytic effect and improved cognition in prediabetic rats. When compared to control rats, the prediabetic rats exhibited slow learning. This was evident with an increase in transfer latency. Delta percentage was minimum in prediabetic animals indicating poor learning ability associated with prediabetes. The extract at the dose of 200 mg/Kg BW was found to revert this adverse effect back to near normal. Conclusion: Leaves of Costus pictus D Don can be a better choice for normalizing the hyperglycemic status and improving prediabetic induced mental disturbances such as anxiety and cognitive dysfunction.
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Antioxidant and inflammatory cytokines regulatory actions of fresh snail and seawater gastropods extracts p. 231
Deepak Prakash Pawar, Prashant B Shamkuwar
DOI:10.4103/ajprhc.ajprhc_77_22  
Context: Mollusca also termed mollusks. These are unsegmented, bilateral animals. Freshwater and seawater gastropods are considered rich source of bioactive molecules that possesses various therapeutic potential. Aim: The present work aimed to investigate the antioxidant, wound healing, and anti-inflammatory effects along with the regulation of inflammatory protein at the cellular level by apple snail (freshwater gastropod) and tibia shell (seawater gastropod) extract. Materials and Methods: The mass of freshwater and seawater gastropods was macerated in water. Results: The aqueous extract of apple snail exhibited the highest 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity and 2,2'-azinobis-(3-ethylbenzothiazoline)-6-sulphonic acid (ABTS) activity at 85.62% and 73.35% at 10 mg/ml, whereas the aqueous extract of seawater gastropod exhibited the highest DPPH radical scavenging activity and ABTS activity 83.53% and 76.14% at 1 mg/ml. Marine water snail aqueous extract and freshwater snail aqueous extract, each of 250 mg/kg showed 83% and 67.14% inhibition of paw edema, respectively. The cell viability study was performed by MTT assay and both the extracts showed cell viability above 97%. Both samples (freshwater snail extract and seawater gastropod extract) have good anti-inflammatory effects as they lower the concentration of tumor necrosis factor-alpha (pro-inflammatory cytokines) and increase interleukin-10 (anti-inflammatory cytokines). Conclusion: The present work concluded that the extracts of seawater gastropods were found to be more effective as an antioxidant and anti-inflammatory agent.
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The phenomenon of giving hypnotic medications to children without a therapeutic purpose p. 238
Mhdia Elhadi Osman, Heba Ali Khaloofi
DOI:10.4103/ajprhc.ajprhc_53_22  
Background: The antihistamines such as chlorpheniramine malate, triprolidine, and pseudoephedrine cause sedation and are prescribed for insomnia as a first-line drug. Some mothers in Saudi Arabia reported using these medications for their children to induce and regulate sleep without prescription. This unnecessary and dangerous practice can cause serious side effects. Objective: The research aimed to discover the prevalence of sedative medication use among children in Saudi Arabia and evaluation of the mother's awareness of the seriousness of these medications' effects. This research also aimed to provide natural alternatives. Materials and Methods: A cross-sectional study has been conducted using a structured online questionnaire. The survey has been performed to identify the views of mothers on the subject and the reasons for their use of medicines and the most widely used drugs, dosage, and side effects. Fifty responses were collected from mothers and evaluated using Statistical Package for the Social Sciences (SPSS) software. Results: Most participants use sedative drugs to keep their children calm and in a deep sleep with ignorance and a lack of awareness of their serious side effects. We strongly encourage the initiation of awareness campaigns using pamphlets and other platforms including messages. Conclusion: Mothers, mainly working women, tend to use hypnotic medication for their children without a therapeutic indication. This practice needs to be stopped by awareness campaigns using both traditional and electronic formats.
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Community assessment of incidence of quantitative microalbuminuria at the time of first diagnosis of type 2 diabetes mellitus – kumbakonam urban–rural epidemiological study – kures 9 p. 243
MR Suchitra, Monica Anand, Balachandar Saravanan, S Parthasarathy
DOI:10.4103/ajprhc.ajprhc_101_22  
Background: Diabetic nephropathy (DN) is a condition defined by persistent albuminuria and progressive loss of kidney function, with the term implying the occurrence of a typical described pattern of glomerular disorder. The early marker of the disease is detecting microalbuminuria in the urine. Methods: The patients who consented for the sampling was considered when they were diagnosed with diabetes mellitus (DM) for the first time. The first hundred adult patients who consented to participate were included. Established methods were used to estimate quantitative microalbumin in the urine from the first sample of the morning. All the positive reports were counter-checked. The initiation of drugs was left to the physician's choice. Any other events were recorded. On arrival, random blood sugar and blood pressures were recorded. Descriptive analyses and Pearson correlation analyses were used. Results: A total of 101 patients were analyzed. There were 58 males and 43 females. The microalbuminuria was positive in 44.6% of newly diagnosed cases. There was no relationship between the random sugar values, age, or sex with the incidence of microalbuminuria. The mean ages of both the positive and negative cases were similar. Conclusion: There was a high incidence of microalbuminuria in our study among newly diagnosed DM. With such a high incidence of early renal damage on diagnosis, we suggest that the initial management should switch from other drugs to inhibitors of the sodium-glucose cotransporter 2 (SGLT2). We theorize that the high incidence may be due to a delayed diagnosis of diabetes in our area and a poor control of the disease. With such a high incidence of early renal damage on diagnosis, we suggest that the initial management should switch from other drugs to inhibitors of the SGLT2. This is the first such study on the incidence of early nephropathy on first diagnosis of DM.
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